Successful transcollateral approach for chronic total occlusion of the superficial femoral artery using a side-hole sheath
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1 Successful transcollateral approach for chronic total occlusion of the superficial femoral artery using a side-hole sheath Tokyo Kenta Onodera 1, Yasuhiro Takahashi 1, Reiko Shiomura 1, Hiroki Goda 1, Isamu Fukuizumi 1, Taisuke Sato 1, Wataru Shimizu 2 1. Department of Cardiology, 2. Department of Cardiovascular Medicine, Nippon Medical School
2 Disclosure Speaker name: Kenta Onodera I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 Case A 63-year-old man with a history of diabetes mellitus and dyslipidemia presented to our hospital with claudication. Magnetic resonance imaging previously performed at another hospital revealed severe stenosis of his bilateral external iliac arteries (EIAs) and chronic total occlusion (CTO) of his bilateral superficial femoral arteries (SFAs). Ankle brachial index measured 0.52 and 0.53 at rest on the right and left side, respectively. He successfully underwent endovascular treatment (EVT) of both EIAs and the right SFA, and then was readmitted to our hospital for EVT of the left SFA.
4 Case
5 Strategy Approach: Ipsilateral antegrade approach Sheath: Side-hole sheath Guidewire crossing: Antegrade approach through the side hole Transcollateral approach Distal femoral puncture (Omote-pun) Image guidance: Transvenous intravascular ultrasound (IVUS)
6 Side-hole sheath (RIKISHI H 3 K 2 ) Stainless steel pipe 2.0 mm 10 mm diameter side hole Tapered tip with a inch guidewire lumen Skin fixing sleeve Detachable Y-connector
7 Conventional ipsilateral antegrade approach SFA CTO CFA DFA
8 Conventional ipsilateral antegrade approach SFA CTO CFA DFA
9 Conventional ipsilateral antegrade approach SFA CTO CFA DFA
10 Conventional ipsilateral antegrade approach SFA CTO CFA DFA
11 Conventional ipsilateral antegrade approach SFA CTO CFA DFA
12 Side-hole sheath (RIKISHI H 3 K 2 ) SFA CTO CFA DFA
13 Case
14 Case
15 Case SFA Support catheter: Rubicon Guidewire: Chevalier 14 Tapered 30 g DFA Bifurcation of SFA and DFA
16 Case
17 Strategy Approach: Ipsilateral antegrade approach Sheath: Side-hole sheath Guidewire crossing: Antegrade approach through the side hole Transcollateral approach Distal femoral puncture (Omote-pun) Image guidance: Transvenous IVUS
18 Transcollateral approach by using a side-hole sheath SFA CTO DFA CFA
19 Case Transcollateral approach Support catheter: Prominent standard Guidewire: Cruise inch 300 cm
20 Case Transcollateral approach Support catheter: Prominent standard Guidewire: Cruise inch 300 cm
21 Case Transcollateral approach Support catheter: Prominent standard Guidewire: Halberd inch
22 Case
23 Case
24 Case
25 Case Rendezvous Retrograde: Chevalier 14 Tapered 30g Antegrade: Rubicon inch
26 Case Sterling Rx 5.0 mm/220 mm
27 Case Final angiography After the treatment Improvement of claudication Left ABI :
28 Discussion It s generally difficult to use the transcollateral approach in the treatment of the SFA CTO. SFA CTO CFA DFA Crossover approach
29 Discussion It s generally difficult to use the transcollateral approach in the treatment of the SFA CTO. SFA CTO DFA CFA Ipsilateral antegrade approach
30 Discussion A side-hole sheath features a side hole 7 cm from the tip. Antegrade guidewire crossing is performed through the side hole and the tip of the sheath is inserted in the DFA. SFA CTO DFA CFA
31 Conclusion A side-hole sheath was very useful in the treatment of CTO of the SFA using a transcollateral approach.
32 Sumida River Fire Works Festival Tokyo Skytree (634 m) Sumo Stadium Hokusai s birth place and the Sumida Hokusai Museum
33 Successful transcollateral approach for chronic total occlusion of the superficial femoral artery using a side-hole sheath Tokyo Kenta Onodera 1, Yasuhiro Takahashi 1, Reiko Shiomura 1, Hiroki Goda 1, Isamu Fukuizumi 1, Taisuke Sato 1, Wataru Shimizu 2 1. Department of Cardiology, 2. Department of Cardiovascular Medicine, Nippon Medical School
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