1. To focus on the needs for and challenges in organising a multidisciplinary team.
2. To understand the role of clinical as well as radiological evaluation for outpatients consultation and post-procedure visits.
3. To understand how to implement vascular intervention training programmes.
Peripheral arterial disease (PAD) continues to grow in global prevalence, consuming an increasing amount of resources in the health care system. Overall rates of intervention for PAD have been rising steadily in recent years. Changing demographics, evolution of technologies, and an expanding database of outcomes studies are primary forces influencing clinical decision making in PAD. The management of PAD is multidisciplinary, involving primary care physicians and vascular specialists with varying expertise in diagnostic and treatment modalities. This approach has the greatest chance of providing optimal care for the patients and ensuring ongoing surveillance of the patient’s overall health, ultimately resulting in better quality of life and increased longevity. Furthermore, it has been recognized that clinical management of patients undergoing interventional radiological procedures is an essential component of a successful, contemporary interventional radiology practice, with several well-respected interventional radiologists emphasizing the importance of direct patient management. To effectively participate in patient management, interventionalists require a clinical knowhow as well as an infrastructure within their practice to support these services. All these clinical as well as radiological aspects need to be integrated and implemented in dedicated vascular intervention training programmes. Main goals of these programs should be to provide IR fellows with an organized, comprehensive, supervised, full-time educational experience including the ability to provide consultation and case selection, perform the full array of vascular and interventional procedures, identify and manage potential complications, provide appropriate peri-procedure care, and assist in long-term management integrated with the clinical management of referring physicians.
1. To become familiar with clinical diagnosis and classification of arterial occlusive disease.
2. To understand the disease states being treated and their clinical management.
3. To learn about intraprocedural and postprocedural medical treatment.
For decision-making within the vascular board, it is important to understand not only the anatomy and potential revascularisation strategies, but also to respect the patient's clinical status, age and frailty, renal impairment, as well as cardiovascular and bleeding risk to impact on both symptom relief and prognosis in PAD patients, regarding wound healing and limb salvage. Cutting edge studies have recently changed our understanding of how to implement the best medical treatment for the underlying disease of atherosclerosis and atherothrombosis. This talk will focus on major cardiovascular risk factors and their respective best medical treatment, ranging from goals of antihypertensive and lipid-lowering treatment and vascular protection from new antidiabetics to strategic changes in the treatment of atherothrombosis, including the current recommendation of NOACs and antiplatelet therapy in PAD. Finally, caveats of age such as frailty, renal impairment and the safe use of contrast media will be covered.
1. To understand the crucial role of US in the diagnostic assessment and patient recruitment.
2. To learn when is needed to perform a MRA, CTA, or DSA examination.
3. To learn the optimal imaging algorithm for diagnosis and follow-up.
Non-invasive vascular imaging is now considered a cornerstone of the pre-interventional workup of patients with peripheral arterial disease. Although imaging is not needed to establish the diagnosis, imaging provides a roadmap for endovascular intervention and it can outline surgical therapeutic options. In my lecture I will discuss the strengths and limitations as well as the practical implementation of the most commonly used non-invasive imaging tools to asses peripheral arterial disease.
1. To understand how to perform an accurate treatment planning.
2. To learn how to select the right endovascular treatment for the right patient.
3. To understand the challenges and future prospective of endovascular devices and treatments.
Percutaneous endovascular interventions have evolved to the mainstay treatment of peripheral arterial disease manifesting as short distance claudication or critical limb ischemia (CLI). Several new technologies, such as biomimetic metal stents, drug-eluting stents, covered stents, and drug-coated balloons, have emerged to address the Achilles heel of neointimal hyperplasia and restenosis, and thereby improve long-term patency outcomes. Novel techniques of arterial access and recanalisation, like the pedal or transradial approach, the pedal-loop techniques, and complex rendezvous strategies may help save legs in cases of advanced CLI with severe anatomical complexity. Transcatheter atherectomy may achieve atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy may allow for a more uniform angioplasty result at lower pressures with consequently less vessel barotrauma, improved luminal gain and potential combination with drug-coated balloons without permanent stent implants. Newer functional imaging modalities such as perfusion angiography and near infrared spectroscopy to monitor deep tissue oxygen levels will be part of multimodality peripheral interventions of the future.