Peripheal artery occlusive disease(from aorta to popliteal) 연세대학교의과대학 심장혈관병원최동훈
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1 Peripheal artery occlusive disease(from aorta to popliteal) 연세대학교의과대학 심장혈관병원최동훈
2 Case 1 Aorta disease -antegrade via brachial artery, subintimal approach, wire retraction, kissing stent-
3 M / 59 # C.C : intermittent claudication (Fontain IIb) D : remote 2 years PHx : HTN (7 yrs),dm(2 yrs) on medication P.Ex: BP 130 / 90 mmhg HR 60 /min Lab : BUN/Cr 24.7/1.5 mg/dl, HbA1c 6.9 % TC/TG/HDL/LDL 186/149/40/125 mg/dl
4 Aorta angioplasty ( )
5 Aorta angioplasty subintimal technique 8Fr Shuttle sheath-035 Terumo Wire J tip subintimal approach to both iliac artery
6 Aorta angioplasty Wire retraction with SNARE catheter : Multi-SNARE 15 mm
7 Aorta angioplasty Kissing stent Zilver 8 X 80mm at both iliac artery Kissing balloon angioplasty
8 Aorta angioplasty Immediate final angiography 6 months follow up angiography
9 Guiding catheter Wire Balloon catheter Stent Etc.
10 Case 2 Superficial femoral artery -contralateral approach, subintimal approach-
11 M/71 # CC : Aggravated Claudication of Lt. leg (20 m) D : 30 days, remotely for 1 year PHx : HTN (+) - 2 yrs DM (+) - 4 yrs CVA (+) - 2 yrs P/Ex : BP 140/70 mmhg, Lt. popliteal & dorsalis pedis a. - not palpable Lab : AC glc 120 mg/dl, HbA1c 7.7% BUN/Cr 17.0/1.1 mg/dl T.chol/TG/HDL/ LDL 200/72/50/136 mg/dl
12 HD # 3 : C-angioC CAD (1-vessel disease) PTCA with stenting at d-lad d
13 collateral atheroma old thrombus Cross-section PTA
14 I II III IV Cross-section PTA
15 HD #5 : PTA via contralateral approach 8F contralateral sheath
16 Lt. lower limb arteries
17 035 Terumo wire & 5F multipurpose catheter 035 Stiff wire & 6 x 100 UTD balloon
18 Angio after balloon dilatation
19 Self-expandable expandable Nitinol stent : SMART (Cordis( Cordis) 7 x 80 mm
20 Angio after Additional ballooning
21 Pressure gradient after PTA Plethysmography 3 months later
22 Guiding catheter Wire Balloon catheter Stent Etc.
23 Case 3 Superficial femoral & Popliteal artery -antegrade approach, intraluminal approach-
24 M/35 # CC : Claudication of Lt. leg (Fontaine IIb) D : 4 years PHx : HTN (-), DM (-) Smoking (+) - 10 PYs P/Ex : BP 130/70 mmhg Lt. popliteal & dorsalis pedis a. - not palpable Lab : Glc 88 mg/dl, BUN/Cr 14.3/0.8 mg/dl T.chol/TG/HDL/ LDL 187/282/29/102 mg/dl
