Seoul National University Hospital

• Tuesday, March 13th: 9:19 - 9:49, Room 1 - Main Arena

  Case 02 – Superficial femoral artery stenosis/occlusion suspected by arterial function test

  Center:

  Seoul National University Hospital

  Case 02 – SNU 01: male, 66 years (K-K)

  Operators:

  • Jae Kyu Kim,
  • Saebeom Hur

  CLINICAL DATA
  Claudication right calf
  s/p stent insertion at Rt. focal stenosis and Lt CTO, CIA (kissing stent) (2016.2.27)
  Right ABI : 0.55 (2016.1.29) à 0.86 (2016.11.18) à 0.76 (2017.5.12) à 0.61 (2017.10.20)
  Parkinsonism and neurogenic bladder
  
  RISK FACTORS
  Hypertension, hyperlipidemia
  
  PROCEDURAL STEPS
  1. Right groin antegrade approach
  - 7F sheath
  2. Guidewire passage and PTA
  - 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO) and 5F Davis catheter 90 cm (TERUMO) for intraluminal or subintimal GW passage
  - Jetstream (BOSTON SCIENTIFIC) with Emboshield (ABBOTT) or HalkOne (MEDTRONIC) with SpiderFX (COVIDIEN)
  - 5.0 mm Ultraverse balloon (BARD)
  - 5.0 or 6.0 mm Lutonix drug coated balloon (BARD)
  3. (PRN) Bail-out stenting
  - Innova stent (BOSTON SCIENTIFIC) or Supera stent (ABBOTT)

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• Wednesday, March 14th: 8:35 - 9:01, Room 1 - Main Arena

  Case 11 –TASC D iliac occlusion, left

  Center:

  Seoul National University Hospital

  Case 11 – SNU 02: male, 63 years (K-B)

  Operators:

  • Hwan Jun Jae,
  • Saebeom Hur

  CLINICAL DATA
  Severe claudication left calf, walking capacity 100 meters
  
  IMPORTANT ITEMS
  Quit smoking 1 year ago after 90-pack-years
  ABI : unavailable
  Bladder cancer (UCC) with M/bone (T7)
  s/p Radical Cystectomy ('12.11.6) & T7 transverse tumorectomy ('13.3.27)
  EGC, s/p LADG ('16.5.18)
  Old Tbc; GB stone, s/p L-Cholecystectomy (30YA)
  Rt. leg neural damage (after TA, >20Y)
  
  PROCEDURAL STEPS
  1. Right groin retrograde and cross-over approach
  - 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO)
  - 7F 40 cm Balkin Up&Over sheath (COOK)
  2. Left groin retrograde approach
  - 0.035" Radiofocus guidewire 190 cm (TERUMO)
  - 6F 10 cm Super sheath (BOSTON SCIENTIFIC)
  --> 8F sheath after passage
  3. Guidewire passage and PTA
  - 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO) and 5F Davis catheter 70 cm (TERUMO) for intraluminal or subintimal GW passage
  - 4.0/40 mm Armada 35 balloon (ABBOTT)
  - 6.0 or 7.0/100 mm Armada balloon (ABBOTT)
  - Bail-out usage of Goose neck snare (EV3) or Outback (CORDIS)
  4. Stenting
  - 8 mm/60 mm Lifestream balloon-expandable covered stent (BARD)
  - Consider bilateral common iliac kissing stent
  - 7 mm/120 mm self-expandable stent for left external iliac segment

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• Wednesday, March 14th: 11:06 - 11:31, Room 1 - Main Arena

  Case 14 – TASC D SFA occlusion right

  Center:

  Seoul National University Hospital

  Case 14 – SNU 03: male, 72 years (Y-O)

  Operators:

  • Hwan Jun Jae,
  • Saebeom Hur

  CLINICAL DATA
  Severe claudication right calf, 100 m
  
  IMPORTANT ITEMS
  Hypertension
  s/p Thrombectomy, Lt. CFA to crural a.. Rt. CFA, DFA, SFA, Endarterectomy, both CFA
  Fem-Fem bypass (Lt to Rt) with 7 mm PTFE graft (2015.11.19)
  Right ABI : 0.33 (2016.2.4) --> 0.58 (2016.10.31) --> 0.60 (2017.8.18) --> 0.65 (2018.2.6)
  In hospital cardiac arrest, idopathic (2015.11.19)
  DVT in Rt. popliteal vein, on astrix, pletaal, berasil, podox, roisol
  
  PROCEDURAL STEPS
  1. Right groin antegrade approach
  - 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO)
  - 6F 10 cm Supersheath sheath (BOSTON SCIENTIFIC)
  2. (PRN) Right ATA retrograde approach
  - 0.018" V-18 guidewire (BOSTON SCIENTIFIC)
  - CXI supporting catheter 90 cm (COOK)
  3. Guidewire passage and PTA
  - 0.018" V-18 guidewire (BOSTON SCIENTIFIC) and CXI catheter 90 cm (COOK) for intraluminal or subintimal GW passage
  - (PRN) Jetstream artherectomy (BOSTON SCIENTIFIC) with embolic protection device, if intraluminal passage achieved
  - (PRN) reverse-CART if subintimal passage was made
  - 5.0 mm Armada balloon (ABBOTT)
  4. Stenting
  - Multiple 6 mm Eluvia drug eluting stent (BOSTON SCIENTIFIC)

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• Wednesday, March 14th: 12:54 - 13:30, Room 2 - Technical Forum

  Case 21 – Instent-restenosis of central vein stent with focal stenosis at brachial vein in brachio-brachial arterio-venous fistula for hemodialysis

  Center:

  Seoul National University Hospital

  Case 21 – SNU 04: female, 73 years (J-W)

  Operators:

  • Saebeom Hur,
  • Sanghyun Ahn

  CLINICAL DATA
  Hemodialysis via Permcath
  Left arm swelling (+)
  
  PATIENT HISTORY
  2017.3.9 AVF formation (Br-Br), Lt.
  2017.4.24 Lt. autogenous brachial-brachial upper arm transposition (2nd)
  2017.8.16 – 8.19 wound care
  2017.9.20 First use(+)
  2017.10.11 Stent placement for Lt. innominate vein occlusion
  2017.12.14 PTA for brachial vein stenosis
  using 7*40 mm Mustang balloon & 6 mm*2 cm Cutting balloon
  
  PROCEDURAL STEPS
  1. US guided brachial vein access
  - 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO)
  - 7F 10 cm Supersheath sheath (BOSTON SCIENTIFIC)
  2. Guidewire passage and PTA
  - 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO) and Kumpe catheter 65 cm (COOK) for intraluminal GW passage
  - 6 mm, 7 mm/40 mm Conquest high-pressure balloon (BARD)
  - 6 mm, 7 mm/40 mm Lutonix drug coated balloon (BARD)
  3. (PRN) Stenting
  - 10 mm Niti-S stent (TAEWOONG)

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