Thrombolysis, thromboaspiration, ultrasound thrombectomy: adjuncts techniques for aorto-iliac recanalization.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Thrombolysis, thromboaspiration, ultrasound thrombectomy: adjuncts techniques for aorto-iliac recanalization."

Transcription

1 Thrombolysis, thromboaspiration, ultrasound thrombectomy: adjuncts techniques for aorto-iliac recanalization. Dr. S. Schepers Dr. F. Van Elst Sint-Trudo Hospital Sint-Truiden Belgium

2 Chronic aorto-iliac occlusions Thrombolysis thrombectomy Laser Acute aorto-iliac occlusions Thrombolysis Aspiration thrombectomy Mechanical thrombectomy Ultrasoun thrombectomy

3 Chronic aorto-iliac occlusive disease

4 Chronic aorto-iliac occlusive disease Treatment evolved from surgical endarterectomy to surgical bypass grafting to endovascular treatment TASC A TASC D PTA Treatment decision: life expectancy age classification surgery co-morbidity previous procedures

5 Chronic aorto-iliac occlusive disease

6 Chronic aorto-iliac occlusive disease

7 Chronic aorto-iliac occlusive disease Thrombolysis and thrombectomy recent occlusion simplify occlusion by conversion into stenosis Laser chronic thrombus plaque dominant lesions definitive therapy! (PTA and/or surgery)

8 Chronic aorto-iliac occlusive 1. Thrombolysis disease dissolve the occluding thrombus restore perfusion identify underlying cause of arterial/graft occlusion convert major reconstruction to limited procedure lyse thrombi in distal arteries, restoring patency to outflow

9 2. Laser Chronic aorto-iliac occlusive disease pulse-light to minimize thermal injury slow progression continuous saline infusion to limit dissection

10 2. Laser Chronic oarto-iliac occlusive disease Percutaneous laser-assisted recanalization of long chronic iliac artery occlusions: primary and mid-term results. (Balzer et al Eur Radiol 2006 Feb) 46 chronic iliac occlusion (average lenght 57.1mm) laser and PTA results: primary technical success rate was 95.3%, with a major complication rate of 6.9% overall primary patency rate was 86.1% follow-up 4 year

11 Chronic aorto-iliac occlusive disease

12 Chronic aorto-iliac occlusive disease

13 Chronic aorto-iliac occlusive disease

14 Acute aorto-iliac occlusion

15 Acute aorto-iliac occlusion Risk of morbidity and mortality following open surgical intervention remains high (5 20%) Why? old patients high rate of cardiac and other co-morbidities

16 Acute aorto-iliac occlusion Need for less invasive intervention: Thrombolytic therapy Aspiration thrombectomy Mechanical thrombectomy (Ultrasound thrombectomy) +/- PTA and/or surgery!

17 Acute aorto-iliac occlusion Thrombolytic therapy Followed by definitive therapy to address the underlying lesion that caused the occlusion. If not: high risk early rethrombosis 3 clinical trials of thrombolytic therapy versus surgery - Rochester series -Surgery or Thrombolysis for the Ischemic Lower Extremity (STILE) trial -Thrombolysis Or Peripheral Arterial Surgery (TOPAS) trial

18 ROCHESTER series single center, 114 pt urokinase vs. surgery identical amputation rate different mortality rate due to perioperative cardiopulmonary complications

19 STILE trial 393 pt in 3 groups: rt-pa, urokinase or surgery finally 2 thrombolytic groups combined endpoints of amputation and death equivalent

20 STILE trial 2 subgroup analysis: native artery vs. bypass graft occlusion results: rate major amputation higher in native artery occlusions treated with thrombolysis (10% vs 0% after 1 year) lower amputation rate in bypass graft occlusions treated with thrombolysis Conclusion: thrombolysis may be of greatest benefit in patients with acute bypass occlusions of less than 14d

21 TOPAS trial 544 patients randomized to recombinant urokinase or surgery similar rate of amputationfree survival after 1 year conclusion: acute leg ischemia could be managed with thrombolysis achieving similar amputation and mortality rates but avoiding open surgical procedure

22 Acute aorto-iliac occlusion Thrombolysis: how to do it? contralateral approach infusion catheter several centimeters into thrombus (single end hole 3F or 4F) low-dose infusion - Urokinase concomitant heparine to prevent pericatheter thrombosis control angiogram at least every 12h patient monitoring hematologic control definitive therapy

23 Acute aorto-iliac occlusion Complications of thrombolysis bleeding (up to 10%) stroke (2%) distal embolisation (10%) National Audit of Thrombolysis for Acute Leg Ischemia (NATALI) database. (Br J Surgery 2003;90) > 1000 procedures results: amputation free survival rates of 75% at 30 days mortality rate of 12,5% amputation with survival rate of 12,5% high risk for amputation: female, diabetic, neurologic deficit, ischemic heart disease

24 Acute aorto-iliac occlusion Aspiration thrombectomy = removing small fragments of clot percutaneously - 6 to 8F catheter passed into the occlusion; 50ml syringe attached to the end of the catheter and aspirated at the time it is withdrawn through the occlusion - good result in selected patients with small emboli - acute occlusions in distal peripheral arteries, not in larger arterial branches like iliac vessels

25 Acute aorto-iliac occlusion Mechanical thrombectomy = breaking up thrombus within the vessel and aspirating it - expensive single-use equipment - only occlusions < 14 days - no comparative trials with surgery or thrombolysis - arterial damage, hematoma (large puncture wounds)

26 Acute aorto-iliac occlusion Mechanical thrombectomy 1. Amplatz thrombectomy device: - rotational forces to break up thrombus into tiny fragments that simply disperse within the circulation. - clinical significant embolization is rare

27 Acute aorto-iliac occlusion Mechanical thrombectomy 2. High-pressure saline jet device: - high-pressure saline jets to create a vortex at the catheter tip, so that thrombus is aspirated into a maceration chamber and then removed through a separate channel - AngioJet, Hydrolyser, Oasis - hazard that a great volume of blood can be lost during aspiration!

