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TCTAP C-238 Endovascular Revascularization: Ostial Common Iliac Artery Occlusion
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
Case Summary. Pseudoaneurysm is a specific manifestation of Behcet disease. We believed the pseudoaneurysm in this patient caused by vascular puncture and vessel injury when wiring the chronic total occlusion site. Careful evaluation the patient history in young patient with peripheral vascular occlusive disease is essential to early recognized of Behcet disease. A pre-operation immune suppression agent warranted for preventing vascular complication. In patient with Behcet disease and pseudoaneurysm, combined with surgical cut down of healthy vessel and covered stent implantation is a alternative choice and may reduce the incidence of further diseased vessel injury and pesudoaneurysm formation. TCTAP C-238 Endovascular Revascularization: Ostial Common Iliac Artery Occlusion Dimas Rio Balti,1 Yudi Her Oktaviono,2 Rerdin Julario Romdoni2 1 Cardiologist resident, Indonesia; 2RSUD Dr. Soetomo hospital, Indonesia [CLINICAL INFORMATION] Patient initials or identifier number. Mr. AJ Relevant clinical history and physical exam. Mr. AJ, a 58 years old man complaining of bilateral lower extremity paraesthesia, numbness, coldness and pain. The pain has been present for few months, but he has noticed an increase within the last weeks. He describes it as a sharp pain, especially his left leg. The pain worsens when he walks long distances and subsides within a few minutes after he stops physical activity and rests. Relevant test results prior to catheterization. Chest X-ray found cardiomegaly. Echocardiography : Mild mitralregurgitation, and normal other cardiac valves. Left atrial and left ventricle dilatation. Poor systolic left ventricle function (Ejection fraction by teich32%, by biplane 29%), abnormal left ventricle relaxation, and there is large soft thrombus in apex until lateral left ventricle wall. Eccentric left ventricle hypertrophy.CT angiography we found the total occlusion incommon illiac artery that run off in illiac bifurcation and run off in common femoral arteri with the occlusion length along 13.02 cm.
Relevant catheterization findings. From the arteriography examination, we got CTO (Chronic Total Occlusion) in external illac artery until common femoral artery, CTO in popliteal artery and collateral grade III from popliteal arteryto anterior tibial artery. Then, the revascularization was performed. [INTERVENTIONAL MANAGEMENT] Procedural step. After Arteriography, then, the revascularization performed. In this patient, the access selected from right common femoral artery with JR 4.0 6F catheter. The catheter was replaced by a IM (internal mammary) 6F catheter in order that the wire could penetrate the lesion more easily. Glide wire Terumo (tips angle) 0.035 “penetrated the lesion through common femoral arteryin the right side, with the nuckling shaped wire tip to avoid penetration into the extralumen. Balloon mustang 5.0 x 100 mm was penetrated towards the left common femoral artery until the common iliac artery and dilatated 10 atm for 30 seconds. The left common femoral artery is punctured retrograde ipsilateral with the guiding wire from the contralateral artery, so the balloon could be delivered and stent could be installed more easily. Balloon Mustang 5.0 x 100 mm through the right CFA is developed at 10 atm for 30 seconds in the femoral artery to the ostial common left ilia cartery. Due to the long lesion, we installed INNOVA 8 x 150 mm (self expandable) stent from the artery to femoral artery with the satisfied result.
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
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deliver 2.0-20 mm Coyote balloon (Boston Scientific) and could dilate the lesion. Angiography showed the insufficient result, then we Ò adopted 2.0w2.5-210 Rapid cross balloon.However, Rapid cross Ò balloon could not be pulled out because of failurein deflating. We tried to take out the balloon in some way,but the balloon shaft broke off. Then we tried to puncture the undeflated balloon via trans dermal with 18G needle (Im 39). Consecutively, we inflated a 2.5-150 mm Ò Ò Crosperio balloon inside the guiding catheter (Partent )and succeeded in extracting the remained balloon shaft.
