1720_Kum.pdf

1、Case presentationA tough nut to crack and PTX EmbolismSteven Kum MBBS MMed FRCS FAMS CWSPVascular SurgeonMount Elizabeth Novena Hospital/Changi General HospitalSingapore 87 Female Past Hx DM Hypt Valvular Heart Disease TR MS Pulm Hypt Liver Cirrhosis Childs A PVD right toe wounds underwent Angioplas

2、ty and DCB of SFA/POP and Peroneal with extensive DCB(Passeo Lux)1 week ago in another country Developed worsening dusky toes and heel after intervention MRI no collections in foot,Myositis,CK elevated Dialysis catheter infection with fever1 Month later4 monthsSplit Skin Graft 3 monthsWhy do I suspe

3、ct PTX embolism?Patient had stable 1sttoe wound only without dusky toes before her index intervention in another country,dusky toes only after 1 week SFA stenosis was improved after initial DCB treatment,although there were some residual recoil CK elevated and MRI reports diffuse calf and foot muscl

4、e myositis DCB used is known to have large particles Lessons to learn Avoid extensive DCB in patients with poor outflow,use a DES for inflow Dialysis patients require a lot of effort for Revascularization Wound care Archilles heel of a Drug Coated Balloon is the Balloon,lumen gain is not perfect Innovative methods to pass lesions and fracture calcium can be useful I am waiting for a long DES BTK,120 mm long,cheap,.Case presentationA tough nut to crack and PTX EmbolismSteven Kum MBBS MMed FRCS FAMS CWSPVascular SurgeonMount Elizabeth Novena Hospital/Changi General HospitalSingapore