28 AngioJet Acute aorto-iliac occlusion

29 Acute aorto-iliac occlusion

30 Acute aorto-iliac occlusion

31 Acute aorto-iliac occlusion

32 Authors n Conduit, no (%) No (%), success Adjunctive lysis, no(%) Complications (%) Primary Patency (%) Müller- Hülsbeck et al 112 Native, 99 (86) Graft, 16 (14) 80 (71) 20 (18) Embolization (9.8) Dissection (8) Perforation (3.6) Amputation (1.8) Mortality (7) 6 mo (68) 2 yr (60) 3 yr (58) Silva et al 22 Native, 13 (59) Graft, 9 (41) 21 (95) None Hemorrhage (10) Embolism (9) Dissection (5) Occlusion (18) Amputation (5) Mortality (14) Not applicable Wagner et al 50 Native, 39 (78) Graft, 11 (22) 36 (52) 15 (30) Hemorrhage (6) Emboli (6) Dissection (6) Perforation (4) Amputation (8) 1 yr (69) Mortality (0) Kasirajan et al 86 Native, 52 (63) Graft, 31 (37) 70 (84) 50 (58) Hemorrhage (3.5) Embolism (2.3) Dissection (3.5) Perforation (2.3) Amputation (11.6) 6 mo (79)

33 Acute aorto-iliac occlusion Trellis system = mechanically assisted pharmacologic thrombolysis - drug dispersion and thrombectomy catheter - 2 balloons to isolate treatment zone and maintain thrombolytic agent locally - after inflation change guidewire for dispersion wire - aspirate thrombus after 15min - vessels 4 to 12mm

34 Acute aorto-iliac occlusion

35 Acute aort-iliac occlusions Trellis system: Sarac TP et al: Clinical and economic evaluation of the Trellis thrombectomy device for arterial occlusions: preliminary analysis. J Vasc Surg 2004; 39(3): patients treated results: 58% acute and 42% chronic occlusion 73% infra-inguinal and 27 supra-inguinal technical succes 92% 30-day amputation-free survival rate 96% no difference acute/chronic, infra/supra-inguinal conclusion: Early results suggests that it is as effective as traditional catheter-directed thrombolysis. Furthermore, there were no bleeding complications, likely the result of the Trellis device requiring shorter procedure and infusion times.

36 CONCLUSION (1) The practical management of aorto-iliac occlusions remains a challenge, as it involves one of the most complex decision pathways in vascular surgery. Thrombolysis and thrombectomy offers a less invasive approach to thrombotic occlusions, with the opportunity to address the unmasked, causative lesions directly. Correction of these lesions can often be accomplished through an endovascular approach such as PTA(S).

37 CONCLUSION (2) Even when after thrombolysis and/or thombectomy a bypass graft must be placed, the procedure can frequently be performed in an elective setting after adequate patient preparation. A successfull outcome depends upon an experienced team with access to the full range of available techniques, and the ability to use them appropriately in individually selected patients.

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty Round Table: Antithrombotic therapy beyond ACS Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty M. Matsagkas, MD, PhD, EBSQ-Vasc Associate Professor

More information

Atherosclerosis is the cause of the vast majority of cases

Atherosclerosis is the cause of the vast majority of cases Antithrombotic Therapy in Peripheral Arterial Occlusive Disease Mark R. Jackson, MD, Chair; and G. Patrick Clagett, MD Abbreviations: ACD absolute claudication distance; CI confidence interval; INR international

More information

PRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators

PRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease PRECOMBAT Trial Seung-Whan Lee, MD, PhD On behalf

More information

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY

More information

Complications of Femoral Catheterization. Daniel Kaufman, MD University Hospital of Brooklyn December 16, 2005

Complications of Femoral Catheterization. Daniel Kaufman, MD University Hospital of Brooklyn December 16, 2005 Complications of Femoral Catheterization Daniel Kaufman, MD University Hospital of Brooklyn December 16, 2005 Case Presentation xx yr old female presents with fever, chills, and painful swelling of R groin

More information

Cilostazol versus Clopidogrel after Coronary Stenting

Cilostazol versus Clopidogrel after Coronary Stenting Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background

More information

Credentials for Peripheral Angioplasty: Comments on Society of Cardiac Angiography and Intervention Revisions

Credentials for Peripheral Angioplasty: Comments on Society of Cardiac Angiography and Intervention Revisions Credentials for Peripheral Angioplasty: Comments on Society of Cardiac Angiography and Intervention Revisions David Sacks, MD, Gary J. Becker, MD, and Terence A.S. Matalon, MD J Vasc Interv Radiol 2003;

