SUPERFICIAL FEMORAL ARTERY STENTGRAFT: WHEN, HOW (and WHY) Raffaello ... · Raffaello Bellosta, MD...
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SUPERFICIAL FEMORAL ARTERY STENTGRAFT: WHEN, HOW (and WHY) Raffaello Bellosta Poliambulanza Foundation Hospital – Brescia
Transcript of SUPERFICIAL FEMORAL ARTERY STENTGRAFT: WHEN, HOW (and WHY) Raffaello ... · Raffaello Bellosta, MD...
SUPERFICIAL FEMORAL ARTERY STENTGRAFT: WHEN, HOW (and WHY)
Raffaello BellostaPoliambulanza Foundation Hospital – Brescia
WHEN
De Novo occlusive lesions
In Stent Restenosis
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSISDe novo
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSISDe novo
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSIS
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSIS
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSIS
Total occlusion(%)
Occlusionlenght (mm)
Zilver PTX 29 66
Viastar 79 190
Vibrant 59 180
Circ Cardiovasc Interv 2011;4:495-504.
J Am Coll Cardiol 2013;62:1320-7.
J Vasc Surg 2013;58:386-95.
De novo
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSIS
Total occlusion(%)
Occlusionlenght (mm)
Zilver PTX 29 66
Viastar 79 190
Vibrant 59 180
Circ Cardiovasc Interv 2011;4:495-504.
J Am Coll Cardiol 2013;62:1320-7.
J Vasc Surg 2013;58:386-95.
Zilver PTX Viastar/Vibrant
De novo
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSISISR
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSISISR
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSISISR
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSISISR
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
DATA ANALYSIS - WHEN
• LONG (> 20 cm) LESIONS (TOTAL OCCLUSION) STENTGRAFT ACHIVIED SATISFACTORY RESULTS (75% Primary patency @ 12 mo)
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
HOW
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
HOW - PLANNING
ABI: 0.29
Prox SFA: 6 mm
AK Pop: 5 mm
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
HOW - PLANNING
HOW - PROCEDURE
Antegrade access (proximal SFA patent)
Angiography
Intraluminal recanalization (Ber II + .35 floppy or stiff wire)
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
HOW - PROCEDURE
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
HOW - PROCEDURE
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
PRE POST
HOW VIABAHN“Viabhan rules”
1. Avoid excessive oversizing (max oversize 1 mm vessel
diameter)
2. Ensure adequate Inflow and outflow
3. Treat All of the disease (stent “healthy to healthy”)
4. PrescriBe dual antiplatelet therapy
5. PostdilAte
6. Place device at tHe SFA origin if proximal SFA disease is
present
7. Regular duplex ultrasoNography follow-up (every 3 ms,
1st year)Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
HOW – FOLLOW UP
Double track
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
Viabhan
Double track
Viabhan BMS
BMS
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
HOW – FOLLOW UP
from “healthy to healthy”
Proximal
DistalLanding zones
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
Compliance
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
CLINICAL CASE
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
59 yrs
Smoker
Diabetes
2016 Jan right fem-pop BMS (Everflex 6 x 200 mm + 7 x 40 mm; other setting)
2016 Sept: Recurrence RL claudication
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
foot
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
POBA POST POBA
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
ViabahnPAJ 6 x 250 (distal)
ViabahnPAJ 7 x 150 (prox)
+
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
PRE POST
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
PRE POST
WHY STENTGRAFT in ISR?
Previous stent had already failed
The best method to cover echogenicmaterial (reducing In stent restenosis)
It’s a real reline surgery (ENDOBYPASS)
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
CONCLUSIONS
Long (> 20 cm) de novo lesions SG achiviedbetter results compared BMS (Viastar: 71% Vs 36% @ 12m).
Available data (Reline trial) suggests goodoutcomes (75% @ 12 m.) with the use of Viabhan for ISR lesions (first line therapy).
With covered stents we must be verymeticolous with our technique (planning, landing zones, follow up etc [Viabhan Rules]).
RCT’s SG Vs DCB Vs BPS are needed
Raffaello Bellosta, MD –Poliambulanza Foundation Hospital
