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Left Common Iliac Artery Lesion Treated by Stent implantation
- Operator: Kazushi Urasawa, MD
Case Presentation
The patients was a 79 year-old man with intermittent claudication of buttock for 2 years. His cardiovascular risk factors were hypertension, dyslipidemia and ex-smoking. He was diagnosed with peripheral artery disease (Left common iliac artery) by abdominal CT at another hospital. He visited Asan medical center for proper management. He was treated with percutaneous coronary intervention about 1 month ago.
Baseline coronary angiography
A total occlusion of common iliac artery and 70% stenosis of external iliac artery were revealed (Figure 1). CT angiography showed total occlusion of left common iliac artery and external artery. Segemental limb pressure with Doppler revealed decreased left ankle-brachial index and pressure drop was noted at left aortoiliac segment.
Procedural Step
A 4Fr sized sheath and a 6Fr sized sheath were inserted into the right and left femoral arteries, respectively. An Athetlteruby hard 0.014 inch wire and a Conquest pro-12 0.014 inch wire were used attempting to pass through the left common iliac artery lesion via antegrade and retrograde approach. But it was difficult to pass through the lesion. There was a dissection on follow up angiography ( Movie 1). So another 5Fr sized sheath was inserted into the left brachial artery. An Athetlteruby hard 0.014 inch wire was inserted into left brachial artery and passed through the lesion. The Virtual Histology was performed. There were many thrombi at the lesion. After that, this Athetlteruby wire was replaced with a Floppy BMW 0.014 inch wire (Figure 2). Pre-ballooning with SLEEK 3.0 x 60 mm sized balloon upto 3.0 (6 atm) was performed at left common iliac artery ( Movie 2). And then, thrombectomy was done three times. A huge red thrombus was suctioned. Additional ballooning with Aviator 6.0 x 30mm sized balloon upto 5.83 (8 atm) was performed at lesion site. And then, stenting with two Zilver 7.0 x 100mm sized stents was performed. Post-deployment balloon dilatation was performed, sequentially ( Movie 3). Final angiogram showed well-positioned stent in left common iliac artery ( Movie 4).
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