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 TCTAP C-200 Peripheral Arterial Disease with Chronic Total Occlusion over Right Common Iliac Artery

2016 ◽  
Vol 67 (16) ◽  
pp. S340-S342
Author(s):  
Tzu Chieh Lin ◽  
Chun-Yuan Chu ◽  
Wen-Hsien Lee ◽  
Po-Chao Hsu ◽  
Ho-Ming Su ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Iliac Artery ◽  
Chronic Total Occlusion ◽  
Common Iliac Artery ◽  
Arterial Disease ◽  
Total Occlusion ◽  
Peripheral Arterial

Efficacy of metal tip catheter for chronic total occlusion lesions in peripheral arterial disease

2011 ◽  
Vol 27 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Minoru Ihara ◽  
Tsugiyoshi Yamazaki ◽  
Masaharu Kudo ◽  
Osamu Murai ◽  
Yoshiaki Tsukamoto
Keyword(s):  
Peripheral Arterial Disease ◽  
Chronic Total Occlusion ◽  
Arterial Disease ◽  
Total Occlusion ◽  
Metal Tip ◽  
Peripheral Arterial

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 Revascularization of Chronic Total Occlusion of the Infrarenal Aorta in a Patient with Triple Vessel Disease: Report of a Case Treated by Endovascular Approach

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Mahek Shah ◽  
Soumya Patnaik ◽  
Rahul Sinha ◽  
Issac Opoku-Asare ◽  
Khalid Chaudhry ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Significant Coronary Artery Disease ◽  
Arterial Disease ◽  
Occlusive Disease ◽  
Infrarenal Aorta ◽  
Aortoiliac Occlusive Disease ◽  
Total Occlusion ◽  
Triple Vessel Disease ◽  
Technological Advances ◽  
Peripheral Arterial

Surgical management of advance aortoiliac occlusive disease is time-tested and a widely practiced strategy, particularly when there is significant coronary artery disease associated with aortoiliac occlusive disease. The technological advances in the field of percutaneous techniques have facilitated the use of nonsurgical endovascular alternatives for peripheral arterial disease in patients with significant comorbidities at high surgical risk, as illustrated in our case report. We report a case of chronic total occlusion of the aorta that was treated percutaneously with endovascular stenting. We also discuss the specific technique used in this procedure.

scholarly journals The Association of Cardio-Ankle Vascular Index and Ankle-Brachial Index in Patients with Peripheral Arterial Disease

Pulse ◽  
2021 ◽  
pp. 1-6
Author(s):  
Taichiro Hayase
Keyword(s):  
Peripheral Arterial Disease ◽  
Chronic Total Occlusion ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Artery Stenosis ◽  
Total Occlusion ◽  
Brachial Blood Pressure ◽  
Below The Knee ◽  
Peripheral Arterial ◽  
Stenotic Lesions

<b><i>Introduction:</i></b> The cardio-ankle vascular index (CAVI) is a well-known index to evaluate arterial stiffness and predict cardiovascular risk. <b><i>Methods:</i></b> We investigated whether CAVI can predict severity and extent of peripheral arterial disease. This study was a single-center, retrospective, observational study approved by the Ethics Committee of Yokohama Shintoshi Neurosurgical Hospital. A total of 96 patients (males, 63) with an abnormal ankle-brachial blood pressure index (ABI) of &#x3c;0.9 and who underwent extremity arteriography at our hospital from 2015 to 2018 were enrolled in this study. We defined that CAVI with a range of &#x3c;8.0 was normal. <b><i>Results:</i></b> Coronary angiography and extremity arteriography were performed for patients who had intermittent claudication and abnormal ABI. We divided the affected limbs into 3 categories: above-the-knee artery stenosis, above-the-knee artery chronic total occlusion, and only below-the-knee artery stenosis/occlusion groups. CAVI pseudonormalization was seen in 28, 76, and 19%, respectively. The above-the-knee artery stenosis and the only below-the-knee artery stenosis/occlusion groups had a high odds ratio of abnormalization of CAVI (3.1, 95% confidence interval [CI]: 1.39–7.22; <i>p</i> = 0.05, 4.56, 95% CI: 1.64–14.7). <b><i>Discussion/Conclusion:</i></b> In the presence of the above-the-knee artery chronic total occlusion, CAVI pseudonormalization was likely to be seen. The presence of CTO in the above-the-knee artery is one cause of pseudonormalized CAVI. In the range of ABI, in which stenotic lesions and obstructive lesions coexist, it may be possible to detect the existence of CTO by a combination of both ABI and CAVI.

