Iliac Occlusions Managed with Endovascular Interventions Aravinda Nanjundappa

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Iliac Occlusions Managed with Endovascular Interventions Aravinda Nanjundappa, MD, FSCAI, RVT Associate Professor of

Iliac Occlusions Managed with Endovascular Interventions Aravinda Nanjundappa, MD, FSCAI, RVT Associate Professor of Medicine and Surgery West Virginia University Charleston, WV

Disclosure • Paid Speaker § Bristol Mayer Squib § COOK

Disclosure • Paid Speaker § Bristol Mayer Squib § COOK

Case 1 • 72 yr old male with HTN, hypercholesterolemia, CAD, s/p CABG, obesity,

Case 1 • 72 yr old male with HTN, hypercholesterolemia, CAD, s/p CABG, obesity, tobacco use, DVT, PE presents with non healing right leg ulcer 3 months • Baseline angiogram showed right CIA, EIA and proximal CFA occlusion

Baseline Angiogram

Baseline Angiogram

Baseline Angiogram

Baseline Angiogram

How to approach? • Access from left CFA • Bio-cardia Flex catheter • Terumo

How to approach? • Access from left CFA • Bio-cardia Flex catheter • Terumo wire • Glide 5 Fr MP catheter • Ipsilateral 8 Fr Short sheath

Technique 6 x 40 Balloon • Bilateral 25 cm Bright tip sheaths • 9

Technique 6 x 40 Balloon • Bilateral 25 cm Bright tip sheaths • 9 x 59 mm BE stents • Unsheath stents • Deploy at nominal pressures Distal SFA

Kissing stents 9 x 59 Stents

Kissing stents 9 x 59 Stents

Leg ulcer before and after

Leg ulcer before and after

Case 2 • 52 yr old with history of HTN, smoking, high cholesterol levels

Case 2 • 52 yr old with history of HTN, smoking, high cholesterol levels PAD S/P left EIA stent one year ago • Left leg claudication • ABI was 0. 48

Baseline Angiogram Occluded left CIA

Baseline Angiogram Occluded left CIA

Crossing lesion

Crossing lesion

Balloon inflation with Proteus Balloon

Balloon inflation with Proteus Balloon

Final results

Final results

Case 3 • 72 yr old with right leg claudication • ABI 0. 70

Case 3 • 72 yr old with right leg claudication • ABI 0. 70 • Persistent symptoms despite medical treatment

Baseline Images

Baseline Images

Right femoral access

Right femoral access

Brachial Access

Brachial Access

Final Angiograms

Final Angiograms

Case • 73 yr old female with history of colon carcinoma opted not to

Case • 73 yr old female with history of colon carcinoma opted not to be treated x 2 years • Presented with blue toes to the ER • Absent bilateral femoral pulse with right femoral faint bruit • ABI 0 left leg and 0. 2 right leg • Duplex Ultrasound showed bilateral CFA monophasic flow and reconstitution of bilateral SFA

Baseline Imaging

Baseline Imaging

Runoff

Runoff

Successful Left CFA access Proteus Balloon Inflation Balloon Involution

Successful Left CFA access Proteus Balloon Inflation Balloon Involution

Post Angioslide

Post Angioslide

Angioslide

Angioslide

Final Angiogram

Final Angiogram

Conclusions • Iliac occlusions can be approached with ipsilateral CFA access or contra lateral

Conclusions • Iliac occlusions can be approached with ipsilateral CFA access or contra lateral femoral • Brachial access is beneficial in failed femoral • Reentry catheter maybe useful • Raise bifurcation 3 to 5 mm above the iliac origin • Simultaneous kissing stents

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