Complex Cases in Peripheral Vascular Interventions PDF

Preface

Indications for endovascular treatment of peripheral arterial diseases are dramatically expanding during the recent years, and peripheral vascular interventions (PVI) today are a wellaccepted therapeutic approach for virtually all vessel areas. Rapidly advancing technologies enable treatment of more and more complex lesions. The minimal invasive approach offers the advantage of a reduced risk for complications compared to conventional surgery and enables treatment even of severely diseased patients who otherwise would have been considered unfit for surgical procedures.

With increasing numbers of heavily diseased patients treated in the cath lab, several centers have gained an exceptional expertise in treatment of complex morphologies. Sophisticated interventional strategies and meticulous techniques have been developed to handle morphologies that would have been considered not feasible for PVI in earlier years. Furthermore, industry has recognized the utmost importance of PVI and meanwhile offers amultitude of technical solutions dedicated to specific peripheral vessel areas and specific vascular morphologies. Today, particularly for complex scenarios, the concept of "one fits all" has been abandoned and has been replaced by a patient- and lesion-tailored treatment strategy.

The present book aims to systematically review complex cases in PVI. Typical and atypical complex cases are described for all peripheral vessel areas, and methods how to successfully and safely handle these interventions are outlined.

The book is divided in two sections:

Section I—General considerations: This section briefly reviews general aspects on managing complex patients in PVI.

Section II—Complex Cases in Specific Vessel Areas: Section II covers the interventions from puncture to closure, from the head to the toe. Each of the chapters on the specific vessel areas is divided into three parts:

(Part 1) The Introduction to each vessel area addresses the following questions:

(a) What makes a lesion "complex" in this vessel area?

(b) What are the clinical indications for endovascular treatment of complex lesions in this vessel area?

(c) What are the potential hazards of treating complex lesions in this vessel area?

(d) Which specific interventional strategies can be considered for this vessel area?

(e) Which specific interventional tools are available to handle complex lesions in this vessel area?

(f) Summary on technical success rates, acute and long-term outcomes after endovascular treatment of complex lesions in this vessel area.

(g) Checklist for the authors' recommended equipment for complex interventions in this specific vessel area.

(Part 2) Selected teaching cases in the specific vessel area are then described step-by-step from puncture to closure addressing the same issues as listed above for the specific cases:

(a) What made the lesion "complex" in this specific case?

(b) What was the clinical indication for treatment of this specific case?

(c) What were the potential hazards of treating this specific patient and this lesion?

(d) Which interventional strategies were considered for this lesion?

(e) Which interventional tools were used to handle this lesion?

(f) Summary: How was the case managed, is there anything that could have been improved, what was the immediate and long-term outcome?

(g) List of equipment used in this case.

(h) Key learning issues of this specific case.

(Part 3) Authors' summary of key issues for successful and safe treatment of complex lesions in this vessel area.

In summary, the book intends to focus on practical tips for the interventionist in the cath lab, to review complex cases and outline the different strategies theoretically and in real-life cases, thus to share the experience of high-volume interventionists with the reader.