1025_Purushottam.pdf

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1、PRINCIPLES OF SFA CTO CROSSINGBhaskar Purushottam MD,FACC,FSCAI,FSVMInterventional Cardiologist and Endovascular MedicinePresident,Midwest Heart and Vascular Associates,Rapid City,SDMedical Director,Monument Health ResearchMonument Health Rapid City Hospital,Rapid City,SDClinical Associate Professor

2、 of Medicine,Sanford School of Medicine,University of South DakotaSpeaker/Advisory Board/ConsultantPenumbra,Abiomed,Medtronic,Gore,Abbott,TeleflexAlgorithms Should be Dynamica.Patient presentation Claudication vs.CLIb.Patient clinical characteristicsc.Operator and lab experienced.Surgical back-upe.P

3、revious attemptsf.Previous surgeriesg.Angiographic AnatomyAngiographic AnatomyProximal cap of the CTOCollaterals,Branches,CalcificationIliac and CFA involvementMain body of the CTOCalcification,LengthDistal cap of the CTO Collaterals,Branches,CalcificationPopliteal involvementInfrapopliteal Run-offV

4、essel SizeISRSurgeryvs.Endovascular vs.Medicalvs.Refervs.Hybridvs.Team approachWhat is My Primary AccessDetermined by PatientCTO location and lengthCTO morphologyAorto-iliac-common femoral anatomySkillsBack upStandard Retrograde Contralateral CFAShould be the preferred accessTried and tested a milli

5、on timesTreatment options for complicationsAntegrade CFA ApproachLeft Brachial ApproachAxillary Arterial AccessRadial Approach Selected cases Equipment:Not long enough Challenging for complex CTOs 6 Fr.System:Occlusion?Thoracic Plaque DisruptionAccessing the Fem-Fem Bypass GraftPopliteal Arterial Ac

6、cess-MUST USE ULTRASOUNDPrior Failed Attempt via Left Brachial with Assoc.BA complication requiring a Bypass Distal Popliteal or TPT Access in Complex CTOPrimary Pedal Approach Not as your first case Hand pick the patients work with a senior mentor Preferably short CTO Avoid ISR often thrombus Make