scholarly journals Transluminal Recanalization of Chronic Total Occlusion of Radial Artery Using Rendezvous Technique: A Case Report and Literature Review

2014 ◽  
Vol 4 ◽  
pp. 36 ◽  
Author(s):  
Mohammad Arabi ◽  
Ishtiaq Ahmed ◽  
Nabeel Qattan
Keyword(s):  
Radial Artery ◽  
Chronic Total Occlusion ◽  
Index Finger ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Total Occlusion ◽  
Hand Ischemia ◽  
Rendezvous Technique ◽  
Peripheral Arterial ◽  
The Right

Although endovascular management of lower extremity peripheral arterial disease (PAD) is well studied, little information exists regarding endovascular treatment of critical upper limb ischemia. We report a case of transluminal recanalization of right radial artery chronic total occlusion (CTO) using rendezvous technique in a patient with critical hand ischemia and dry gangrene of the right index finger.

A comparative study of geometry-based methods and intra-arterial pressure measurements to assess the hemodynamic significance of equivocal iliac artery stenoses

Vascular ◽  
2018 ◽  
Vol 27 (2) ◽  
pp. 119-127
Author(s):  
Stefan GH Heinen ◽  
Wouter Huberts ◽  
Daniel AF van den Heuvel ◽  
Frans N van de Vosse ◽  
Jean-Paul PM de Vries ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Iliac Artery ◽  
Visual Inspection ◽  
Arterial Disease ◽  
Lumen Diameter ◽  
Pressure Measurements ◽  
Rotational Angiography ◽  
3D Rotational Angiography ◽  
Peripheral Arterial ◽  
Diameter Reduction

Objectives To date, the ultimate decision to treat iliac artery stenoses in patients suffering from symptomatic peripheral arterial disease is based on the patient’s symptoms and on visual inspection of angiographical images. The primary aim of this study was to investigate the accuracy of geometry-based methods (i.e. visual inspection and quantitative vascular analysis (Viewforum version R7.2v1 Advanced vessel analysis, Philips Healthcare, Best, The Netherlands) of 3D rotational angiography) to identify the severity of equivocal iliac artery stenosis in peripheral arterial disease patients with intra-arterial hyperemic pressure measurements (gold standard) as a reference. Methods Twenty patients with symptomatic iliac artery stenoses were subjected to 3D rotational angiography. Intra-arterial pressure measurements under hyperemic conditions were performed across 24 visually identified iliac artery stenoses. Three experienced interventional-radiologists retrospectively estimated the lumen diameter reduction by visual inspection. Furthermore, quantitative vascular analysis was performed on the 3D rotational angiography data. Geometry-based estimates were classified into two groups: lumen diameter reduction of <50% (non-significant) and diameter reduction [Formula: see text]50% (significant), and compared to the intra-arterial hyperemic pressure gradients. A stenosis causing a pressure gradient (Δp) ≥10 mmHg was considered hemodynamically significant. Results Visual inspection and quantitative vascular analysis correctly identified hemodynamically significant stenoses in, respectively, 83% and 67% of the 24 iliac artery stenoses. Quantitative vascular analysis-based identification of hemodynamic significant stenoses (Δp ≥ 10 mmHg) could be optimized by lowering the threshold to a 42% lumen diameter reduction which improved the accuracy from 67% to 83%. Conclusions Visual inspection of 3D rotational angiography by experienced interventional-radiologists has an 83% accuracy to identify hemodynamic significant iliac artery stenoses (Δ p ≥10 mmHg). The use of quantitative vascular analysis software did not improve accuracy.

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