Global revascularization
J S Jenkins1, T J Collins, S R Ramee
1Department of Cardiology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, LA.
Insights
Percutaneous endovascular intervention offers a vital treatment for peripheral vascular disease, especially for non-surgical candidates. Cardiologists can effectively apply coronary angioplasty skills to peripheral interventions, improving patient care.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Radiology
Background:
- Peripheral vascular disease (PVD) affects many patients unsuitable for surgery.
- Cardiologists possess transferable skills from coronary angioplasty to peripheral interventions.
- Co-existing coronary artery disease is common in patients with atherosclerotic PVD.
Purpose of the Study:
- To highlight the effectiveness of percutaneous endovascular intervention for PVD.
- To emphasize the transferability of interventional cardiology skills to peripheral vasculature.
- To advocate for the integrated care of PVD patients by cardiologists.
Main Methods:
- Review of percutaneous endovascular intervention techniques.
- Application of coronary angioplasty skills to peripheral vascular disease.
- Analysis of patient and lesion selection criteria for peripheral interventions.
Main Results:
- Percutaneous endovascular intervention provides a successful treatment alternative for non-surgical PVD patients.
- Technical skills for coronary angioplasty are transferable to peripheral interventions.
- Comprehensive understanding of PVD natural history and treatment options is crucial.
Conclusions:
- Interventional cardiologists are well-positioned to perform percutaneous endovascular interventions for PVD.
- Integrated care, including pre- and post-procedure management by the interventionalist, offers patient advantages.
- Cardiologist involvement is appropriate given the high incidence of coronary artery disease in PVD patients.
Abstract:
Percutaneous endovascular intervention has revolutionized the treatment of peripheral vascular disease by allowing successful treatment of patients who are not good surgical candidates. Cardiologists with peripheral vascular training are more readily able to identify patients with concomitant peripheral arterial disease. It has been our experience that the technical skills necessary to perform coronary angioplasty are transferable to the peripheral vasculature. However, an understanding of the natural history of peripheral disease and of patient and lesion selection criteria, and the knowledge of other treatment alternatives are essential elements required to perform these procedures safely and effectively. There are inherent advantages for patients when the interventionalist performing the procedure is also the clinician responsible for the pre- and post-procedure care, analogous to the vascular surgeon who cares for patients before and after surgical procedures. In view of the increased incidence of coronary artery disease in patients with atherosclerotic peripheral vascular disease, the participation of a cardiologist in their care seems appropriate.
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