More information

Talent Thoracic Stent Graft with THE Xcelerant Delivery System. Expanding the Indications for TEVAR

Talent Thoracic Stent Graft with THE Xcelerant Delivery System. Expanding the Indications for TEVAR Talent Thoracic with THE Xcelerant Delivery System Expanding the Indications for TEVAR Talent Thoracic Precise placement 1 Broad patient applicability 1 Excellent clinical outcomes 1, a + Xcelerant Delivery

More information

The Bioresorbable Vascular Stent Dr Albert Ko

The Bioresorbable Vascular Stent Dr Albert Ko The Bioresorbable Vascular Stent Dr Albert Ko Dr Albert Ko MB BS, FRACP, FCSANZ Interventional/General Cardiologist Ascot Cardiology Symposium 2013 Treatment Goals for Coronary Artery Disease Relieve of

More information

Majestic Trial 12 Month Results

Majestic Trial 12 Month Results Majestic Trial 12 Month Results S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA ACADEMIC HOSPITALS Flensburg of Kiel University Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, 24939 FLENSBURG Dept.

More information

REPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES

REPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES REPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES Effective January 1, 2015, there was a change in CPT that affects reporting specific endovascular services provided in the

More information

Duration of Dual Antiplatelet Therapy After Coronary Stenting

Duration of Dual Antiplatelet Therapy After Coronary Stenting Duration of Dual Antiplatelet Therapy After Coronary Stenting C. DEAN KATSAMAKIS, DO, FACC, FSCAI INTERVENTIONAL CARDIOLOGIST ADVOCATE LUTHERAN GENERAL HOSPITAL INTRODUCTION Coronary artery stents are

More information

EkoSonic Endovascular System Nursing Presentation. Imagine where we can go. Imagine where we can go.

EkoSonic Endovascular System Nursing Presentation. Imagine where we can go. Imagine where we can go. EkoSonic Endovascular System Nursing Presentation Imagine where we can go. Imagine where we can go. Forward-looking statement This presentation and information communicated verbally to you may contain

More information

Surgeons Role in Atrial Fibrillation

Surgeons Role in Atrial Fibrillation Atrial Fibrillation Surgeons Role in Atrial Fibrillation Steven J Feldhaus, MD, FACS 2015 Cardiac Symposium September 18, 2015 Stages of Atrial Fibrillation Paroxysmal (Intermittent) Persistent (Continuous)

More information

University of Missouri Kansas City School of Medicine and the Mid America Heart Institute of Saint Luke s Hospital

University of Missouri Kansas City School of Medicine and the Mid America Heart Institute of Saint Luke s Hospital PROGRAM DIRECTOR: Dr. Steven Laster University of Missouri Kansas City School of Medicine and the Mid America Heart Institute of Saint Luke s Hospital 1 Interventional Cardiology Fellowship Training Program

More information

Liau DW : Injuries and Liability Related to Peripheral Catheters: A Closed Claims Analysis. ASA Newsletter 70(6): 11-13 & 16, 2006.

Liau DW : Injuries and Liability Related to Peripheral Catheters: A Closed Claims Analysis. ASA Newsletter 70(6): 11-13 & 16, 2006. Citation Liau DW : Injuries and Liability Related to Peripheral Catheters: A Closed Claims Analysis. ASA Newsletter 70(6): 11-13 & 16, 2006. Full Text An anesthesiologist inserted a 14-gauge peripheral

More information

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012 Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced

More information

Endovascular Repair of an Axillary Artery Aneurysm: A Novel Approach

Endovascular Repair of an Axillary Artery Aneurysm: A Novel Approach Endovascular Repair of an Axillary Artery Aneurysm: A Novel Approach Bao- Thuy D. Hoang, MD 1, Jonathan- Hien Vu, MD 2, Jerry Matteo, MD 3 1 Department of Surgery, University of Florida College of Medicine,

More information

What is Vascular Surgery Worth to a Health Care System?

What is Vascular Surgery Worth to a Health Care System? What is Vascular Surgery Worth to a Health Care System? Peter Gloviczki, MD Robert Zwolak, MD Sean Roddy, MD Conflict of Interest NONE Mayo Clinic, Rochester, MN, Dartmouth-Hitchcock Medical Center, Lebanon,

More information

Renal artery stenting: are there any indications left?

Renal artery stenting: are there any indications left? there any indications left? Luís Mendes Pedro, MD. PhD, FEBVS Lisbon Academic Medical Centre (University of Lisbon and Hospital Santa Maria) Instituto Cardiovascular de Lisboa Disclosures Speaker name:

More information

California Health and Safety Code, Section 1256.01

California Health and Safety Code, Section 1256.01 California Health and Safety Code, Section 1256.01 1256.01. (a) The Elective Percutaneous Coronary Intervention (PCI) Pilot Program is hereby established in the department. The purpose of the pilot program

More information

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation Obtain complete heath history including allergies, drug history and possible drug Assess baseline coagulation studies and CBC Assess for history of bleeding disorders, GI bleeding, cerebral bleed, recent

More information

AORTOENTERIC FISTULA. Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005

AORTOENTERIC FISTULA. Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA diagnosis and management Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA Aortoenteric

