0855_Mouawad.pdf

1、PRESENTATION TITLE SLIDE SAMPLEIliac CTOs Access,Tools and Crossing TechniquesPRESENTATION TITLE SLIDE SAMPLENicolas J.Mouawad,MD MPH MBA DFSVS FACS FRCS RPVIChief,Vascular&Endovascular SurgeryChair,Department of SurgeryChair,Cardiovascular ResearchMcLaren Health System,Bay City,MI USANickMouawadMDD

2、isclosures Advisory Board:Boston Scientific,Contego Medical,Inari Medical,Veryan Medical CEC:Magical BTK,ELITE R3 BTK Consultant:Bard BD,Boston Scientific,Contego Medical,Endologix LLC,Inari Medical,Microvention,MiMedx,Philips,Silkroad Medical,Shockwave Medical,Terumo,WL Gore Proctor:Endologix LLC,I

3、nari Medical,Silkroad Medical,Terumo Aortic Speaker:Abbott/CSI,Janssen Pharmaceuticals,Medtronic PeripheralDealing with a CTO They are common They are challenging Extremely variable Time intensive Radiation exposure Success rate 50-70%JEVT 2023 Jun;30(3):433440Treatment Challenges of Lower Extremity

4、 CTO Failing to cross CTO eliminates endovascular options Crossing CTOs accounts for up to 15%of complications*Often have long segment/multi-level occlusions Difficulty penetrating the fibrous/calcific cap or entering distal target vesselWhat Exactly is a CTO?Collagen with superimposed thrombusAcute

5、/SubacuteChronic organizedHighly variable Composition(lipid core,fibrosis,neovascularity,microchannels,calcium).Composition can directly impact recanalization success,and complicationsWill affect choice for equipment needed1 year old5 yrs oldHistology of Total OcclusionRecent(3 months)Thrombus/embol

6、usChronic total occlusion(3 months)Organized thrombusFibrotic tissueResistant proximal and distal capsCalcificationMicrochannels 1/3 of PAD is AIOD.Stenotic lesions in the common or external iliac arteries are an established indication for percutaneous procedures,but occlusions of the iliac arteries