1710_Petruzzi.pdf

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1、AtlanticareCase 67 yo M CLI/PAD prior intervention OSH 2011,COPD,HTN,CAD,presents with 6 month history nonhealing ulcerations right ant shinCan only examine with leg on ground CTA shows right CFA occlusion,SFA distal occlusion,pop occlusion,tibial reconstitutionPlan for endarterectomy/bypass,felt to

2、 be poor surgical candidate by partners,referred for possible endo attemptWoundsExamNonpalpable right CFA through tibialsFaint mono PT nondetectable DPABI 0.28UlcerationsSuperficial right 5thtoe,dorsal footmoderate achillesR5/R6 CLTIInterventionUp and over 6 F 45 cm SheathAttempt to cross 018 Rubico

3、n 014 Glide AdvSelective injection suggests a microchannel could not wireUsed 014 30 g Victory wire to pierce throughEscalated to Victory 14 30 g InterventionTrue lumen re-entryTandem popliteal occlusionSelective injection beyond CFA did show hibernating runoff Intervention Sub-I cross pop ctoCould

4、not Reenter beyond pop occlusion Next steps?Retrograde gives ability to CART CART/Reverse CARTCART CARTIf that doesnt work If that doesnt work IVUS post crossInterventionDifficulty with exchange for further crossing decided to treat CFA first6 x 60 M5 Plus CFA post IVLFollowed w 6 x 60 mm Ranger DCB

5、InterventionOpted for Sup-uvia pop-SFA originDCB CFA post IVLIVUS PostFollowupComplete resolution rest painWounds healing,reperfusion edema,granulation 3 months PostRemodeling!SummaryR5/R6 CLTI with CFA through BTK occlusive disease in poor operative candidate Successful crossed with variety of techniques Weighted tip wires Retrograde/SAFARICART Treated by vessel prep(IVL)and combination of woven stents,drug eluting stents,and drug coated balloon.Successful Limb salvage Questions?Atlanticare