A New Algorithm to Treat Patients with Peripheral Vascular Disease
Peripheral vascular disease (PVD) consists of vascular disease outside of the coronary bed. Atherosclerosis is the dominant cause of PVD. Patients with PVD carry high mortality and morbidity due to increased incidence of stroke and myocardial infarction in these patients. Management of PVD should include risk factor reduction for atherosclerosis.
Pedal Artery Access: Advances in Management of Critical limb ischemia
Critical limb ischemia (CLI) management has been dominated by endovascular advances in the last century. These advances include mostly below knee interventions, use of low profile balloons, crossing devices, and reentry devices.
Pedal Artery Access for Critical Limb Ischemia
Patients with critical limb ischemia typically have multivessel lower extremity arterial disease. Revascularization of such advanced tibioperoneal artery disease can be challenging and cumbersome. The traditional approaches include retrograde femoral access, antegrade femoral artery access, or popliteal artery access. The role of brachial or radial artery to perform infrainguinal interventions is limited due to length of the sheaths, balloon stents, and wires available in the U.S.
Controversies in the Management of Carotid Artery Disease
The advent of best medical treatment and advances in carotid artery stenting has created equipoise for surgical versus medical/endovascular management of carotid artery disease. Most vascular specialists agree that symptomatic carotid stenosis >70% needs carotid endarterectomy unless those patients are too high-risk for surgery. The controversies exist for asymptomatic carotid artery disease of >60%.
Outcomes of Amputation
Patients with advanced peripheral vascular disease (PVD) may have severe lower extremity atherosclerosis that cannot be revascularized by percutaneous or surgical techniques. Such patients, if they develop wound, ulcer, gangrene, or rest pain will need amputation, which carries serious cardiovascular morbidity and mortality. At our center, a retrospective analysis showed below knee amputation 30-day mortality was 8.5% and above knee amputation mortality was 16%. Hip disarticulation carried 100% mortality. The 6-month mortality of above knee amputations was 50%.
Are you ready for myocardial infarction or stroke? If so, are you at the right place?
People plan their finances with the aid of a financial planner so that their future is secure. This entails savings, bank balance, retirement, insurance, estate planning, and living will. However, not much planning is done regarding life-altering situations such as myocardial infarction or stroke. Both of these conditions result in high rates of morbidity and mortality. One important step is to address risk factor reduction such as control of hypertension, diabetes mellitus, hypercholesterolemia, and lifestyle changes.
Status of Carotid Artery Revascularization in 2011
Carotid endarterectomy (CEA) is shown as a very safe and durable procedure for symptomatic carotid artery stenosis >70% and asymptomatic stenosis >60%. The benefits of CEA in patients with symptomatic lesions 50% to 70% and asymptomatic lesions 60% to 80% are marginal. The role of carotid artery stenting per Medicare guidelines includes those patients with symptomatic stenosis >70% and high risk for CEA due to cardiopulmonary and anatomical comorbidities.
The Future of Vascular Surgery
As a faculty member of vascular surgery department, I am witnessing the evolution of endovascular procedures among vascular surgeons. In the future, it looks like there will be more emphasis on endovascular training and possibly a reduction in the number of open vascular procedures. The concern regarding this evolution is the complexity of open vascular procedures.
EVAR, TEVAR and TAVI Deliver Minimally Invasive Approaches to Invasive Procedures
Several revolutionary advancements have occurred in the treatment of cardiovascular disease in the past few decades — notably, the use of a percutaneous route for more than just diagnostic evaluations.
Annual Conference at St. Vincent, West Indies
Every year a small group of multidisciplinary physicians of cardiology, neurology, dermatology, pastoral care and infectious disease organize the Annual Cardiovascular Disease of the Caribbean. The conference was held at Trinity School of Medicine, St. Vincent West Indies.
