Case 01 – NY 01: Chronic total occlusion RSFA (TASC D)
Center:
Mount Sinai Hospital, New York, USA
Case 01 – NY 01: male, 71 years, (C-T)
Operators:
Prakash Krishnan,
Karthik Gujja,
Vishal Kapur
R leg claudication, Rutherford class II, category III, Fontaine IIB
US duplex showed occlusion of RSFA
RISK FACTORS
Hypertension, diabetes mellitus II, dyslipidemia, ex smoker, PAD
PROCEDURAL STEPS 1. Left common femoral access and up and over
- 7F Pinnacle destination sheath 45 cm, up and over (TERUMO)
- If necessary, R pedal posterior tibial retrograde access (4F COOK sheath)
2. Intra-luminal approach
- 0.014" 4F Viance catheter, 150 cm (MEDTRONIC)
- 0.038" Vertip catheter, 125 cm (CARDINAL HEALTH)
- 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR)
- 0.035" Glide wire, 300 cm (TERUMO)
3. Filter placement
- exchanged with 0.014" Bare wire, 315 cm (ABBOTT VASCULAR)
- Emboshield filter 4/7 mm embolic protection system (ABBOTT VASCULAR)
4. PTA and stenting as indicated
- Lutonix drug coated balloons 6.0/150 mm (C.R.BARD)
- Supera stenting 5.5/100 mm (ABBOTT VASCULAR)
Case 03 – NY 02: Severely calcified chronic total occlusion of LSFA
Center:
Mount Sinai Hospital, New York, USA
Case 03 – NY 02: male, 70 years (A-K)
Operators:
Prakash Krishnan,
Karthik Gujja,
Vishal Kapur
CLINICAL DATA
Left leg pain, Rutherford class II, category III, Fontaine IIB
ABI R LE - 0.9 and L LE - 0.6
US duplex showed occlusion of calcified LSFA
RISK FACTORS
Hypertension, diabetes mellitus type II, dyslipidemia, ex-smoker,
CAD s/p multiple PCI's, PAD
PROCEDURAL STEPS 1. Right common femoral access and cross-over approach
- 7F Pinnacle destination sheath 45 cm up and over sheath (TERUMO)
2. Guide wire passage
- 0.014" Spartacore wire, 300 cm (ABBOTT VASCULAR)
- 0.038" Vertebral 135" Tempa Aqua catheter, 125 cm (CARDINAL HEALTH)
- 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR)
- 0.035" Glide wire, 300 cm (TERUMO)
3. Filter placement
- exchanged with 0.014/Bare wire, 315 cm (ABBOTT VASCULAR)
- Emboshield filter 4/7 mm embolic protection system (ABBOTT VASCULAR)
Case 04 – NY 03: Chronic total occlusion with in-stent occlusion in mid segment RSFA
Center:
Mount Sinai Hospital, New York, USA
Case 04 – NY 03: male, 76 years (J-S)
Operators:
Prakash Krishnan,
Karthik Gujja,
Vishal Kapur
CLINICAL DATA
R leg claudication, Rutherford class II, category III, Fontaine IIB
US duplex showed occlusion of RSFA with instent occlusion in mid RSFA
RISK FACTORS
Hypertension, diabetes mellitus II, dyslipidemia, ex smoker, PAD
PROCEDURAL STEPS 1. Left common femoral access and up and over
- 7 Fr Pinnacle destination sheath 45 cm, up and over (TERUMO)
- If necessary, R pedal posterior tibial retrograde access (4F COOK sheath) and direct stent access
2. Intra-luminal approach
- 0.014" 4F Viance catheter, 150 cm (MEDTRONIC)
- 0.038" Vertip catheter, 125 cm (CARDINAL HEALTH)
- 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR)
- 0.035" Glide wire, 300 cm (TERUMO)
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