Case Summary. In conclusion, a patient Mr. AJ 58 years old complaining of bilateral lower extremity paraesthesia, numbness, coldness and pain has diagnosed with ostial common iliac artery occlusion. Patient with aortoiliac disease need appropriate evaluation and management of this disease. Patient with risk factors of arterial embolism, such as heart failure with dyskinetic of left ventricle and soft thrombus need accurate physical examination, noninvasive and invasive diagnostic evaluation. We report this case to remind physician always consider aortic disorder during differential diagnosis of bilateral lower extremity paraesthesia, numbness, coldness and pain. TCTAP C-239 Transdermal Balloon Puncture for Extracting Remained Un-deflated Balloon Below-the-Knee Lesion Masanori Tsurugida,1 Hideaki Otsuji,1 Takashi Sakoda,1 Koichi Kihara1 1 Fujimoto General Hospital, Japan [CLINICAL INFORMATION] Patient initials or identifier number. 8091 Relevant clinical history and physical exam. A 65 year-old-female referred to our hospital because of a right lower limb ulceration. Past medical history included chronic renal failure and hemodialysis. A clinical examination showed her right leg pale with ulceration at right lower limb. She had absent pulses in dorsalis pedis artery and posterior tibial artery on both sides. And her ABI showed 0.54 at right lowerlimb. Relevant test results prior to catheterization. A computerized tomography (CT)angiography revealed the right anterior tibial artery (ATA) occluded and the right posterior tibial artery (PTA) narrowing accompanied with severe calcification. Relevant catheterization findings. Arteriography showed total occlusion of the right ATA and 50% stenosis of the right PTA. [INTERVENTIONAL MANAGEMENT] Procedural step. We tried to perform endovascular treatment(EVT) for Ò the right ATA, and passed Command guide wire (AbbottVascular) through he CTO lesion Òof the ATA. After wiring, we dilated the lesion with 1.2-15 mm Coyote balloon (Boston Scientific), which resulted in rupture at the middle of the lesion because of severe calcification. Ò Then, we tried to dilate the lesion with 2.0-20 mm Coyote balloon (Boston Scientific), but which couldn’t pass the lesion. Next, we Ò adopted Crosser to debulk the calcified lesion and succeeded in passing across the calcified lesion of ATA. After crossing, we could
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
Case Summary. Pseudoaneurysm is a specific manifestation of Behcet disease. We believed the pseudoaneurysm in this patient caused by vascular puncture and vessel injury when wiring the chronic total occlusion site. Careful evaluation the patient history in young patient with peripheral vascular occlusive disease is essential to early recognized of Behcet disease. A pre-operation immune suppression agent warranted for preventing vascular complication. In patient with Behcet disease and pseudoaneurysm, combined with surgical cut down of healthy vessel and covered stent implantation is a alternative choice and may reduce the incidence of further diseased vessel injury and pesudoaneurysm formation. TCTAP C-238 Endovascular Revascularization: Ostial Common Iliac Artery Occlusion Dimas Rio Balti,1 Yudi Her Oktaviono,2 Rerdin Julario Romdoni2 1 Cardiologist resident, Indonesia; 2RSUD Dr. Soetomo hospital, Indonesia [CLINICAL INFORMATION] Patient initials or identifier number. Mr. AJ Relevant clinical history and physical exam. Mr. AJ, a 58 years old man complaining of bilateral lower extremity paraesthesia, numbness, coldness and pain. The pain has been present for few months, but he has noticed an increase within the last weeks. He describes it as a sharp pain, especially his left leg. The pain worsens when he walks long distances and subsides within a few minutes after he stops physical activity and rests. Relevant test results prior to catheterization. Chest X-ray found cardiomegaly. Echocardiography : Mild mitralregurgitation, and normal other cardiac valves. Left atrial and left ventricle dilatation. Poor systolic left ventricle function (Ejection fraction by teich32%, by biplane 29%), abnormal left ventricle relaxation, and there is large soft thrombus in apex until lateral left ventricle wall. Eccentric left ventricle hypertrophy.CT angiography we found the total occlusion incommon illiac artery that run off in illiac bifurcation and run off in common femoral arteri with the occlusion length along 13.02 cm.
