Presentation is loading. Please wait.

Presentation is loading. Please wait.

Case presentation: Critical Limb Ischemia Subhash Banerjee, MD VA North Texas Health Care & UT Southwestern Med. Ctr. Dallas, TX Strategies on the Frontline.

Similar presentations


Presentation on theme: "Case presentation: Critical Limb Ischemia Subhash Banerjee, MD VA North Texas Health Care & UT Southwestern Med. Ctr. Dallas, TX Strategies on the Frontline."— Presentation transcript:

1 Case presentation: Critical Limb Ischemia Subhash Banerjee, MD VA North Texas Health Care & UT Southwestern Med. Ctr. Dallas, TX Strategies on the Frontline

2 Case presentation 77 year old diabetic male Veteran with presents with c/o a “deep sensation of pain” in his right calf Partial relief is often obtained by taking a short walk around the room Right coronary artery PCI 6 months ago Continues to smoke cigarettes ABI: 0.5 (B/L); ankle pressure 52 mm Hg

3 Diagnostic angiographic images

4

5 Initial unsuccessful attempt Contralateral CFA access 6F Crossover sheath Primary GW/support catheter crossing Contralateral CFA access 6F Crossover sheath Primary GW/support catheter crossing Escalation of symptoms after failed attempt Escalation of symptoms after failed attempt

6 Repeat attempt in 4 weeks Antegrade access with 6F 45 cm sheath Antegrade access with 6F 45 cm sheath

7 Primary crossing with Viance catheter Right lateral view

8 Viance blunt microdissection catheter Torque Handle Distal Catheter Tip (rounded, atraumatic, 1 mm) (a) (b) 0.014” guidewire (300 cm) 135 cm shaft (2.3F) OD: compatible with most support catheters

9 Subintimal passage and re-entry with Enteer Successful TP trunk re-entry with Enteer catheter & wire Followed by IVUS confirmation Successful TP trunk re-entry with Enteer catheter & wire Followed by IVUS confirmation

10 IVUS confirmation of distal true lumen access Compressed true lumen atheroma Sub-intimal space s/p balloon dilation

11 Enteer re-entry catheter Orienting balloon with radio-opaque markers indicating wire-exit ports on diametrically opposite sides of the balloon Orienting balloon with radio-opaque markers indicating wire-exit ports on diametrically opposite sides of the balloon Stingray GW with ” distal taper

12 Final result after distal SFA & TP trunk stenting 6x40mm nSES Two 3x38mm DES Significant improvement in patient symptoms at 3m F/U


Download ppt "Case presentation: Critical Limb Ischemia Subhash Banerjee, MD VA North Texas Health Care & UT Southwestern Med. Ctr. Dallas, TX Strategies on the Frontline."

Similar presentations


Ads by Google