Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices –...
Transcript of Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices –...
![Page 1: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/1.jpg)
Giuseppe Papia, MD, MSc.Assistant Professor
Division of Vascular Surgery
J. Ross and Patricia Quigley Chair in Limb Preservation
Interdepartmental Division of Critical Care Medicine
Schulich Heart Centre
University of Toronto, Canada
Limb Salvage at All Costs: How do you leverage all of the tools in your toolbox?
![Page 2: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/2.jpg)
Disclosure
Speaker name: Giuseppe Papia
.................................................................................
I have the following potential conflicts of interest to report:
Consulting: Medtronic, Cook, Gore
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
X
![Page 4: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/4.jpg)
Conclusions: Limb Saving
• It’s Not a Procedure, It’s a Project!
![Page 5: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/5.jpg)
Toolbox A: OPEN
![Page 6: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/6.jpg)
• Wires– 0.035”
• stiff and floppy Terumo glide wire• Amplatz• Rosen
– 0.18” wires • V-18
– 0.14” wires• PT2, miracle bros 3 and 6, confianza• grandslam, ironman
• 5-9F Sheaths – Short and Long– Cook Raabe and Check Flow
• 60cm and 100cm catheters– Omniflush, VCF– Angled Glide Catheter, Kumpe, Vertebral– MPA -125cm
• QuickCross Catheters– 0.14, 0.18, 0.35”; 90cm, 135, 150cm
• PTA balloons– 0.35” otpa pro/ admiral/ agiltrac– 0.18” sterling/ savvy– 0.14” ampherion deep/maverick/
sleek
• Stents– Nitinol 2-15cm, 3-10mm
• Stent Grafts– Viabahn– Icast
• Retry Devices– Pioneer/Outback
• IVUS– Volcano/Galaxy
• Guides– 6-8F MPA, MPB, straight
• Aspiration Devices– Export / Diver / Pronto Catheter– Angiojet– Rinsperator
Toolbox B: ENDO
![Page 7: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/7.jpg)
Toolbox Today
• Wires– 0.035”
• stiff and floppy Terumo glide wire• Amplatz• Rosen
– 0.18” wires • V-18
– 0.14” wires• PT2, miracle bros 3 and 6, confianza• grandslam, ironman
• 5-9F Sheaths – Short and Long– Cook Raabe and Check Flow
• 60cm and 100cm catheters– Omniflush, VCF– Angled Glide Catheter, Kumpe, Vertebral– MPA -125cm
• QuickCross Catheters– 0.14, 0.18, 0.35”; 90cm, 135, 150cm
• PTA balloons– 0.35” otpa pro/ admiral/ agiltrac– 0.18” sterling/ savvy– 0.14” ampherion deep/maverick/
sleek• Stents
– Nitinol 2-15cm, 3-10mm• Stent Grafts
– Viabahn– Icast
• Retry Devices– Pioneer/Outback
• IVUS– Volcano/Galaxy
• Guides– 6-8F MPA, MPB, straight
• Aspiration Devices– Export / Diver / Pronto Catheter– Angiojet– Rinsperator
![Page 8: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/8.jpg)
“Drop the gloves”
![Page 9: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/9.jpg)
“Drop the gloves”
![Page 10: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/10.jpg)
Case: Mr. Black Toes• 66 yo male• PMHx: AML, DM, CRF (Cr 220’s)
• HxPI: necrotic first and second toes, third lateral toe, and heel
![Page 11: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/11.jpg)
![Page 12: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/12.jpg)
Case: Mr. Black Toes• Duplex:
• Biphasic femoral and popliteal• CNO, monophasic tibials• TcPO2 =14
![Page 13: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/13.jpg)
![Page 14: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/14.jpg)
![Page 15: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/15.jpg)
![Page 16: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/16.jpg)
![Page 17: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/17.jpg)
![Page 18: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/18.jpg)
Case: Mr. Black Toes• Duplex:
• Biphasic femorals and popliteal• CNO, monophasic tibials• TcPO2 =26• ongoing rest pain• increase in necrosis
![Page 19: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/19.jpg)
![Page 20: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/20.jpg)
![Page 21: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/21.jpg)
![Page 22: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/22.jpg)
![Page 23: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/23.jpg)
6 weeks
![Page 24: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/24.jpg)
3 months
![Page 25: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/25.jpg)
![Page 26: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/26.jpg)
![Page 27: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/27.jpg)
![Page 28: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/28.jpg)
![Page 29: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/29.jpg)
![Page 30: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/30.jpg)
6 months
![Page 31: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/31.jpg)
![Page 32: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/32.jpg)
12 months
![Page 33: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/33.jpg)
Conclusions: Limb Saving
• It’s Not a Procedure, It’s a Project!
![Page 34: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/34.jpg)
![Page 36: Limb Salvage at All Costs - Login - NMSuite...– 6-8F MPA, MPB, straight • Aspiration Devices – Export / Diver / Pronto Catheter – Angiojet – Rinsperator Toolbox B: ENDO Toolbox](https://reader033.fdocuments.in/reader033/viewer/2022061000/60af68c8a4bd1c7a542b2113/html5/thumbnails/36.jpg)
Giuseppe Papia, MD, MSc.Assistant Professor
Division of Vascular Surgery
J. Ross and Patricia Quigley Chair in Limb Preservation
Interdepartmental Division of Critical Care Medicine
Schulich Heart Centre
University of Toronto, Canada
Limb Salvage at All Costs: How do you leverage all of the tools in your toolbox?