BEC 2011 BTK case K. Deloose M. Bosiers.

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Presentation transcript:

BEC 2011 BTK case K. Deloose M. Bosiers

Patient presentation Demographics Risk Factors Current medication Gender : male Age : 78 years Race : White/Caucasian Length : 172 cm Weight : 80 kg Risk Factors Hypertension (under medication) Hypercholesterolemia Current medication Bisoprolol, Zestril, Lipitor, Ezetrol, Cardegic, Persantine

Patient presentation Clinical presentation Intermittent Claudication right leg, Rutherford III Ankle brachial index Right : 0.65 Left : 0.88 MR angiography 

Contralateral femoral retrograde access Cross-over procedure Cook 5F RIM catheter Terumo 0.035” guidewire, bent, stiff Exchange to Terumo 6F Destination sheath, 45cm long

Coral reef occlusion Distal femoral – proximal popliteal artery

Attempts to pass the occlusion Intraluminal / subintimal Terumo 0.035” guidewire, bent Terumo 0.035” guidewire, straight 4F Berenstein catheter Abbott 5/80 Fox balloon  unsuccessful

Retrograde access Duplex-guided Via anterior tibial artery Cook micropuncture set

Micropuncture set

Retrograde access Advancement of Boston Scientific 0.018” V18 guidewire Anterior tibial artery

Retrograde access Advancement of Boston Scientific 0.018” V18 guidewire Popliteal artery

Retrograde access Advancement of Boston Scientific 0.018” V18 guidewire Distal femoral artery Support of 0.018 CXI support catheter (Cook)

Retrograde access Steering of the Boston Scientific 0.018” V18 guidewire into the 5F Berenstein catheter

Guidewire exchange Exchange of the retrograde Boston Scientific 0.018” V18 guidewire into anterograde position with the Cook CXI 0.018” support catheter Predilation with Biotronik 3.5/170mm Passeo-18 balloon

Stenting & Final result Exchange Boston Scientific 0.018” V18 guidewire to a straight, stiff Terumo 0.035 wire Stenting: ev3 6.0/200mm Everflex stent ev3 6.0/100mm Everflex stent Post-dilation: Ev3 4.0/100mm Evercross balloon  Final angiographic result proximal

Final result Final angiographic result distal

Distal puncture site control Control of anterior tibial puncture site, post manual compression