More information

CLINICAL AND EPIDEMIOLOGICAL ASSESSMENT CONCERNING HYBRID REVASCULARIZATION TECHNIQUES IN THE TREATMENT OF MULTILEVEL ARTERIAL OCCLUSIVE DISEASE

CLINICAL AND EPIDEMIOLOGICAL ASSESSMENT CONCERNING HYBRID REVASCULARIZATION TECHNIQUES IN THE TREATMENT OF MULTILEVEL ARTERIAL OCCLUSIVE DISEASE Rev. Med. Chir. Soc. Med. Nat., Iaşi 2014 vol. 118, no. 3 PREVENTIVE MEDICINE - LABORATORY ORIGINAL PAPERS CLINICAL AND EPIDEMIOLOGICAL ASSESSMENT CONCERNING HYBRID REVASCULARIZATION TECHNIQUES IN THE

More information

Medicare C-Codes for AngioDynamics Products

Medicare C-Codes for AngioDynamics Products Medicare C-Codes for AngioDynamics Products The HCPCS C-codes used to designate the devices used in hospital outpatient procedures must be reported. The C-codes will be used for tracking the devices, number

More information

Wingspan Stent System with Gateway PTA Balloon Catheter

Wingspan Stent System with Gateway PTA Balloon Catheter Wingspan System with Gateway PTA Balloon Catheter Directions for Use AUS Australian Sponsor Address Boston Scientific (Australia) Pty Ltd PO Box 332 BOTANY NSW 1455 Australia Free Phone 1800 676 133 Free

More information

STROKE OCCURRENCE SYMPTOMS OF STROKE

STROKE OCCURRENCE SYMPTOMS OF STROKE STROKE OCCURRENCE SYMPTOMS OF STROKE The symptoms of stroke depend on what part of the brain is affected and how large an area is involved. A stroke is a sudden event accompanied by one or more of the

More information

The largest clinical study of Bayer's Xarelto (rivaroxaban) Wednesday, 14 November 2012 07:38

The largest clinical study of Bayer's Xarelto (rivaroxaban) Wednesday, 14 November 2012 07:38 Bayer HealthCare has announced the initiation of the COMPASS study, the largest clinical study of its oral anticoagulant Xarelto (rivaroxaban) to date, investigating the prevention of major adverse cardiac

More information

MEDICAL POLICY No. 91580-R1 DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE

MEDICAL POLICY No. 91580-R1 DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE Effective Date: October 1, 2015 Review Dates: 10/11, 10/12, 10/13, 8/14, 8/15 Date Of Origin: October 12, 2011 Status: Current Summary of Changes Clarifications:

More information

Pulmonary Embolic Disease: Caval Filtration and Other Stuff. Tony P. Smith, M.D. October 2, 2009

Pulmonary Embolic Disease: Caval Filtration and Other Stuff. Tony P. Smith, M.D. October 2, 2009 Pulmonary Embolic Disease: Caval Filtration and Other Stuff Tony P. Smith, M.D. October 2, 2009 Controversies in Treatment of Acute Pulmonary Embolic Disease Scope of the problem Transcatheter therapy

More information

1. Utility of transradial approach in endovascular management of chronic mesenteric ischemia

1. Utility of transradial approach in endovascular management of chronic mesenteric ischemia PUBLICATIONS, ABSTRACTS AND PRESENTATIONS : 1. Utility of transradial approach in endovascular management of chronic mesenteric ischemia 2. Endovascular management of the suprarenal IVC agenesis 3. The

More information

STONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY

STONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY STONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY Per Medical Board decision March 18, 2008: These credentialing standards do NOT apply to peripheral angiography performed in the context

More information

SIR Reporting Standards for the Treatment of Acute Limb Ischemia with Use of Transluminal Removal of Arterial Thrombus

SIR Reporting Standards for the Treatment of Acute Limb Ischemia with Use of Transluminal Removal of Arterial Thrombus SIR Reporting Standards for the Treatment of Acute Limb Ischemia with Use of Transluminal Removal of Arterial Thrombus Nilesh Patel, MD, Subcommittee Chair, David Sacks, MD, Committee Chair, Rajesh I.

More information

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators Long-Term Outcomes Using a Self- Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Deemed Extreme Risk for Surgery: Two-Year Results From the CoreValve US Pivotal Trial Steven J. Yakubov,

More information

Process Representation #1 : The PAD algorithm as a sequential flow thru all sections

Process Representation #1 : The PAD algorithm as a sequential flow thru all sections Process Representation #1 : The PAD algorithm as a sequential flow thru all sections An exploded version of the above scoped section flow is shown below. Notes: The flow presupposes existing services (

More information

Patient Information Booklet. Endovascular Stent Grafts: A Treatment for Abdominal Aortic Aneurysms

Patient Information Booklet. Endovascular Stent Grafts: A Treatment for Abdominal Aortic Aneurysms Patient Information Booklet Endovascular Stent Grafts: A Treatment for Abdominal Aortic Aneurysms TABLE OF CONTENTS Introduction 1 Glossary 2 Abdominal Aorta 4 Abdominal Aortic Aneurysm 5 Causes 6 Symptoms

