MLCTO 2023, Brussels, Belgium – Lecture on minimally invasive treatment of patients with peripheral arterial disease and diabetic foot.
What was presented at MLCTO 2023 in Brussels?
At MLCTO 2023 in Brussels, Belgium, the talk concerned the minimally invasive treatment of patients with peripheral arterial disease and diabetic foot.
The peripheral arterial disease is usually a sign of fat build-up in the arteries. It is treated minimally invasively with angioplasty and stent, without open surgery.
What are chronic total occlusions?
These are arteries that have closed completely over a long period. MLCTO is a conference dedicated specifically to them: the acronym CTO stands for Chronic Total Occlusion. They are among the most demanding lesions, since the catheter has to cross hard, calcified material.
How are they treated in a minimally invasive way?
With special wires and balloons that open the lumen, while in selected cases atherectomy catheters are used to remove the plaque. The general rule in the lower limbs is to avoid placing a stent where possible, because of the risk of restenosis.
How is it linked to diabetic foot?
Patients with diabetes often have extensive occlusions in the arteries below the knee. Restoring flow there is the precondition for a wound to heal and for amputation to be avoided. See in detail diabetic foot.
How is the diagnosis made?
From palpation of the pulses and the ankle-brachial index, where a value below 0.9 establishes the diagnosis, to colour duplex ultrasound and CT angiography when a procedure is being planned. See peripheral arterial disease.
When is a procedure needed?
When is a procedure needed? When the pain seriously limits daily life, or when there are signs of critical ischaemia: pain at rest, a wound that does not heal, a cold or blue toe. In the early stages the management is conservative, with medication, an organised walking programme, stopping smoking and control of the risk factors.
What does it mean for the patient?
The minimally invasive approach is performed under local anaesthesia and with a puncture of a few millimetres. The patient is mobilised on the same or the next day. See the risk factors.
MLCTO takes place in Brussels and brings together specialists who work exclusively on chronic total occlusions. The exchange of technical experience has direct practical value, since each such lesion requires a different approach strategy. See the pioneering procedures.
