[MO-77] Presentation Awards
A case with whole iliac artery CTO lesion related to chronic aortic dissection who underwent optimal revascularization using balloon expandable covered stent
A 70-year-old female with a history of type A acute aortic dissection and total occlusion in the right CIA simultaneously about 30 years ago was referred to our department for severe intermittent claudication of the right lower extremity. Contrast CT revealed the total occlusion from the ostium of the right CIA to the distal right external iliac artery (EIA). Because of the remaining dissection in the descending aorta, only transfemoral endovascular treatment was planned. A 6-Fr sheath was inserted through the right common femoral artery (CFA) as a retrograde approach. Although using IVUS guided wiring, 0.014/18 inch guidewires easily proceeded into the subintimal space, and the dissection lumen was rapidly expanded. A bi-directional approach was an only treatment option in such a situation. Therefore, the guiding catheter was adjusted in the proximal stump of the right CIA via the left CFA as an antegrade approach, a 0.014 inch CTO guidewire was managed to cross into the obstruction, and finally advanced into the retrograde microcatheter. IVUS Imaging revealed the guidewire passing through the dissection lumen in the entire EIA and the intimal plaque in the whole CIA, respectively. Without pre dilatation considering the possible risk of rupture, two pieces of 7.0/79 mm balloon expandable covered stent “VBX ® were implanted with overlap from the just proximal-CIA to EIA. Following post-dilatation with a 10.0 mm balloon for the proximal side, the final angiogram revealed an optimal result without any complication. We experienced a rare case with CIA-CTO occurred with aortic dissection who successfully underwent optimal revascularization using balloon expandable covered stents in the long-term stage.