In this episode, host Dr. Aaron Fritts is joined by interventional cardiologists Dr. Sameh Sayfo (Baylor Scott & White in Plano, TX) and Dr. Nicolas Shammas (Cardiovascular Medicine in Davenport, IA) for a discussion about critical limb ischemia (CLI) and the use of lasers in below-the-knee (BTK) treatment. To start, Dr. Shammas explains that infrapopliteal disease is difficult to treat due to the high rate of total occlusions and the high degree of medial calcinosis. Next, he gives an introduction to laser atherectomy for certain plaque locations and morphologies, and he describes previous studies that have shown its efficacy for calcified lesions. Intravascular ultrasound (IVUS) can also help guide vessel sizing, plaque morphology, and appropriate device selection. Dr. Shammas believes that the current atherectomy devices on the market are easy to learn to use and can be incorporated into any CLI program. The doctors discuss the ongoing multicenter study on outcomes of the Auryon laser atherectomy system in CLI patients. Dr. Shammas reviews the study design, proposed endpoints, and current data on 30 day outcomes. We end the episode with advice on building a strong CLI program, which includes multidisciplinary collaboration, advocating for resources, a variety of different tools, and appropriate management of cardiovascular risk factors. --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SHOW NOTES 00:00 - Introduction 04:18 - Current Treatment Limitations for Infrapopliteal Disease 07:38 - Laser Atherectomy for Calcified Lesions 12:10 - Learning Curve for Laser Atherectomy Devices 15:38 - 30-Day Results of the Auryon BTK Study 23:35 - Technical Approach and Tools for Infrapopliteal Segments 29:00 - Upcoming Developments in CLI Treatment 31:33 - Advice for Building a CLI Program --- RESOURCES Calcium 360 Trial: https://pubmed.ncbi.nlm.nih.gov/22891826/ Auryon Laser Atherectomy System: https://www.angiodynamics.com/product/auryon/ Nexcimer Laser Atherectomy System: https://www.usa.philips.com/healthcare/product/HCIGTDPHLLSRSYSTM/laser-system-hcigtdphllsrsystm 30-Day Results of the Auryon BTK Study: https://www.jacc.org/doi/10.1016/j.jacc.2023.09.194 Midwest Cardiovascular Research Foundation: http://www.mcrfmd.com/ Life-BTK Study: https://www.cardiovascular.abbott/us/en/patients/treatments-therapies/peripheral-artery-disease/life-btk.html Promise II Study: https://www.nejm.org/doi/full/10.1056/NEJMoa2212754 BackTable Ep. 350- Building a CLI Program with Dr. Zola N’Dandu: https://www.backtable.com/shows/vi/podcasts/350/building-a-cli-program