BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...
Transcript of BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...
![Page 1: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/1.jpg)
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
![Page 2: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/2.jpg)
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
![Page 3: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/3.jpg)
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
![Page 4: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/4.jpg)
![Page 5: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/5.jpg)
![Page 6: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/6.jpg)
+ 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
![Page 7: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/7.jpg)
![Page 8: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/8.jpg)
![Page 9: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/9.jpg)
![Page 10: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/10.jpg)
1 wound
3 angio
2 plain X-ray
![Page 11: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/11.jpg)
+ 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
![Page 12: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/12.jpg)
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
![Page 13: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/13.jpg)
![Page 14: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/14.jpg)
![Page 15: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/15.jpg)
![Page 16: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/16.jpg)
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
![Page 17: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/17.jpg)
![Page 18: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/18.jpg)
![Page 19: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/19.jpg)
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
![Page 20: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/20.jpg)
+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
![Page 21: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/21.jpg)
pDVA acute result
![Page 22: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/22.jpg)
![Page 23: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/23.jpg)
![Page 24: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/24.jpg)
+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
![Page 25: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/25.jpg)
![Page 26: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/26.jpg)
![Page 27: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/27.jpg)
Arterialized circuit focalization
to the forefoot
![Page 28: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/28.jpg)
![Page 29: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/29.jpg)
![Page 30: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/30.jpg)
+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
![Page 31: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/31.jpg)
![Page 32: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/32.jpg)
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
![Page 33: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/33.jpg)
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
![Page 34: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/34.jpg)
+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
![Page 35: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/35.jpg)
+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
![Page 36: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/36.jpg)
+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
![Page 37: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/37.jpg)
![Page 38: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/38.jpg)
• 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!
![Page 39: BAD (Big Artery Disease) and SAD (Small Artery Disease) an ...](https://reader031.fdocuments.net/reader031/viewer/2022012507/6183c04f53b4e9551c573d1f/html5/thumbnails/39.jpg)
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