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dr.

Sahal Fatah, SpB, SpBTKV

Objectives Arterial Vascular Disease


1.
2.

3.
4.
5.

Peripheral Artery Disease


Thoracic Aortic Aneurysms
Abdominal Aortic Aneurysms
Lower and Upper Extremity Revascularization
Lower and Upper Extremity Amputation

Objectives Venous Vascular Disease


1.

2.
3.
4.

5.

Deep Vein Thrombosis


Superficial Vein Thrombosis
Varicose Veins
Varicose Ulcers
Venous Gangrene

Operative Management

Endovascular Surgery
Percutaneous Transluminal Angioplasty/Stenting (PTA)
Femoropopliteal Percutaneous Endovascular

Intervention

Minimally Invasive (VATS)


Lumbal or Thoracal Symphatectomy

Open Surgical Therapy


Femoropopliteal Bypass (SVG, Dakron, ePTFE)
Thromboembolectomy and Endarterectomy
Amputation

Evolution of Endovascular
Diagnostics and Therapeutics

Era of Diagnostics
(19291959)
The surgeon Renaldo Dos Santos, breakthrough
applied to the extremities and to develop
arteriography and aortography
Forssmann should be possible to insert a
catheter into the right side of the heart through a
venous channel and thereby:

monitor cardiac pressures


obtain blood for analysis, and
administer therapeutic agents

Renaldo Dos Santos, MD,


Pioneer surgeon and original
developer of diagnostic arterial
visualization techniques and
technologies

Werner Forssmann, MD,


Physician credited with developing
endovascular diagnostics by
demonstrating cardiac assessment
using catheter

Andr Frdric Cournand


A physiology from Columbia
University of Physicians and
Surgeons who is known for cardio
catheterization

Sven Ivar Seldinger


A radiologist from Sweden. He
introduced technique to obtain safe
access to blood vessels and other
hollow organs

Era of Therapeutics
(19601990)
EmbolectomyFogarty The earliest disease
entity to be approached intraluminally was
embolic occlusion.
Balloon AngioplastyDotter/Grntzig used
a balloon catheter made by Fogarty to
expansion of the balloon caused an increase
in the lumen diameter (iliac stenosis).
AtherectomySimpson developed the idea
of mechanically removing atheroma from
vessels lumen (atherectomy).

Dr. Thomas J. Fogarty


An American surgeon inventor of the
embolectomy catheter for removing an
embolus, or blood clot

Charles Theodore Dotter


The Father of Intervention.
Described angioplasty in 1964

Andreas Roland Grntzig


A German cardiologist who first
developed successful balloon
angioplasty for expanding lumens of
narrowed arteries

Julio Palmaz
Doctor of vascular radiology. He got
the idea for his stent after listening
to a lecture by Gruentzig at a
conference in New Orleans in 1978.

John B. Simpson, MD,


Cardiologist and innovator
of catheter-mediated techniques for
treating coronary artery
atherosclerosis

Juan C. Parodi, MD,


Vascular surgeon and designer who
advanced the clinical techniques and
applications for the transluminally
placed endovascular endograft

Lower Extremity Revascularization


Anatomy

Femoropopliteal percutaneous
endovascular intervention

3. Femoropopliteal or Pop-DP, etc.


bypass

Cross Over Graft

Deep Vein Thrombectomy

Before and After Thoracoscopy Symphatectomy


(Reynouds Disease)

Aortic Vascular Disease


Aortic Aneurysm (Thoracalis, Abdominalis)
2. Aortic Dessection
1.

Procedure :
Endovascular (TEVAR, EVAR)
Repair Aneurysm (AAA)

TEVAR

TEVAR

AAA

EVAR

OPEN REPAIR AAA