[MO-25] Presentation Awards
A successful GACHON technique case to left Popliteal ALI
Case is 64 years female with ESKD(eGFR=15). She had hospitalized with complaint of left leg sharp pain for one week at rest, numbness, feeling of cold. ABI revealed 0.41 at left leg and doppler echography revealed clot-related occlusion at left popliteal artery. We judged acute limb ischemia(ALI). Because skilled surgeon was not caught on a holiday, and Fogarty clot exclusion method was not able to take effect, so we performed emergent Angiography and EVT. Angiography also revealed total occlusion at left politeal artery. The clot direct absorption by 6FrGC(Autobahn) was invalid, but 0.035inch radifocus wire could be easily crossed to the distal site. Run off to the distal site was slightly recovered after sequential POBA with 2.5mm size balloon both to PTA and ATA. So we tried thrombectomy therapy by Urokinase using Lumine catheter, but was invalid. IVUS revealed popliteal artery had large vessel size about 8.0mm, so we judged it necessary of expanding with a bigger size balloon while recongnizing that there was the peripheral embolic risk. We deliveried two Filtrap3.5mm wire both to PTA and ATA and, dilated 5.0mm size balloon at popliteal artery. After that we confirmed that mobility came out to the clot of the popliteal artery, so we decided to perform GACHON(Glab A Clot and Hold ON) technique. We slightly started to expand Protege stent 8.0/100mm from part of TPT, and slowly pulled up to Popoliteal artery, SFA distal. By contrasting, we comfirmed all the clots of the popliteal artery domain disappeared before expanding stent, and after full-expansion, we also comfirmed fullcovering all of the clot, slow fow was not recognized. After that, we suffered from collection of Filtrap wire picked up with a stent, but bailed out, and finally succeed to get good run off without any thromboembolic event.