Embed Size (px)
Citation preview
Vincenzo Foppa, 1462“The miracle of the salvaged foot” Cappella Portinari, S. Eustorgio Church Milan, Italy
BAD (Big Artery Disease) and SAD (Small Artery Disease) – an appraisal of the challenges in CLI revascularization
Disclosure
Roberto Ferraresi, MD
In the last 2 years I have the following potential conflicts of interest to report:
Consultant: Medtronic, Abbott, Boston Scientific, Contract Medical International, Cook, Asahi, Ivascular, Biotronik, Limflow, Spectranetics, Shire, Kardia, Astra Zeneca, Orbus, Bard, Philips, Volcano, Novena, Angiodroid, M&L Healthcare
Virtual shareholder: Limflow
Baseline → 2017 Feb
- 8 yo→ T1DM
- 42 yo→ blindness
- 44 yo→ ESRD-HD
- 45 yo→ AMI (PCI)
- 48 yo→ CLTI onset: pain at rest,
suffering of the 1-2 toes
- Poor socio-economical status
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
+ 4 months
- Persistent pain at rest
- Suffering of 1-2 toes, 1 falanx
osteomyelitis
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
1 wound
3 angio
2 plain X-ray
+ 4 months
• No pain• Complete healing
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
+ 6 months
• Pain during dialysis• New infected ulcer
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
+ 7 months
• Increasing pain at rest• Suffering of 1-2-3 toes
Jun 2017 April 2018 2018 Nov
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
+22 months → Dec 2018
pDVA
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
pDVA acute result
+1 months
- Pain at rest +++
- Suffering of all toes,
reinfection, antibiotics
- TcPO2 5 mmHg
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
Arterialized circuit focalization
to the forefoot
+30 days
- Dorsal necrosis
- Good plantar
aspect
- New angio
- TMT amputation
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
Jun 2017 April 2018 2018 Nov
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
Jun 2017
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
2018 Feb
+20 days
- Dorsal necrosis
- Good plantar
aspect
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
+35 days
- New infection
- WBC 16.000
- Pain +++
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
+40 days
- BTK major amputation
2017 2018 2019
J F M A M J J A S O N D J F M A M J J A S O N D J F M
• SAD, the progressive desertification of the distribution system of the foot, is a major determinant of CLTI
• PTA in foot vessels has always a transient result
• Infection is one of the major determinant of major amputation
• FVA procedures are still in an “artisanal” era
• Was this complex approach correct for a pt coming from a distant region and lacking of a strong socio-economical (and medical) support?
• Do you think that a primary major amputation would have been the best choice?
• The target was independence: he wants to walk at home and to go to the toilet by himself! Nothing more….
Fighting CLTI we fight for dignity!
Vincenzo Foppa, 1462“The miracle of the salvaged foot” Cappella Portinari, S. Eustorgio Church Milan, Italy
BAD (Big Artery Disease) and SAD (Small Artery Disease) – an appraisal of the challenges in CLI revascularization
