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A New View on Endovascular Intervention
Representing a major health care burden worldwide, peripheral artery disease is on a sharp increase in prevalence in both high- and low-income countries, according to a study published last year in The Lancet by Fowkes and colleagues. With the dire social and economic implications of unchecked PAD, one of the strategies many are turning to in an effort to combat this dilemma is endovascular revascularization.
This past February, I was invited to the Cleveland Clinic’s Miller Family Heart & Vascular Institute to see an endovascular intervention case in a patient with critical limb ischemia and diabetes firsthand. Having attended a coronary procedure last year, one of the aspects of peripheral intervention that struck me was the sheer amount of time and resources it takes to perfuse a lesion. Often, as it was the case with this procedure, multiple access points are tried and additional blockages need to be traversed and treated before reaching the culprit lesion, necessitating a large amount of time and concentration from the entire staff.
“There are so many steps involved in a 3-hour case like this one,” Mehdi H. Shishehbor, DO, MPH, PhD, director of endovascular services, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, said during the procedure. “If you lose concentration for even a moment, you can easily make a big mistake.”
In this issue, we present this case in our photo feature, which documents the many steps involved in returning perfusion to a lower extremity ulcer. In addition to insight from Dr. Shishehbor, the article also includes comments from the cath lab staff, the patient and his wife to provide complete perspective on what the intervention takes from a procedural standpoint and the effect it has on the lives of those directly impacted.
My sincere thanks to Dr. Shishehbor and the entire Cleveland Clinic team for their invaluable assistance throughout the entirety of the shoot. This article would not have been possible without their accommodations, knowledge and dedication.
– Brian Ellis
Managing Editor, Cardiology Today’s Intervention
bellis@slackinc.com