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 10/24/2018 SPL 61580 Rev. B Case presentation

66 year old male PMHx: of HTN, HLD, NIDDM, CAD s/p 4V CABG, who presents with L>R lower extremity claudication(Rutherford Class II-3). Prior lower extremity bypass and R femoral endarterectomy. Medications: Lisinopril, Glucophage, Aspirin, Zocor, Carvedilol, Pletal, Gabapentin

Hb- 12.0, INR- 1.0, Creatinine- 1.0 SPL 61580 Rev. B Abdominal Aortogram - AIOD SPL 61580 Rev. B Iliac Angiogram

SPL 61580 Rev. B CT of abdomen and pelvis Short segment focal dissection of the infrarenal abdominal aorta extending into the bilateral common iliac arteries, as described above. There is thrombosis of the true lumens bilaterally with contrast filling of the false lumens.

Non obstructive disease of the CFA, SFA and pop. Bilateral single vessel run off. SPL 61580 Rev. B CTA measurements SPL 61580 Rev. B

CTA measurements SPL 61580 Rev. B STRATEGY 7Fr RCFA and 17Fr LCFA Shockwave Lithotripsy

Endologix AFX endograft system Therapeutic anticoagulation- Herparin SPL 61580 Rev. B SPL 61580 Rev. B Mortality and complications after aortic bifurcated bypass procedures for

chronic aortoiliac occlusive disease Number of inserted aortic bifurcated grafts (circles) for chronic limb ischemia in Denmark. b, The development in mortality (squares) and major complications (circles) at 30 days during the study

period. SPL 61580 Rev. B SPL 61580 Rev. B SPL 61580 Rev. B

COBEST trial -A comparison of covered vs bare expandable stents for the treatment of aortoiliac occlusive disease COBEST demonstrates covered and bare-metal stents produce similar and acceptable results for TASC B lesions. However, covered stents perform better for TASC C and D lesions than bare stents in longer-term patency and clinical

outcome Journal of Vascular Surgery, Volume 55, Issue 5, May 2012 SPL 61580 Rev. B Self-Expanding Versus Balloon-Expandable Stents for Iliac Artery Occlusive Disease The Randomized ICE Trial

SPL 61580 Rev. B SPL 61580 Rev. B SPL 61580 Rev. B 24-Month Data from the BRAVISSIMO: A Large-Scale Prospective

Registry on Iliac Stenting for TASC A & B and TASC C & D Lesions Ann Vasc Surg 2015; 29: 738750 SPL 61580 Rev. B BRAVISSIMO RCT of SE vs. BE Stents According to TASC Class- No need to preclude TASC C/D lesions

The 24-month primary patency rate after 24 months for the total population was 87.9% (88.0% for TASC A, 88.5% for TASC B, 91.9% for TASC C and 84.8% for TASC D). SPL 61580 Rev. B Early and Midterm Results of Kissing Stent Technique in the

Management of Aortoiliac Obstructive Disease SPL 61580 Rev. B KaplanMeier curve for primary patency during follow-up with numbers of patients at risk (kissing stents vs other techniques) SPL 61580 Rev. B

A comparison between aortobifemoral bypass and aortoiliac kissing stents in patients with complex aortoiliac obstructive disease SPL 61580 Rev. B SPL 61580 Rev. B Aortoiliac Occlusive Disease Rx with Stent-Grafts

Used for combination stenotic & aneurysmal disease, thrombus, clinical evidence for embolization Less flow disturbance than kissing stents SPL 61580 Rev. B Treatment of Aortoiliac Occlusive Disease with the Endologix AFX Unibody Endograft

Eur J Vasc Endovasc Surg. 2016 Jul;52(1):64-74. doi: 10.1016/j.ejvs.2016.04.003. Epub 2016 May 6 SPL 61580 Rev. B Endovascular treatment of TransAtlantic Inter-Society Consensus D aortoiliac occlusive disease using unibody

bifurcated endografts SPL 61580 Rev. B Endologix AFX unibody stent-graft : potential advantages for the treatment of AIOD anatomical fixation combined with high columnar strength stent obviates active proximal fixation. Unlike proximal fixation designs, the AFX bifurcated unibody

endograft allows for natural blood flow and preserves the native bifurcation avoids limb competition eliminates gate cannulation and avoids limb competition in the distal aorta, allows for future endovascular interventions (enables up and over procedures) protects against potentially fatal aortoiliac rupture in heavily calcified lesions SPL 61580 Rev. B

Shockwave Peripheral IVL System Components COMPACT & RECHARGABLE Portable, IV-pole Mountable IVL Battery-Powered IVL

Generator No External Connections Distal and proximal markers SIMPLE & QUICK Smart Magnetic Connection IVL

Connector IVL Connector Push-Button Activated Cable Cable 5 lithotripsy emitters

IVL IVL Catheter Catheter Integrated 60mm semi-compliant balloon

SPL 61580 Rev. B INTUITIVE & SAFE OTW System Any .014 Guidewire Standard Technique 180 Lithotripsy Pulses

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