More information

Clinical Study Synopsis

Clinical Study Synopsis Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace

More information

Non-surgical treatment of severe varicose veins

Non-surgical treatment of severe varicose veins Non-surgical treatment of severe varicose veins Yasu Harasaki UCHSC Department of Surgery General Surgery Grand Rounds March 19, 2007 Definition Dilated, palpable, subcutaneous veins generally >3mm in

More information

Imaging of Thoracic Endovascular Stent-Grafts

Imaging of Thoracic Endovascular Stent-Grafts Imaging of Thoracic Endovascular Stent-Grafts Tariq Hameed, M.D. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana Disclosures: No relevant financial

More information

DISCLOSURE. Atrial Fibrillation Management An Evidence-based Approach OBJECTIVES BACKGROUND AFFIRM 9/16/2015

DISCLOSURE. Atrial Fibrillation Management An Evidence-based Approach OBJECTIVES BACKGROUND AFFIRM 9/16/2015 Death (%) Mortality (%) 9/16/2015 DISCLOSURE Atrial Fibrillation Management An Evidence-based Approach Jonathon Adams, MD, FHRS Relevant Financial Relationship(s) None Off Label Usage None OBJECTIVES What

More information

A Patient s Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair

A Patient s Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair A Patient s Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair Table of Contents The AFX Endovascular AAA System............................................ 1 What is an Abdominal Aortic Aneurysm

More information

Overview of Newer Stent Devices for Aneurysm Treatment

Overview of Newer Stent Devices for Aneurysm Treatment Overview of Newer Stent Devices for Aneurysm Treatment Randall C. Edgell, M.D. Associate Professor Vascular and Interventional Neurology Saint Louis University Disclosure Outcome adjudication for THERAPY,

More information

Chronic Thromboembolic Disease. Chronic Thromboembolic Disease Definition. Diagnosis Prevention Treatment Surgical Nonsurgical

Chronic Thromboembolic Disease. Chronic Thromboembolic Disease Definition. Diagnosis Prevention Treatment Surgical Nonsurgical Chronic Thromboembolic Disease Diagnosis Prevention Treatment Surgical Nonsurgical Chronic Thromboembolic Disease Definition Pulmonary Hypertension due to chronic thromboembolism 6 months post acute PE:

More information

STROKE PREVENTION IN ATRIAL FIBRILLATION

STROKE PREVENTION IN ATRIAL FIBRILLATION STROKE PREVENTION IN ATRIAL FIBRILLATION OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention of ischemic stroke and arterial thromboembolism in patients

More information

ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY. Dr. Mahesh Vakamudi. Professor and Head

ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY. Dr. Mahesh Vakamudi. Professor and Head ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY Dr. Mahesh Vakamudi Professor and Head Department of Anesthesiology, Critical Care and Pain Medicine Sri Ramachandra University INTRODUCTION

More information

Coding Updates for 2013: Cardiology

Coding Updates for 2013: Cardiology Coding Updates for 2013: Cardiology Presented by: David Dunn, MD, FACS CIRCC, CPC-H, CCVTC, CCC, CCS, RCC National Coding Standards Sources of information Centers for Medicare and Medicare (CMS) Provider

More information

When Procedural Support really matters. Navien TM A+ Intracranial Support Catheter

When Procedural Support really matters. Navien TM A+ Intracranial Support Catheter When Procedural Support really matters Navien TM A+ Intracranial Support Catheter Coils / Liquid Embolics DURABLE ovalization resistance, Maintains patent lumen in tortuosity for smooth micro catheter

More information

Christopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona

Christopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona Christopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona Areas to be covered Historical, current, and future treatments for various cardiovascular disease: Atherosclerosis (Coronary

More information

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,

More information

What You Should Know About Cerebral Aneurysms

What You Should Know About Cerebral Aneurysms What You Should Know About Cerebral Aneurysms From the Cerebrovascular Imaging and Interventions Committee of the American Heart Association Cardiovascular Radiology Council Randall T. Higashida, M.D.,

More information

06 Validation of risk prediction model

06 Validation of risk prediction model HA Territory-wide PCI Audit 2003-06 06 Validation of risk prediction model PCI Audit Working Group Central Committee (Cardiac Services) HA Convention 2007 Background Participants: All HA hospitals via

More information

OHTAC Recommendation

OHTAC Recommendation OHTAC Recommendation Multiple Sclerosis and Chronic Cerebrospinal Venous Insufficiency Presented to the Ontario Health Technology Advisory Committee in May 2010 May 2010 Issue Background A review on the

More information

Is this pt s brain dysfunction due to ischemia? Onset & progression of sx; location of deficit

Is this pt s brain dysfunction due to ischemia? Onset & progression of sx; location of deficit CEREBROVASCULAR ACCIDENTS & TIA s Maggie Kelly History: Onset of symptoms exact time Previous sxs suggestive of TIA s Progression of symptoms Headache? Medications Past history of CVA, clotting events

More information

RADIOLOGY 2014 CPT Codes

RADIOLOGY 2014 CPT Codes RADIOLOGY 2014 CPT Codes Radiology 2014 CPT Codes CMS has issued 36 new procedure codes (one is a radiation therapy code) for CY 2014 that directly pertain to radiology with 26 of those codes the result

More information

STROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND:

STROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND: STROKE PREVENTION IN ATRIAL FIBRILLATION TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention

