1010_Doshi.pdf

1、Contemporary Data on SFA InterventionsHarsh Doshi MD,FSCAI,FACC,RPVI JFK University Medical CenterHackensack Meridien Health System I have no relevant financial disclosures pertaining to this talk The prevalence of SFA disease,is generally 4%to 15%in the general adult populationSFANo“One Size Fits A

2、ll”AlgorithmAngiographic/Procedural Factors Degree of calcification Length of disease Focal vs diffuse Type of disease Stenosis vs CTO Characteristic of contrast flow Lesion characteristics Fibrotic,fibrocalcific,thrombotic Presence and location of collaterals Prior interventions ISR Inclusion vs ex

3、clusion of profunda/CFA Runoff Surgical backup Location of intervention(OBL vs hospital)Patient Characteristics Claudicant vs CLI Diabetes,HLD,Smoker Compliance Prior interventions Destination&Adjunctive Therapy POBA vs BMS POBA vs DCB POBA vs DES DCB vs DES DCB+BMS vs DES Tacks Covered stents PTAB

4、Atherectomy Atherotomy Thrombectomy IVUS Lithotripsy Laser High pressure balloons Crack and Pave Re-entry cathetersImportance of Vessel PrepRECOIL is BADheavily calcified or fibrotic lesions likely high chance of recoil.Optimal vessel preparation limit dissectionimprove luminal gain avoid elastic re

5、coil homogenous drug application and uptakeVessel Prep Options Lithotripsy High pressure balloon angioplasty Atherectomy/Thrombectomy Atherotomy LaserRole of Atherectomy Atherectomy+DCB vs DCB alone reduces rate of bailout stenting,achieves more technical success,and fewer flow limiting dissections

6、Technique matters Directional has been studied the most VIVA REALITY DEFINITIVE AR DIRECT TRIAL DISRUPT PAD III TRIAL (IVL vs PTA)Consider use of IVUS Ample data showing the benefits of IVUS Currently class 2b The goal of endovascular interventionsStandard of Comparison5 Year patency of different ty