scholarly journals Efficacy of three-dimensional roadmapping by fusion of computed tomography angiography with volumetric data from an angiography machine in endovascular therapy for iliac chronic total occlusion: a case report

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Naoki Hayakawa ◽  
Satoshi Kodera ◽  
Noriyoshi Ohki ◽  
Junji Kanda
Keyword(s):  
Computed Tomography ◽  
Endovascular Therapy ◽  
Iliac Artery ◽  
Chronic Total Occlusion ◽  
Three Dimensional ◽  
External Iliac Artery ◽  
Common Femoral Artery ◽  
Volumetric Data ◽  
Total Occlusion ◽  
Enhanced Computed Tomography

Abstract Background The usefulness of endovascular therapy (EVT) for the iliac artery has been established. However, difficult cases such as a long total occlusion and tortuous vessels are sometimes encountered. We recently performed rotational angiography with an angiography machine immediately before EVT and fused three-dimensional (3D) anatomical information obtained from preoperative enhanced computed tomography (CT) that had been performed in advance to create a 3D roadmap. We termed this method the CT fusion 3D roadmap (CTf3D-RM) technique and used it for treatment of iliac occlusive disease. Case presentation A 73-year-old man presented with pain in his left leg while resting. CT showed total occlusion from the ostium of the common iliac artery (CIA) to the distal part of the external iliac artery (EIA). A guiding sheath was inserted from the left common femoral artery using the CTf3D-RM technique, and the occlusive vessel was clearly observed. The guidewire could be passed retrogradely without bidirectional wiring. The time taken to pass the guidewire was only about 9 min despite the long and hard chronic total occlusion (CTO). Intravascular ultrasound showed that all of the guidewire followed the intraplaque route. After ballooning the entire lesion, we deployed two stent grafts and three bare nitinol stents from the left CIA ostium to the distal EIA. Final angiography showed good expansion and sufficient flow to the left leg. Conclusions The use of a 3D roadmap by fusion of CT angiography with volumetric data from an angiography machine in EVT for iliac CTO was shown to be effective.

scholarly journals Treatment of an external iliac artery chronic total occlusion using alternate access sites

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Justin Ratcliffe ◽  
Mike Gorenchtein ◽  
Pankaj Khullar ◽  
Abel Casso Dominguez ◽  
Mohan Satish ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Chronic Total Occlusion ◽  
External Iliac Artery ◽  
Arterial Disease ◽  
Patient Comfort ◽  
Vascular Lesions ◽  
Symptom Improvement ◽  
Total Occlusion ◽  
Maximal Medical Therapy ◽  
Peripheral Arterial

Abstract Background With the advent of endovascular techniques, alternate sites such as the pedal and radial arteries can now be accessed when treating peripheral arterial disease to reduce procedural complications, shorten recovery time, and improve patient comfort. However, a paucity of literature exists on the availability of support devices that can be utilized during challenging cases. Case presentation A 70 year-old female patient presented for evaluation of severe lifestyle-limiting left-sided claudication refractory to maximal medical therapy. Angiography revealed a chronic total occlusion of the left external iliac artery, which was treated successfully by percutaneous intervention via a primary transpedal approach and with the assistance of the Outback® Elite re-entry device. The patient was discharged 2 h after the procedure and reported significant symptom improvement at follow-up. Conclusion This case highlights a newly adopted endovascular approach through an alternate access site and illustrates how the Outback® Elite device can be used as an adjunctive tool in the treatment of complex lower-extremity vascular lesions.

scholarly journals Three-Dimensional Quantitative Volumetry of Chronic Total Occlusion Plaque Using Coronary Multidetector Computed Tomography

2011 ◽  
Vol 75 (2) ◽  
pp. 366-375 ◽  
Author(s):  
Jin-Ho Choi ◽  
Young Bin Song ◽  
Joo-Yong Hahn ◽  
Seung Hyuk Choi ◽  
Hyeon-Cheol Gwon ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Chronic Total Occlusion ◽  
Three Dimensional ◽  
Total Occlusion

scholarly journals Dual alternate access sites for the treatment of an ostial left common iliac artery chronic total occlusion

2020 ◽  
Vol 8 ◽  
pp. 2050313X2092919
Author(s):  
Mohan Satish ◽  
Sanjum S Sethi ◽  
Sahil Parikh ◽  
Philip Green ◽  
Justin Ratcliffe
Keyword(s):  
Femoral Artery ◽  
Iliac Artery ◽  
Chronic Total Occlusion ◽  
Common Iliac Artery ◽  
Ulnar Artery ◽  
Common Femoral Artery ◽  
Peroneal Artery ◽  
True Lumen ◽  
Total Occlusion ◽  
Left Common Iliac Artery

Growing endovascular strategies with TASC D lesions in aortoiliac disease reflect increasing technical success with evidenced safety and efficacy. In cases of failed transfemoral access, revascularization of iliac chronic total occlusions has prompted the utilization of other alternate access sites (e.g. transradial and transbrachial approaches) as important options in aortoiliac TASC D lesions. We describe a case of successful revascularization of an occluded ostial left common iliac artery in an 81-year-old man using a dual ulnar and tibioperoneal approach (absent radial artery). A Controlled Antegrade and Retrograde Tracking technique was performed where a balloon was advanced from the peroneal artery into the distal cap of the chronic total occlusion in the proximal common femoral artery. Balloon inflation was performed and a glidewire from transulnar access was advanced and re-entered into the true lumen in the common femoral artery. The wire was then snared and externalized out the transpedal access site creating a continuous true lumen from the ulnar artery to the peroneal artery. To reconstruct the aortic bifurcation, kissing balloon inflations were performed from the peroneal as well as the ulnar artery approaches. A 10 mm × 59 mm balloon expandable stent was placed in the ostial left common iliac artery and a 8 mm × 60 mm self-expanding stent was placed in the left external iliac artery successfully.

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