1 / 47

2010

Below-the Knee: Anatomy, Angiography and Intervention. Yoshiaki Yokoi, M.D.,FACC,FSCAI Department of Cardiology Kishiwada Tokusyukai Hospital Osaka, Japan. 2010. Critical Limb Ends up by Major Amupatin. Different Diagnosis of Diabetic Foot. Skin Perfusion Pressure for Severe Limb Ischemia.

declan
Download Presentation

2010

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Below-the Knee: Anatomy, Angiography and Intervention Yoshiaki Yokoi, M.D.,FACC,FSCAIDepartment of CardiologyKishiwada Tokusyukai HospitalOsaka, Japan 2010

  2. Critical Limb Ends up by Major Amupatin

  3. Different Diagnosis ofDiabetic Foot

  4. Skin Perfusion Pressurefor Severe Limb Ischemia

  5. 80% accuracy of skin perfusion pressure • < 30 mmHg ; Non healin ulcer • > 30 mmHg : Ulcer healing Castronuovo et al. J. Vasc. Surg. 1997; 26: 629-637.

  6. Ischemic Wound healing is unlikely (CLI) Marginal Ischemia (PAD) Not Ischemic Wound Critical Limb Ischemia by SPP Adapted from Castronuovo et al. J. Vasc. Surg. 1997; 26:629-637.

  7. Ischemic or Diabetic？ 64yo, male, Diabetus, Dialysis、 60yo, male, Diabetus, Dialysis、

  8. Diabetic vs. Ischemic 64 yo, M, DM, HD 60yo, M, DM, HD SPP 90mmHg SPP 25mmHg SPP 75mmHg SPP 20mmHg

  9. Below-the KneeAwareness of anatomical variations for infrapopliteral intervention

  10. Basic Knowledge of Infrapopliteal Artery Anterior tibial a. Anterior tibial a. Posterior tibial a. Tibioperoneal trunk Dorsal pedis a. Posterior tibial a. Lateral plantar a. Peroneal a. Medial plantar a.

  11. Anatomical variations of infrapopliteal artery Type I-A Type I-B Type I-C Kawarada O, Yokoi Y. Cathet Cardiovasc Interv,

  12. Anatomical variations Type I-A:

  13. Anatomical variations Type I-B: Trifurcation 1C ないですか？

  14. Anatomical variations- High ATA - Type II-B Type II-A1 Type II-A2 Type II-C

  15. Anatomical variations High ATA: TypellA-1 ⅡA2、ⅡB、ⅡCないですか？

  16. Anatomical variations High ATA: TypellA-2 ATA CTO attempted

  17. Anatomical variations- Dominant Peroneal -

  18. Anatomical variationsDominant Peroneal:Type lllA

  19. Variation of Infrapopliteal Artery ATA ATA High take off ATA PTA PTA Peroneal Peroneal Plantar Dorsal pedis

  20. BTK Angiography

  21. Angiography for BTK Intervention • Puncture common femoral artery - Two wires technique • Placing short sheath - Femoropopliteal artery angiography • Placing 30cm sheath - Infrapopliteal artery angiography • Placing 3-4Fr Multipurpose catheter - Two ipsilateral views - Two contralateral views

  22. Double Wire Technique A B C D 4Fr sheath DFA 0.025’ DFA SFA 0.025’ 0.025’

  23. SFAとDFAの分離 87歳、男性,、Ruhterford 3

  24. Stepping DSA for Femoropopliteal and Infrapopliteal Artery 61 year, Male, Rutherford 4NIDDM, Resting pain

  25. How to take left BK angiogram LAO 30° RAO 30°

  26. Left Infrapopliteal Artery Left Infrapopliteal Artery Ipsilateral Contralateral

  27. Distal Left Infrapopliteal ArteryPre and Post Angioplasty Pre Post

  28. Infrapopliteal Artery Angiography • The most difficult artery for angiography • DSA with a small amount of dye • Separation of three tibial arteries • Clarify: Anterotibial to dorsal pedis Poserotibial to plantar artery • Proximal BK: Ipsilateral view • Distal BK: Contralateral view

  29. Antegrade BTK Intervention

  30. Infrapopliteal arteryOne Vessel Runoff: Peroneal

  31. Infrapopliteal artery AngioplastyTwo Vessel Runoff: Anterotibial

  32. 55 y/o Male Rutherford 6 • Tissue loss of right 2nd and 3rd toe • Hemodyalysis×7years • Diabetus SPP 40/46 mmHg

  33. Complete Revascularizationby balloon angioplasty Pre Post Pre Post 2 months

  34. 65 y/o Female, Ruthrford 4 Pre Pre Post SPP 18 mmHg Post SPP 67 mmHg

  35. Antegrade BTK Intervention A Case

  36. - Approach and Devices - Antegrade access ■4Fr 30cm sheath ■4Fr MP catheter 80cm Passage of the lesion ■0.014” runthrough 175cm (Terumo) ■0.014” NEOS Cruise 175cm (Asahi Intec) ■0.018” Treasure 175cm 12g (Asahi Intec) ■0.014” Miracle 175cm 12g(Asahi Intec) Balloon dilatation ■2.0~2.5/40~100mm, 90cm OTW PTA balloon

  37. How Do I Intervene BK CTO (１)- Do understand anatomy - 74 y/o, female Diabetus R-5

  38. How Do I Intervene BK CTO (2)- Do understand anatomy - 74 y/o, female Diabetus R-5

  39. How Do I Intervene BK CTO (3)- Super selective angiography throughOTW balloon - Super selective angiogram Advancing wire 0.018inc. Treasure 12g Balloon angioplasty2.5X100mm

  40. How Do I Intervene BK CTO (4)- Repeat angiography after initial dilatation - Super selective angiogram Crossing wire to dorsal pedis Confirm the wire in the vessel

  41. How Do I Intervene BK CTO (5)- From ATA to Peroneal Intervention - 74 y/o, female Diabetus R-5

  42. How Do I Intervene BK CTO (6)- Take the complete BK angiogram –- Proximal BK -

  43. How Do I Intervene BK CTO (6)- Take the complete BK angiogram –- Distall BK -

  44. How Do I Intervene BK CTO (6)- Take the complete BK angiogram - Pre Post 74 y/o, female Diabetus R-5

  45. How Do I Intervene BK CTO - Tip and Tricks- • Be aware of complex BK anatomy • Wiring with OTW balloon2-2.5mmX10cm • Before wiring CTO, super selective angiographyshould be performed and map the distal vessel • In wire selection, firstly soft 0.014incwire • Minimise the stiff wire negotiation length • Judge the timing to intervene to another vessel

  46. Thank youfor your attention

  47. Thank youfor your attention

More Related