LINC Asia-Pacific 2015 Live Case Guide

Find all Live Cases and Live Case Centers listed below.

Singapore General Hospital, Singapore

3 livecase(s)
  • Wednesday, March 11th: - , Main Arena

    Case 22 – Infra renal AAA 6.6 cm with right CIA anuerysm

    Center:
    Singapore General Hospital, Singapore
    Case 22 – SGH 01: male, 80 years (A-A-R)
    Operators:
    • Kiang Hiong Tay,
    • John Wang,
    • Ankur Patel,
    • Jack Ch‘ng
    CLINICAL DATA
    Incidentally detected infra-renal abdominal aortic anuerysm (6.5 x 6.5 cm)
    extending into the right common iliac artery
    Clinical examination: Expansile pulsatile mass in abdomen

    RISK FACTORS
    Hypertension, hyperlipiedemia
    Mild Alzheimer dementia

    CT AORTOGRAM
    6.5 cm infra-renal AAA with anyersmal right CIA (2.7 cm)

    PLAN
    pEVAR with right iliac branch device

    PROCEDURAL STEPS
    1. US guided percutaneous access of both CFAs followed by preclosing with 2 Proglide closure devices.

    2. Aortogram and placement of Lunderquist wire from right side.

    3. Insertion of Zenith iliac branch device (COOK MEDICAL) from right side.
    Snaring of the through and through wire using Indi snare (COOK MEDICAL) from the left side. Insertion of 7F long sheath into the branch from left side. Selective cannulation of the right internal iliac artery and placement of stiff wire (ROSEN).
    Insertion of Atrium covered stent into the right IIA.

    4. Placement of stiff wire (Lunderquist) from left side.
    Insertion of the COOK Zenith stent graft main body from the left side.

    5. Cannulation of the contra-lateral limb from the right side and placement of bridging piece.

    6. Completion of deployment of main body and extension of left ipsilateral limb.

    7. Closure with preclose Proglide.
    View image
  • Wednesday, March 11th: - , Main Arena

    Case 24 – Right SFA chronic total occlusion

    Center:
    Singapore General Hospital, Singapore
    Case 24 – SGH 02: male, 70 years (T-C-H)
    Operators:
    • Farah Gillan Irani,
    • John Wang,
    • Ankur Patel
    CLINICAL DATA
    Right lateral foot wound, started as an abrasion and gotten progressively worse
    Left BKA

    RISK FACTORS
    Poorly controlled diabetes mellitus
    Chronic hyponatreamia

    DOPPLER STUDY
    Long segment SFA occlusion with stenosis in the popliteal artery and ATA occlusion

    ANGIOGRAM
    Long segment calcified SFA occlusion

    PROCEDURAL STEPS
    1. Antegrade right CFA access with US guidance and insertion of 6F Brite tip sheath (CORDIS)

    2. Antegrade recannalisation of SFA
    - 4F Bernstein and 0.035" stiff terumo/ 0.018" V18
    - 2.7F COOK CXI with 0.014" Winn 200T wire (ABBOTT)

    3. If antegrade approach fails for retrograde access via popliteal artery and SAFARI
    - 0.018" V18 and 2.7F Cook CXI catheter

    4. Following crossing angioplasty with DEB +/- stent

    5. Internal balloon tamponade of popliteal access site

    6. Attempts at recannalisation of the ATA

    7. Closure
    - 6F StarClose closure device (ABBOTT)
    View image
  • Wednesday, March 11th: - , Main Arena

    Case 26 – Chronic total occlusion left SFA

    Center:
    Singapore General Hospital, Singapore
    Case 26 – SGH 03: female, 75 years (N-H-T)
    Operators:
    • Kiang Hiong Tay,
    • Farah Gillan Irani
    CLINICAL DATA
    PAOD with non healing ulcer on lateral aspect of left first toe with sloughy base
    Non palpable left DP/PT /Popliteal

    RISK FACTORS
    Smoker
    Hypertension
    Hyperlipidemia

    DOPPLER STUDY
    Left leg: Chronic total occlusion of left SFA with stenosis
    in the popliteal artery and with long segment ATA occlusion
    Left Toe pressure 60

    PROCEDURAL STEPS
    1. US guided antegrade approach
    - 6F 11 cm Brite tip sheath (CORDIS)

    2. Antegrade crossing of SFA CTO
    - 4F Bernstein catheter and 0.035" stiff terumo (TERUMO)
    - 0.018" V18 wire (BOSTON SCIENTIFIC)
    - If fails then, retrograde approach via proximal ATA puncture using micropuncture set (COOK) and SAFARI technique 2.7F CXI catheter (COOK) and 0.018" V18 wire (BOSTON SCIENTIFIC)

    3. Angioplasty
    - MUSTANG balloon (BOSTON SCIENTIFIC)

    4. Stenting
    - SUPERA stent (ABBOTT)

    5. Proximal ATA access site controlled using internal balloon tamponade
    - 3 mm STERLING balloon (BOSTON SCIENTIFIC)

    6. ATA occlusion recannalisation
    0.018" V18 wire (BOSTON SCIENTIFIC) followed by plasty with 3 mm Sterling balloon

    7. Closure
    - 6F StarClose closure device (ABBOTT) using fluoroscopic and US guidance
    View image