[MO-55] A case of angioscopy-guided hybrid EVT for SFA chronic total occlusion in patient with anti-phospholipid antibody syndrome.
35 years old man, underwent partial resection of small bowel because of superior mesenteric artery thrombosis. Laboratory analysis revealed a diagnosis of anti-phospholipid antibody syndrome (APS). He was suffered from intermittent claudication in the hospital from about one month ago. His left ABI could not be evaluated. Contrast-enhanced computed tomography showed total occlusion in left superficial femoral artery (SFA). APS is a condition that manifests as arterial thrombosis. So he underwent hybrid endovascular treatment (Surgical fogarty catheter thrombectomy＋EVT) to the occluded left SFA.
An ipsilateral femoral was cut-down. A 0.014-inch guidewire Cruise couldn’t pass the CTO entrance. So we used Truepath. The first few centimeters at CTO beginning into intraplaque using angioscopy-guided wiring with a Truepath. And Truepath was switched for Cruise. The knuckle wire technique using a Cruise was conducted through the mid CTO lesion. But IVUS showed that the wire passed through the subintimal lumen. So we performed combination wiring with IVUS guide and angioscopy guide through the distal CTO lesion. After the wire was crossed through the CTO lesion, the wire was replaced by a Filtrap wire for distal protection. Next, we did thrombectomy used by a Fogarty catheter. And a non-complaiant balloon was inserted for ballooning to break any residual thrombus. The final angiography showed a good result without any complications. The lesion was suspected of a thrombotic lesion rather than an arteriosclerotic lesion from the patient’s background, so we used an angioscopy for observation and wiring. It was very useful for knowing the nature of the lesion.
Usually we perform EVT with IVUS guide in our facility. Getting intravascular information by IVUS often leads to good results. But the angioscopy provide different intravascular information than IVUS. We would like to share the findings and possibilities of the angioscopy with the cardiovascular interventional doctors.
An ipsilateral femoral was cut-down. A 0.014-inch guidewire Cruise couldn’t pass the CTO entrance. So we used Truepath. The first few centimeters at CTO beginning into intraplaque using angioscopy-guided wiring with a Truepath. And Truepath was switched for Cruise. The knuckle wire technique using a Cruise was conducted through the mid CTO lesion. But IVUS showed that the wire passed through the subintimal lumen. So we performed combination wiring with IVUS guide and angioscopy guide through the distal CTO lesion. After the wire was crossed through the CTO lesion, the wire was replaced by a Filtrap wire for distal protection. Next, we did thrombectomy used by a Fogarty catheter. And a non-complaiant balloon was inserted for ballooning to break any residual thrombus. The final angiography showed a good result without any complications. The lesion was suspected of a thrombotic lesion rather than an arteriosclerotic lesion from the patient’s background, so we used an angioscopy for observation and wiring. It was very useful for knowing the nature of the lesion.
Usually we perform EVT with IVUS guide in our facility. Getting intravascular information by IVUS often leads to good results. But the angioscopy provide different intravascular information than IVUS. We would like to share the findings and possibilities of the angioscopy with the cardiovascular interventional doctors.