0925_Purushottam.pdf

1、Challenging Contiguous Iliac-CFA CTO with Failed Aorto-Bifemoral BypassBhaskar Purushottam MD,FACC,FSCAI,FSVMInterventional Cardiologist and Endovascular MedicinePresident,Midwest Heart and Vascular Associates,Rapid City,SDMedical Director,Monument Health ResearchMonument Health Rapid City Hospital,

2、Rapid City,SDClinical Associate Professor of Medicine,Sanford School of Medicine,University of South DakotaClinical Case Presentation54 yo woman from the Indian Reservation has a background significant for PAD,Aorto-Bifemoral bypass graft with a known chronically occluded left of the bypass graft,Co

3、gnitive Dysfunction with Developmental Delay,Diabetes A1C of 8,HTN,Dyslipidemia and Recurrent Staph Skin infections has been dealing with CLTI since November 2024 bilateral LE wounds;LR.ABIs:Not performed because of pain.Arterial Duplex:Severe R Limb stenosis,Tardus Parvus flow in the Left Fempop an

4、d Infrapop Segments Known Ao-Bi-Iliac CTO and Occl.L LimbOn near OMT,including ASA,Plavix and Lipitor.Insurance wouldnt pay for Rivaroxaban.Right Limb Revasc with VBX StentingNon-Healing Left Lateral Lower Leg WoundCTA ImagingCTA 3-D SpinApproach Re-Canalize the Native Arterial SystemAttempted Retro

5、grade CrossFailed Retrograde ApproachAbdominal AortogramIdentifying the Proximal CapBeBack Catheter:4Fr.120 cmRe-Entry Assisted with CART TechniqueCrossed into L PFA and IVUSIVUSPlain PTA+Intravascular Lithotipsy:6 x 80 mm E8CFA DCBIVUS to Implant the VBX:To avoid jailing the ostium of the R Native

6、CIAL PFA Arteriotomy Hemostasis:Balloon TamponadeFinal Angiograms7 X 79 mm VBX7 x 100 mm EverflexLeft Lower Extremity AngiogramsL CFA and AortaHealed Left Lateral Lower Leg WoundPost Intervention CTA ImagingPost CTA ImagingThanksChallenging