Dr. Kumar Madassery from Rush University Medical Center in Chicago, IL, shares his experience and case-based evidence using a new technology for repairing post-PTA dissections. The Philips Dissection Repair Device – Tack Endovascular System – is purpose-built to treat dissections, leading to improvements in PTA outcomes and limb salvage.
Hi I'm Kumar Madison very one of the vascular interventional radiologists at Rush Medical Center in sunny Chicago Illinois, I'm gonna take a few minutes here to talk about using the tech device by phillips in critical limb ischemia cases in particular, I'm in charge of the peripheral vascular program as well as the Cli program at Rush University Medical Center. So it's a privilege to take a few minutes to talk about this. These are my disclosures. So the goal is to talk about the time and the need to have a focal tool that helps you with dissection repair specific to PhD interventions. So before having this device in our armamentarium, most typical dissections which are sort of inevitable, especially in long C. T. O. S. Of tibial interventions were using coronary balloon expandable bare metal stents. Now that being what we had at the time, it seemed like it works fine. The data seems to be pretty well. But in fact, we'll talk about it at the end here. That's not the right tool for this type of application. So having a dedicated scaffold that is meant for dissection repair really has changed the game. But let's take a look at what happens before we had it. This is just a briefcase, a patient with a T. M. A. That was not healing. As you can see in the middle picture, you can see in the initial angiograms there's very poor runoff. There's a reconstituted anterior tibial artery and on the far right. You see that there's very poor flow. But after a complex recapitalization which required integrated retrograde access as well as a reentry device in the tibial ballooning was necessary. And as most of us know, you're gonna end up with the dissection and that's after bologna. You can see in the run you can see the the shelf like area of the dissection. It's a little bit of a spiral and dissection. And at the time the only option I have here is ballooning more which we tried and then putting in a coronary drug. Eluting stent which works but it's not ideal. The pictures do well the patient did heal but we know that it's going to recur and you can see that the patient wanted to heal the issues with This is the basic concept of this is it's a stent that's meant for recoil. That's what was used at the time and what we've been using Rather, we have here a dissection which is a tear and having a device that actually tax up the terror rather than just stenting and unnecessary length of vessel. That's kind of the goal of what we should be trying to do. And that's what this device addresses. So going on to a case where now are utilizing this type of technology. Is a patient in the 60s, the vulnerabilities that we see most of our patients had a wound in the toe that progressed with not healing and on the outside hospital, there was no intervention warranted based on what they saw and what they could do as you can see the inflow to this vessel works pretty well, the profusion is adequate. However, there is some disease in the distal popularized in the mid population as well as approximately intuitively, if you look at the last two images. Now, one of the things that we've learned as we've progressed in PhD interventions is what you see on an angiogram, which is a two dimensional view, doesn't always paint the exact picture of what we're seeing and that's where I've. This comes in to help and a lot of us have improved the delivery of our care. And if you look at these ideas images, you can see how much more uh disease there is or is not a very calcified vessel as you see in the static image, but you can see there is a significant blow out of stenosis, plaque in the vessel and you can see how much looming you actually do have and therefore ballooned it with standard high pressure balloons. Sometimes I like to use scoring balloons and also the anterior tibial artery as you see in the middle image and the angiogram afterwards on the right. Now, if you don't pay that much attention, you could say it looks pretty good. But when you use eye this what you true finding that far right images, there is a dissection flap and to me as well as most experienced operators. That is a significant flat and so when you mag up in the middle image, you can really see where that area is And before having this device this would get a coronary bare metal drug loading extent. However, having the right tool here. As you can see two of the tax were deployed in exactly the fashion I wanted. I can stack them a little bit closer than how they deliver. I can spread them out a little bit but there's enough tax in that one deployment set to cover the area I needed. And in the end, what I get is a nicely tacked vessel without having an unnecessary stent. This is a self expanding device so it conforms to the vessel size. So rather than having to choose a balloon expandable stent with different lengths that are not meant for the periphery that are meant for the coronary circulation. I have something that I can pick and choose where I want to deploy them and take care of my disease state here. As you can see when you mag up nicely in the SF A or if you had looked at ivy's, you would see there is a significant dissection there. And whether or not I want to use drug eluting technology here, which most of us would use rather than putting a stent, I can use the tax exactly where I want to tack up those flaps so whether if you have a focal area of a dissection flap or you have a spiraling dissection, it's nice to have a focal treatment of the actual injury and therefore you get a better result. You can still use your drug eluting balloon if you want to before drug coated balloon and then tack it. Um that's what some of the studies have shown and that's what I chose to do here. So after ballooning in with a drug coated balloon then I put the tack device to take care of the dissection. And as you can see completion you do see a great angio. Now some people I would have left it alone, but that's why we have ivy's. That's why we have devices now to really further enhance improving wound care and preventing the patient from losing their limb. Because we know lim is life. I thank you for your time and I hope that you were able to get some pearls from this presentation. Thank you very much.