Cath Lab Digest

Aravinda Nanjundappa, MD, FACC, FSCAI, RVT, Sangeeta Mandapaka, MD, Robert S. Dieter, MD, RVT RVT

The incidence of critical limb ischemia (CLI) continues to rise in the United States and globally due to increasing diabetes mellitus and tobacco use. At a recent dedicated CLI conference SALSAL (Save a Leg, Save a Life) in Orlando, the latest advances in lower-extremity interventions were discussed. We have highlighted some of the important concepts that could serve as tips and tricks for CLI interventions:

1. Use of advanced, atypical access sites such as the distal SFA and tibio-peroneal vessels is challenging and intriguing.

2. Aggressive vasodilator use such as papaverine, verapamil and nitroglycerin in below-the-knee interventions allows visualization of arteries not visible with regular angiography.

3. Placement of selective catheters in the distal popliteal artery aids in better visualization of the tibio-peroneal vessels.

4. Staging the procedure may assist in reducing the operator’s and lab assistants’ fatigue, reduce contrast burden in terms of acute kidney injury and optimizes success.

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ROBERT S. DIETER, MD, RVT
Dr. Dieter is an interventional cardiologist and vascular medicine specialist. He has completed advanced fellowship in Vascular Medicine and Peripheral Vascular Interventions at Georgetown University/Washington Hospital Center in Washington, D.C.

With a patient care emphasis in Vascular Medicine, he specializes in the management of patients with complex vascular diseases. He manages patients with stroke, TIA, and those at risk for stroke, particularly those with carotid artery blockages requiring angioplasty/stenting or those with PFO. He also specializes in renal artery stenosis. In fact, Dr. Dieter has published on new and potentially safer methods to treat blockages in the renal arteries. Dr. Dieter performs minimally invasive abdominal aortic aneurysm repair (endograft). Dr. Dieter has extensive training in the management of patients with claudication, as well as those with critical limb ischemia and non-healing ulcers — particularly in patients with diabetes. Furthermore, Dr. Dieter is board-certified in interventional cardiology and specializes in angioplasty, stenting and myocardial infarction treatment. Although Dr. Dieter is a vascular medicine specialist and interventional cardiologist, his underlying philosophy is the prevention of disease. He completed an advanced fellowship with renowned experts in Preventive Cardiology. Dr. Dieter actively treats patients with complex dyslipidemias.

Dr. Dieter graduated Alpha Omega Alpha from medical school. He has written over 100 journal articles, eight book chapters, is on the editorial board of several medical journals, and lectures internationally on cardiovascular diseases. He is the editor of two textbooks on vascular disease.

ARAVINDA NANJUNDAPPA, MD, RVT
Dr. Nanjundappa completed medical graduation in Adichunchanagiri Institute of Medical Sciences, India. He is specialist in Internal Medicine and Cardiology. He has certification in Cardiovascular Disease, Internal Medicine and Interventional Cardiology. He has been resident and fellow at Seton Hall University, Shands Hospital, Washington Hospital Center. He has also served as Director of Vascular Medicine and Peripheral Interventions at Pitt County Memorial Hospital, Greenville, North Carolina. At present, he is working as an Associate Professor of Medicine and General Surgery at West Virginia University School of Medicine, Charleston, West Virginia. He is a Board-Certified Cardiologist and Interventionalist.

Recipient of numerous teaching, research awards and grants, Dr. Nanjundappa is author of more than 60 peer-review journal articles and text book chapters. A frequent national and international guest lecturer, he serves on the editorial boards of eight journals including: Angiology; Interventional Cardiology (Associate Editor); and The Internet Journal of Endovascular Medicine (Chief Medical Editor). Dr. Nanjundappa has participated in several important Clinical Trials including: CLEVER, CORAL, CAPTURE, CREST, HERCULES, MOBILITY, and CHOICES.

5. Patience, perseverance and innovative techniques can ensure almost 90% plus success rates.