More information

Department of Veterans Affairs VHA DIRECTIVE 2011-038 Veterans Health Administration Washington, DC 20420 November 2, 2011

Department of Veterans Affairs VHA DIRECTIVE 2011-038 Veterans Health Administration Washington, DC 20420 November 2, 2011 Department of Veterans Affairs VHA DIRECTIVE 2011-038 Veterans Health Administration Washington, DC 20420 TREATMENT OF ACUTE ISCHEMIC STROKE (AIS) 1. PURPOSE: This Veterans Health Administration (VHA)

More information

A Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs

A Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs A Patient s Guide to Primary and Secondary Prevention of PATIENT EDUCATION GUIDE What Is Cardiovascular Disease? Cardiovascular disease (CVD) is a broad term that covers any disease of the heart and circulatory

More information

Plumbing 101:! TXA and EMS! Jay H. Reich, MD FACEP! EMS Medical Director! City of Kansas City, Missouri/Kansas City Fire Department!

Plumbing 101:! TXA and EMS! Jay H. Reich, MD FACEP! EMS Medical Director! City of Kansas City, Missouri/Kansas City Fire Department! Plumbing 101:! TXA and EMS! Jay H. Reich, MD FACEP! EMS Medical Director! City of Kansas City, Missouri/Kansas City Fire Department! EMS Section Chief! Department of Emergency Medicine! University of Missouri-Kansas

More information

GENERAL HEART DISEASE KNOW THE FACTS

GENERAL HEART DISEASE KNOW THE FACTS GENERAL HEART DISEASE KNOW THE FACTS WHAT IS Heart disease is a broad term meaning any disease affecting the heart. It is commonly used to refer to coronary heart disease (CHD), a more specific term to

More information

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological

More information

The Cardiac Society of Australia and New Zealand

The Cardiac Society of Australia and New Zealand The Cardiac Society of Australia and New Zealand Guidelines on Support Facilities for Coronary Angiography and Percutaneous Coronary Intervention (PCI) including Guidelines on the Performance of Procedures

More information

INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment

INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment INSTEAD at 5-year follow-up shifts the expectations for endovascular treatment Christoph A. Nienaber, MD, FACC University Heart Center Rostock Department of Medicine I - Cardiology christoph.nienaber@med.uni-rostock.de

More information

Listen to your heart: Good Cardiovascular Health for Life

Listen to your heart: Good Cardiovascular Health for Life Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular

More information

SUTTER MEDICAL CENTER, SACRAMENTO Department of Cardiovascular Disease Cardiology - Delineation of Privileges

SUTTER MEDICAL CENTER, SACRAMENTO Department of Cardiovascular Disease Cardiology - Delineation of Privileges INITIAL: [ ] RENEWED: [ ] DATE: ADDITIONAL: [ ] Privileges are granted for Sutter General Hospital, Sutter Memorial Hospital, Sutter Center for Psychiatry, Sutter Oaks Midtown and the Capitol Pavilion

More information

CARDIA 288 MONTH FOLLOW-UP SUPPLEMENTAL FORM (FORM B) HOSPITALIZATION CASE #: INTERVIEWER ID FY288BIVID2. Page 1 of 6 FY288BH4CN

CARDIA 288 MONTH FOLLOW-UP SUPPLEMENTAL FORM (FORM B) HOSPITALIZATION CASE #: INTERVIEWER ID FY288BIVID2. Page 1 of 6 FY288BH4CN HOSPITALIZATION CASE #: 2 8 8 0 H FY288BH4CN Has the participant indicated any of the following reasons for being admitted overnight for this case? 1. Suspected or confirmed problems with the heart, circulation,

More information

Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient?

Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? --- NIRS-IVUS TVC Imaging Adds Additional Information for the Heart Team Dr. Luis Tami Memorial Regional Hospital

More information

EFSUMB EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY Building a European Ultrasound Community

EFSUMB EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY Building a European Ultrasound Community MINIMUM TRAINING REQUIREMENTS FOR THE PRACTICE OF MEDICAL ULTRASOUND IN EUROPE Appendix 8: Vascular Ultrasound Level 1 Training and Practice Practical training should involve at least two half day ultrasound

More information

Endoskopische Venenentnahme der V. saphena in der koronaren Bypasschirurgie - Aktuelle Datenlage - Dr. med. Stefanie Reutter

Endoskopische Venenentnahme der V. saphena in der koronaren Bypasschirurgie - Aktuelle Datenlage - Dr. med. Stefanie Reutter Endoskopische Venenentnahme der V. saphena in der koronaren Bypasschirurgie - Aktuelle Datenlage - Dr. med. Stefanie Reutter Endoskopische Venenentnahme (EVH) - Einführung 1979 Tevaearai und Kollegen haben

More information

PIHRATE Trial. Polish-Italian-Hungarian Randomized ThrombEctomy Trial. Dariusz Dudek MD, PhD. On behalf PIHRATE investigators

PIHRATE Trial. Polish-Italian-Hungarian Randomized ThrombEctomy Trial. Dariusz Dudek MD, PhD. On behalf PIHRATE investigators Polish-Italian-Hungarian Randomized ThrombEctomy Trial PIHRATE Trial On behalf PIHRATE investigators Dariusz Dudek MD, PhD Institute of Cardiology, Krakow, Poland Impact of distal embolization Distal embolization

