Takayasu’s Disease Takayasu’s Disease NewNew

Louay Altarazi , M.D Damascus, Syr ia

Case 1Case 1

Case 2Case 2

Case 3Case 3

Buerger’s Disease Buerger’s Disease New endovascular approach New endovascular approach

Louay Altarazi , M.D Damascus, Syr ia

"Oriental" countries are well known for certain life style and "Oriental" countries are well known for certain life style and history, they also share certain characteristic vascular history, they also share certain characteristic vascular

pathologies and social reactions to disease and treatment.pathologies and social reactions to disease and treatment.

Buerger’s disease “TAO” may be the most typical Buerger’s disease “TAO” may be the most typical entity due to its high prevalence in our region entity due to its high prevalence in our region and rarity in occidental population, the and rarity in occidental population, the diff icult ies to deal with the character ist ic diff icult ies to deal with the character ist ic psychic background of those young patients and psychic background of those young patients and the increase of young smokers in oriental the increase of young smokers in oriental societ ies . societ ies . In Syria this pathology presents 6 -15% of all In Syria this pathology presents 6 -15% of all

foots critical ischemia cases andfoots critical ischemia cases and

More than 70% of male young's foot necrosisMore than 70% of male young's foot necrosis

What Treatment ? (literature)What Treatment ? (literature)

Ultrasonic diagnosticUltrasonic diagnostic

corkscrew appearance, bidirectional flow corkscrew appearance, bidirectional flow

Inclusion CriteriaInclusion Criteria

Olin’s Diagnostic cr iter ia Olin’s Diagnostic cr iter ia

The procedure The procedure (in brief)(in brief)

before during after

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The procedure The procedure (in brief)(in brief)

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The procedure The procedure (in brief)(in brief)

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The procedure The procedure (in brief)(in brief)

Angiosomal conceptAngiosomal concept

A T PER P T

Anatomic ConsiderationAnatomic Consideration

BTK endovascular procedures BTK endovascular procedures characteristicscharacteristics

AtherosclerosisDiabetic arteriopathy

Buerger’s disease

Pain during procedure

slightly painful specially during inflating balloons

painless Can be very Painful

Recoil after PTA Possible leading toVascular reoclusion

Very rare Frequent but often transitory

Wire & cath-balloon passage

Relatively easy somehow difficult Difficult needs hard pushability

Subintimal way Almost possible Sometimes feasible impossible

Incomplete recanalization

Rarely useful ineffective Can be effective du to intense vasavasorium development

Peri-procedure carePeri-procedure care

From January 2006 to July 2011From January 2006 to July 2011

Clinical ImprovementClinical Improvement ( (21 patients fol lowed for 6-30 months)21 patients fol lowed for 6-30 months)

One major and three minor amputation

Before afterBefore after

Clinical caseClinical case

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Clinical caseClinical case

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Clinical caseClinical case

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Clinical caseClinical case

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Clinical caseClinical case

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Clinical caseClinical case

ConclusionConclusion