Relevant catheterization findings. From the arteriography examination, we got CTO (Chronic Total Occlusion) in external illac artery until common femoral artery, CTO in popliteal artery and collateral grade III from popliteal arteryto anterior tibial artery. Then, the revascularization was performed. [INTERVENTIONAL MANAGEMENT] Procedural step. After Arteriography, then, the revascularization performed. In this patient, the access selected from right common femoral artery with JR 4.0 6F catheter. The catheter was replaced by a IM (internal mammary) 6F catheter in order that the wire could penetrate the lesion more easily. Glide wire Terumo (tips angle) 0.035 “penetrated the lesion through common femoral arteryin the right side, with the nuckling shaped wire tip to avoid penetration into the extralumen. Balloon mustang 5.0 x 100 mm was penetrated towards the left common femoral artery until the common iliac artery and dilatated 10 atm for 30 seconds. The left common femoral artery is punctured retrograde ipsilateral with the guiding wire from the contralateral artery, so the balloon could be delivered and stent could be installed more easily. Balloon Mustang 5.0 x 100 mm through the right CFA is developed at 10 atm for 30 seconds in the femoral artery to the ostial common left ilia cartery. Due to the long lesion, we installed INNOVA 8 x 150 mm (self expandable) stent from the artery to femoral artery with the satisfied result.
S327
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
Ò
deliver 2.0-20 mm Coyote balloon (Boston Scientific) and could dilate the lesion. Angiography showed the insufficient result, then we Ò adopted 2.0w2.5-210 Rapid cross balloon.However, Rapid cross Ò balloon could not be pulled out because of failurein deflating. We tried to take out the balloon in some way,but the balloon shaft broke off. Then we tried to puncture the undeflated balloon via trans dermal with 18G needle (Im 39). Consecutively, we inflated a 2.5-150 mm Ò Ò Crosperio balloon inside the guiding catheter (Partent )and succeeded in extracting the remained balloon shaft.
Case Summary. In conclusion, a patient Mr. AJ 58 years old complaining of bilateral lower extremity paraesthesia, numbness, coldness and pain has diagnosed with ostial common iliac artery occlusion. Patient with aortoiliac disease need appropriate evaluation and management of this disease. Patient with risk factors of arterial embolism, such as heart failure with dyskinetic of left ventricle and soft thrombus need accurate physical examination, noninvasive and invasive diagnostic evaluation. We report this case to remind physician always consider aortic disorder during differential diagnosis of bilateral lower extremity paraesthesia, numbness, coldness and pain. TCTAP C-239 Transdermal Balloon Puncture for Extracting Remained Un-deflated Balloon Below-the-Knee Lesion Masanori Tsurugida,1 Hideaki Otsuji,1 Takashi Sakoda,1 Koichi Kihara1 1 Fujimoto General Hospital, Japan [CLINICAL INFORMATION] Patient initials or identifier number. 8091 Relevant clinical history and physical exam. A 65 year-old-female referred to our hospital because of a right lower limb ulceration. Past medical history included chronic renal failure and hemodialysis. A clinical examination showed her right leg pale with ulceration at right lower limb. She had absent pulses in dorsalis pedis artery and posterior tibial artery on both sides. And her ABI showed 0.54 at right lowerlimb. Relevant test results prior to catheterization. A computerized tomography (CT)angiography revealed the right anterior tibial artery (ATA) occluded and the right posterior tibial artery (PTA) narrowing accompanied with severe calcification. Relevant catheterization findings. Arteriography showed total occlusion of the right ATA and 50% stenosis of the right PTA. [INTERVENTIONAL MANAGEMENT] Procedural step. We tried to perform endovascular treatment(EVT) for Ò the right ATA, and passed Command guide wire (AbbottVascular) through he CTO lesion Òof the ATA. After wiring, we dilated the lesion with 1.2-15 mm Coyote balloon (Boston Scientific), which resulted in rupture at the middle of the lesion because of severe calcification. Ò Then, we tried to dilate the lesion with 2.0-20 mm Coyote balloon (Boston Scientific), but which couldn’t pass the lesion. Next, we Ò adopted Crosser to debulk the calcified lesion and succeeded in passing across the calcified lesion of ATA. After crossing, we could