More information

Antonio Colombo MD on behalf of the SECURITY Investigators

Antonio Colombo MD on behalf of the SECURITY Investigators Second Generation Drug-Eluting Stents Implantation Followed by Six Versus Twelve-Month - Dual Antiplatelet Therapy - The SECURITY Randomized Clinical Trial Antonio Colombo MD on behalf of the SECURITY

More information

Uterine Fibroid Symptoms, Diagnosis and Treatment

Uterine Fibroid Symptoms, Diagnosis and Treatment Fibroids and IR Uterine Fibroid Symptoms, Diagnosis and Treatment Interventional radiologists use MRIs to determine if fibroids can be embolised, detect alternate causes for the symptoms and rule out misdiagnosis,

More information

Lifecheque Basic Critical Illness Insurance

Lifecheque Basic Critical Illness Insurance Lifecheque Basic Critical Illness Insurance Strong. Reliable. Trustworthy. Forward-thinking. Extra help on the road to recovery Surviving a critical illness can be very challenging financially Few of us

More information

Donor Adverse Events

Donor Adverse Events Donor Adverse Events Common terminology Frequency Risk factors Hold still, Mrs. Brown, while I draw your blood Mindy Goldman, MD Canadian Blood Services IHN Seminar, Paris March 11, 2016 Outline Donor

More information

Utilizing the Cath Lab for Cardiac Arrest

Utilizing the Cath Lab for Cardiac Arrest Utilizing the Cath Lab for Cardiac Arrest Khaled M. Ziada, MD Director, Cardiovascular Catheterization Laboratories Gill Heart Institute, University of Kentucky UK/AHA Strive to Revive Symposium May 2013

More information

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations.

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. INTRODUCTION Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. Although decrease in cardiovascular mortality still major cause of morbidity & burden of disease.

More information

Cardiac Catheterization Curriculum for Fellows in Cardiology Dartmouth-Hitchcock Medical Center Level 1 and Level 2 Training 2008-2009

Cardiac Catheterization Curriculum for Fellows in Cardiology Dartmouth-Hitchcock Medical Center Level 1 and Level 2 Training 2008-2009 Cardiac Catheterization Curriculum for Fellows in Cardiology Dartmouth-Hitchcock Medical Center Level 1 and Level 2 Training 2008-2009 I. Overview of Training in Cardiac Catheterization Cardiac catheterization

More information

Understanding your Renal Stent Procedure. A patient Guide (COVER PAGE) TABLE OF CONTENTS (inside front page)

Understanding your Renal Stent Procedure. A patient Guide (COVER PAGE) TABLE OF CONTENTS (inside front page) Understanding your Renal Stent Procedure. A patient Guide (COVER PAGE) TABLE OF CONTENTS (inside front page) The Kidney and the Renal Arteries... 1 Renal Artery Disease... 2 Diagnosis of Renal.Artery Disease...

More information

Cardiac Catheterization

Cardiac Catheterization Page 1 Cardiac Catheterization What Other Terms Are Used To Describe Cardiac Catheterization? Heart Cath (catheter) Angiogram What Is Cardiac Catheterization? This procedure is nonsurgical and is performed

More information

Optimal Management of Splenic/Portal Vein Thrombosis. David Mauchley University of Colorado

Optimal Management of Splenic/Portal Vein Thrombosis. David Mauchley University of Colorado Optimal Management of Splenic/Portal Vein Thrombosis David Mauchley University of Colorado Overview Portal Vein Thrombosis (PVT) Etiology Presentation/Clinical Aspects Diagnosis Management Cirrhotic vs.

More information

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 WEIGHT LOSS SURGERY Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 EDUCATIONAL OBJECTIVES: Discuss the available pharmaceutical options for weight loss and risks of these medications Explain the

More information

Popliteal artery: to stent or not to stent?

Popliteal artery: to stent or not to stent? Popliteal artery: to stent or not to stent? Karl-Ludwig Schulte Vascular Center Berlin Ev. Hospital Königin Elisabeth St. Gertrauden Hospital University Hospital Charité, CC11 Humboldt-University Berlin

More information

Overview. Total Joint Replacement in the U.S. KP National Total Joint Registry EMR Tools and Outcome Assessment: A Model for Vascular Surgery?

Overview. Total Joint Replacement in the U.S. KP National Total Joint Registry EMR Tools and Outcome Assessment: A Model for Vascular Surgery? KP National Total Joint Registry EMR Tools and Outcome Assessment: A Model for Vascular Surgery? Liz Paxton Director of Surgical Outcomes and Analysis Overview KP Total Joint Replacement Registry Background

More information

Vascular Quality Initiative - Carotid Artery Stent. Last Name First Name Middle Initial

Vascular Quality Initiative - Carotid Artery Stent. Last Name First Name Middle Initial Vascular Quality Initiative - Carotid Artery Stent Last Name First Name Middle Initial Date of Birth Medical Record Social Security General Information Patient Data Zip/Postal Code Gender Male Female Ethnicity

More information

Listen to Your Heart. What Everyone Needs To Know About Atrial Fibrillation & Stroke. The S-ICD System. The protection you need

Listen to Your Heart. What Everyone Needs To Know About Atrial Fibrillation & Stroke. The S-ICD System. The protection you need Listen to Your Heart The S-ICD System What Everyone Needs To Know About Atrial Fibrillation & Stroke The protection you need without Stroke. touching Are you your at heart risk? Increase your knowledge.

