1044_Tummala.pdf

1、CFA Cases Endovascular Therapy vs SurgerySrini Tummala,MDFounder&Director Vascular DiseaseFlorida Vascular SpecialistsSouth FloridaVice Chair SIR PAD Clinical Specialty CouncilVoluntary Asst ProfessorUniv of Miami Health System DR.TUMMALAS VASCULAR CHANNELSriniTummalaDISCLOSURESConsultant/Course Fac

2、ulty/Speaker:Abbott VascularBD Peripheral VascularNiPro Medical CorpPhilipsEndovascular Therapy for the CFA?ENDOCFECFE is the“Gold Standard”?PROS Excellent patency Flexion point/Crush forces?Heavy calcium Bifurcation involvementCONS1.Comorbities Obesity Diabetes Cardiac Risk2.Inconsistent surgical t

3、echnique Clamp injury Simple endarterectomy vs.patch vs.eversion vs.bypass etc.Exposure3.Healing4.ComplicationsEndo is Ready for its Moment!CONS Less patency?Crush forces/Fracture Heavy calcium Bifurcation involvement(Retro techniques)Jail the PFA!Limited data Dissections More reinterventions?PROS E

4、arly recovery Hostile groin favorable(R2P/Pedal)Potentially can do CFE later Address inflow/outflow lesions(iliacs/distal vessels)CFA ClassificationCFA Trials(RCTs)Definitions-AzmaTao MJ,et al.Vasc Endovascular Surg.2022;56(4):357-368.Azma L,et al.Eur J Vasc Endovasc Surg.2011;41(6):787-793.Definiti

5、ons-RabellinoLOCATION(III/VI)STENOSIS(I-IV)CALCIFICATION(I-IV)LOCATION:SFA(S)DFA/PFA(D)BOTH(B)STENOSIS:STENOTIC(S)OCCLUSIVE(O)CALCIFICATION:MILD/MOD(M)SEVERE/HEAVY(H)Rabellino M,et al.Cardiovasc Intervent Radiol.2022;45(4):438-447.Studies of Isolated PFA RevascularizationOverview Isolated PFA revasc

6、ularization is rare compared with inline reconstructions Performed selectively in CLTI patients Evidence is limited but includes both surgical and endovascular series Outcomes reported in intermediate-term follow-up studiesSummary1.Isolated PFA revascularizati