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
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.
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)
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