LINC Asia-Pacific 2015 Live Case Guide

Singapore General Hospital, Singapore

• Wednesday, March 11th: 9:18 - 9:50, 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.

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• Wednesday, March 11th: 11:31 - 12:00, 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)

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• Wednesday, March 11th: 13:00 - 15:00, 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

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