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Expert Recommendations for Below-the-Knee PAD

Expert Recommendations for Below-the-Knee PAD

Infrapopliteal (IP) arterial disease, also known as “below-the-knee” or tibial disease, is a condition commonly seen in the elderly or patients with long-standing diabetes or chronic kidney disease. One of the most concerning manifestations of peripheral arterial disease (PAD) in these high-risk patients is the development of critical limb ischemia (CLI), a painful and chronic condition that can lead to amputation. As the population ages and number of patients with diabetes rises, the rate of CLI is expected to increase. The incidence of obesity and diabetes is increasing, which in turn has increased the number of patients with PAD in the arteries of the limbs. Oftentimes, the IP arterial bed is calcified and has diffuse, multilevel disease. “There is a paucity of scientific evidence for the generalizability of percutaneous revascularization in these patients,” explains Bruce H. Gray, DO, FSCAI. “This is due to the complexity of the patient population, their comorbidities, and the severity of vascular disease.” In general, guidelines have recommended that non-ambulatory patients with a short life expectancy and extensive necrosis or gangrene undergo primary amputation. Surgical bypass can be considered for ambulatory patients who are acceptable candidates for surgery, which includes those who are expected to survive more than 2 years with a patent IP artery that provides direct flow to the foot and those with an adequate autologous venous conduit. Use of endovascular approaches should be considered first-line therapy for patients: ♦ With significant medical comorbidities that limit life expectancy. ♦ At increased risk for surgery. ♦ Without an adequate distal target for bypass. ♦ With poor venous conduit. Coming to a Consensus In 2014,...

Surgery in Space: I Foresee Problems

The astronauts are halfway to Mars when suddenly one of them develops abdominal pain and requires surgery. What will they do? According to NASA, a miniature robot capable of assisting in surgery has been developed, tested in pigs, and is soon to be trialed in a weightless environment. The robot, which weighs less than 1 pound, can be inserted into the abdomen via the umbilicus and controlled remotely. The press release from NASA said types of operations that the robot would be capable of performing were “emergency appendectomies, emergency cholecystectomies, emergency perforation of gastric ulcers [sic], and intra-abdominal bleeding due to trauma.” NASA meant to say “repair of perforated gastric ulcers.” Not surprisingly, many science reporters for media outlets, for example, SFGate and WiredUK, did not notice the error. New Scientist also missed it, but at least published a later correction. However, even the famous da Vinci robot is incapable of performing surgery on its own. The original idea was that a surgeon on the ground would direct the robot’s movements, but that will not be possible for two reasons. In deep space, the time lag between the earthbound surgeon’s actions and the robot’s response would be too long, and a recent article about remote-controlled drone crashes highlighted the problems that can occur when links are lost or computers malfunction. The plan is to train the astronauts to perform minimally invasive robotic surgery on each other. What could go wrong? A lot. If they are only going to train on simulators and then have to do real surgery in space, they will be completely lost, robot or not. I...
2014 VEITH Symposium

2014 VEITH Symposium

New research is being presented at the 2014 VEITH Symposium, the 41st Annual Symposium on Vascular and Endovascular Issues, from November 18 to 22 in New York City.    Conference Highlights Gender Differences in EVAR: A 20-Year Look Age, Urgency, & TEVAR Iliac Vein Stenting in the Elderly Open Vs Endovascular RAAA Repair ltrasound-Accelerated, Catheter-Directed Thrombolysis for DVT   News From the Meeting Two-Year PYTHAGORAS Data Presented for Lombard Medical’s Aorfix Device Initial Data Presented From EVAS FORWARD–Global Registry for Endologix’ Nellix Device Innovation + Investment Roundtable At VEITHsymposium Scheduled for Friday, Nov. 21, Gramercy Suite West, 2nd Floor.  Details Include Schedule of Presentations Lower Extremity Disease Treatment Presentations at VEITHsymposium: Stents, Drug-Eluting Balloons and Trial Updates Management Options, Diagnosis and Treatment for Pulmonary Embolism Topics to be Presented Final 5-Year Results of RCT Comparing Heparin Bonded PTFE Propaten Grafts vs. Standard PTFE Grafts in Fem-Pop and Fem-Fem Bypasses Durability to be Presented A Review of Endovascular vs. Open Surgery for Critical Limb Ischemia Innovation and Roundtable Session at VEITHsymposium:  Medical Devices, Pharmaceutical and Diagnostic Companies On-Hand To Showcase Products The INSTEAD Trials May Not Be Enough to Justify TEVAR for All Uncomplicated TBADs: Experts State More Trials May be Needed While Other’s Disagree The Future of Carotid Stenting Is Bright  CAS Will Emerge as an Effective and Justifiable Mainstream Treatment With a Bright Future To Help Patients Further Studies to Document that Promise Are in Order Multiple Sclerosis and CCSVI Discussions Heat Up At the 41st Annual VEITHsymposium   More From the Meeting General Information Program Faculty Register Introduction to Academic Surgery Hemodialysis Access Endovenous Management Wound Care...
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