1036_Mouawad.pdf

1、Concomitant CFA and Iliac(or SFA)Disease:Should I Treat Both?Hybrid vs.Endovascular Does it Matter?Nicolas J.Mouawad,MD MPH MBA DFSVS FACS FRCS RPVIChief,Vascular&Endovascular SurgeryChair,Department of SurgeryChair,Cardiovascular ResearchMcLaren Health System,Bay City,MI USANickMouawadMDDisclosures

2、Advisory Board:Boston Scientific,Contego Medical,Inari Medical,Veryan MedicalCEC:Magical BTK,ELITE R3 BTKConsultant:Bard BD,Boston Scientific,Contego Medical,Endologix LLC,Inari Medical,Microvention,MiMedx,Philips,Silkroad Medical,Shockwave Medical,Terumo,WL GoreProctor:Endologix LLC,Inari Medical,S

3、ilkroad Medical,Terumo AorticSpeaker:Abbott/CSI,Janssen Pharmaceuticals,Medtronic PeripheralObjectivesDefine the problem:concomitant CFA+iliac/SFA diseaseReview open,endovascular,and hybrid optionsSummarize contemporary evidence comparing strategiesProvide a pragmatic decision algorithm and referenc

4、esTreatment OptionsOpen:Common femoral endarterectomy(CFE)patch angioplastyEndovascular:CFA stenting,atherectomy+adjunct PTAHybrid:CFE+iliac(or SFA)endovascular interventions in the same settingMultilevel endovascular-only strategies(iliac+SFA+/-IVL+/-CFA stent)Systematic reviews/meta-analyses show

5、durable results with endarterectomy but increasing data support CFA stenting in selected patientsRecent RCTs and registry data suggest comparable short-term outcomes with endovascular CFA stenting and lower early morbidity in some series.Evidence CFA:Open vs Endovascular92.52%vs 97.02%HR 0.38(95%CI

6、0.270.54,p 0.00183.10%vs 91.64%HR 0.45(95%CI 0.300.67,p 0.05Ravikumar N,Sreejith G,Law SHC,Anand P,Varghese N et al.Hematol Rep.2022 Jun 1;14(2):179-202.Ravikumar N,Sreejith G,Law SHC,Anand P,Varghese N et al.Hematol Rep.2022 Jun 1;14(2):179-202.2.44%vs 3.61%HR 0.67(95%CI 0.441.02,p=0.88)Ravikumar N