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)
Taipei Veterans General Hospital, Taipei City, Taiwan
Case 28 – TAI 02: female, 41 years (HSU,T-S)
Operators:
Po-Lin Chen,
I-Ming Chen
CLINICAL DATA
ESRD s/p PD for 2 years, shifted to HD since 2013/07 due to peritonitis
Right forearm loop AVG was created on 2013/08. High pressure since 2014/12
Type 1 DM, hypertension
Left renal cell carcinoma s/p laparoscopic radial nephrectomy in 2014
PROCEDURAL STEPS 1. Antegrade puncture of AV graft
- 7F 5 cm sheath (TERUMO)
2. PTA to venous anastomosis and basilic vein with DEB
- 6/80 mm Admiral (MEDTRONIC)
- 7/80 mm InPact Admiral DEB (MEDTRONIC)
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
Case 30 – LEI 09: Iliac occlusion left with failed recanalization attempt
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 30 – LEI 09: male, 54 years (J-K)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
PAOD Rutherford 3, severe claudication left leg
ABI left 0.71
Stenting right common iliac artery 2012,
Unsuccessful recanalizaiton attempt left CIA 1/2016 elsewhere
CAD, PTCA 6/2015
Diabetes mellitus type 2, current smoker
ANGIOGRAPHY
Common iliac occlusion left, plaque distal abdominal aorta, stent CIA right patent
PROCEDURAL STEPS 1. Left brachial access
- 7F 90 cm Check-Flow-Performer sheath (COOK) Left femoral approach
- 11F 25 cm Radiofocus II sheath (TERUMO)
2. Guidewire passage of the occlusion left CIA
transbrachial:
- 5F 125 cm Judkins Right Diagnostic catheter (CARDINAL HEALTH)
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
left femoral:
- 5F 80 cm Multipurpose Diagnostic catheter (CARDINAL HEALTH)
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- potentially double-balloon technique
3. Stenting
- Sinus aortic stent for the abdominal aorta (OPTIMED)
- Lifestream 8/57 mm covered stent left CIA (C.R.BARD)
- Lifestream 8/37 mm covered stent right CIA (C.R.BARD)
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 32 – LEI 10: male, 57 years (P-K)
Operators:
Andrej Schmidt,
Yvonne Bausback
CLINICAL DATA
PAOD Rutherford 4, Restpein right foot
ABI left 0.44
PTA left SFA and popliteal artery 1/2016
CEA right groin 2012
RISK FACTORS
Diabetes mellitus type 2, current smoker
ANGIOGRAPHY
Occlusion distal SFA / Apop artery right
PROCEDURAL STEPS 1. Right groin antegrade access
- 6F 55 cm Check-Flow-Performer sheath (COOK)
2. Guidewire passage:
- 0.018" Connect guidewire, 300 cm (ABBOTT)
- CXC 0,018" 90 cm support catheter (COOK)
In case of failure:
- 0.035" stiff angled glidewire (TERUMO)
- CXC 0,035" 90 cm support catheter (COOK)
If failure:
retrograde access via posterior tibial artery
3. PTA and stenting
- Armada 35 balloon (ABBOTT)
- Supera Interwoven nitinol stent (ABBOTT)
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