Description
Endovascular Management of Peripheral Artery Disease focuses on minimally invasive techniques used to restore blood flow in patients with PAD. The webinar will discuss current approaches such as angioplasty, stenting, atherectomy, and newer device-based therapies. Participants will gain insights into patient selection, procedural planning, and post-procedure care to optimize outcomes. The session aims to equip clinicians with evidence-based strategies to reduce limb ischemia, improve mobility, and enhance overall vascular health in PAD patients.
Summary Listen
- Peripheral artery disease (PAD) presents diagnostic and treatment challenges, with real-life cases demonstrating the potential for limb salvage through timely intervention. Early recognition, angiography, and angioplasty are crucial to avoid amputations, as illustrated by a diabetic patient who recovered walking ability after intervention following a foot injury. Another case highlighted the dangers of delayed or alternative treatments, emphasizing the importance of prompt vascular consultation.
- PAD can manifest as claudication or critical limb ischemia (CLI), with CLI associated with high mortality and amputation rates. Traditional approaches like lumbar sympathectomy and waiting for demarcation lines are outdated. Revascularization, whether surgical or endovascular, is the primary goal, aiming to restore blood flow to the foot.
- Surgical revascularization, involving bypass procedures, can be effective but carries risks like comorbidities, vein unavailability, and wound complications. Endovascular treatment, including angioplasty, stenting, atherectomy, and thrombectomy, offers minimally invasive options with rapid recovery, making it suitable for high-risk patients, though it requires expertise and may have lower long-term durability.
- The choice between surgical and endovascular approaches depends on factors like patient age, disease severity, and location of blockages. Endovascular therapy is often the first-line treatment due to its lower risk profile. Various endovascular modalities, including drug-coated balloons and stents, are selected based on specific case characteristics.
- Imaging modalities like Doppler ultrasound, CTA, and MRA play crucial roles in pre-procedural planning and post-procedure follow-up. While Doppler ultrasound is a non-invasive initial diagnostic tool, CTA and MRA provide detailed anatomical information for intervention planning. DSA is necessary in high calcified vessels.
- Outcomes of endovascular therapy compared to open surgery depend on factors like disease severity and location of blockages. Aorta-iliac disease may benefit more from surgical bypass, but endovascular options are often preferred initially due to lower risk. Infra-inguinal disease has lower patency rates for both approaches.
- Comorbidities like diabetes, renal impairment, and advanced age influence procedural planning and outcomes. Diabetic patients often have multi-level disease and require aggressive wound management alongside revascularization. Comorbidities make them better candidates for endovascular management.
- Post-procedural medical therapies, including antiplatelets, statins, rivaroxaban, and cilostazol, are essential to maintain patency and prevent disease progression. Recognizing the five "P's" of acute limb ischemia (pain, pallor, pulselessness, paralysis, paresthesia) is critical for prompt referral to a vascular surgeon.
Sample Certificate
About the Speakers
Dr. Sumeet Kapadia
Director and Vascular & Endovascular Specialist, Venus Hospital, Director, Aadicura Hospitals, Gujarat
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