Chapters Transcript Video S. Jay Mathews NCHV 2019 Below-the-knee case review Below-the-knee case presented at NCVH 2019 by Dr. Jay Mathews D053366-00 let me do some quick cases as well. To hear this is a 74 year old gentleman with a rutherford five, uh, situation with multiple 4 ft wounds. Typical risk factors as well. To this is what we have below the knee. So you can see we have quite a bit of disease. The Pts out the para kneel on the 80 are both good potential targets. And so I went after the the Para Neil on TP trunk original. You could see the Ivies picture that the vessel size is quite small. And some of this is actually due to a tragic effect that you can see Eric. People talked about this on the live case, and, uh, you know, sometimes we tend to undersize tibial vessels, but it's also important I've It's really kind of gauge how big this is. You could see downstream distantly. It's only about two millimeters, but then it actually tapers up quite significant approximately over 30 and then the pop deal segment. You can see it's 4 to 5. So if we move on as well to you can see here now we're performing laser a threat to me. I do laser forwards and backwards. And you can do that so you could do multiple passes with escalating energies. Typically, I use 60 40 60 60 60 80 in 60 80. So, in doing this, we're actually then able to take a nice Angela Scott balloon based on the sizing from the IBIs. Went a little bit smaller and used a to five initially here because I didn't wanna oversized downstream on. Then you could see this is what we had afterwards by IBIs. So a fairly nice result here, too. With a significant removal of plaque material, you could see there's still a little bit of stuff just at that junction there the teepee trunk area, but again, good liberal gain. And since we don't really have a great drug coated balloon technology yet these air currently an investigation and I certainly did not want a stent in that area if I could avoid it. Uh, this is, uh this is actually a very reasonable result. So then I went after the 18. You can see here. You know, we've got quite a bit of disease in this segment, and you can see this is what it looks like under IBIs. So there's actually a lot of variation in the size of this vessel. But in general, based on this to I'd say I was gonna go out with about a three millimeter scoring blue and afterwards so you could see how it kind of gets bigger and smaller. And that's very typical. You could see that calcium all throughout as well. So if we go in afterwards. So we went ahead and formed a laser wrath, direct me, and then we went ahead with our, uh, scoring balloon. I used that one for, uh, turbo laser catheter. And after that, we went with a long 30 100 just called balloon. And then you could see what we have afterwards here to kind of coming up. You can see we do have some significant movement. There is still some residual tissue. There is well, too. And, uh, So what do you do in this scenario? Well, this is kind of a judgment call, because there is still significant plaque. And before, when we weren't looking at these things, we looked at the angiograms and saying, Hey, looks pretty good. Well, what do we do? So this is actually a patient. I show this just to show that not always doesn't look perfect by I vis and geographically looks pretty good. And we have very nice run off. So clinically the patient did well. But this is a patient I put into my file to save on for 11 of our below the knee trials. Because when when and if this patient does come back, that's an area of interest for me as well, too. And hopefully I'll be able to treat it with one of our newer technologies. Published January 18, 2019 Created by
