Chapters Transcript Video S. Jay Mathews NCHV 2019 Pedal intervention case review pedal intervention case presented at NCVH 2019 by Dr. Jay Mathews D053368-00 This is another patient presenting with both hell and Halik spoons. He's a prior under graph and morbidly obese. So these air challenging patients obviously can't go up and over doing contra lateral approach and to grade could be a very difficult option. His pants goes down to his knee. So this is a situation in which, uh, I like thio sometimes use a pedal approach for this. You know, in CLI patients, you know, you have to be very careful with doing people intervention, but sometimes it's absolutely necessary. You always want to make sure you check afterwards that you've got a good outflow as well. So I did have some access from above two for imaging purposes, but primarily in terms of my intervention was from below. You can see here initially were accessing, uh, the posterior tibial. And then here we went up on, uh, I don't know if it's gonna play there for a second or two. We went across We performed laser wrath rectum E with a 14 laser and then went with, uh, 30 40 angel scope balloon. And we got some very nice results. It was a very focal stenosis. there too. We did. I've assists as well to for sizing purposes, but for time I'm not gonna show that. But let's take a look at the other side too. So we actually then access the door Sallis Pieterse artery and went up. So we actually have two people. Access is at this point on, uh went up and actually performed by vis imaging of this vessel. You could see there's a lot of variation as well, too, and actually significant plaque burden as well. Um, it's actually fairly focal, though, so there is diffuse disease, but the areas that airflow liming are actually fairly short. So in this situation, you might be tempted to just put a big long balloon and geographically, But I've this tells you that you could get away with a much shorter treatment zone. So again we performed laser a threat to me on. Then it went with a focal balloon again. Another three by four. Uh, anja sculpt. And I guess afterwards shows us what we have here. Let's see if this way go. So that little area of artifact there, that's a ring artifact, so you can disregard that That's not the dissection you could see that we've actually fractured the calcium there too. And, God, actually, very reasonable Luminal gain. And, uh, there's no real flow limited sections it all again. Little tiny minor, two sections we don't really get too excited about because they don't typically impact the outcome of the patient. And you could see afterwards we got a very nice results. So the point the learning point here is that you don't always have toe put in a to 20 balloon. Uh, when you see that disease you're creating additional injury that may be unnecessary, potentially could be a failure mode. Whenever you do below the interventions, you always have to think about the fact that the moment you interviewed on these vessels it results in this, uh, this rapid restore, not a cascade. So by limiting your length of intervention and maybe potentially beneficial again with some of these newer BTK technologies air coming out as well to hopefully we can get longer term results Published January 18, 2019 Created by
