stent through two stents

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Endovascular Case PresentationStent through two stents : 

Endovascular Case PresentationStent through two stents Mr.Mohamed Omar El-Farok M.Sc, FRCS

History : 

Personal Hist. : 54 Y Female patient C/O Gangrene left second toe HPI : -may 99 presented with gangrene left foot and had left common iliac stent and SFA angioplasty - Feb2001 another gangrene left foot and had left external iliac stent and angioplasty Diabetic Type II , Hypertensive , Chronic Renal Imairement Cr=2.1 , and previous right below knee amputation 10 years ago History

Examination : 

Obese Bilateral femoral pulses and no popliteal or distal pulses Examination

Duplex Scan : 

No mention of stents 90% stenosis upper third SFA and occlusion lower third and occluded peroneal and posterio tibial pulses Left GSV is thrombosed Duplex Scan

Angiogram : 


Angiogram : 


Plan of management : : 

Contralateral access Intraluminal recanalization Primary SFA stenting using nitinol self expandable stent Plan of management :

Access from contralateral : 

Access from contralateral

Slide 9: 

Why the cross over sheath does not pass ? What to do ?

Finally : 


SFA intraluminal or subintimal : 

SFA intraluminal or subintimal

Primary Stenting is it safe ? : 

Primary Stenting is it safe ?

Distal Embolization : 

Distal Embolization

What to do other than screeming? : 

Thorombus sucking Thrombolysis Vasodilators Others All of the above What to do other than screeming?

After Praying : 

After Praying

Stent Shouldering or Spasm? : 

Why ? What to do ? Is it improtant Stent Shouldering or Spasm?

Take Home Message : 

Stenting definitely increase the long term results in iliac interventions Crossing inside two stents is possible but be very careful and use the correct tools Distal embolization is the worst possible complications we face even after all precautions Take Home Message

Slide 18: 

Pleasure in the job puts perfection in the work. - Aristotle (384–322 BC) Greek philosopher, Enjoy your meeting

Slide 19: 

Thank You

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