1510_Bianchi.pdf

1、PTAB vs.PTFE bypass for claudication.Pro:PTFE Bypass is Still a Viable Option for Patients Who Have Failed Endovascular Therapy in Whom an Adequate Venous Conduit is Not AvailableChristian Bianchi,MD DFSVS FACS Associate Professor SurgeryLoma Linda University University of California RiversideFounde

2、r Western Vascular AMCDisclosuresCBI(not AI)was used in the creation of this content Endovascular therapy has rightfully challenged surgical approach to the Femoral-popliteal segmentA study of Medicare patients found that the total volume of surgical PAD treatments decreased from 67,137 in 2011 to 5

3、3,390 in 2016.In contrast,endovascular procedures saw a 25%increase during the same period.Every patient is an endovascular candidatesome are better than othersPTAB vs.PTFE BYPASS FOR CLAUDICATION|Pro:PTFE Bypass is Still a Viable Option for Patients Who Have Failed Endovascular Therapy in Whom an A

4、dequate Venous Conduit is Not AvailableIntermittent Claudication?Cohort 16,428 patients 1-year overall amputationPVI 11,006 patients(67%)1.3%Bypass 5,420 patients(33%)2.1%PTFE Bypass is Still a Viable Option for Patients Who Have Failed Endovascular Therapy in Whom an Adequate Venous Conduit is Not

5、Available(presenting with claudication)Clinical scenario:Post peripheral vascular intervention presenting with recurrent Intermittent Claudication?RAND appropriateness method(RAM)model Rated 2280 unique scenarios in AOID,CFA,Fem-popOnly 0.4%disagreement(9 scenarios)Rating panel:SVS,ACC,SIR Femoro-po

6、pliteal segment RecommendationsStraight forward/Complex anatomic disease(TASC II A/B)Initial therapy Exercise=Benefit risk Endovasc=Risk benefitOpen surgical=Risk benefit After completed exercise therapy Endovasc=BenefitriskOpen Surgical =Risk benefit(except high risk)After Prior