Vascupedia VIEWS 3.0 Episode 4: Subintimal vs Intraluminal crossing of arterial CTO – what is the best approach?
Dr. Hady Lichaa
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Dr. Hady Lichaa
Dr. Mariano Palena
Prof. Raphaël Coscas, Paris
Feet fighter – When no endovascular or open option is considered out of the game.
Three retrograde punctures in two different rounds. Loads of bailout tricks to come out from different difficult situations.
This is an 81-Year-old patient presented with a spontaneous rupture of the superficial femoral artery of the left leg and on arrival to hospital he developed DVT in the same leg with pulmonary emboli which makes the anticoagulation policy to be quiet interesting, IVC filter has been deployed and covered stent has been implanted in his ruptured artery with endoleak type 1 B which settled conservatively, I hope you enjoy watching this case and looking forward to all your great comments
Mr. Mohamed Omar Elfarok M.Sc, FRCSEng, FRCSEd, IME
Consultant Vascular Surgeon
Royal College of Surgeons of England Examiner
This is a current review of the literature regarding the endovascular treatment of the CFA disease presented during the AMP meeting in Chicago. Which treatment modality showed better outcomes: POBA, primary stenting, atherectomy, bioresorbable stents or lithoplasty?
A 79-year-old diabetic male patient with no history of coronary disease is referred to you to undergo angioplasty for tissue loss on the tips of the hallux and second toe. He is taking Aspirin 75mg. From preoperative imaging he needs a 20cm SFA occlusion stopping before the adductor hiatus recanalizing as well as multilevel tibial disease which appears to be a combination of short occlusions and stenoses. The dorsal pedal is seen in the foot and is in continuity with the arch. The PT artery appears occluded through it’s whole length.
This case demonstrates the recanalization of the femoropopliteal artery in a patient with CLTI. The reason for the solely retrograde approach was a Y-graft for AAA having the anastomoses at both common femoral arteries, the above-knee amputation of the contralateral limb and the extent of the disease. Primary stent implantation was performed by using the Pulsar-18 (Biotronik) bare-metal stent, which has a 4Fr profile and a proven efficacy according to the 4EVER trial.
Age: 79 years old
Comorbidity: Arterial hypertension, Dyslipidemia,
Implantation of a bare metal stent right SFA 4 years ago, Debulking and DCB angioplasty for ISR 2 years ago
Symptoms: Calf claudication after 50 meters
DUS: SFA stent Occlusion