4/8/2017 Proctor/Speaker - Abbott, Cook, Spectranetics, Medtronic. - - PowerPoint PPT Presentation

4/8/2017 1

Below the ankle interventions

Montero-Baker, Miguel Associate Professor of Surgery Division of Vascular and Endovascular Surgery Baylor College of Medicine

Proctor/Speaker

• Abbott, Cook, Spectranetics, Medtronic.

Stockholder Thermopeutics/PROFUSA

Leipzig, Germany 2007

4/8/2017 2

• 59 yo female
• DM2
• CKD on HD
• S/P CFA-PT GSV BPG
• Non-healing amputation site to 4-5th

4/8/2017 3

4/8/2017 4

4/8/2017 5

4/8/2017 6

<<< ANTERIOR TIBIAL INTERVENTION POSTERIOR TIBIAL INTERVENTION>>>

A patent bypass will fail to heal ca. 16% of ischemic heel wounds when there is an incomplete arch – Bercelli et al. JVS 1999

Rashid et al – JVS 2013

4/8/2017 7 RENAL FAILURE PATIENTS DID SHOW DIFFERENCE

Under recognition of a sub-group of highly complex diabetic patients that suffer from erratic flow patterns secondary to small vessel disease (choke-vessel disease)

Do we have objective performance goals? “…Achieve direct in-line flow to the foot…” TASC 2 Pedal loop classification (Kawarada 2012)

4/8/2017 8

Nakama – JEVT 2016

WOUND-O-SOME

Graziani - EuroPCR 2005

4/8/2017 9

Graziani - EuroPCR 2005

WOUND-O-SOME

NON HEALING HEEL WOUND

4/8/2017 10

4/8/2017 11

Obvious angiographosome Obvious angiographosome reopened Baseline heel perfusion

WB +

WOUND-O-SOME

Validation and OPG O2 Lumee

4/8/2017 12

Conclusions

• Pedal loop angioplasties are technically

feasible, but potentially disastrous.

• Preliminary data suggests that this may be

more important in patient with long-standing diabetes and ESRD.

• Diagnostic tools of regional ischemia need to

be developed, as they may also offer validation and performance goals.

The Division of Division of Vascular Surgery & Endovascular Therapy and iCAMP Accepting National and International Visitors

The Division

• f

Vascular Surgery and Endovascular Therapy in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine is inviting national and international visitors to work at with world-renowned physicians and scientists in Vascular Surgery, Podiatry Medicine, Limb Salvage, Neurorehabilitation, and Bioengineering to contribute in innovative interdisciplinary research in the area personalized and precision medicine targeting aging population, people with diabetes and plantar ulcers, and those suffering from peripheral arterial disease. Visiting scholars who are visiting for longer than 6 months enjoy:

(a) Library privileges identical with those of the faculty; (b) Privilege of auditing seminars without fee or record, as space allows (c) Use of laboratory, Clinical, and other space and facilities to the extent they are available. (d) Working in an interdisciplinary environment and be actively engaged in highly innovative clinical and translational researches to improve stability, healing and mobility across disciplines and in particular among patients suf fering from diabetes as well as aging population undergoing major surgical interventions. (e) Candidates will be highly encouraged and are supported to publish the results of their research in high impact peer-reviewed journals and/or presenting in national and international conferences. (d) Candidates will receive training in using advanced technologies/tools designed for the purpose of outcomes research, wound healing, fall prevention, frailty screening, vascular assessment, and motor-cognitive screening.

Visitors must meet the following requirements:

• Independent funding
• Minimum of 6 month

commitment

• English Proficiency
• Compliance with USCIS

Visa Regulations for non-USA residents

A DS-2019 Request form has to be completed for a J-1 Visa prior to visiting. Applicants should send an updated CV and a cover letter summarizing your motivations and your qualifications to:

i-camp@bcm.edu

@monteromiguel mmontero@bcm.edu