The role of DCB in SFA subintimal tracking lesion
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1 The role of DCB in SFA subintimal tracking lesion Wei-chun Chang M.D. Wen-Lieng Lee, MD, PhD Cardiovascular Center, Taichung Veterans General Hospital, Taiwan R.O.C
2 Disclosure Speaker name:... 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 Clinical Evidence From literature review: IMPACT SFA 2- year outcome and LEVANT2, DCB in FPD diastase is promising but all lesions are intra-luminal approach. The data about DCB effect in SFA subintimal tracking lesion is very limited.
4 DCB Sub-intimal Potential Performance DCBATE-SFA Randomized Trial
5 Drug-Eluting Balloon in Peripheral Intervention for Below the Knee Angioplasty Evaluation (DEBATE-BTK) Francesco Liistro et al. Circulation. 2013;128:
6 Lesson from DEBATE-BTK trial There should be a one-to-one ratio between the DEB and the vessel. It is not worth it to oversize the balloon with respect to the vessel diameter, because on follow-up, we could see in 3% of the cases that there is an ectatic effect from the drug delivery in the vessel.
7 DCB in A Case of Femoropopliteal PAD with Subintimal Tracking EVT
8 Case Sharing 21 y/o man with intermittent claudication of right leg for months. PAD, Right leg post surgical thrombolectomy on April 14 th, 2015, and popliteal pseudoaneurysm untreated. successful PTA to ATA (POBA, Export aspiration thrombectomy, local thrombolytic therapy) and PTA (POBA, Export aspiration thrombectomy, local thrombolytic therapy) on April 25 th, Protein C/Protein S/Antithrombin-III deficiency with wafarin (INR: 1.6) and cilostazol
9 Case Sharing Recurrent PAD, Right leg post successful POBA + Impact Admiral DCB x2 of R't SFA ostial to middle long CTO with bi-directional technique; successful POBA+ Impact Admiral DCB of R't SFA-D to TP trunk CTO; successful POBA of ATA-P and Peroneal- P on Nov. 27 th, Terminal ileum ulcer with active bleeding after EVT Pseudo-aneurysm of left CFA (puncture site) s/p surgical repair in Jan.18 th, Recurrent pseudo-aneurysm of SFA M, right after surgical repair of pseudo-aneurysm of left CFA
10 First PTA for Thromboembolism of ATA/PTA
11 Before PTA PTA+ CDT with UK After PTA
12 Recurrent PAD 7 months later
13 Cross-over EVT Backend of control V-18 after failed crossing with Victory 30gm Subintimal tracking with control V-18 Suppored with Pacific 4.0mmx15cm
14 Retrograde Puncture of D-SFA
15 Angio of SFA after POBA a BC-assisted hemostasis
16 Pop to TP trunk CTO Subintimal tracking with V-18
17 EVT in BTK Victory 30gm in Peroneal artery RegaliaXS in ATA with Crusade support
18 BTK Angio KBT of ATA and TP trunk
19 Final Angio Three Impact Admiral DCB: SFA-ostium to Popliteal artery
20 But. Massive GI bleeding with Terminal ileal Uncer (Hb:12>6) A Pseudo-aneurysm of left CFA
21 Jan. 18th, 2016 Left femoral artery repair, interposition with 8mm ringed PTFE graft 1 cm in length.
22 Jan. 24th, 2016
23 Viabahn 7mmx10cm surgical cutdown via R t CFA on Feb. 4th, 2016 Progressive enlargement of pseudoaneurysm (2.1cm 4.7cm)
24 Hospital Course Possible Behcet's disease with GI and vascular involvement. Skin biopsy of erythema nodosum of right leg: favored vasculitis Ileocecal ulcer: four
25 Hospital Course PET scan: severe vasculitis of lower extremites Steroid and Endoxan pulse therapy
26 Discussion From DEBATE SFA trial, DCB effect is positive irrespective of the recanalization approach (true lumen vs. subintimal) and no arterial aneurysm due to DCB was reported. The Global SFA Registry of LUTONIX DCB: Preliminary safety information from the 437 patients enrolled indicates that the most frequent SAEs are pseudoaneurysm (0.7%, 3/437) and Occlusion/Closure (0.7%, 3/437).
27 Conclusion We reported a rare case of young PAOD treated with subintimal approach and DCB, but multiple pseudoaneurysm developed after procedure. The location of pseudoaneurysm is not related to DCB. Finally, vascular Behcet s disease is diagnosed and we treated the complication by hybrid procedure with surgical repair/viabahn stenting. The main strategy of treatment is medication of immunosupressants.
28 Thank You for Attention!
29 The role of DCB in SFA subintimal tracking lesion Wei-chun Chang M.D. Wen-Lieng Lee, MD, PhD Cardiovascular Center, Taichung Veterans General Hospital, Taiwan R.O.C
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