Perfusion assessment

Montero-Baker, Miguel

Associate Professor of Surgery

Division of Vascular and Endovascular Surgery

Baylor College of Medicine

Disclosures

PROFUSA – advisory board, stock options

Otherwise, No Relevant Financial Relationships to Disclose

<<< 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

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

We have no way of validating our

endovascular intervention

Pedal loop classification (Kawarada 2012)

Nakama – JEVT 2016

WOUND-OSOME

Three dimensional block of WOUNDED tissue perfused by a major blood vessel below the knee/ankle

WOUND-O-SOME

Graziani - EuroPCR 2005

Graziani - EuroPCR 2005

WOUND-O-SOME

After POBA from above to disrupt

dissection planes

Laser atherectomy

Final Angiogram

Obvious angiographosome

reopened

Baseline heel perfusion

WB +

WOUND-O-SOME

O2 Lumee

9

2 provocation challenges during follow-up visit, heathy volunteer results

Pressure

cuff

around

the calf

Healthy volunteer results

In a healthy subject, we observe…

• Decline in O2 upon applying

pressure

• Increase in O2 when pressure is

released

Occlusion ChallengeApply pressure for 1 minute

Release pressure and recover

for 5 minutes

Leg Raise ChallengeRaise leg for 5 minutes

Back to horizontal

position for 5 minutes

In a healthy subject, we

observe…

• Upon leg raise, O2 drops

first, but gradually rises

possibly due to

vasodilation

• Upon returning to

horizontal position, O2

rises rapidly.

LEG RAISE LEG HORIZONTAL

18

Day 0 Pre

Procedure

WIfI – 1, 2, 0

ABI – 0.58

DP Pressure – 70 mmHg

PT Pressure – 40 mmHg

Discharge WIfI – 1, 0, 0

ABI – 1.14

DP Pressure – 100 mmHg

PT Pressure – 160 mmHg

2

3

4

• Pre-intervention,

there was no

recovery after

occlusion

challenge; O2

stayed low

• Post-intervention,

O2 decrease/

increase was

observed upon

challenge

2

3

4

No

recovery

No

recovery

No

recovery

9

2 provocation challenges during follow-up visit, heathy volunteer results

Pressure

cuff

around

the calf

Healthy volunteer results

In a healthy subject, we observe…

• Decline in O2 upon applying

pressure

• Increase in O2 when pressure is

released

Occlusion ChallengeApply pressure for 1 minute

Release pressure and recover

for 5 minutes

Leg Raise ChallengeRaise leg for 5 minutes

Back to horizontal

position for 5 minutes

In a healthy subject, we

observe…

• Upon leg raise, O2 drops

first, but gradually rises

possibly due to

vasodilation

• Upon returning to

horizontal position, O2

rises rapidly.

The Division of Division of Vascular

Surgery & Endovascular Therapy and

iCAMP Accepting National and

International Visitors

The Division of 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