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Use of Intravascular Ultrasound (IVUS) and Extravascular Ultrasound (EVUS) to Enhance your CLI Treatment Algorithm for Best Patient Outcome



Jihad A. Mustapha, MD, FACC, FSCAI 
Co-founder and CEO 
Advanced Cardiac & Vascular Centers for Amputation Prevention 
Michigan State University College of Osteopathic Medicine 
Grand Rapids, Michigan 

Chief Operation Officer 
Advanced Cardiac & Vascular Centers for Amputation Prevention 
Michigan State University College of Osteopathic Medicine 
Grand Rapids, Michigan 


George A. Pliagas, MD, FACS, FRCSC 
Vascular Surgery 
Advanced Cardiac & Vascular Centers for Amputation Prevention 
Knoxville, Tennessee 


Paul Michael, MD, FSCAI 
Medical Director, JFK Wound Management & Limb Preservation Center  
JFK Medical Center 
Boca Raton, Florida 

Martyn Knowles, MD, MBA  
Adjunct Assistant Professor of Surgery
Medical Director of the Aortic Center, UNC Rex Hospital 
University of North Carolina 
Raleigh, North Carolina 

Kumar Madassery, MD  
Assistant Professor, Vascular Interventional Radiology
Director Advanced VIR Fellowship 
Rush University Medical Center 
Glenview, Illinois 

Bryan Fisher, Sr., MD
Chief of Vascular Surgery 
Centennial Medical Center 
Nashville, Tennessee


Provided by North American Center for Continuing Medical Education, LLC, an HMP Company.

For questions regarding this educational activity, please call 609-371-1137 or email


This activity is designed for interventional cardiologists, vascular surgeons, interventional radiologists, wound care specialists, podiatrists, nurses, vascular technologists, and cardiovascular catheterization laboratory team members. 


After this activity participants should be able to:  

  • Apply a comprehensive, multidisciplinary best practice approach for patients with advanced peripheral arterial disease (PAD) and critical limb ischemia (CLI) at risk for major amputation.  

  • Describe the role of atherectomy in CLI and its application in amputation prevention 

  • Treat complex chronic total occlusions in tibial and pedal arterial vessels in the patient with CLI.  

  • Describe arterial angiosome anatomy in conjunction with cutaneous and ultrasonic angiosome mapping in patients with advanced tibio-pedal arterial disease at risk for major amputation. 

  • Implement procedural and technological advances in wound care practices for patients facing major amputation due to advanced PAD, advanced non-healing wounds, and gangrene. 

  • Identify the components necessary to build a multidisciplinary amputation prevention program. 

  • Implement a diagnostic algorithm which includes selective angiography as a critical step for patients with CLI who are at risk for amputation. 

  • Incorporate advanced tibio-pedal access in combination with antegrade access in limb salvage procedures. 

  • Describe tips and tricks for safe and effective surgical and endovascular treatment of CLI from access to closure. 

  • Describe unique considerations when evaluating the diabetic foot ulcer in the setting of CLI.  

  • Describe currently available drug eluting technology for the treatment of above the knee and below the knee lesions in the patient with CLI. 

  • Describe current wire, catheter, balloon, crossing, atherectomy, re-entry, and closure devices available for treatment of CLI, and describe mechanism of action and when most appropriate to utilize. 


To be eligible for credit, participants must complete the online activity, a post-test assessment, and the evaluation. Upon completing the activity, there will be instructions on how to print a certificate or other documentation of credit.

Participants who completed the live version of the iactivity are not eligible to receive credit for this on-demand webcast.

Release Date: August 21, 2020
Reaccredited: September 30, 2021
Expiration Date: September 30, 2022
Estimated time to complete: 1 hour

There is no fee associated with this activity.


NACCME would like to thank the following company who has supported the "Use of Intravascular Ultrasound (IVUS) and Extravascular Ultrasound (EVUS) to Enhance your CLI Treatment Algorithm for Best Patient Outcome" through an educational grant: Philips IGTD.


 In support of improving patient care, NACCME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


NACCME designates this enduring internet activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


This continuing nursing education internet enduring activity awards 1 contact hour. 

Provider approved by the California Board of Registered Nursing, Provider #13255 for 1.0 contact hour.


NACCME has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with the AAPA CME Criteria. This internet enduring activity is designated for 1 AAPA Category 1 credit. PAs should only claim credit commensurate with the extent of their participation.


Use of Intravascular Ultrasound (IVUS) and Extravascular Ultrasound (EVUS) to Enhance your CLI Treatment Algorithm for Best Patient Outcome taking place from September 30, 2021 to September 30, 2022 has been approved for 1.0 A+ ARRT CE credits by the Association for Vascular and Interventional Radiographers (AVIR). The AVIR is an ARRT Recognized Continuing Education Evaluating Mechanism, (RCEEM).


NACCME is approved by the Council on Podiatric Medical Education as a provider of continuing education in podiatric medicine. NACCME has approved this activity for a maximum of 1.0 continuing education contact hour.


