In this episode, interventional cardiologist Dr. Peter Soukas joins us to discuss percutaneous transmural arterial bypass (PTAB) using the DETOUR system, a novel percutaneous treatment for extensive and complex blockages in the superficial femoral artery (SFA).

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SYNPOSIS

Dr. Soukas shares his extensive experience and insights into PTAB development, benefits, patient selection, and procedural details. The idea behind PTAB is to create an SFA-to-popliteal artery bypass through endovascular means, using a system of overlapping stent grafts within the femoral vein as a conduit. When planning the procedure, it is important to consider the location of reentry into the popliteal artery, avoid calcified zones, and meet femoral vein size criteria. Additionally, we explore the advantages of PTAB over other endovascular options and traditional open surgical bypass, which carry a higher likelihood of restenosis and longer recovery times, respectively.

We also discuss the types of training and support available for physicians interested in adopting this technique, cost and reimbursement aspects, and the future direction of PTAB, including ongoing post-market studies.

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TIMESTAMPS

00:00 Introduction

02:38 Dr. Soukas’ Career in Vascular Medicine

05:19 Introduction to PTAB

13:00 Landing Zones

19:37 Stent Graft Sizing

23:14 Patient Selection and Adjunctive Medical Therapy

28:04 Procedural Risks

29:18 Navigating PTAB Implementation

32:20 Opportunities for Learning PTAB

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RESOURCES

PTAB with the DETOUR System:

https://endologix.com/ptab/detour/

Brown Vascular and Endovascular Fellowship:

https://brownmedicine.org/3/cardiology-vascular-endovascular-fellowship/

COMPASS Trial:

https://www.nejm.org/doi/full/10.1056/NEJMoa1709118

VOYAGER Trial:

https://www.nejm.org/doi/full/10.1056/NEJMoa2000052

DETOUR 2 Trial:

https://www.jvascsurg.org/article/S0741-5214(22)01274-5/fulltext