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.
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)
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
We use cookies so that we can offer you the best possible website experience. This includes cookies which are necessary for the operation of the website and to manage our corporate commercial objectives, as well as other cookies which are used solely for anonymous statistical purposes, for more comfortable website settings, or for the display of personalised content. You are free to decide which categories you would like to permit. Please note that depending on the settings you choose, the full functionality of the website may no longer be available. Further information can be found in our privacy statement and legal notice.