Experts opinion
Experts opinion
LINC 2020: Prestige Pilot study — IVUS guided atherectomy and DCB therapy Dr Michael Lichtenberg
Case report
Anterior tibial artery revascularization with piercing technique.
This case report was previously published in CLIC LATAM course in 2019.
We report case of a 60-year-old male patient with a history of hypertension and diabetes mellitus who currently has critical limb ischemia of the left foot with rest pain and trophic disorders at second and third toes and the forefoot. (WIfI 122 classification).
Angiography showed occlusion of both tibial arteries.
Due to the high risk of amputation, it was decided to continue with angioplasty of both tibial arteries.
Strategy:
Ultra-sound guided puncture of the left common femoral artery.
5 Fr sheath placement.
CXI support catheter.
V-14 and V-18 guidewires.
Conventional balloon angioplasty.
Endoluminal and antegrade revascularization with balloon angioplasty of the posterior tibial artery was performed without complications.
The anterior tibial artery could not be recanalized anterogradely with the V-14 guide, so a V-18 guide was used. Once the V-18 guidewire was located in the dorsalis pedis artery, an unsuccessful attempt was made to progress the CXI catheter to be able to exchange the 0.018” guide for a 300 cm 0.014” guide and perform balloon angioplasty due to the severe calcification of the vessel. A piercing technique was performed by fracturing arterial calcium with the percutaneous puncture of the vessel with an 18G puncture needle at the ankle level. Then, the progression of the CXI catheter towards the dorsalis pedis artery is achieved and the exchange of guides is carried out to continue with balloon angioplasty. There were no complications secondary to the use of an aggressive technique such as “piercing” in this case, which carries a high risk of amputation without adequate revascularization.
Vascupedia VIEWS 2.0
Vascupedia Views Episode 5 How to be successful in my BTK revascularisation: the magic toolbox
Vascupedia Views Episode 5
How to be successful in my BTK revascularisation: the magic toolbox
Dr. Michael Lichtenberg (Germany)
Moderator: Dr. Konstantinos Stavroulakis (Germany)
Recorded video case
IVUS guided kissing endovascular lithoplasty and bare-metal-stent implantation for a coral reef aortic stenosis in visceral segment
Recorded case of a 72 yrs old woman with CLTI (Rutherford V, TASC D lesion), not suitable for open repair, treated in a hybrid setting with IVUS guided kissing endovascular lithoplasty and bare-metal-stent implantation for a coral reef aortic stenosis in visceral segment, with a stent-graft for the right CIA and bare-metal-stent for the right CEA for the iliac high-grade stenosis and a femorofemoral bypass.
Vascupedia VIEWS 2.0
Vascupedia Views Episode 4 UPSIDE DOWN DEBATE
Vascupedia Views Episode 4
UPSIDE DOWN DEBATE
Fem distal bypass: the limitations of my technique
N. Ahmad, UK
Distal revascularization: the limitations of my technique
K. Pereira, US
Vascupedia VIEWS 2.0
Vascupedia Views Episode 3 Correct imaging of the foot vessels: how to understand what you are doing
Vascupedia Views Episode 3
Correct imaging of the foot vessels: how to understand what you are doing
Dr. Marco Manzi (Italy)
Moderator: Dr. Lorenzo Patrone (UK)
Case report
Type A dissection: The endovascular solution
We report a case of a type A dissection after TAVI procedure in 82-year-old fragile high-risk patient.
This work could be of interest because we decided to perform a bailout TEVAR procedure to treat a type A dissection with a primary entry tear in middle segment of the ascending aorta because the severe comobordities of the patient do not allow to proceed to the standard surgical repair.
The current endovascular stent graft technology could offer an alternative and emerging treatment option in selected high-risk patients with acute type A dissection who are unfit for surgical repair
