Crossing complete occlusion of the right common iliac artery | Figure 1

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Crossing complete occlusion of the right common iliac artery in Patient who has disabling claudication. My approach was from the left brachial artery after failure of crossing the occlusion from the ipsilateral femoral artery. Then I snared the wire from the common femoral artery to do intervention from there. Alhamdollah succeeded with stenting of lesion by omnilink stent. The key 🔑 success of this case is using coaxial system which consists of destination sheath + guiding catheter 6 Fr + guiding catheter 4 Fr and treumo wire....💪



In the operating room, thromboembolism is performed with Fogarty catheter through a common femoral art, extracting an abundance of thrombi from the femoral-popliteal arterial axis. Angioplasty of the common femoral artery was also performed on the eccentric plaque area. Terrible evolution in the following 6 hours: Severe ischemia from the distal third of the leg and foot. Once again, the surgery is performed thrombectomy through pedia and posterior tibial arteries extracting organized thrombi. Successful evolution immediately.



Answers:\

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    Through the right femoral vein a 5 Fr KMP catheter and stiff Glidewire were used to cross the occluded IVC (Fig 1). However, on the left central access was not obtained, despite numerous attempts the left popliteal vein was not canalized due to the presence of hard thrombus. The left pedal vein was cannulated instead and a 5 Fr KMP catheter placed.
    Thrombolytics were initiated with heparin drip through the right femoral vein sheath at 300 units/hr and TPA through both right and left infusion catheters at 0.5 mg/hr. The patient returned to the OR the next day, and obtaining access on the left side still proved difficult. On ultrasound, no discernible popliteal vein was seen. A small superficial venous tributary was accessed and used to find a patent segment of the superficial femoral vein under fluoroscopy (Fig 2&3).

    From this access point, a 0.035 in road runner wire was advanced through a support catheter to traverse the chronic occlusion in the left common femoral vein, external iliac vein, common iliac vein, and low IVC. Next, kissing balloon angioplasty was performed on the infrarenal IVC with subsequent stent placement (Fig 4). Additional stents were placed inferiorly with good inline flow from the right and left lower extremity. (Fig 5).
    Case courtesy of:
    Student: Ben Varughese, BS
    Attending(s): David Wynne, MD
    Program/Dept(s): Baylor College of Medicine Department of Interventional Radiology



This is multifocal embolic disease without identifiable etiology. Abrupt occlusion of mid-distal R. radial artery. Multiple occlusions in proximal & mid R. ulnar & common interosseous arteries. Multiple occlusions of R. princeps pollicis & digital arteries. Abrupt occlusion of R. posterior humeral circumflex artery. Findings represent R. upper extremity embolic disease secondary to quadrilateral space syndrome. Improved flow at day 2, following Uni-Fuse® catheter placement in distal brachial artery for lysis. From Dr. Allen Swanson Jr., MD, Mayo Clinic Dept. of Interventional Radiology.



Middle age male seen a month after initial presentation for CP/NSTEMI after Initial Cath (2nd image) showed occluded circumflex and attempts to cross a short segment CTO failed, remained pain free and treated medically with normal LVEF. Referred for attempted CTO intervention due to ongoing DOE. 3rd image is CTO intervention with simultaneous injection of the left main and RCA with a catheter in LM from femoral artery and RCA catheter from radial approach showing occluded segment with retrograde filling of Lcx from RCA (yellow arrow). Able to cross antegrade and placed one stent.



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Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?