The Chinese University of Hong Kong, Prince of Wales Hospital

• Tuesday, March 12th: 11:30 - 12:05, Room 1 - Main Arena

  Case 03 – Prox SFA diffuse disease and distal SFA occlusion

  Center:

  The Chinese University of Hong Kong, Prince of Wales Hospital

  Case 03 – POW 01: female, 65 years (PLT)

  Operators:

  • Bryan Yan,
  • Skyi Yin Chun Pang,
  • GuangMing Tan,
  • Sven Bräunlich

  CLINICAL DATA
  DM/HT/Lipid/IHD
  Right RF 4 claudication
  ABI right 0.5, left 0.83
  
  ANGIOGRAPHY
  Diagnostic angiogram shows right proximal SFA multi-focal stenosis and distal SFA occlusion
  
  PROCEDURAL STEPS
  1. Cross-over approach
  – 6F Destination cross-over sheath (TERUMO)
  2. Antegrade crossing
  – V18 wire (BOSTON SCIENTIFIC)
  – CTO wire (ASAHI)
  3. Retrograde distal access and wiring if antegrade failure
  4. Proximal SFA directional atherectomy
  – HawkOne (MEDTRONIC)
  – In.Pact DCB (MEDTRONIC)
  5. Bail-out stenting on indication
  – Complete nitinol-stent (MEDTRONIC)

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• Wednesday, March 13th: 9:30 - 9:54, Room 2 - Technical Forum

  Case 20 – Left common iliac occlusion (May-Thurner Syndrome)

  Center:

  The Chinese University of Hong Kong, Prince of Wales Hospital

  Case 20 – POW 05: male, 47 years (M-C)

  Operators:

  • Bryan Yan,
  • GuangMing Tan,
  • Steven Kum,
  • Sven Bräunlich

  CLINICAL DATA
  JAK2 +ve Myeloproliferative disease
  History of left ilio-femoral DVT and PE 2017
  Persistent left leg swelling and pain
  CEAP 4 and Villalta 18
  
  IMPORTANT ITEMS
  CT showed left CIV compression
  Latest DUS showed proximal clot extended to left CIV with partial recanalization
  Popliteal vein patent
  
  PROCEDURAL STEPS
  1. (day before) Left popliteal puncture under ultrasound
  2. (day before) Antegrade crossing of left CFV-EIV-CIV
  – Advantage wire (TERUMO)
  – Navicross support catheter (TERUMO)
  3. (day before) Ultrasound assisted thrombolysis infusion catheter (BOSTON SCIENTIFIC)
  4. (day before) 24 hour ultrasound assisted thrombolytic infusion
  5. Balloon angioplasty
  – Conquest or Atlas (BARD/BD)
  6. Intravascular ultrasound guided vessel sizing
  – Volcano Vision PV .035 (PHILIPS)
  7. Stenting
  – Venovo stent (BARD/BD)

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• Wednesday, March 13th: 11:18 - 11:39, Room 1 - Main Arena

  Case 12 – Long femoral-popliteal occlusion

  Center:

  The Chinese University of Hong Kong, Prince of Wales Hospital

  Case 12 – POW 02: male, 51 years (YCP)

  Operators:

  • GuangMing Tan,
  • Skyi Yin Chun Pang,
  • Bryan Yan,
  • Steven Kum,
  • Sven Bräunlich

  CLINICAL DATA
  Debilitating bilateral RF3 claudication; previous PTA to right side
  
  RISK FACTORS
  Smoker
  
  ANGIOGRAPHY
  Diagnostic angiogram shows long CTO from mSFA to TPT
  
  PROCEDURAL STEPS
  1. Antegrade CFA 6F sheath
  2. Antegrade wire crossing
  – V18 (BOSTON SCIENTIFIC)
  – CTO wires (ASAHI)
  – Navicross support catheter (TERUMO)
  3. Retrograde distal tibial puncture and wire crossing
  4. Optimal predilatation
  5. Stenting
  – Supera stent (ABBOTT)

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• Wednesday, March 13th: 15:19 - 15:44, Room 1 - Main Arena

  Case 16 – Right calcified SFA CTO

  Center:

  The Chinese University of Hong Kong, Prince of Wales Hospital

  Case 16 – POW 03: male, 62 years (TKP)

  Operators:

  • Bryan Yan,
  • Skyi Yin Chun Pang,
  • GuangMing Tan,
  • Steven Kum,
  • Sven Bräunlich

  CLINICAL DATA
  DM, debilitating claudication RF3 symptoms
  
  ANGIOGRAPHY
  Diagnostic angiogram showed bilateral SFA occlusion
  Refused surgery
  
  PROCEDURAL STEPS
  1. Antegrade CFA
  – 6F sheath
  2. Antegrade truelumen wire crossing
  – V18 (Boston scientific)
  – CTO wires (Asahi)
  – Navicross support catheter (TERUMO)
  3. Retrograde distal PTA puncture and crossing if antegrade failure
  4. Diamondback orbital atherectomy if no significant dissection (CSI)
  5. In.Pact DCB +/- bailout Supera stent (ABBOTT)

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• Wednesday, March 13th: 17:16 - 17:38, Room 1 - Main Arena

  Case 19 – Femoral-popliteal CTO

  Center:

  The Chinese University of Hong Kong, Prince of Wales Hospital

  Case 19 – POW 04: female, 71 years (TTL)

  Operators:

  • GuangMing Tan,
  • Bryan Yan

  CLINICAL DATA
  DM/HT/Lipid, recent Rt B/T infection with ray amputation
  Complicated by post op NSTEMI with PCI done
  Non healing wound
  
  ANGIOGRAPHY
  Diagnostic angiogram shows distal SFA to P3 occlusion, focal ATA lesion
  
  PROCEDURAL STEPS
  1. CFA antegrade puncture under ultrasound
  – Micropuncture kits (COOK)
  2. Antegrade crossing
  – V18 wire (BOSTON SCIENTIFIC )
  – CTO wires (Asahi)
  3. Retrograde distal ATA puncture and crossing if antegrade failure
  4. Optimal balloon dilatation
  – Jade (OrbusNeich)
  5. Ranger DCB (BOSTON SCIENTIFIC) +/- bailout stent

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