Aorto Iliac Arterial Interventions Dmitriy N Feldman MD FACC FSCAI FSVM Director Endovascular Servic e Director Interventional ObservationTelemetry Unit Associate Professor of Medicine ID: 934459
Download Presentation The PPT/PDF document "2020 SCAI Guidelines on Device Selection..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
2020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial Interventions
Dmitriy N. Feldman, MD, FACC, FSCAI, FSVM
Director, Endovascular Servic
e
Director, Interventional Observation/Telemetry Unit
Associate Professor of Medicine
Interventional Cardiac and Endovascular Laboratory
Weill Cornell Medical College, New York Presbyterian Hospital
May 14
th
, 2020
Slide2DisclosuresNo relevant disclosures
Slide32016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Arterial Disease
GUIDELINES: Symptomatic Patients
Slide4Aorto-Iliac Revascularization Indications AORTO-ILIAC DISEASE WITH SYMPTOMS Relieve claudicationWound healing in CLIImprove functional status and Quality of Life (QOL)AORTO-ILIAC DISEASE WITHOUT SYMPTOMSSituations where large-bore arterial access is required for hemodynamic support devices (e.g., IABP or other catheter-based ventricular assist devices), for structural/valvular (e.g., TAVR), and vascular (e.g., endovascular aortic aneurysm repair) proceduresKlein A, Jaff M, Gray B et al. Catheter Cardiovasc
Interv
. 2017;90:E90–E110.
Slide5Rise of endovascular interventions – patient preference
Slide6Evolution of Device Selection in Peripheral Interventions1st DCB
Slide7Klein AJ et al. Catheter Cardivasc
Interv
2014;84:520
AUC for
Aorto
-Iliac Peripheral Interventions
Klein AJ et al. Catheter
Cardiovasc
Interv
. 2017;90(4):E90-E110.
2014
2017
Slide8AORTO-ILIAC INTERVENTIONAppropriate Use CriteriaProvisional or Primary stenting appropriate when vascular access required (e.g. for IABP, TAVR), with or without symptomsAppropriate in claudicants >50% aorto-iliac stenosis or gradients at rest of ≥10 mmHgClaudicants who fail medical/exercise therapyAll CLI (RC 4-6)
Klein AJ et al. Catheter
Cardiovasc
Interv
. 2017;90(4):E90-E110.
Slide9Bailey SR et al. J
Am
Coll
Cardiol
. 2019 Jan 22;73(2):214-237
Slide10Aorto-Iliac Revascularization Device Options Device Options:Uncoated balloon PTASpecialty balloon PTADCBBMS (balloon expandable)BMS (self-expanding)
Covered stent (balloon expandable)
Covered stent (self-expanding)
DES
Atherectomy
Slide11TASC II Classification of Aorto-Iliac lesions
Norgren
L et al. JVS 2007:S5A-S67A.
Slide122020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial InterventionsProvide a comprehensive review of comparative effectiveness data in aorto-iliac arterial interventionsFocus on safety and efficacy of groups of devicesThe cost of the devices is considered secondary to examining efficacy and safety dataProvide clinicians with guidance (class of recommendation and level of evidence) for device selection, when these devices are intended as definitive therapy.
Slide132020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial InterventionsStudy Selection Process
Feldman DN et al. Catheter
Cardiovasc
Interv
2020
Slide142020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial InterventionsApplying Class of Recommendation and Level of Evidence to Device Strategies
Feldman DN et al. Catheter
Cardiovasc
Interv
2020
Slide152020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial Interventions (Uncoated Balloons PTA)Recommendations for PTA with Uncoated Balloons
Feldman DN et al. Catheter
Cardiovasc
Interv
2020.
Slide162020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial Interventions (Specialty Balloons PTA)Recommendations for PTA with Specialty Balloons
Feldman DN et al. Catheter
Cardiovasc
Interv
2020.
Slide172020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial Interventions (BMS)
Slide182020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial Interventions (DES and DCB)
Slide192020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial Interventions (Covered Stents)
Slide20Conclusions
PVI is a very effective therapy for patients with lifestyle-limiting claudication and
hemodynamically
significant
Aorto
-Iliac disease.
The role of PVI is symptomatic and functional status improvement.
SCAI 2017 AUC and 2018 ACC/AHA/SCAI/SIR/SVM AUC were developed to provide clinicians with guidance regarding appropriateness of PVI for specific clinical and anatomical criteria.
2020 SCAI guidelines document provides comprehensive guidance with specific recommendations (COR and LOE) for
Aorto
-Iliac device selection, when these devices are intended as the definitive therapy.
Slide21Thank you!