Successful endovascular treatment with GuideLiner catheter of chronic aortic occlusion with severe calcification
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CASE REPORT
Successful endovascular treatment with GuideLiner catheter of chronic aortic occlusion with severe calcification Hiroshi Kubota1 • Taku Kato1 • Tetsuya Nomura1 • Natsuya Keira1 Tetsuya Tatsumi1
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Received: 5 October 2015 / Accepted: 5 January 2016 Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract An 80-year-old Japanese woman was referred to our department because of bilateral intermittent claudication. Diagnostic angiography and computed tomography revealed total occlusion with severe calcification in the terminal aorta and bilateral common iliac arteries. We performed endovascular treatment. Although a guidewire antegradely passed the occlusive lesion of the left CIA, no balloon or microcatheter could pass the lesion. Therefore, we used the GuideLiner catheter to facilitate balloon catheter delivery. The GuideLiner catheter advanced into the occlusive lesion, and the balloon crossed the lesion. This is a first report of the use of the GuideLiner catheter in peripheral intervention. Keywords Aorto-iliac artery Chronic total occlusion Endovascular treatment Calcification
Introduction Although favorable results of endovascular treatment (EVT) in aorto-iliac lesions have been reported [1–3], EVT for complex lesions, especially chronic total occlusion (CTO) with severely calcified lesion, still remains challenging. The GuideLiner catheter (Vascular Solutions, MN, USA) has been widely used for complex coronary intervention in other countries [4, 5], and it became available in Japan in 2014. This catheter is a rapid-exchange child
& Taku Kato [email protected] 1
Department of Cardiovascular Medicine, Nantan General Hospital, 25 Yagi-Ueno, Yagi-cho, Nantan, Kyoto 629-0197, Japan
catheter that increases the backup force and facilitates device delivery. This case report demonstrates the usefulness of the GuideLiner catheter in peripheral intervention, especially in the treatment of complex lesions.
Case report An 80-year-old Japanese woman with hypertension was referred to our department because of bilateral intermittent claudication. The patient had been aware of intermittent claudication (Rutherford class 3) for more than 10 years. The ankle brachial blood pressure index (ABI) at rest was 0.42 on the right side, and 0.61 on the left side. Duplex ultrasound suggested an obstructive pattern in the bilateral common iliac artery (CIA). Plain computed tomography showed a tortuous descending aorta (Fig. 1a) and severe calcifications in the aorto-iliac bifurcation, especially in the bilateral CIA (Fig. 1b, c). Diagnostic angiography showed total occlusion of the terminal abdominal aorta and bilateral CIA (Fig. 1d). Endovascular treatment for this chronic total occlusion (CTO) lesion was performed. We inserted a 6-Fr 95-cm guiding sheath (Parent plus; Medikit, Tokyo, Japan) from the left brachial artery, and 6-Fr sheaths from the bilateral femoral artery. Firstly, we started retrograde wiring of the right side. A 0.018-in. Astato wire (Asahi Intecc, Aichi, Japan) re
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