Dr. Fadi Saab, the Director of Cardiology and Vascular Medicine at Advanced Cardiac and Vascular Centers for Amputation Prevention in Grand Rapids, MI, shares a unique CLI case, and how he used the Philips Dissection Repair Device – Tack Endovascular System – to treat his patients. Tack Endovascular System is purpose-built to treat dissections, leading to improvements in PTA outcomes and limb salvage.
D016573-00 Hello everyone. My name is Farid Saab. I am the I'm an interventional cardiologist and the director of cardiac cardiac and vascular medicine at Advanced cardiac and vascular centers for Amputation prevention. I have an interesting case that I would like to share with you how we applied the phillips tax system in the vascular system in our patient population. Our practices is heavily focused on patients with critical limb ischemia and this was a very unique case. Um And I thought that might be helpful to share some some of our peers and colleagues out there. So this is a an 85 year old male. He's Rutherford class four of the right lower extremity. He did have prior wound on the contra lateral limb in the past so he is at risk of progressing um in his wound presentation. Uh multiple risk factors including diabetes. Hyper lipid E me a tobacco used in the past patient presented out of area pharaoh for limited um PhD options of treatment. He underwent multiple revascularization procedures and unfortunately had an occluded write them to tibial bypass. Ah He also unfortunately reported that the recurrence of a second to alteration that progressed to digital digits one through three. Um At the time he underwent ultrasound evaluation that showed evidence of an included bypass. Um and the native sfe and papa till artery. Also 80 perennial ndp. He underwent successful revascularization of occluded, right superficial from her artery. Um As you can imagine especially with the post surgical patients. It tends to be a little bit challenging because the anatomy is really modified and it's different. There's a lot of fiber optic tissue. But nonetheless we were able to recapitalize the superficial farmer artery, the papa till the T. P. T. And the posterior tibial artery. And what you can see in the middle panel there an area that's a little bit hazy that closer to the pop little segment where there's a dissection there and at that time, you know because of the length of the procedure, the amount of contrast radiation exposure. And we we we felt that let's see if a patient will be able to recover. Um and this dissection would heal on its own because I really did not want to place a metal stent within that segment of a puppeteer artery. So um we have a protocol for patients that are out of area that usually we evaluate them the next day, We follow up with them before they return to their home. In this case the patient was three hours away. Um The ultrasound was performed at the time. There were elevated velocities noted within the digital right political artery with some estrogenic material and the FBI's were at 0.47. Unfortunately the same limitations that were there on the prior day were there on the next day. The foot was still warm patient symptoms have improved and we decided that we want to allow some time for the patient to recover. We want to make sure that there is no evidence of contrast induced neuropathy. Um And we want the patient to come back within uh within one week to evaluate the area again to evaluate the profusion of a patient again. And this was the angiogram on the follow up time. Uh The good news is that the vessel was still patent. Obviously the FBI did not magically improved um despite slight improvement in the patient rest paying symptoms, we felt that there is no this is not going to be a sustainable result for this patient. So here the the options of therapy are somewhat limited because you and geographically at least can see that the patient had very excellent results when it comes to the native superficial femoral artery. And with the cli patients we would like to avoid placing stents within a difficult or the difficult pop little segment. So here the tax system would present itself as a reasonable option of therapy. On the right side panel here you see the intravascular ultrasound images showing you basically the dissection um in the intimate dissection of that disease segment of the vessel. It's there's internal calcification, There is soft black, there's calcified plaques. It's a complex lesion to begin with. But also at the same time you want to preserve the T. P. T. Papa tl junction and even the A. T junction when it comes to that as you can see on the left panel there. So the decision was made to proceed with the placement of two links of the tax system. Uh exactly at that dissection area because that's really what's limiting the flow for this patient. So we used we used the 4.5 tax system. Um uh two of them were deployed within that segment there and this was followed by post dilating that segment with its sequential balloon angioplasty initially started with a four point oh followed by a five point oh 60 millimeter balloon. And this was an geographic result. You still see a little bit of a dissection flap there. Um But we we went higher pressure post angiogram complete. You can see complete resolution of the dissection. We had an interventional ultrasonography er right there with us that confirmed that the dissection was really taxed against the wall and the high velocities have normalized within that segment patient ended up with two of us will run off and their A. B. I. S. The next day were reported to be improved at 1.1. So the patient follow up presented in october uh reports doing well alteration was completely healed and the patient continued to follow up with us via telehealth telehealth because they lived three hours away and remains in a stable condition. Thank you very much for listening to this presentation and we thank the sponsors for allowing us to share this case with our peers