advanced techniques for complex peripheral interventions · montero-baker, miguel associate...
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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
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