1500_Ali.pdf

1、TIBIAL TOOLBOX AND ACCESS TECHNIQUESIBRAHIM ALIINTERVENTIONAL CARDIOLOGY AND ENDOVASCULAR MEDICINENORTHWELL HEALTH-NORTHSHORE UNIVERSITY HOSPITAL AND LONG ISLAND JEWISH HOSPITALWHEN TO PERFORM TIBIAL INTERVENTIONS:Patient profile DiabeticsRenal Disease ASCVDSmokers Severe Claudication(Rutherford 3)(

2、AHA 2B level C evidence)Consider the lesion in single vessel CLTI(Rutherford 4-6)Angiosome guided revascularization ALIImproving outflow of proximal vesselsConsider when placing covered stents in fem-pop space Team based approach(Class 1)COMMON CHALLENGES IN TIBIAL INTERVENTION:Small vessels Heavily

3、 calcified vesselsVariable anatomy Long CTOsDifficult direct revascularization Lack of dedicated equipment Poor therapy patency(endo and open)Few bailout strategies for complications Destination TherapyLesion ModificationLesion CrossingAccess/Alternatives Case PlanningACCESSPRINCIPLES OF VASCULAR AC

4、CESS:Respect the groin Access site complications are the most common complication Dont rush especially when poking tibial arteriesUp and over will not always workGet comfortable with alternative access Learning ultrasound is a mustFloro is still an important toolRoadmaps CalciumPlan closure at the t

5、ime of access External vs Internal Bailout strategiesTIPS FOR US ACCESS:Put the cover on tight and remove air bubblesOrient yourself to the vessel(tap tap)Palpate to find a compressible spotIs a radial band feasible Identify the tibial veins Aim shallow,miss shallow,redirectMake sure to see the need

6、le tent the vessel Dont drop the probe when you see blood Use a micropuncture but watch the wireTake a picture before committing Tibial arteries are not forgiving Dont forget the cocktailTIPS FOR US ACCESS:Put the cover on tight and remove air bubblesOrient yourself to the vessel(tap tap)Palpate to