More information

Adult Cardiology. Diagnosis of Arterial Disease of the Lower Extremities With Duplex Scanning: A Validation Study

Adult Cardiology. Diagnosis of Arterial Disease of the Lower Extremities With Duplex Scanning: A Validation Study Adult Cardiology Diagnosis of Arterial Disease of the Lower Extremities With Duplex Scanning: A Validation Study Rosella S. Arellano, MD; Ma. Teresa B. Abola, MD. Background --- While standard x-ray arteriography

More information

Instructions for Use. Device Description The AMPLATZER Vascular Plug II is a self-expandable nitinol mesh occlusion device (see Figure 1).

Instructions for Use. Device Description The AMPLATZER Vascular Plug II is a self-expandable nitinol mesh occlusion device (see Figure 1). Vascular Plug II Instructions for Use Device Description The AMPLATZER Vascular Plug II is a self-expandable nitinol mesh occlusion device (see Figure 1). A B Figure 1. AMPLATZER Vascular Plug II A. Nitinol

More information

SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE

SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE TITLE: ISSUED FOR: (crc13-nursing) (crc.013-respiratory) Nursing, Special Care Areas Respiratory Care Services Perioperative Services DATE: REVIEWED: PAGES:

More information

Therapeutic Management Options for. Acute Ischemic Stroke Anna Rosenbaum, MD

Therapeutic Management Options for. Acute Ischemic Stroke Anna Rosenbaum, MD Therapeutic Management Options for Acute Ischemic Stroke Anna Rosenbaum, MD Epidemiology Epidemiology 4 th leading cause of death in the United States 1 Leading cause of disability Increase in projected

More information

Iliac Artery Disease: A Case-Based Approach To Stent Selection

Iliac Artery Disease: A Case-Based Approach To Stent Selection Society for Vascular Medicine Iliac Artery Disease: A Case-Based Approach To Stent Selection Annotated Cited Reference Material (2002). "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin

More information

Surgical Options for Venous Disease. Sandra C Carr MD Vascular Surgery Meriter Wisconsin Heart

Surgical Options for Venous Disease. Sandra C Carr MD Vascular Surgery Meriter Wisconsin Heart Surgical Options for Venous Disease Sandra C Carr MD Vascular Surgery Meriter Wisconsin Heart Chronic Venous Disease Approximately 23% of adults in the US have varicose veins Estimated 22 million women

More information

Coronary Stents. What is a Coronary Artery stent?

Coronary Stents. What is a Coronary Artery stent? What is a Coronary Artery stent? Coronary Stents A coronary stent is stainless tube with slots. It is mounted on a balloon catheter in a "crimped" or collapsed state. When the balloon of is inflated, the

More information

REFLECTIONS: FORTY YEARS OF VASCULAR CARE

REFLECTIONS: FORTY YEARS OF VASCULAR CARE REFLECTIONS: FORTY YEARS OF VASCULAR CARE REFLECTIONS: FORTY YEARS OF VASCULAR CARE CEA AAA CEA AAA REDDY WHITEHOUSE ZELENOCK ZITO CEA AAA EVAR CEA CAS AAA VASCULAR SURGERY AS A SPECIALTY NON-INVASIVE

More information

U.S. Food and Drug Administration

U.S. Food and Drug Administration U.S. Food and Drug Administration Notice: Archived Document The content in this document is provided on the FDA s website for reference purposes only. It was current when produced, but is no longer maintained

More information

Policies and Procedures. Related to. IABP Therapy

Policies and Procedures. Related to. IABP Therapy Policies and Procedures Related to IABP Therapy Courtesy of Datascope Corp. Clinical Support Services The following policies and procedures are intended to serve as guidelines for developing hospital policy.

More information

Section Two: Arterial Pressure Monitoring

Section Two: Arterial Pressure Monitoring Section Two: Arterial Pressure Monitoring Indications An arterial line is indicated for blood pressure monitoring for the patient with any medical or surgical condition that compromises cardiac output,

More information

The weight of the world.

The weight of the world. The weight of the world. SONY ANTHONY Obesity Derived from the Latin word obesus to devour Definition: having a very high amount of body fat in relation to lean body mass Classifications using Body Mass

More information

STANDARDS OF PRACTICE

STANDARDS OF PRACTICE STANDARDS OF PRACTICE Multisociety Consensus Quality Improvement Guidelines for Intraarterial Catheter-directed Treatment of Acute Ischemic Stroke, from the American Society of Neuroradiology, Canadian

More information

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG

More information

2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions

2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions 2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions IC-221010-AA Jan 2014 Page 1 of 10 Interventional Cardiology This for interventional cardiology procedures provides coding

More information

Perspectives on the Selection and Duration of Dual Antiplatelet Therapy

Perspectives on the Selection and Duration of Dual Antiplatelet Therapy Perspectives on the Selection and Duration of Dual Antiplatelet Therapy Dominick J. Angiolillo, MD, PhD, FACC, FESC, FSCAI Director of Cardiovascular Research Associate Professor of Medicine University

More information