4/8/2017 Proctor/Speaker - Abbott, Cook, Spectranetics, Medtronic. Stockholder Thermopeutics/PROFUSA Below the ankle interventions Montero-Baker, Miguel Associate Professor of Surgery Division of Vascular and Endovascular Surgery Baylor College of Medicine Leipzig, Germany 2007 1
4/8/2017 • 59 yo female • DM2 • CKD on HD • S/P CFA-PT GSV BPG • Non-healing amputation site to 4-5th 2
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4/8/2017 <<< ANTERIOR TIBIAL INTERVENTION POSTERIOR TIBIAL INTERVENTION>>> A patent bypass will fail to heal ca. 16% of ischemic heel wounds when there is an incomplete arch – Bercelli et al. JVS 1999 Rashid et al – JVS 2013 6
4/8/2017 Under recognition of a sub-group of highly complex diabetic patients that suffer from erratic flow patterns secondary to small vessel disease (choke-vessel disease) RENAL FAILURE PATIENTS DID SHOW DIFFERENCE Do we have objective performance goals? Pedal loop classification (Kawarada 2012) “…Achieve direct in-line flow to the foot…” TASC 2 7
4/8/2017 Nakama – JEVT 2016 WOUND-O-SOME Graziani - EuroPCR 2005 8
4/8/2017 Graziani - EuroPCR 2005 NON HEALING HEEL WOUND WOUND-O-SOME 9
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4/8/2017 Baseline heel perfusion Validation and OPG WOUND-O-SOME WB + Obvious angiographosome Obvious angiographosome reopened O2 Lumee 11
4/8/2017 Conclusions • Pedal loop angioplasties are technically The Division of Division of Vascular Surgery & Endovascular Therapy and iCAMP Accepting National and International Visitors feasible, but potentially disastrous. The Division of Vascular Surgery and Endovascular Therapy in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine is inviting national and international visitors to work at with world-renowned physicians and scientists in Vascular Surgery, Podiatry Medicine, Limb Salvage, Neurorehabilitation, and • Preliminary data suggests that this may be Bioengineering to contribute in innovative interdisciplinary research in the area personalized and precision medicine targeting aging population, people with diabetes and plantar ulcers, and those Visitors must meet the suffering from peripheral arterial disease. more important in patient with long-standing following requirements: Visiting scholars who are visiting for longer than 6 months enjoy: • Independent funding diabetes and ESRD. • Minimum of 6 month (a) Library privileges identical with those of the faculty; (b) Privilege of auditing seminars without fee or record, as space commitment allows (c) Use of laboratory, Clinical, and other space and facilities to • English Proficiency the extent they are available. • Compliance with USCIS (d) Working in an interdisciplinary environment and be actively engaged in highly innovative clinical and translational Visa Regulations for researches to improve stability, healing and mobility across non-USA residents disciplines and in particular among patients suf fering from diabetes as well as aging population undergoing major surgical interventions. • Diagnostic tools of regional ischemia need to A DS-2019 Request form has to (e) Candidates will be highly encouraged and are supported to be completed for a J-1 Visa prior publish the results of their research in high impact peer-reviewed journals and/or presenting in national and to visiting. Applicants should send international conferences. an updated CV and a cover letter (d) Candidates will receive training in using advanced summarizing your motivations technologies/tools designed for the purpose of outcomes research, wound healing, fall prevention, frailty screening, be developed, as they may also offer and your qualifications to: vascular assessment, and motor-cognitive screening. i-camp@bcm.edu validation and performance goals. @monteromiguel mmontero@bcm.edu 12
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