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How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and Interventional Radiology Konkuk University Hospital, Seoul, Korea

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Page 1: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

How to Manage Complications during BTK Intervention

Sang Woo Park, MD PhD

Director, Konkuk Limb Vascular Center

Professor, Vascular and Interventional Radiology

Konkuk University Hospital, Seoul, Korea

Page 2: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Disclosure

Speaker name: Sang Woo Park

.................................................................................

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interestV

Page 3: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Complications during BTK intervention ?

• Common / Rare

: Vascular Spasm

: Dissection (Flow limiting)

: Perforation

: Breakdown (Cut) of Guide wire

: Distal thromboembolism

: Cx of puncture site in case of retrograde access

Page 4: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Vascular Spasm

• M/60 / DM

• Ulcer in dorsum of Rt foot & chronic resting pain in Lt foot (du: 1~2 years)

Page 5: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Vascular Spasm

• 2.5mm/12cm balloon catheter

Page 6: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Vascular Spasm

• 2.5mm/12cm balloon catheter • NTG through balloon catheter

Page 7: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Vascular Spasm

• M/72

• DM

• Chronic resting pain in left foot (du:

several years)

• Current aggravation of pain and

discoloration after acupuncture (du:

7D)

Page 8: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Vascular Spasm

Urokinase 1,500,000 IU / 15 hr + Stent-graft in popliteal artery

Page 9: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Vascular Spasm

• NTG and Eglandin injection through 5Fr sheath with balloon angioplasty

Page 10: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Vascular Spasm

• After 15min inflation of same sized balloon catheter

Page 11: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Dissection

• M/69 / DM & HTN / Resting pain and coldness in Lt foot

Page 12: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Dissection• 2.5mm/12cm balloon catheter / 15min inflation

Page 13: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Dissection

Page 14: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Dissection

@ 14 month

• Cypher select stent 3mm/18mm (Cordis)

Page 15: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Perforation

• M/54. DM. Ulcer in Rt big toe.

Page 16: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

PerforationDifferent Channel of Subintimal Tract.

Page 17: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Perforation

• M/70. DM. Gangrenous change in left 4th toe.

Page 18: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Perforation

External compression by bandage

Page 19: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Perforation

Page 20: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Perforation• F/88. DM. Resting pain in left foot

0.035-Hydrophilic GW during Stenting

Page 21: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Perforation

Microcatheter and Gelfoam

Page 22: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Disconnection of GW

• F/79. DM. Ulcer in both feet

Subintimal pass of 0.016 GW

Goose neck snare

Page 23: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Disconnection of GW

• M/59. DM. Resting pain in both feet

Page 24: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Disconnection of GW

• M/59. DM. Resting pain in both feet

Page 25: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Distal thromboembolism

• F/79. DM. Ulcer in both feet

Page 26: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Distal thromboembolism

• 2.5mm/12cm balloon catheter / 10min inflation

• 5Fr Guiding catheter

Page 27: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Cx of puncture site in retrograde access

• M/77. DM. Resting pain and coldness in right foot

Page 28: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Cx of puncture site in retrograde access

• 2.5mm/22cm balloon catheter / 15min inflation

External compression for 10min

Page 29: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Conclusion

• Complications during BTK intervention

: Not common & Not rare, esp. perforation

: Almost completely recovered

: Management of Complication First Consideration Limb salvage

Page 30: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

Thank you for your attention

Page 31: How to Manage Complications during BTK …...How to Manage Complications during BTK Intervention Sang Woo Park, MD PhD Director, Konkuk Limb Vascular Center Professor, Vascular and

How to Manage Complications during BTK Intervention

Sang Woo Park, MD PhD

Director, Konkuk Limb Vascular Center

Professor, Vascular and Interventional Radiology

Konkuk University Hospital, Seoul, Korea


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