JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO.

16, SUPPL S, 2016 S347

Relevant test results prior to catheterization. ECG revealed atrial fibril-

lation, low voltage and CRBBB. Left ventricular ejection fraction was
decreased to 45%, pericardial effusion. ABI was unmeasurable, MRSA
and EXBL-producing Proteus mirabilis had been detected in the cul-
ture inspection of foot wound part. In the lower extremity arteries
duplex echographs, it was determined the 20cm chronic obstructive
lesion of left SFA, the occlusion of ATA and PTA.

Case Summary. SVC syndrome in patient with history of right upper

chest trauma, such as gunshot injury is different from conventional
case. AV fistula should be considered and may worsened clinical
symptoms of SVC syndrome. Trying to re-open an occluded SVC is
usually difficult and carries a significant risk of vessel perforation and
injury to nearby structures. In this patient, the occluded SVC was
reopened with end-tip of V-18 GW under guidance of contralateral
jugular vein injection. The AV fistula was closed successfully with
coil. His symptoms improved remarkably.

TCTAP C-205
Duplex Guided Endovascular Therapy for Chronic Occlusion of Superficial
Femoral Artery
Shinji Tayama1
1
JCHO Kumamoto General Hospital, Japan

[CLINICAL INFORMATION]
Patient initials or identifier number. 0000906221
Relevant clinical history and physical exam. 83 year-old male patient with
hemodialysis for chronic renal failure, presented diabetic gangrene of his
left heal and toe. Lower limb amputation is compulsory, it has been intro-
duced in the endovascular treatment of adaptation for wound healing.
On physical examination, he had a BP¼95/60mmHg, HR 75bpm
atrial fibrillation. Foot half was the state of gangrene. Arterial pulsa-
tion of popliteal artery was decreased.

Relevant catheterization findings. I obtained contralateral approach via

right femoral artery. The left superficial femoral artery (SFA) was
occluded up to 24 cm from the ostium. The stump of the SFA was
detected. peripheral SFA was contrast via deep femoral artery.
[INTERVENTIONAL MANAGEMENT]
Procedural step. The vascular echo, Precision Apure (Toshiba), was
prepared without sterilized. The Destination 6F-45cm guide sheath
was inserted via right femoral artery to the left common femoral
artery.
After fluoroscopic equipment was removed, the sonogrpher
manipulate the echo from the left site of the patient.
I advanced the Chevalier Tapered 30 with SABER OTW balloon
3.0x40 mm, while the guide wire was manipulated under the navi-
gation of duplex echogram. The long axis view of the SFA was used for
secure and determined where the guide wire was crossing. As inten-
ded, the guide wire was able to pass the center of the vessel.
After dilatation with SABER-OTW 3.0x40 and Sterling 5.0x100mm,
followed with Misago 6.0x150 and SMART 7.0x150 due to spiral di-
rection at proximal lesion.

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injury risk in the endovascular treatment of long lesions with SFA

chronic occlusion and could lead to higher success rate.

TCTAP C-206
Limited Simultaneous Endovascular Treatment for the Iliac Artery and the
Superficial Femoral Artery
Hirooki Higami,1 Ritsuya Tachiiri,1 Nobuya Higashitani,1
Toshikazu Jinnai1
1
Otsu Red Cross Hospital, Japan

[CLINICAL INFORMATION]
Patient initials or identifier number. 223565
Relevant clinical history and physical exam. A 69-year-old-male who had
suffered from intermittent claudication for a few years realized his
symptom getting worse and walked shorter distance than before.
(Rutherford classification: 3)
His ankle brachial pressure index was 0.61 on the right side and 0.40
on the left side. There was no other artery disease including coronary
or carotid artery diseases.
Relevant test results prior to catheterization. In the contrast-enhanced
CT, severe stenosis of the right common iliac artery and CTO of the left
common iliac artery and SFA were found.
At the first session, endovascular therapy for right common iliac
artery was performed at the other division. Large hematoma was
generated around the puncture site of the right SFA, which dissatis-
fied the patient and the patient was transferred to our division to treat
contra lateral side leg ischemia.
Relevant catheterization findings.
The patient refused the puncture of right femoral artery.
In the angiography, left common artery was occluded from terminal
aorta and collateral artery perfuse the distal lumen of SFA-DFA
bifurcation. In addition, mid-SFA was chronic totally occluded.
[INTERVENTIONAL MANAGEMENT]
Procedural step. Sheathless guiding catheter (6F Destination 90cm) was
inserted form the left brachial artery. Corsair PV was inserted from SFA
without sheath and the iliac CTO was penetrated by bi-directional wire
rendez-bout technique. Self-expanding stent (SMART control) was
deployed in the left iliac artery and approached to the SFA CTO lesion. It
was difficult to penetrate the CTO lesion from anterograde approach,
therefore, tibial puncture was performed as retrograde approach. The
SFA CTO lesion was penetrated by wire rendez-bout technique and
“reverse crusade parallel technique”. The reason of necessity of
“Reverse crusade parallel technique” was that the proximal entry of
CTO lesion was stump type, therefore, it was difficult to bet a coaxial
force. I devised the “Reverse crusade parallel technique” that the side
branch wire was inserted from the side port of crusade, then, the tip of
crusade and the wire is able to directed to the entry of CTO and have
strong penetration force. After wire externalization, self-expand stent
that was delivered from left brachial artery was deployed in SFA.

Case Summary. In case of extreme long chronic total occlusion of su-

perficial femoral artery, we sometimes failed endovascular therapy for
guide wire perforation only with fluoroscopic wire maneuver. Endo-
vascular treatment with duplex echo guide can reduce the vascular

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