Case

Total Occluded Left Common Iliac Artery Lesion Treated by Stent Implantation

- Operator : Kazushi Urasawa

Total Occluded Left Common Iliac Artery Lesion Treated by Stent Implantation
- Operator: Kazushi Urasawa, MD
Case Presentation
A 65 year-old man was admitted for recently aggravated claudication. Five years ago, his lower extremity showed total occlusion of left common iliac artery (CIA) and external iliac artery (EIA) in other hospital. At that time, bypass surgery was recommended to him. However, he refused surgery and had continued medical therapy. His cardiovascular risk factors were diabetes, hyperlipidemia, and ex-smoking. He also has a past medical history of PCI at distal LM-proximal LAD about 5 years ago caused by NSTEMI.
Baseline angiography & CT angiography
The peripheral angiogram showed total occlusion of Lt. CIA ( Movie 1, Movie 2).
The CT angiography showed total occlusion of Lt. CIA and EIA, but the distal runoffs were patent (Figure 1). Segmental limb pressure with Doppler revealed decreased left ankle-brachial index (ABI 0.62) and pressure drop was noted at left aorto-iliac segment (Figure 2).
Procedures
A 6Fr sized sheaths were inserted into the right and left femoral artery for bidirectional approach. Two Conquest wires with Finecross Microcatheter were used to pass the left common iliac artery lesion via bidirectional approach (Figure 3). Retrograde Conquest wire could pass through the lesion (Figure 4). And then, Conquest wire was exchanged into 0.014 inch Chevalier wire and IVUS was performed to check the true lumen. Pre-balloon angioplasty with a Sleek 3.0x40mm balloon and a Powerflex 5.0x40mm balloon were performed at left common iliac artery (Figure 5). And then, stenting with two self expandable Zilver 6.0x80mm and 7.0x100mm stents was performed (Figure 6). Post-stent balloon dilatation with a Powerflex 5.0x40mm balloon was performed (Figure 7). Final angiogram showed well-positioned stent in left common iliac artery ( Movie 3).

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