Step it Up Everyone! Learning Advanced Vascular Ultrasound Techniques for CLTI patients with Dr. Miguel Montero-Baker and Jill Sommerset
Aaron Fritts MD
Co-Founder and CEO of BackTable. Trained Diagnostic and Interventional Radiologist.
In this episode, guest host Jill Sommerset interviews vascular surgeon Dr. Miguel Montero-Baker about his evolving use of ultrasound throughout his career in caring for critical limb-threatening ischemia (CLTI) patients.
Dr. Montero-Baker starts by outlining his journey from training in Costa Rica, Germany, and Arizona, to building a multidisciplinary limb salvage center at Methodist Houston. Despite his geographic relocations, he is still very involved in endovascular education in Latin America through HENDOLAT, an online community and annual conference.
Next, they delve into the uses for ultrasound during the workup stages for CLTI. Dr. Montero-Baker highlights the information that ultrasound can provide: locating the region and extent of disease, pursuing an open versus endovascular treatment approach, and the tools you will need. He points out that a lot of institutions currently only rely on pulse volume recording (PVR), ankle brachial index (ABI), and toe brachial index (TBI), and do not have access to a robust vascular lab for full ultrasounds. Dr. Montero-Baker discusses some hurdles preventing the wide implementation of ultrasound, such as additional cost and variability in operators.?
However, he believes that ultrasound can be a phenomenal tool if practices can invest the time to train vascular technologists and implement its use. They frame the ultrasound conversation around incentives for each party: the technologist can achieve higher job satisfaction and further subspecialize, the treating physician can have a better understanding of each patient’s disease and management, and the institution can minimize extended stays and readmissions. Additionally, ultrasound is very useful when institutions are facing the global contrast shortage or treating patients with renal disease.
On Deep Vein Arterialization:
“Patients with diabetes and chronic renal failure have very few options. They face very high high limb loss rates. However, some data from many years ago, probably sparked from the days of congenital heart research, showed that you could actually access the capillaries through a vein.
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We started progressing the technique and understanding the anatomy of the pedal veins and how we could access the veins and in a better way. Ultrasound has been our focus because this procedure requires a lot of knowledge of the venous anatomy.”
Finally, they look at the pathophysiology of diabetic and chronic renal failure patients who have extreme below the knee and below the ankle disease. These patients with medial artery calcification patterns have very few treatment options and high limb loss rates. Dr. Montero-Baker describes a new method of pedal venous access for deep vein arterialization. Listen to the full episode to learn more!
Resources
BackTable en Espanol- Enfermedad Arterial Periférica y Salvamento de Extremidades en la Comunidad Latino Americana:
Dr. Miguel Montero-Baker’s Twitter: https://twitter.com/monteromiguel?
HENDOLAT: https://hendolat.com/
Society for Vascular Ultrasound: https://www.svu.org/?
Vascular Technologist and Technical Director of the Vascular Lab at Hill Vascular & Vein Center
2 年Shall have a listen.. I love BackTable!!!
Cardiovascular Innovation Expert
2 年That’s really good - thank you for sharing.