Marcel Voos

MD
Interventional cardiologist dedicated to endovascular peripheral interventions.
  • Function: Specialist
  • Speciality: Cardiology
  • Country: AR
  • Working place: Hemodinamia Integral, Santiago del Estero, AR

Activities

Comment on May 15, 2020

Marcel Voos replied to your comment on presentation Anterior tibial artery revascularization with piercing technique..

»Dear Dr. Naren Gupta Thanks for your comments. I used in this case a coronary non-compliant balloon for vessell preparation in the mostly calcified zone after the piercing technique. Then I used Coyote balloons for dilatation (2.5 mm and 3.0 mm). In my daily practice, I use non-compliant balloons and rotational atherectomy for vessel prep for highly calcified lesions in BTK interventions.«
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.

May 3, 2020 2 Comments
Show presentation
Poll 02/02/2019 – 28/02/2019

The acute limb ischemia

Patient’s characteristics

Gender: Female

Age: 65 years old

Comorbidity: Arterial hypertension, Dyslipidemia

Symptoms:  Acute onset of claudication (<2 weeks), Rutherford class 3 of the left limb

Previous operations: None

ABI: 0.5

DUS: Occlusion of the left popliteal artery

Poll 01/03/2019 – 31/03/2019

The chronic mesenteric ischemia

Patient’s characteristics

 

Gender: Female

Age: 69 years old

Comorbidity: Arterial hypertension, Dyslipidemia, coronary heart disease (DES deployment 2 years ago)

Symptoms:  Postprandial pain

Previous abdominal operations: None

DUS: Occlusion of the superior mesenteric artery

Poll 01/04/2019 – 30/04/2019

The AV access salvage procedure

Gender: Male

Age: 75 years old

Comorbidity: End-Stage Renal Disease, Diabetes, Arterial hypertension, Dyslipidemia, on hemodialysis in the last 5 years

Symptoms:  Acute occlusion of a surgically created left-sided brachial cephalic AV fistula