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How I Deal With... SVGs. Simon Redwood St Thomas’. No Conflict of Interest to Declare. Mr PM, 55 years old CABG 1993 SVG – LAD SVG – OM2 8F LCB. How should we tackle this?. Laser Catheter. 0.9, 1.4. 1.7. 2.0 mm diameter. Particle Size post 308 nm ablation. 5% : > 5 - <12 micron.

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how i deal with svgs

How I Deal With...SVGs

Simon Redwood

St Thomas’

slide3

Mr PM, 55 years old

  • CABG 1993
  • SVG – LAD
  • SVG – OM2
  • 8F LCB
slide5

Laser Catheter

0.9, 1.4. 1.7. 2.0 mm diameter

slide6

Particle Size post 308 nm ablation

5% : > 5 - <12 micron

50% : < 1 micron

45% : 1 – 5 micron

Erytrocyte = 7µ

slide7

Saline Infusion Protocol

In order to obtain an optimal contact between catheter tip and lesion it is mandatory to implement the saline infusion protocol.

15-20 ml saline bolus after each contrast injection

15-20 ml saline flush during every laseractivation (5 sec)

slide8

Saline Infusion

Images taken from the DVD: Critical Limb Ischemia, New Techniques For Complex Interventions, Prof. Dr. Giancarlo Biamino - Dr. Dierk Scheinert (Herzzentrum Leipzig) Michael Jaff, MD (Lennox Hill, NY)

slide10

Luge

  • 2.0c laser
slide12

5x28 to mid lesion

  • 5.0x20 proximal
  • 5.0x15 Quantum
slide14

Mr JN, 64 years old

  • CABG 1988
  • LIMA – LAD
  • SVG – RCA and “LCx”
  • Tn +ve ACS
  • Anterolat ST changes
  • LIMA – LAD normal
  • SVG – RCA occluded
slide16

8F HS

  • IABP
  • Luge
slide21

4.0x20 distal

  • 4.0x28 prox
  • 4.0 post dilatation
slide23

Mrs DC, 72 years old

  • CABG 1999
    • LIMA-LAD
    • SVG-OM1 and RCA
  • Tn +ve ACS (>2)
  • Infero-lat ST depression
slide25

Luge

  • 2.0c laser
slide27

Filterwire

  • 4.5x28 distal
slide28

4.5x24 prox

Peak CK 205

summary
Summary

Conventional wire

Debulk with laser

Filter device

Stent – usually BMS, occ. covered

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