[MO-81] Presentation Awards
Successful of hybrid revascularization in TASC D AIOD Aortic aneurysm occlusion plus bilateral iliac artery occlusion by applying standard EVAR device
Objective: we describe the hybrid revascularization technique for treatment of TASC D AIOD
Method: Review technique of this case
Result: A 76 year-old male with history of HT and dyslipidemia present with disabling claudication both legs for 6 months. ABI of Rt. leg and Lt. Leg were 0.51 and 0.50. CTA showed CTO of small size of AAA with 3.5 cms in maximal diameter and CTO of bilateral Iliac artery with severe stenosis of bilateral CFA. Patient was revascularized with hybrid-endovascular technique. We access from Rt. brachial artery (cutdown) via 6 Fr long sheath.We used 0.035 hydrophilic guidewire to make loop by continually rotating and advancing guidewire, 5-Fr catheter and 6 Fr. Long sheath subintimally through the occlusion into Lt.CFA. Lt.CFA was cut down. Then hydrophilic guide wire was substituted with supracore wire. 6 Fr. long sheath was taken out from Rt. brachial artery and then inserted again. Then 0.035 hydrophilic guidewire was again used with the same technique through the occlusion into Rt.CFA. Hydrophilic guide wire was substituted with stiff guide wire. Standard EVAR device & CERAB concept were applied in this situation. Abdominal aorta and bilateral iliac artery were predilated with Admiral balloon then Endurant II extension cuff stent graft was deployed below Lt. Renal artery. Endurant II limb graft were deployed in bilateral CIA. Lifestream stent graft were deployed in bilateral EIA. And Everflex stent were deployed down to bilateral distal EIA. Bilateral common femoral endarterectomy were made and bilateral CFA were closed with saphenous vein patch. Completion angiography showed technically successful of this hybrid revascularization. CTA at 3 month & 9 month after operation show patent all of the stent.
Conclusions: Hybrid revascularization is safe for TASC D AIOD with good early outcome.
Method: Review technique of this case
Result: A 76 year-old male with history of HT and dyslipidemia present with disabling claudication both legs for 6 months. ABI of Rt. leg and Lt. Leg were 0.51 and 0.50. CTA showed CTO of small size of AAA with 3.5 cms in maximal diameter and CTO of bilateral Iliac artery with severe stenosis of bilateral CFA. Patient was revascularized with hybrid-endovascular technique. We access from Rt. brachial artery (cutdown) via 6 Fr long sheath.We used 0.035 hydrophilic guidewire to make loop by continually rotating and advancing guidewire, 5-Fr catheter and 6 Fr. Long sheath subintimally through the occlusion into Lt.CFA. Lt.CFA was cut down. Then hydrophilic guide wire was substituted with supracore wire. 6 Fr. long sheath was taken out from Rt. brachial artery and then inserted again. Then 0.035 hydrophilic guidewire was again used with the same technique through the occlusion into Rt.CFA. Hydrophilic guide wire was substituted with stiff guide wire. Standard EVAR device & CERAB concept were applied in this situation. Abdominal aorta and bilateral iliac artery were predilated with Admiral balloon then Endurant II extension cuff stent graft was deployed below Lt. Renal artery. Endurant II limb graft were deployed in bilateral CIA. Lifestream stent graft were deployed in bilateral EIA. And Everflex stent were deployed down to bilateral distal EIA. Bilateral common femoral endarterectomy were made and bilateral CFA were closed with saphenous vein patch. Completion angiography showed technically successful of this hybrid revascularization. CTA at 3 month & 9 month after operation show patent all of the stent.
Conclusions: Hybrid revascularization is safe for TASC D AIOD with good early outcome.