Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-137
A Challenging Case Report: Right Iliac Artery Extravasations
By Su Po Hsueh
Presenter
Su Po Hsueh
Authors
Su Po Hsueh1
Affiliation
National Cheng Kung University Hospital, Taiwan1,
View Study Report
TCTAP C-137
ENDOVASCULAR - Complications
A Challenging Case Report: Right Iliac Artery Extravasations
Su Po Hsueh1
National Cheng Kung University Hospital, Taiwan1,
Clinical Information
Patient initials or Identifier Number
15969073
Relevant Clinical History and Physical Exam
44-year-old female patient had past medical history of mitral valve corda tendinea rupture, s/p Da vinci mitral valve repair surgery on 2019-07-09. She presented to our hospital due to intermitent right lower limb soreness on sertion and limping for 1 year. Claudication and tenderness were noted. Physical examination showed right lower limb coldness and pulseless.
Relevant Test Results Prior to Catheterization
Relevant Catheterization Findings
We use a Xtreme balloon 6.0 x 120 mm , 80cm to dilate CTO lesion with less than 2 mmHg, severe abdominal pain and external iliac artery dissection with extravasation was noted. Then, we use a Fluency Plus Vascular Stent Graft 6mm x 40mm was deployed at dissection lesion. Final angio showed no more extravasion and successful CTO revascularization.
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17.wmv 18.wmv 23.wmvInterventional Management
Procedural Step
Right external iliac artery CTO Remark: 1. Right external iliac artery CTO 2. PTA for was recommended
PTA note:1. Right femoral artery retrograde approach and left cross over antegrade approach.2. Guiding wire: Terumo wire.3. A Terumo wire support with JR4 (6F) to CTO lesion.4. Retrograde puncture at right SFA successfully under fluoro-guide.5. We use a Astato , V-18 control wire (0.018 in X 300 cm) with suppport of CXI Supprot Catheter(.018/90cm) to corss CTO lesion, but unable to reach proximal exteral iliac artery ostium.6. Antegrade approach using a Terumo wire with CXI Support catheter (4F/.035"/90cm) to cross CTO lesion successfully.7. We use a Mustang balloon 3.0 x 20 mm , 75cm to dilate CTO lesion with 6-8mmHg.8. We use a Mustang balloon 5.0 x 40 mm , 75cm to dilate CTO lesion with 8-10mmHg.9. We use a Xtreme balloon 6.0 x 120 mm , 80cm to dilate CTO lesion with less than 2 mmHg, severe abdominal pain and external iliac artery dissection with extravasation was noted.10. A Fluency Plus Vascular Stent Graft 6mm x 40mm was deployed at dissection lesion.11. Final angio showed no more extravasion and successful CTO revascularization.
Complication and special event: NilPost PTA conclusion: 1. Right external iliac artery CTO s/p bilateral approach, complicated with right iliac artery perforation s/p bailed-out Graft stenting x 1 .
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PTA note:1. Right femoral artery retrograde approach and left cross over antegrade approach.2. Guiding wire: Terumo wire.3. A Terumo wire support with JR4 (6F) to CTO lesion.4. Retrograde puncture at right SFA successfully under fluoro-guide.5. We use a Astato , V-18 control wire (0.018 in X 300 cm) with suppport of CXI Supprot Catheter(.018/90cm) to corss CTO lesion, but unable to reach proximal exteral iliac artery ostium.6. Antegrade approach using a Terumo wire with CXI Support catheter (4F/.035"/90cm) to cross CTO lesion successfully.7. We use a Mustang balloon 3.0 x 20 mm , 75cm to dilate CTO lesion with 6-8mmHg.8. We use a Mustang balloon 5.0 x 40 mm , 75cm to dilate CTO lesion with 8-10mmHg.9. We use a Xtreme balloon 6.0 x 120 mm , 80cm to dilate CTO lesion with less than 2 mmHg, severe abdominal pain and external iliac artery dissection with extravasation was noted.10. A Fluency Plus Vascular Stent Graft 6mm x 40mm was deployed at dissection lesion.11. Final angio showed no more extravasion and successful CTO revascularization.
Complication and special event: NilPost PTA conclusion: 1. Right external iliac artery CTO s/p bilateral approach, complicated with right iliac artery perforation s/p bailed-out Graft stenting x 1 .
17.wmv 18.wmv 23.wmvCase Summary
Right external iliac artery CTO, we use bilateral approach to manage chronic total occlusion. However, complications of right iliac artery perforation was noted during balloon inflation.
Bailed-out Graft stenting was successfully placed at extravasation site.