This continuing medical education activity may include device or medicine brand names for participant clarity purposes only, due to the presence of different branded versions of the same product. No product promotion or recommendation should be inferred.


This activity may contain information about experimental and other uses of drugs or devices that are not currently approved by the European Medicines Agency (EMA) of the European Union or the Food and Drug Administration (FDA) of the United States. Participants are strongly encouraged to consult approved product labeling for any drug or device mentioned in this activity before use. The opinions expressed during this activity are the opinions of the respective authors, presenters or moderators and do not necessarily reflect the opinions of NACCME.


The material presented and related discussions are not intended to be medical advice, and the presentation or discussion of such material is not intended to create and does not establish a physician-patient relationship. Medical advice of any nature should be sought from an individual’s own physician.

Neither NACCME nor any of its subsidiaries or affiliates is affiliated with, or formally endorsed by a medical society.

The opinions expressed in this educational activity are those of the faculty and are not attributable to NACCME or HMP. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this activity are not necessarily the same as indicated in the package insert for each product, may reflect the clinical experience of the presenters, and may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.


NACCME, LLC is an independent provider of continuing medical education. NACCME, LLC has no proprietary or financial interest in medical or healthcare products over which the FDA (USA) or EMA (EU) has regulatory authority.

In accordance with our disclosure policies, NACCME is committed to ensuring balance, independence, objectivity, and scientific rigor for all accredited continuing education. These policies include assigning relevance to, and mitigating, all perceived or real conflicts of interest between any individual with control over the content and any ineligible company (commercial interest) as defined by the ACCME.

Any individual with control over accredited content, including planner, faculty, and reviewer, is required to globally disclose:

  1. Individual relationship(s) or lack thereof, and its nature, with any/all ineligible company, and;
  2. any investigational, off-label, or non-FDA approved content or discussion

NACCME has reviewed these disclosures, assigned relevance based on the relationship and scope of content, and identified those with the potential to compromise the goals and educational integrity of the education. Relevant relationships, or lack thereof, are shared with the learner.

Education has been independently peer-reviewed to validate content, mitigate identified conflicts of interest, and ensure:

  1. All recommendations involving clinical medicine is based on evidence that is accepted within the medical profession as adequate justification for their indications and contraindications in the care of patients.
  2. All scientific research referred to, reported, or used in accredited continuing education in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection, and analysis.
  3. Content is appropriate, fair and balanced, unbiased, referenced, and non-promotional.


The faculty has reported the following:

Dr. Fisher: Consultant – Abbott, Bard, Cordis, Philips, Shockwave, Veryon; Grant/Research Support - Abbott, Speakers’ Bureau – Philips, Veryon
Dr. Madassery: Consultant - Abbott, Cook, Penumbra, Philips
Dr. Mustapha: Chief Medical Officer - Micromedical Solutions; Consultant - Angiodynamics, Avinger, BD Bard, Boston Scientific, Cardiovascular Systems, Inc., Medtronic, Philips, Terumo, PQ Bypass; Grant/Research Support - Avinger, Boston Scientific, PQ Bypass, Terumo; Major Stock Shareholder - CardioFlow
Dr. Pliagas: Speakers' Bureau - CSI, Cook, Medtronic, Philips; Major Stock Shareholder - Penumbra
Dr. Saab: Consultant - BD Bard, Boston Scientific, Medtronic, Philips, Terumo; Grant/Research Support - Boston Scientific, CardioFlow, PQ Bypass, Terumo, Micromedical Solutions; Major Stock Shareholder - CardioFlow

Dr. Knowles and Dr. Michael have disclosed no relevant financial relationships with any ineligible companies (commercial interests).


Jos C. van den Berg
Ospedale Regionale di Lugano sede Civico University of Bern
Lugano, Switzerland

Dr. van den Berg has disclosed no relevant financial relationship with any ineligible company (commercial interest).


Susie Seaman, NP, MSN, CWOCN (nurse planner)
Susie Seaman Wound Care Consulting
San Diego, CA

Ms. Seaman has disclosed no relevant financial relationship with any ineligible company (commercial interest).

NACCME planners and staff include Samantha Bella, Samantha Conforti, Caitlin Eastman, MaryEllen Fama, Randy Robbin, Greaton Sellers, Margie Stefan and Colleen Waters.

No NACCME planner or staff has disclosed a relevant financial relationship with any ineligible company (commercial interest).


North American Center for Continuing Medical Education (NACCME) complies with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please call 609-371-1137.


NACCME protects the privacy of personal and other information regarding participants, educational partners, and joint providers. NACCME and our joint providers will not release personally identifiable information to a third party without the individual’s consent, except such information as is required for reporting purposes to the appropriate accrediting agency. NACCME maintains physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

Copyright © 2021 by North American Center for Continuing Medical Education, LLC. All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from North American Center for Continuing Medical Education.