Singapore, Singapore General Hospital

• Thursday, March 16th: 9:58 - 10:23, Room 1 - Main Arena

  Case 24 – Left radio-cephalic AV fistuloplasty

  Center:

  Singapore, Singapore General Hospital

  Case 24 – SGH 01: female, 56 years (NBI)

  Operators:

  • Farah Gillan Irani,
  • Sum Leong

  CLINICAL DATA
  Left RC AVF created April 2016.
  Aug 2016 underwent fistuloplasty of juxta-anastomotic segment and outflow cephalic vein at elbow using with 5mm POBA with good results.
  Also underwent coil embolization of competing draining collateral vein at same sitting.
  Currently: reducing transonic flow.
  
  RISK FACTORS
  ESRF (since 2015) secondary to diabetes & hypertension.
  Ischaemic heart disease. Failed peritoneal dialysis, now on haemodialysis.
  
  PRESENT STATE
  Reducing transonic flow. AVF duplex scan shows >75% recurrent stenosis at Juxta-anastomotic segment.
  
  PROCEDURAL STEPS
  1. Fistulogram via retrograde ultrasound guided 'V' cannulation site access
  
  2. Stenosis crossing using V18 wire supported by 4F Berenstein II catheter
  
  3. Angioplasty
  - 4 – 5 mm (POBA) angioplasty, if unable to efface lesion/suboptimal result, for cutting balloon angioplasty (5/20 mm)
  
  4. Definitive angioplasty with 5 – 6 mm drug coated balloon (DCB)
  
  5. In case of rupture, bail out covered stenting with 6/50 mm Viabahn

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• Thursday, March 16th: 13:30 - 16:00, Room 1 - Main Arena

  Case 26 – Left SFA and anterior tibial CTOs

  Center:

  Singapore, Singapore General Hospital

  Case 26 – SGH 02: female, 60 years (CYC)

  Operators:

  • Kiang Hiong Tay,
  • Farah Gillan Irani

  CLINICAL DATA
  Left calf claudication for several months, recently rest pain
  No tissue loss
  
  PRESENT STATE
  Non Smoker
  Diabetes mellitus, hypertension, hyperlipidaemia
  Toe pressures: R 60 mmHg, L 50 mmHg
  Duplex scan showed SFA and ATA CTOs
  
  PROCEDURAL STEPS
  1. Downhill puncture
  - 5F Britetip short sheath
  
  2. Intra luminal crossing of SFA CTO
  - In case of failure subintimal crossing will be performed.
  If wire fails to reenter true lumen, retrograde crossing will be attempted via popliteal artery puncture.
  
  3. Angioplasty
  - Passeo Lux drug coated balloons. Spot stenting if necessary with Pulsar 18 stent.
  
  4. Balloon assisted haemostasis for popliteal puncture site (if any)
  
  5. Exchange for long 35 cm sheath
  
  6. Intra luminal crossing of ATA CTO
  - V18 wire
  - In case of failure subintimal crossing will be performed.
  If wire fails to reenter true lumen, retrograde crossing will be attempted via distal ATA puncture.
  
  7. Angioplasty
  - Passeo Lux drug coated balloons
  
  8. Balloon assisted haemostasis for ATA puncture site (if any)
  
  9. Groin hemostasis with manual compression

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• Thursday, March 16th: 13:30 - 16:00, Room 1 - Main Arena

  Case 27 – Right SFA critical stenosis and distal disease

  Center:

  Singapore, Singapore General Hospital

  Case 27 – SGH 03: male, 64 years (HCS)

  Operators:

  • Tze Tec Chong,
  • Edward Choke

  CLINICAL DATA
  Patient with severe claudication and rest pain, no tissue loss
  
  RISK FACTORS
  Hyperlipidemia, hypertension, peripheral artery disease
  
  PROCEDURAL STEPS
  1. Access considerations given axillobifemoral graft
  
  2. Crossing of SFA lesion
  
  3. Consideration for arthrectomy
  
  4. Deployment of distal embolic protection device
  
  5. Drug eluting balloon and balloon angioplasty
  
  6. Consideration for DES
  
  7. Evaluation of tibial disease
  
  8. Tibial angioplasty
  
  9. DEB tibial
  
  10. Hemostasis – suture

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