Dr. Omar P. Haqqani, MD discusses the details of catheter based blood vessel intervention, focussed on management of peripheral arterial disease (PAD).

1. CATHETER BASED INTERVENTION AND SURGICAL
MANAGEMENT OF PERIPHERAL ARTERIAL OCCLUSIVE
DISEASE: TECHNIQUE AND RESULTS
Dr Omar P. Haqqani, MD
Chief, Vascular and Endovascular Surgery
Associate Professor of Surgery, Central Michigan University

2. DISCLOSURE
Author does not have any disclosures

3. IMPACT OF PAD ON MARTALITY

4. Lifestyle modification
•Smoking cessation
•Regular exercise training
•Diet
Pharmacological treatment
•Antiplatelet therapy
•Control risk factors (e.g. hypertension, blood
glucose)
•Vasodilators for symptomatic relief
MANAGEMENT OF PAD PATIENTS

5. • Lifestyle limiting claudication
• Rest Pain
• Non-healing wounds
INDICATION FOR INTERVENTION

6. Endovascular
•Revascularization (Angioplasty)
•Stent Placement
•Atherectomy (Directional or Laser)
•Intravascular Ultrasound (IVUS)
Surgical
•Endarterectomy
•Peripheral Bypass Graft
•Amputation
INDICATION FOR INTERVENTION

7. Endovascular
•Revascularization (Angioplasty)
•Stent Placement
•Atherectomy (Directional or Laser)
•Intravascular Ultrasound (IVUS)
Surgical
•Endarterectomy
•Peripheral Bypass Graft
•Amputation
INDICATION FOR INTERVENTION
Plain Balloon
•modifies obstructions through a
disruptive stretching process
Drug-coated Balloon (DCB)
•modifies obstructions through a
disruptive stretching process with
high-concentration, rapid local
release of an antirestenotic drug

8. PLAIN BALLOON ANGIOPLASTY

9. DRUG COATED BALLOON (DCB) ANGIOPLASTY

10. Endovascular
•Revascularization (Angioplasty)
•Stent Placement
•Atherectomy (Directional or Laser)
•Intravascular Ultrasound (IVUS)
Surgical
•Endarterectomy
•Peripheral Bypass Graft
•Amputation
INDICATION FOR INTERVENTION
Bare Metal Stent
•modifies obstructions using a
metallic scaffolding
Drug-eluting Stent (DES)
•modifies obstructions using a
metallic scaffolding with a slowly
releasing drug to block cell
proliferation

11. BARE METAL STENT PLACEMENT

12. DRUG ELUTING STENT (DES) PLACEMENT

13. Endovascular
•Revascularization (Angioplasty)
•Stent Placement
•Atherectomy (Directional or Laser)
•Intravascular Ultrasound (IVUS)
Surgical
•Endarterectomy
•Peripheral Bypass Graft
•Amputation
INDICATION FOR INTERVENTION
LASER Atherectomy
•Pulverizes obstructions using
ultraviolet pulsed light
Directional Atherectomy
•Excises obstructions using
mechanical cutting devices

14. EXCIMER LASER ATHERECTOMY

15. DIRECTIONAL ATHERECTOMY

16. Endovascular
•Revascularization (Angioplasty)
•Stent Placement
•Atherectomy (Directional or Laser)
•Intravascular Ultrasound (IVUS)
Surgical
•Endarterectomy
•Peripheral Bypass Graft
•Amputation
INDICATION FOR INTERVENTION
Intravascular Ultrasound (IVUS)
•Intra-vessel ultrasonography to
delineate composition and extent of
obstructions

17. INTRAVASCULAR ULTRASOUND (IVUS)

18. RESULTS OF ARTERIAL RECONSTRUCTION

19. RESULTS OF ARTERIAL RECONSTRUCTION

20. RESULTS OF ARTERIAL RECONSTRUCTION

21. RESULTS OF ABOVE-KNEE INTERVENTION
POB
A
DCB DES DAth LASE
R
BMS

22. RESULTS OF BELOW-KNEE INTERVENTION
POB
A
DCB

23. Endovascular
•Revascularization (Angioplasty)
•Stent Placement
•Atherectomy (Directional or Laser)
•Intravascular Ultrasound (IVUS)
Surgical
•Endarterectomy
•Peripheral Bypass Graft
•Amputation
INDICATION FOR INTERVENTION

24. RESULTS OF ARTERIAL RECONSTRUCTION

25. RESULTS OF ABOVE-KNEE BYPASS

26. RESULTS OF BELOW-KNEE BYPASS

27. 37 YO DM WITH ESRD

28. WET GANGRENE

29. 37 YO DM WITH ESRD

30. 37 YO DM WITH ESRD

31. ENDO VS OPEN OUTCOMES
BASIL (Bypass versus angioplasty in severe
ischemia of the leg)– Angioplasty is
recommended only for high risk patients with
a projected survival of less than 2 years
Among patients undergoing repeat
interventions 1 year patency 22 %

32. BENEFITS OF AN ENDO-FIRST APPROACH
• Remarkably safe even in high-risk patients
• Emergency operative bailout a rare event
• Endovascular re-intervention as successful
as initial intervention
• Repeat interventions allows limb salvage to
be prolonged in some cases indefinitely
• Preservation of distal targets

33. THANK YOU
Thank You