Thank you so much. Dr solid. Okay folks, come on up to the microphone. We have a few minutes for questions. There's no statistical differences of yet for cardiovascular outcomes. Primary secondary other than LDL lowering. Uh And like I said, I think that's just really more so that the medications are new. We don't have data more than five years. And hopefully in the next year or two we'll have 10 year data. But as of right now there's no specific number to say yes lowering. It does does decrease your risk of M. I. Or or cli for example, there are lots of trials going back to the seventies and eighties. The cholesterol try lists the CTT trial that show that have a direct correlation where if you lower LDL you lower event rates but that's not specific to these medications as of yet. Great, thank you. Okay, back from one. Hello, my name is Lucas cousins. I'm a podiatry resident PG. Y. To question for dr lee and Dr Ambani. Um unfortunately have a lot of patients who do require um post intervention agreement and the reputation most of time time frame window. What you would recommend performing such surgery? That's a great question. Um I you know that target has moved a lot. I would say in the last couple of decades. Um I would usually recommend at least kind of waiting like a day or two to allow some development of the vascular bed so that the collaterals etcetera into the area of the wound is well developed before you do the surgery. Um I wouldn't necessarily wait a month. I think the best time is essentially almost immediately afterwards. You want to allow some time for the collaterals to fill the territory of the wound, the small arteries. Um But do the procedure pretty rapidly afterwards. That's exactly my opinion too. I think waiting a day of doing it within 48 hours, the appropriate. Thank you. Well the two of you have microphones, their aneurysm concept. So Dr. Lee you've got a beautiful petey. Let's make it an 80. Target beautiful blood flow into the dorsal speechless. But there's a hell wound that dr fried just can't heal. Um which would be surprising. So what are you gonna do? You gonna target that 80 or are you gonna try to recapitalize a let's say a long segment. PT occlusion to get in that angels? Um That's a great question. A lot of that depends on how the wound looks. So if it's a small wound you may be able to get away with the indirect revascularization. The other components are how good are your collaterals. So it is your 80 filling the pedal arch and then goes into the plantar. Um For example the second case I showed has a very small heel wound. And luckily we were able to heal with collaterals only. Um If he had a more extensive peel wound then you might want to approach more direct revascularization. The literature on this is a little bit mixed. A lot of the data is um you know just observational data is not randomized. Um And you may imagine that the patients who are difficult to revascularization, they actually undergo indirect revascularization because they failed the director revascularization. The other component that it may be important is something called a wound blush. We're still working on things items that might improve our assessment intra procedurally such as the medtronic format because that might give us a better idea during the procedure itself of is this enough blood flow for us to stop the procedure at this point? Yeah I think I agree with the Andes OMA theory in that we know the paranormal bypass is enough blood flow even though it's not direct to the foot to heal wounds. I think preserved. Looking for the vessel that's buying the foot even though it may not be a direct line. And giving postal blood flow to that vessel is the key to holding the foot. I think looking for collaterals like dr Lee said is important is the main happy the if there's two vessels making, which revascularization may depend on which kind of collateral supply the area of the wound. Great Laverne, you got a question. Hi everyone. Thank you all for your talks. My name is Laverne Thompson. I'm a general surgery PG Y three. And my question was for you Dr White. You mentioned during your talk that african american patients are still significantly more likely to receive an amputation even when presenting to higher level of care centers. Do you have any any insight as to why that bias still exists? Is it that they're presenting with a higher degree of disease at presentation? Is it because of concerns with follow up or ability to remain compliant due to socioeconomic concerns? Where exactly is that coming from? Yeah. Thank you. Excellent question. Um the real answer is we don't fully understand why we see that discrepancy because even after we've controlled for all of the risk factors, diabetes, this and that that disparity still remains, which is interesting. But I do know that African americans are more likely to present a severe stage when they do present in the hospital with cli compared to other groups that could be playing a role? Could, you know, unconscious bias or other factors be playing a role? Certainly it can be kind of tricky to tease apart some of these things, but we do know that even after controlling for, you know, different comorbidities, we still see this disparity. Thank you. Great. Okay folks, thanks very much. We're gonna take a brief break
Related Presenters