25 Antegrade Approach Ext. Iliac a. Com. femoral a. Sup. femoral a.
26 8 Fr Sheath 035 Terumo J wire & 5F Multipurpose catheter
27 After passage of 035 Terumo wire & Multipurpose catheter
28 035 Terumo wire PTA with UTD 4 x 40 mm
29 After balloon dilatation SMART 6 x 40 mm
30 Guiding catheter Wire Balloon catheter Stent Etc.
31 Case 4 Popliteal artery -contralateral approach, intraluminal approach-
32 M / 91 # C.C : Intermittent claudication (Fontain IIb) D : 6 months PHx : HTN (15 yrs), DM(15 yrs) on medication PEx : BP 130 / 90 mmhg HR 80 /min Lab : BUN/Cr 20.3/1.3 mg/dl, HbA1c 6.9 % TC/TG/HDL/LDL 134/143/55/74 mg/dl
33 Lower Extremity CT Angiography Lt. SFA, distal portion obstruction, Rt. PTA obstruction, Rt. ATA 에 multifocal stenosis
34 PTCA at RCA and PTA at Lt.SFA cypher 3.0 * 28 mm Powerflex 5 X 40 mm SMART 6X100 mm
35 Peripheral angioplasty : Rt. PTA 014 G/W PTCA balloon 3.0X 20 mm Cypher 3.0X33 mm
36 Peripheral angioplasty
37 Case 5 Aorta -antegrade approach, intraluminal approach, thrombolysis-
38 F / 68 # C.C : Claudication (IIb), both leg paresthesia D : 1 week PHx : HTN ( 10 yrs) on medication P.Ex: BP 130 / 80 mmhg HR 62 /min Lab : BUN/Cr 3.7/ 0.6 mg/dl,
39 CT Aorta ( )
40 CT Aorta ( )
41 Aorta angioplasty ( )
42 Aorta angioplasty ( ) 035 Termo wire & Powerflex 5 X 40mm
43 Aorta angioplasty ( ) UK infusion (5000U/hr for 12 hrs)
44 Aorta angioplasty ( ) Taewoong Vascular Stent 28 x 60mm & Jailed Lt renal artery
45 Aorta angioplasty ( ) Cordis PTCA Guiding cath 6F JR3.5 PTCA G/W 014 CONQUEST
46 Aorta angioplasty ( ) PTCA BALLOON SPRINTER 4.0x20, ENDEAVOR 4.0x18
47 Aorta angioplasty ( ) Peripheral Genesis stent 8 x 39 mm PTA BALLOON UTD 8 X40 mm Final angiography
48 Case 7 Aorta -antegrade approach, intraluminal approach-
49 F / 48 # C.C : Intermittent Claudication (Fontain IIb) D : 10 months PHx : NSTEMI, CAOD (1-VD) PTCA stent insertion at plad both iliac artery total occlusion 2nd stage PTA failed P.Ex : BP 140 / 80 mmhg Lab : BUN / Cr TC/TG/ HDL/ LDL HR 80 /min 10.7 / 0.7 mg/dl 151/ 132/ 76/ 63 mg/dl
50 PVR ( )
51 PTA ( ) Total occlusion Lt CIA, Rt EIA UTD 5X60mm Balloon
52 PTA ( ) UTD 5X60mm Balloon
53 PTA ( ) Smart control stent 8x100mm Peripheral Genesis stent 7x39 mm
54 PTA ( ) Final Angiography
55 Spectrum of Peripheral Arterial Disease Claudication Lim b-threatening Ischem ia "Norm al Fatigue, Heaviness M ild M oderate- Severe Rest pain Poor wound healing Im pending or overt gangrene Worsening flow limitation
56 5 P s s ; pulselessness,, pain, pallor, paresthesias,, paralysis Acute limb ischemia Intermittent claudication Chronic limb ischemia
57 SFA Angioplasty: Acute and Late Clinical Results Aorto-iliac SFA/popliteal Infrapopliteal Acute 95-97% 72-95% 65-87% Late (1-3 3 yr) 85-93% 47-60% 35-60% JVS 2000
58
59 Case 4 Popliteal artery -antegrade approach, intraluminal approach-
60 KJI M/46 (# ) C.C: Claudication for 3 weeks (Fontaine Class IIb) PHx : Other involved vessels : Rt, distal SFA to politeal artery stenosis PTA with stent ( ) Atherosclerotic risk factors : Hypertension(-), Diabetes(-), Smoking(-), Age(-), Male(+) Current medications : Aspirin, plavix,vessel Due, berasil, coumadin 2.5 mg Lab : BUN/Cr 12.0/0.9 mg/dl T.chol/TG/ HDL/LDL 183/52/47/143 mg/dl
61 Lower Extremity CT Angiography Patent Rt. popliteal artery stent. Occlusion of ATA and PTA with prominent peroneal artery Stenosis with focal dissection at Lt.popliteal artery.
62 KJI M/46 (# )
63 KJI M/46 (# ) Peripheral angiography, Lt
64 KJI M/46 (# ) Power flex 5*4 SMART 6*40 mm Adjuvant powerflex 5*4
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