[POSTER] Poster session

[MP-13] Bi-femoral approach EVT for CLI case of Iliac and Femoral double CTO

Takefumi Ozaki (Sapporo Orthopaedics Cardiovascular Hospital)

This case is 90 years-old man with limb ulcer. He was capable of standing and ambulant so far. The staff of an elderly nursing home found an intractable ulcer in his left toe and it spread rapidly. His limb Computed Tomography Angiography showed double long chronic total occlusion (CTO) of the left iliac artery (IA) and superficial femoral artery (SFA). We judged to perform revascularization therapy one stage early. However, it was considered that right femoral cross-over approach was very difficult because the iliac bifurcation angle was very narrow, and the IA was occluded at just bifurcation. We punctured into a very short segment of his left common femoral artery retrogradely with duplex-echo-guide. A 014guidewire passed the left IA-CTO retrogradely with intra-vascular-ultra-sound (IVUS) guide, and it was performed revascularization for the IA-CTO. Next, we punctured his right common femoral artery retrogradely, and a 035guidewire passed into the existing left femoral sheath by femoral-femoral pull-through. The pull-through 035wire was very strong back-up. The right femoral sheath was able to reach to his left common femoral artery with cross-over. A 014 tapered wire inserted an occluded proximal edge of the left SFA-CTO with duplex-echo-guide, and a 035 J-type guidewire with catheter passed to popliteal artery by knuckle-wire-technique. It was performed revascularization for the left SFA-CTO.
The guide sheath cross-over insertion with femoral-femoral pull-through technique could have up in very strong back-up. In addition, this duplex-echo and intra-vascular-echo guide EVT in both side femoral approach was effective to revascularization for this double long CTO case.
His limb ulcer was improved for around one month.