angiovis 2007 clinical casesangiovis.org/pdfs/examples.pdf · 2009. 11. 10. · dsadsa pta...
TRANSCRIPT
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CLINICAL CASE 1 (VIL):72 yar old woman with intermittent claudication right>left. Past medical history significant for prior PTA of right SFA/POP arteries.
CTA 09-SEP:• focal narrowing of infrarenal aorta (non-calcified plaque)LEFT:• mild and moderate diffuse disease of left SFA• tibio-peroneal trunk and PTA disease, PER occlusionRIGHT: •diffuse disease in right SFA with focal dissection in distal SFA/POP artery which results in a high-grade stenosis.•mild to moderate focal stenosis of ATA origin. PTA and PER arteries are occluded
Treatment plan:percutanous angioplasty/stent of right femoropopliteal artery.
DSA / PTA 10-SEPBallon angioplasty (5mm/8cm) and stent placement (6mm/10cm) in dissected segment.
MIP
ANGIOVIS 2007CLINICAL CASESANGIOVIS 2007CLINICAL CASES
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CASE 1 (continued)
Mul
tiPat
h-C
PR;
thin
, str
etch
ed (c
lose
-up,
w ri
ght l
eg s
how
n on
ly)
DSA
Mul
tiPat
h-C
PR;
thin
, str
etch
ed
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CLINICAL CASE 2 (WAE):73 yar old woman with intermittent claudication bilaterally
CTA 14-OCT:• mildly ectatic CIA bilaterallyLEFT:• diffuse disease w mult dilatations and stenosis of left EIA • diffusely diseases left SFA• short (2cm) sub-total occlusion of distal fem/pop segment.RIGHT: • SFA occlusion (>20cm)
Treatment plan:percutanous angioplasty/stent left ext.iliac and fem-pop arteryconsider surgical revscularization of right lower extrmity (fem-pop bypass).
DSA / PTA 15-OCT:Ballon angioplasty (8mm/4cm) and stent-PTA (10mm/6cm) left EIA, recanalization and PTA (4mm/4cm) of left fem-pop a.
MIP
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Case 2 (continued)
Mul
tiPat
h-C
PR;
3mm
thi
ck, p
roje
cted
DSAThi
nCPR
Left,
str
etch
ed
post PTA
post PTA /stent
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CLINICAL CASE 3 (HAH):59 yar old man with intermittent claudication bilaterally.Past medical history significant for prior Stent-PTA of right EIA.
CTA 25-OCT:AORTA/ILIAC: • Extensively calcified plaque within the distal aorta, extending into the left CIA with significant aortoiliac stenosis. • The right EIA stent is patent, however, there is a small shell of calcium obstructing the proximal end of the stent.LEFT: • long SFA occlusion w. numerous collaterals.RIGHT: • long SFA occlusion w. numerous collaterals.
Treatment plan: Percutaneous treatment of inflow disease.
DSA / PTA 27-OCTBallon angioplasty and "kissing" stent placement in bilaterl aortoiliacarteries (10mm/4cm and 10mm/6cm), stent PTA of right EIA (10 mm/3cm).
MIP
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Case 3 (continued)
MultiPath-CPR; thin, stretched
DSA
ThinCPRRight, stretched
post
ki
ssin
g st
ent
pre-
PTA
/re-s
tent
of
sten
t-ste
nosi
s
MultiPath-CPR; thin, stretched, close-up
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CLINICAL CASE 4 (ALF):81 year old woman with PAOD (Fontain stage IV) of right lower extremity. Past medical history significant for prior above-knee amputation of left lower extremity.CTA 20-DEC:Maximum intensity projeced (MIP) and thin, stretched curved planar reformation (CPR) through the right popliteal artery demonstrate a high-grade (99%) stenosis with collaterals in the supragenual poplitea segment.
DSA / PTA 21-DECSelective DSA, performed on the following day (with guide-wire in place), shows a 5cm occlusion (caused by the guide-wire passing through the high-grade stenosis), which is treated by balloon angioplasty (4mm/8cm).
MIP
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MIP
Thin
CPR
Rig
htst
retc
hed
DSADSA PTA (4mm/8cm)PTA (4mm/8cm)
Case 4 (continued)
Mul
tiPat
h-C
PR;
thin
, str
etch
ed