Peripheral Vascular Intervention - PowerPoint Presentation

Slide1

Peripheral Vascular Intervention

(PVI)

Dr. Daniel Bertges, University of Vermont

Slide2

De-identified case review

IRR variable variation discussion

General Q & A for PVI

Agenda:

Slide3

Independent audit: Please do not ask for any help from anyone (i.e. other data abstractors/physicians/

etc

).

No dates included

Instructed if they could not find a data element, it was ok to leave it blank and submit without validation

Limitations of the IRR project:

Slide4

Elective = planned/scheduled procedure;

Urgent = required operation within 72 hours, but > 12 hours of admission;

Emergent = required operation within 12 hours of admission to prevent limb loss

Q1: Urgency

Slide5

Elective

Urgent

Emergent

Unknown (leave blank)

Select A1: Urgency

Slide6

Elective

Urgent

Emergent

Unknown (leave blank)

A1: Urgency

Slide7

Asymptomatic: documented peripheral arterial disease without symptoms of claudication or ischemic pain

Mild Claudication: ischemic limb muscle pain that does not limit walking or limits walking only after > 2 blocks (>600 feet or 2 football fields);

Moderate Claudication: ischemic limb muscle pain that limits walking 1-2 blocks (300-600 feet, or 1-2 football fields);

Severe Claudication: ischemic limb muscle pain that limits walking < 1 block (<300 feet or 1 football field);

Ischemic Rest Pain: pain in the distal foot at rest felt to be due to limited arterial perfusion

Q2: Leg Symptoms, Left

Slide8

Ulcer or necrosis (gangrene) = de novo tissue loss due to peripheral arterial disease, not due to non-healing prior amputation.

Non-healing amputation = ulcer, necrosis or lack of primary healing at site of prior amputation causing current tissue loss.

Ulcer + non-healing amp = combination of de novo ulcer (or necrosis/gangrene) separate from a non-healing amputation site.

Acute Ischemia: Acute limb ischemia is defined as a sudden decrease in limb perfusion that causes a potential threat to limb viability (manifested by ischemic rest pain, ischemic ulcers, and/or gangrene) in patients who present within two weeks of the acute event.

Q2: Leg Symptoms, Left (cont’d)

Slide9

Asymptomatic

Mild Claudication

Moderate Claudication

Severe Claudication

Ischemic Rest Pain

Ulcer/necrosis

Non-healing Amputation

Both Ulcer + Non-healing Amp

Acute Ischemia

Unknown (leave blank)

Select A2: Leg Symptoms, Left

Slide10

Asymptomatic

Mild Claudication

Moderate Claudication

Severe Claudication

Ischemic Rest Pain

Ulcer/necrosis

Non-healing Amputation

Both Ulcer + Non-healing Amp

Acute Ischemia

Unknown (leave blank)

A2: Leg Symptoms, Left

Slide11

TASC - Trans-Atlantic Society Consensus

Please go to the resource tab for the diagram for TASC. Note that if femoral and popliteal arteries are treated separately, or common and external iliac, record the TASC classification based on the TASC definition for the combined segments for each of the 2 lesions treated separately.

Protect adjacent artery is recorded when a balloon or stent was placed in an artery with no significant lesion in order to prevent compression by treatment in an adjacent branch, which is commonly done in the proximal common iliac arteries with "kissing" stents.

In this case, sometimes only one side is stenosed but both sides are treated, so use "Protect adjacent artery" to indicate the non-diseased side that was also treated.

