Division of Endovascular Interventions Mount Sinai Hospital New

Division of Endovascular Interventions Mount Sinai Hospital New

Division of Endovascular Interventions Mount Sinai Hospital New York 12/19/2018 SPL 61580 Rev. B Case presentation

66 year old male PMHx: 63 y.o. male with h/o smoking, NIDDM, CKD, HTN, HLD, CAD s/p CABG on 11/1/2018, PAD s/p ?failed attemp at Left fem pop bypass and PTA of right in 2010 Presents with b/l LE claudication, L>R lifestyle limiting claudication (+) ABI with Rt ABI=0.88 and Lt ABI=0.92. Peripheral angio: on 11/28/2018 showed bilateral SFA CTO and LCFA & left popliteal artery disease with bilateral three vessel.

Medications:Aspirin, Crestor, Benicar, HCTZ, Glucophage, Actos, Plavix, Jardiance Hb- 12.0, INR- 1.0, Creatinine- 1.0 SPL 61580 Rev. B Abdominal Aortogram SPL 61580 Rev. B

Left Leg Run off SPL 61580 Rev. B STRATEGY 7Fr RCFA and 45 cm up and over sheath Angiomax

Attempt SFA CTO antegrade-> retrograde via pedal access SPL 61580 Rev. B Treatment of Concomitant CFA disease SPL 61580 Rev. B

CFA Standard Treatment Open surgical revascularisation Thrombendartherectomy atheromateous lesions Embolectomy

embolic lesions Limitations: Scarred tissue Obesity Morbidity up to 5%: Major hematoma Wound infection

Surgical revision Cardon A et al. Endarteriectomy of the femoral tripod: long-term results and analysis of failure factors. Ann Chir 2001;126:777-82. SPL 61580 Rev. B Type of lesion: CFA lesions were classified into four types (Azema Classification):

type I: lesions were located at the iliac external artery and were extended to the CFA type II: lesions were limited to the CFA type III: lesions were located at the CFA and its bifurcation type IV: represents restenosis bypass anastomosis. Eur J Vasc Endovasc Surg. 2011 Jun;41(6):787-93. doi:

10.1016/j.ejvs.2011.02.025. Epub 2011 Mar 24. Endovascular repair of common femoral artery and concomitant arterial lesions. SPL 61580 Rev. B CFA TEA- Outcomes

Kaplan-Meier life table analysis of primary patency (diamonds), assisted primary patency (squares), freedom from new revascularization (triangles), and survival (circles) rates after common femoral endarterectomy. (From Ballotta E, Gruppo M, Mazzalai F, et al. Common femoral artery endarterectomy for occlusive disease: an 8 year single center prospective study. Surgery

2010;147(2):272;). SPL 61580 Rev. B TEA- Complications Ballotta et al. (Surgery 2010;147:268-274) 6,6% minor complication rate Mainly lymph leaks

Kang et al. (J Vasc Surg 2008;48:872-7) 13,8% complication rate 5% required reintervention Kechagias et al. (World J Surg 2008;32:51-54) 17,1% wound infection rate 9% hematomas Derksen et al. (Vasc End Surg 2009;43:69-75) 14% wound infection rate

9% superficial infections, 5% deep infections Cardon et al. (Ann Chir 2001;126(8):777-82) 18% minor complication rate 3,6% major complication rate SPL 61580 Rev. B Endovascular treatment of CFA disease

PTCA DCB with/without Athrectomy Bailout Stenting SPL 61580 Rev. B SPL 61580 Rev. B

CFA Angioplasty Bad Krozingen Experience SPL 61580 Rev. B Bonvini et al. JACC 2011 SPL 61580 Rev. B

SPL 61580 Rev. B SPL 61580 Rev. B TECCO Study SPL 61580 Rev. B

TECCO Trial Primary endpoint Modified intent to treat analysis Surgery (n=61) Morbid-mortality rate @ 1 month, n (%)

16 (26) Stenting (n=56) 7 (12.5) p 0.05

Per protocol analysis Surgery (n=58) Morbid-mortality rate @ 1 month, n (%) 16 (26)

Stenting (n=47) 3 (6.4) p 0.005 SPL 61580 Rev. B

Gouffic Y et al. JACC CI 2017;10:1344 SPL 61580 Rev. B Survival @ 24 months Freedom from TLR @ 24 months

Patency @ 24 months Haemodynamic improvement @ 24 months SPL 61580 Rev. B Gouffic Y et al. JACC CI 2017;10:1344

VMI CFA trail SPL 61580 Rev. B SPL 61580 Rev. B SPL 61580 Rev. B

Lesion characteristics SPL 61580 Rev. B SPL 61580 Rev. B Primary Patency

SPL 61580 Rev. B Frredom from TLR SPL 61580 Rev. B Management of Isolated Atherosclerotic Stenosis of the Common Femoral Artery: A Review of the Literature

David Halpin, MD, Young Erben, MD, Sasanka Jayasuriya, MD, Bennett Cua, MD, Sunny Jhamnani, MD, and Carlos Mena-Hurtado, MD (Vascular and Endovascular Surgery 2017, Vol. 51(4) 220-227 SPL 61580 Rev. B SPL 61580 Rev. B

SPL 61580 Rev. B The review included 7 CFE studies and 4 endovascular studies. Survival was similar between the groups. Primary patency was consistently higher with CFE compared to endovascular therapy. Freedom from TLR was lower with CFE compared to endovascular therapy. Morbidity was reported higher with CFE compared to endovascular therapy. Freedom from amputation was not consistently reported in the endovascular studies.

Conclusion: There is limited data to support endovascular treatment of isolated CFA atherosclerosis. CFE has durable results, but there is significant morbidity and mortality resulting from this procedure. Endovascular interventions have low rates of complications, high rates of technical success, good short-term patency but increased need for repeat interventions when compared to surgery SPL 61580 Rev. B

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