Division of Endovascular Interventions

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Presentation transcript:

Division of Endovascular Interventions Mount Sinai Hospital New York 06/20/18

History and Physical 64 year old, male HTN, smoker (1.5 packs per day), CAD s/p PCI, remote CVA with residual paresis Non-healing ulcer on left 4th toe with rest pain x 4 weeks BP - 144/76 mmHg Pulse - 64/min Left AT and PT have monophasic doppler signal Dependent rubor, 1+ swelling

Labs and work up Hb- 14.5 g/dl Platelets- 193 K INR- 1.1 Creatinine- 1.2 ABI- 0.84 (right), 0.42 (left) Duplex: low velocity monophasic waveform at right left CFA

Strategy Right CFA access (4 F), left CFA access 7F (25 cm brite tip sheath) Therapeutic anticoagulation- Heparin Lesion crossing with 0.014 wire platform (Confianza) + directional support catheter Predilatation? Stent ( Balloon vs. Self expanding, ? Covered)