BackTable Vascular & Interventional

Ep. 563 Techniques for Effective Vessel Prep with Dr. Jay Mathews and Dr. Michael Siah

Aug 5, 2025
Join interventional cardiologist Dr. Jay Mathews, with 20 years of experience in endovascular innovation, and vascular surgeon Dr. Michael Siah, Director of Limb Salvage at UT Southwestern, as they delve into cutting-edge vessel preparation techniques. They discuss advancements like bioresorbable scaffolds and the pivotal role of imaging in assessing critical limb ischemia. Listeners will learn about specialty tools like intravascular lithotripsy and the balance of treatment efficacy against device costs. Exciting emerging technologies promise to reshape their practices!
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ADVICE

Imaging Strategy in CLTI Patients

  • Use CT angiography and ABIs initially for CLTI patients, while acknowledging their limitations in calcified vessels.
  • Immerse in lower extremity angiography combined with IVUS to understand vessel pathology and inform device choice.
INSIGHT

Imaging Reveals Hidden Calcium

  • Angiograms can underestimate calcification severity; IVUS reveals precise calcium location and extent.
  • Full lumen replacement by calcium often necessitates specialty balloons or more aggressive tools.
ADVICE

Use IVL for Bulky Above-Knee Calcium

  • For bulky above-the-knee calcium, prioritize intravascular lithotripsy (IVL) over atherectomy.
  • Combine IVL with specialty balloons and reserve atherectomy for select nodular calcium cases due to limitations.
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