Live cases were presented from Leipzig, Germany, and the Miami Cardiac & Vascular Institute in a session moderated by William Gray, MD. The first case was introduced as a 65-year-old woman with PAD Rutherford 5 and ulceration of the right foot. The patient had a lesion in D1 since October 2018, and past medical history included amputation of toes D2 through D4 on the left foot. The patient is obese and smokes cigarettes, the operating team noted.
The panel offered their opinions on the nature of the lesion and next steps. The possibility of embolic prevention was raised. As discussion continued, the operator weighed in on his treatment choice. He said the opening of balloon was a little difficult, which indicates this was subintimal. After PTA he decides whether he prefers DCB or more stenting. “If I prefer stenting I go with a drug-coated stent. In a situation like this with an ulceration I would definitely like a good solution with a low risk for reintervention,” he stated.
Moderator William Gray, MD, then directed the audience to the next case, also from Germany. The patient was a 78-year-old man with severe claudication on the right side due to a long SFA occlusion. In 2012, the patient was treated by recanalization of the SFA. The patient had some coronary heart disease, arterial hypertension, and chronic renal impairment.
The case appeared straightforward but was actually quite complex, the operators noted. They described the work on the case thus far, including switching balloons and the artery rupturing after using a high-pressure balloon. This was repaired using a Viabahn, the team said.
The panel then discussed the case while the operators proceeded, with panel members commending the operators on their abilities. Discussion centered around whether panel members would have recommended endovascular or surgical repair, and comments were offered that supported both possibilities.
Cases from Miami Cardiac & Vascular Institute were also highlighted. James Benenati, MD, and his team treated a 64-year-old woman with Rutherford 3 left leg claudication and re-occlusion of the left SFA and anterior tibial arteries 1 year after angioplasty. She had been medically managed with dual antiplatelet therapy and cilostazol and exercise had not been successful in managing her condition. The patient had also volunteered to take part in the live physical examination several days earlier at ISET.
The audience was polled on their approach to treating the patient’s occluded SFA stent, and results showed that 22% would choose DCB, 0% would choose atherectomy and POBA, 28% would choose atherectomy and DCB, 45% would choose drug eluting stent, and 5% would choose covered stent.
A second case from Miami was led by Constantino Pena, MD. The patient was a 64-year-old man with a history of bilateral claudication and bilateral iliac artery stent placement with a 3.0 cm left popliteal artery aneurysm.
Moderator Dr. Gray reported the results of a unique polling question. The audience was asked what type of treatment they would prefer if they personally had this popliteal aneurysm. Endovascular repair was chosen by 44% of the audience, while 56% said they would opt for surgery.
In addition to the choice between surgery and endovascular repair, panel discussion mentioned the usefulness of IVUS in this case. Discussion also centered on patient selection. Dr. Gray wrapped up the session by thanking the teams participating and commending them for good work.