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This presentation covers the principles of peripheral angioplasty with and explanation of the TASC stratification and selection of appropriate management according to current guidelines. Endovascular management of peripheral vascular disease.
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PRINCIPLES OF ANGIOPLASTYDr.Saurabh Joshi, MD, FNVIR
Charles Dotter : Father of Interventional Radiology. Performed first angioplasty using a system of serial dialators in 1964
Andreas Gruentzig : German Cardiologist. Invented the Angioplasty Balloon in 1977
SYMPTOMS OF PVD
Rutherford Classification Of PVD
Category / Grade Symptom
Category 0 Assymptomatic
Category 1 Mild Claudication
Category 2 Moderate Claudication
Category 3 Severe Claudication
Category 4 Rest Pain
Category 5 Minor Tissue Loss
Category 6 Major Tissue Loss
Risk factor modification, Exercise, Cardiovascular Rehabilitation
Medications
Intervention Necessary
MECHANISM OF ANGIOPLASTY
• Rupture of plaque and fibers in the intima and media
• Compression of plaque / thrombus
• Compression of medial layers
• Distribution of plaque / thrombus at inner surface of artery
• Overstretching of artery
STEPS OF ANGIOPLASTY
Insure the patient is on Dual Antiplatelets !!
1.Pretreatment angiography with localization of the arterial obstruction
2.Crossing the lesion with a guidewire or catheter with a flexible tip
3.Advancement of the treating catheter or instrument over the guidewire and confirming patency of runoff arteries
4.Exchange of the diagnostic catheter for the balloon catheter or stent
5.Dilation of the stenosis with the angioplasty balloon, followed by deflation
6.Completion angiography followed by treatment of runoff vessels with different balloon catheters or stents
7.Exchange of catheter materials and occlusion of the arterial puncture site by manual compression or a closure device
8.Placement of a compression bandage above the puncture site, followed by patient monitoring for a minimum of 2 hours
TASC II CLASSIFICATION
• Trans-Atlantic Inter-Society Consensus
• TASC classification gives recommendations for the management of PVD secondary to atherosclerosis affecting the lower limbs.
TASC FOR AORTOILIAC DISEASE
TASC D Lesion
TASC FOR FEMORO-POPLITEAL DISEASE
TASC A LESION
TASC B Lesion
TASC C LESION
TASC FOR INFRAPOPLITEAL DISEASE
Angiography showed tight stenosis of tibio peroneal trunk and origins of peroneal and Posterior tibial arteries.
Angioplasty performed using dedicated Tibial balloon.
Post angioplasty angiogram showing good forward flow with no residual stenosis
• Thank You !
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