LINC Asia-Pacific 2016 live case guide

Singapore General Hospital, Singapore, Singapore

• Thursday, March 10th: 9:13 - 9:38, Room 1 - Main Arena 1

  Case 25 – SGH 01: Chimney EVAS

  Center:

  Singapore General Hospital, Singapore, Singapore

  Case 25 – SGH 01: male, 65 years (CKM)

  Operators:

  • Tze Tec Chong ,
  • Kiang Hiong Tay

  CLINICAL DATA
  Asymptomatic 6.9cm AAA
  Ex-smoker, hypertensive, hyperlipidaemia, chronic obstructive airway disease,
  ischemic heart disease, mulitnodular goitre, chronic kidney disease (baseline sCr 300+),
  anaemia of chronic illness (Hb 7 to 8 g/dl), Ca prostate (conservative treatment)
  Ischemic bowel s/p subtotal colectomy and ileostomy in 2009
  
  PROCEDURAL STEPS
  1. Bilateral femoral arterial punctures, US guided,
  pre close with Proglide x 2 each side.
  Bilateral brachial arterial punctures, US guided, 6F sheaths
  
  2. Both renal arteries cannulated from brachial approach with TERUMO glidewire
  and MPA catheter. Exchanged for Rosen wire and 7F x 90cm Destination sheaths
  (TERUMO) to introduce 5x38 mm BeGraft (INNOMED) for renal chimneys
  
  3. Nellix device introduced from below over Lunderquist wires.
  Test fill endobags with saline followed by angio run
  to confirm good aneurysm seal/exclusion.
  
  4.Fill endobags with polymer and allow to cure.
  Check for endoleaks. Secondary fill if needed.

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• Thursday, March 10th: 11:00 - 11:25, Room 1 - Main Arena 1

  Case 27 – SGH 02: Left brachiocephalic vein occlusion

  Center:

  Singapore General Hospital, Singapore, Singapore

  Case 27 – SGH 02: male, 70 years (DFN)

  Operators:

  • Ankur Patel,
  • Sum Leong

  CLINICAL DATA
  Recurrent left arm swelling
  Diabetic, hypertensive, hyperlipidaemia, ischaemic heart disease.
  End stage kidney disease on hemodialysis via left arm brachiocephalic AVF x 6 years.
  
  CURRENT STATE
  Had left arm swelling 3 months ago due to left brachiocephalic vein occlusion treated successfully with balloon angioplasty. Now symptoms recurred.
  
  PROCEDURAL STEPS
  1. Antegrade puncture of left BCAVF, 7F sheath
  
  2. Lesion crossing
  - 0.035 TERUMO glidewire and 4F Ber catheter
  - Right femoral approach if lesion crossing failed via arm approach.
  
  3. Angioplasty
  - 14.0/40 mm Conquest balloon (C.R.BARD)
  
  4. Stenting if poor result
  - Sinus XL stent (OPTIMED)

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• Thursday, March 10th: 13:15 - 16:00, Room 1 - Main Arena 1

  Case 29 – SGH 03: Long segment SFA and ATA CTO

  Center:

  Singapore General Hospital, Singapore, Singapore

  Case 29 – SGH 03: female, 75 years (CEM)

  Operators:

  • Kiang Hiong Tay,
  • Karthikeyan Damodharan

  CLINICAL DATA
  Non healing right big toe ulcer x 3 months
  Diabetic, hypertensive, hyperlipidaemia, ischaemic heart disease with CABG 10 yrs ago
  (EF 50%), end stage kidney disease on hemodialysis
  Toe pressures: right 40mmHg, left 129mmHg
  Duplex scan of right leg showed long segment CTO of upper/mid SFA and anterior tibial
  
  PROCEDURAL STEPS
  1. Ultrasound guided downhill puncture
  - 6F Britetip sheath
  
  2. Subintimal crossing of SFA CTO
  - 0.035 TERUMO glidewire and 4F Ber catheter
  - Retrograde popliteal access if antegrade crossing failed.
  
  3. Angioplasty
  - 6.0/200mm Mustang balloon (BOSTON SCIENTIFIC)
  - Ranger drug eluting balloon (BOSTON SCIENTIFIC)
  
  4. Subintimal crossing of ATA/DP CTO
  - V18 Control wire and 4F Ber catheter.
  - Pedal plantar loop technique if antegrade crossing failed.
  
  5. Angioplasty
  - 3.0/150 mm Sterling balloon (BOSTON SCIENTIFIC)
  - Ranger drug eluting balloon (BOSTON SCIENTIFIC)

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