0845_Siah.pdf

1、Data for Deep Vein ArterializationMichael C.Siah MDDirector of Limb SalvageAssistant Professor of SurgeryDepartment of Vascular SurgeryDallas,TX USADisclosures2Consult/Advisor-Inari,Cagent,Philips,Shockwave,Reflow,Contego,Medtronic,AbbottWho is a“No Option”Patient3N Troisi 2022Reasons:Reasons:Anatom

2、ical Physiological TechnicalHow Many Patients are There?4High Intensity Revascularization(open/endo)Medium Intensity Diagnostic angiographyLow Intensity No angiography(within the prior year)Retrospective analysis of Medicare Claims Data(2016-2019)CLTI diagnosis+major amputation92%of patients that DI

3、D NOT GET REVASCULARIZEDDidnt even get an angiogramWe all see this5NO ENDO OR SURGICAL OPTIONS6Frontiers in Surgery 2021Journal of CLI 2021WHAT ABOUT DEEP VEIN ARTERIALIZATION?!Deep Vein Arterialization7Choice when conventional strategies unsuccessful OR impossible(“No Option”)Creation of a FISTULA

4、between a tibial artery and its corresponding veinTypically done percutaneouslyLeverages a patent tibial venous system to deliver oxygenated blood to the footDVA Techniques8Percutaneous“Artisanal”/Off the ShelfUse available tools(stents,snares,balloons,crossing catheters)Limflow SystemFDA approved k

5、it with dedicated crossing system,valvulotome and stentsOpen Surgical Arterialization Deep or Superficial venous systems can be usedFundamentally a bypass using arterial inflow ALONEValves of outflow venous system addressed with valvulotome or endo toolsPROMISE II Overview9PRIMARY ENDPOINT MET(Publi

6、shed in NEJM)NATIONAL PIsDr.Dan ClairVanderbilt UniversityDr.Mehdi ShishehborUniversity Hosp.ClevelandENROLLMENT105patients20sites in USKEY CRITERIAInclusionNo-option CLTIRutherford 5/6Non-healing ischemic ulcer in setting of wound care66%66%Amputation-free survival76%76%Limb SalvageHalfHalf of pati