2020 SCAI Guidelines on Device Selection in Aorto-Iliac

Arterial Interventions

Dmitriy N. Feldman, MD, FACC, FSCAI, FSVM

Director, Endovascular Service
Director, Interventional Observation/Telemetry Unit
Associate Professor of Medicine
Interventional Cardiac and Endovascular Laboratory
Weill Cornell Medical College, New York Presbyterian Hospital

May 14th, 2020

Disclosures

No relevant disclosures
GUIDELINES: Symptomatic Patients

2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Arterial Disease
 Aorto-Iliac Revascularization Indications
AORTO-ILIAC DISEASE WITH SYMPTOMS
• Relieve claudication
• Wound healing in CLI
• Improve functional status and Quality of Life (QOL)

AORTO-ILIAC DISEASE WITHOUT SYMPTOMS

• Situations where large-bore arterial access is required for hemodynamic
support devices (e.g., IABP or other catheter-based ventricular assist
devices), for structural/valvular (e.g., TAVR), and vascular (e.g.,
endovascular aortic aneurysm repair) procedures

Klein A, Jaff M, Gray B et al. Catheter Cardiovasc Interv. 2017;90:E90–E110.

Rise of endovascular interventions – patient preference
Evolution of Device Selection in Peripheral Interventions
1st DCB
AUC for Aorto-Iliac Peripheral Interventions
2014

2017

Klein AJ et al. Catheter Cardivasc Interv 2014;84:520

Klein AJ et al. Catheter Cardiovasc Interv. 2017;90(4):E90-E110.
 AORTO-ILIAC INTERVENTION
Appropriate Use Criteria

• Provisional or Primary stenting appropriate

when vascular access required (e.g. for IABP,
TAVR), with or without symptoms
• Appropriate in claudicants >50% aorto-iliac
stenosis or gradients at rest of ≥10 mmHg
• Claudicants who fail medical/exercise therapy
• All CLI (RC 4-6)

Klein AJ et al. Catheter Cardiovasc Interv. 2017;90(4):E90-E110.

Bailey SR et al. J Am Coll Cardiol. 2019 Jan 22;73(2):214-237
Aorto-Iliac Revascularization Device Options

Device Options:
• Uncoated balloon PTA
• Specialty balloon PTA
• DCB
• BMS (balloon expandable)
• BMS (self-expanding)
• Covered stent (balloon expandable)
• Covered stent (self-expanding)
• DES
• Atherectomy
TASC II Classification of Aorto-Iliac lesions

Norgren L et al. JVS 2007:S5A-S67A.

 2020 SCAI Guidelines on Device Selection
in Aorto-Iliac Arterial Interventions
• Provide a comprehensive review of comparative effectiveness
data in aorto-iliac arterial interventions
• Focus on safety and efficacy of groups of devices
• The cost of the devices is considered secondary to examining
efficacy and safety data
• Provide clinicians with guidance (class of recommendation and
level of evidence) for device selection, when these devices are
intended as definitive therapy.
2020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial
Interventions

Feldman DN et al. Catheter Cardiovasc Interv 2020

Study Selection Process

2020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial
Interventions

Applying Class of Recommendation and Level

of Evidence to Device Strategies
Feldman DN et al. Catheter Cardiovasc Interv 2020
 2020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial
Interventions (Uncoated Balloons PTA)

Recommendations for PTA

with Uncoated Balloons

Feldman DN et al. Catheter Cardiovasc Interv 2020.

 2020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial
Interventions (Specialty Balloons PTA)

Recommendations for PTA

with Specialty Balloons

Feldman DN et al. Catheter Cardiovasc Interv 2020.

2020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial
Interventions (BMS)
2020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial
Interventions (DES and DCB)
2020 SCAI Guidelines on Device Selection in Aorto-Iliac Arterial
Interventions (Covered Stents)
 Conclusions

• PVI is a very effective therapy for patients with lifestyle-limiting claudication and
hemodynamically significant Aorto-Iliac disease.
• The role of PVI is symptomatic and functional status improvement.
• SCAI 2017 AUC and 2018 ACC/AHA/SCAI/SIR/SVM AUC were developed to provide
clinicians with guidance regarding appropriateness of PVI for specific clinical and
anatomical criteria.
• 2020 SCAI guidelines document provides comprehensive guidance with specific
recommendations (COR and LOE) for Aorto-Iliac device selection, when these
devices are intended as the definitive therapy.
Thank you!