CLI Case Study Presentation Jos C. van den Berg, MD PhD Ospedale - - PowerPoint PPT Presentation

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Nov 28, 2022 127 likes •372 views

CLI Case Study Presentation Jos C. van den Berg, MD PhD Ospedale Regionale di Lugano, sede Civico, Lugano University of Bern Switzerland Disclosures No disclosures related to this presentation Brand names are included in this presentation

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CLI Case Study Presentation

Jos C. van den Berg, MD PhD Ospedale Regionale di Lugano, sede Civico, Lugano University of Bern Switzerland

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Disclosures

No disclosures related to this presentation

Brand names are included in this presentation for participant clarification purposes only. No product promotion should be inferred.

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Case presentation

89 year-old man
Resection axillary melanoma 2011
Atrial fibrillation (anticoagulation Lixiane)
Non-healing post-traumatic pre-tibial ulcer (7 weeks)
Prior stenting popliteal artery April 2018 (St.

Elsewhere)

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Clinical presentation

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Plethysmography

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Duplex

Occlusion stent popliteal artery
Status BTK?

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Therapeutic plan

Antegrade puncture (US guidance) left CFA
Diagnostic angiography
Recanalization stent
PTA and DEB in-stent

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Ultrasound guidance

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Ultrasound guidance

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Diagnostic angiography

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Diagnostic angiography

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Diagnostic angiography

Occlusion popliteal artery

– In-stent – P2 and P3 segment

Occlusion trifurcation

– Good quality posterior tibial artery – Stenotic peroneal artery – Occluded anterior tibial artery

Next step? Target vessel?

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Procedure

Intraluminal/subintimal recanalization Preferential course guidewire towards anterior tibial artery (dead end street)

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Procedure

Preferential course guidewire towards peroneal artery

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Procedure

Guidewire towards peroneal artery, remaining subintimal

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Procedure

Selective angiography demonstrates collateral towards posterior tibial artery Cannulation with Carnelian Support14

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Procedure

Carnelian Support 14 with 0.014” Terumo GT Gold, afterwards exchange for 0.014” Terumo Advantage

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Procedure

Advancement from distal to proximal

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Procedure

Re-entry into distal tibioperoneal trunk and popliteal artery

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Procedure

Withdrawal Carnelian Support 14, leaving wire in place and antegrade recanalization with 0.018” CXI using 0.014” guidewire as ‘track’

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Procedure

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Control angiography

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Clinical course

Same day discharge (day-hospital)
Wound rapidly improving (@ 3 weeks FU)