Q3: TASC Grade

Slide12

Q3: TASC Grade

Slide13

A

B

C

D

Protect Adjacent Artery

Unknown (leave blank)

Select A3: TASC Grade

Slide14

A

B

C

D

Protect Adjacent Artery

Unknown (leave blank)

A3: TASC Grade

Slide15

CIN: Contrast Induced Nephropathy

None= none given before or during the procedure to prevent CIN;

Bicarb = IV Bicarb - Sodium Bicarbonate IV;

Saline = Saline IV hydration or other hydration fluid such as lactated ringers;

Both= both Bicarb and Saline

Q4: CIN Prophylaxis

Slide16

None

Bicarb

Saline

Both Bicarb and Saline

Unknown (leave blank)

Select A4: CIN Prophylaxis

Slide17

None

Bicarb

Saline

Both Bicarb and Saline

Unknown (leave blank)

A4: CIN Prophylaxis

Slide18

Enter up to 4 arteries.

When the treatment includes the common and external iliac enter as one (com +

ext

iliac).

When the treatment includes the SFA and popliteal enter as one (SFA + pop). For procedures with greater than 4 arteries treated enter those most clinically important in the judgment of the interventionalist.

Q5: Number of Arteries Treated

Slide19

1

2

3

4

Unknown (leave blank)

Select A5: Number of Arteries Treated (which one/s)

Slide20

1

2

3

4

Unknown (leave blank)

A5: Number of Arteries Treated

Slide21

None=no calcification visible on fluoroscopic, CT or IVUS imaging;

Focal=calcification on one side of artery < half length of lesion;

Mild= calcification on one side of artery > half length of lesion;

Moderate = calcification on both sides of artery < half length of lesion;

Severe = calcification on both sides of artery > half length of lesion;

Not Evaluated=Calcification not evaluated.

Q6: Calcification

Slide22

None

Focal

Mild

Moderate

Severe

Not evaluated

Unknown (leave blank)

Select A6: Calcification

Slide23

None

Focal

Mild

Moderate

Severe

Not evaluated

Unknown (leave blank)

A6: Calcification

Slide24

No = no thrombosis complication occurred;

Medical = thrombosis complication occurred but required no invasive management, i.e. only medical management which could range from outpatient observation to admission to hospital, administration of medications such as heparin, or any non-invasive escalation of care from what was planned, including longer admission;

Interventional = treatment with additional angioplasty, stenting, thrombolysis, suction catheter, etc.;

Surgical = any open surgical procedure including open thrombectomy, bypass, etc.

Q7: Thrombosis: Post op

Slide25

No

Medical

Interventional

Surgical

Unknown (leave blank)

Select A7: Thrombosis: Post op

Slide26

No

Medical

Interventional

Surgical

Unknown (leave blank)

A7: Thrombosis: Post op

Slide27

Renal=New increase in creatinine of >= 0.5mg/dl (44.2

umol

/L), new dialysis (peritoneal, hemodialysis or

hemo

-filtration), observed during the procedure or before discharge after the procedure. Note that complications occurring after discharge are entered on a follow-up form.

Does not apply to patients on dialysis prior to procedure.

Q8: Renal Complication

Slide28

No

Yes

Unknown (leave blank)

Select A8: Renal Complication

Slide29

No

Yes

Unknown (leave blank)

A8: Renal Complication

Slide30

If more than one segment of occlusion, add total of all segments within treated artery.

Occlusion length should be measured with a marker catheter or overlying ruler.

Must be between 0 and 90 (round to the nearest integer).

Enter zero if no occlusion.

Q9: Occlusion Length Popliteal

Slide31

0

8

20

Other

Unknown (leave blank)

Select A9: Occlusion Length Popliteal

Slide32

0

8

20

Other

Unknown (leave blank)

A9: Occlusion Length Popliteal

Slide33

If more than one discrete lesion is treated, add the lengths of each treated segment to derive total treated length.

Lesion length should be measured with a marker catheter or overlying ruler.

Must be between 0 and 90 (round to the nearest integer).

Q10: Treated Length Popliteal

Slide34

0

10

20

25

30

Other

Unknown (leave blank)

Select A10: Treated Length Popliteal

Slide35

0

10

20

25

30

Other

Unknown (leave blank)

A10: Treated Length

Slide36

Questions