usn guidance for peripheral cto treatment · usn guidance for peripheral cto treatment j.a....
TRANSCRIPT
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USN Guidance for Peripheral CTO Treatment
J.A. Mustapha, MD, FACC, FSCAI Director of Cardiovascular Catheterization Laboratories
Metro Health Hospital
Wyoming, MI
Clinical Associate Professor of Medicine
Michigan State University
E. Lansing, MI
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Disclosures
Consultant to: • Abbott Vascular
• Bard Peripheral Vascular
• Boston Scientific
• Cardiovascular Systems, Inc.
• Cook Medical
• Medtronic
• Spectranetics
• Terumo Medical
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EVUS guided CTO cap crossing
From the tibial access to the Pop
CTO cap.
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Final Angiogram
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Ultra-sound guided Tibial-Pedal Interventions
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Clinical Scenario
• 49 year old male with PMH significant for DM. Long standing history.
• HTN, Hyperlipidemia
• The patient developed an ulcer on the plantar aspect of the left great toe
• In four weeks, he presented to the office with…….
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Why show this case?
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Ankle area is challenging Options of therapy used to be limited No stenting options Resistant to balloon angioplasty
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Final Result
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Distal PT Before Intervention
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30 Days Post Intervention
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Angiosome Directed Therapy
EVUS Assisted Crossing of CTO
TAMI Technique
The Future
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Clinical Scenario
• 57 year old with long standing history of diabetes since age 23.
• Presented S/P second toe amputation and a non healing ulcer at the site.
• Ulcer location and angiosome distribution corresponds to the Anterior tibial artery
• Rutherford class V
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Diagnostic Angiogram, Tibial Flow Diagnostic Angiogram, Pedal Flow
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US- guided access of Dorsalis Pedis Artery
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THANK YOU
J.A. Mustapha, MD, FACC, FSCAI Director of Cardiovascular Catheterization Laboratories
Metro Health Hospital
Wyoming, MI
Assistant Clinical Professor of Medicine
Michigan State University
E. Lansing, MI
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USN Guidance for Peripheral CTO Treatment
J.A. Mustapha, MD, FACC, FSCAI Director of Cardiovascular Catheterization Laboratories
Metro Health Hospital
Wyoming, MI
Clinical Associate Professor of Medicine
Michigan State University
E. Lansing, MI