0900_Tarricone.pdf

1、Transverse Tibial Transfer and Advanced Limb Ischemia Arthur Tarricone,DPM,MPHThe University of Texas at San Antonio Objectives Review Landmark studies of CLTI and Important clinical outcomes Discuss Transverse Tibial Transfer Discuss Clinical Outcomes of Transverse Tibial Transfer Not many Options

2、For Patients with CLTI Up to 20%of people with chronic limb-threatening ischemia(CLTI)are not candidates for traditional revascularization procedures due to extensive vascular damage,various comorbidities,or poor overall health Even after successful revascularization,15-20%may still require amputati

3、on due to ongoing issues like insufficient reperfusion,infection,or other complications.High event rates with Surgery or EVT Ferraresi R,Mauri G,Losurdo F,et al.BAD transmission and SAD distribution:a new scenario for critical limb ischemia.J Cardiovasc Surg(Torino)2018;59(5):655-64.452 patients sev

4、ere limb ischemia(75%tissue loss)EVT with POBA vs.BSx(autologous vein).FUP for 2 years.Extended to up to 5 years.All Cause Mortality:36.7%Primary outcome:AFS Total:45%Lancet 2005;366:192534All Cause Mortality:36.7%BEST-CLIBSX vs.best EVTBSx was predefined as autologous vein available Cohort 1(N=1395

5、)Autologous vein not available received a prosthetic graft Cohort 2(N=385).BEST EVT was POBA,DCB,atherectomy,BMS,DES,covered stents at the discretion of the treating operator N Engl J Med 2022;387:2305-2316Total MALE:49%PROMISE Study The PROMISE II study enrolled a highly complex and challenging pat

6、ient cohort,including:No-Option Patients:All 105 patients were independently assessed as having no other endovascular or surgical options for revascularization.Severe Disease:All patients had end-stage CLTI,classified as Rutherford Stage 5 or 6,meaning they had either a non-healing foot ulcer or gan