[MO-21] Presentation Awards
Angiosealed outside-in
This 82 Year old female with past medical history of ESRD, ischemic bowel s/p op with colostomy was admitted because of unhealed right leg wound with severe pain for 3 months.
ABI of right leg was 0.46. Angiography showed diffuse stenosis over proximal SFA, total occlusion of middle SFA, diffuse stenosis of popliteal artery and total occlusion of below knee vessels.
We performed ipsilateral CFA puncture with antegrade approach. SFA was treated with balloon dilatation and stents(Everflex 6x12/Everflex7x12/ Everflex 7x6).Balloon dilatation for popliteal artery and PA(supplying collaterals to foot) were done with acceptable final blood flow. The puncture site was angio-sealed with suboptimal result and manual compression was applied to achieve hemostasis.
The next day morning , relatively cold limb was noticed. Echo demonstrated a target sign with one round mass in SFA. We performed angiography again from contralateral CFA with long sheath and it showed total occlusion of SFA and lumen narrowing of DFA.
Angioseal collagen related vessel occlusion was suspected. The collagen plug overrode on the bifurcation of SFA and DFA. It was difficult to retrieve it with snare or fully dilate the vessel with ballooning. We then re-wired SFA, dilated and stented the collagen occupying site to restore the flow. Final angiography showed acceptable blood flow to foot.
ABI of right leg was 0.46. Angiography showed diffuse stenosis over proximal SFA, total occlusion of middle SFA, diffuse stenosis of popliteal artery and total occlusion of below knee vessels.
We performed ipsilateral CFA puncture with antegrade approach. SFA was treated with balloon dilatation and stents(Everflex 6x12/Everflex7x12/ Everflex 7x6).Balloon dilatation for popliteal artery and PA(supplying collaterals to foot) were done with acceptable final blood flow. The puncture site was angio-sealed with suboptimal result and manual compression was applied to achieve hemostasis.
The next day morning , relatively cold limb was noticed. Echo demonstrated a target sign with one round mass in SFA. We performed angiography again from contralateral CFA with long sheath and it showed total occlusion of SFA and lumen narrowing of DFA.
Angioseal collagen related vessel occlusion was suspected. The collagen plug overrode on the bifurcation of SFA and DFA. It was difficult to retrieve it with snare or fully dilate the vessel with ballooning. We then re-wired SFA, dilated and stented the collagen occupying site to restore the flow. Final angiography showed acceptable blood flow to foot.