Case presentation critical limb ischemia
Download
1 / 12

Case presentation: Critical Limb Ischemia - PowerPoint PPT Presentation


  • 132 Views
  • Uploaded on

Strategies on the Frontline. Case presentation: Critical Limb Ischemia. Subhash Banerjee, MD VA North Texas Health Care & UT Southwestern Med. Ctr. Dallas, TX. Case presentation. 77 year old diabetic male Veteran with presents with c/o a “deep sensation of pain” in his right calf

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Case presentation: Critical Limb Ischemia' - mills


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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Case presentation critical limb ischemia

Strategies on the Frontline

Case presentation:Critical Limb Ischemia

Subhash Banerjee, MD

VA North Texas Health Care &

UT Southwestern Med. Ctr.

Dallas, TX


Case presentation
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




Initial unsuccessful attempt
Initial unsuccessful attempt

Contralateral CFA access

6F Crossover sheath

Primary GW/support

catheter crossing

Escalation of symptoms

after failed attempt


Repeat attempt in 4 weeks
Repeat attempt in 4 weeks

Antegrade access with 6F

45 cm sheath



Viance blunt microdissection catheter

(a)

Viance blunt microdissection catheter

Torque Handle

135 cm shaft (2.3F)

0.035 OD: compatible with most support catheters

0.014” guidewire (300 cm)

Distal Catheter Tip (rounded, atraumatic, 1 mm)

(b)

Torque Handle


Subintimal passage and re entry with enteer
Subintimal passage and re-entry with Enteer

Successful TP trunk re-entry with Enteer catheter & wire

Followed by IVUS confirmation


Ivus confirmation of distal true lumen access
IVUS confirmation of distal true lumen access

Sub-intimal space s/p balloon dilation

Compressed true lumen atheroma


Enteer re entry catheter
Enteer re-entry catheter

Orienting balloon with radio-opaque markers

indicating wire-exit ports on diametrically

opposite sides of the balloon

Stingray GW with 0.0035” distal taper


Final result after distal sfa tp trunk stenting
Final result after distal SFA & TP trunk stenting

6x40mm nSES

Two 3x38mm DES

Significant improvement in patient symptoms at 3m F/U


ad