endovascular technique for difficult cases · endovascular technique for difficult cases stephen...
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![Page 1: Endovascular Technique for Difficult Cases · Endovascular Technique for Difficult Cases Stephen Black Consultant Vascular Surgeon Reader in Venous Surgery. Guy's and St Thomas' NHS](https://reader030.vdocuments.us/reader030/viewer/2022040616/5f11e97d39ec6f33ac735b1c/html5/thumbnails/1.jpg)
Endovascular Technique for Difficult Cases
Stephen Black
Consultant Vascular Surgeon
Reader in Venous Surgery
![Page 2: Endovascular Technique for Difficult Cases · Endovascular Technique for Difficult Cases Stephen Black Consultant Vascular Surgeon Reader in Venous Surgery. Guy's and St Thomas' NHS](https://reader030.vdocuments.us/reader030/viewer/2022040616/5f11e97d39ec6f33ac735b1c/html5/thumbnails/2.jpg)
Access Site
• Internal Jugular
• Ipsilateral Femoral Vein
• Ipsilateral Popliteal
• Less good: contralateral
• Try and avoid Common Femoral Vein
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Not ArterialFinding a path with the wire tip
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Contrast and finding a tract Inflow Vessel
![Page 5: Endovascular Technique for Difficult Cases · Endovascular Technique for Difficult Cases Stephen Black Consultant Vascular Surgeon Reader in Venous Surgery. Guy's and St Thomas' NHS](https://reader030.vdocuments.us/reader030/viewer/2022040616/5f11e97d39ec6f33ac735b1c/html5/thumbnails/5.jpg)
Tri Force Catheter
![Page 6: Endovascular Technique for Difficult Cases · Endovascular Technique for Difficult Cases Stephen Black Consultant Vascular Surgeon Reader in Venous Surgery. Guy's and St Thomas' NHS](https://reader030.vdocuments.us/reader030/viewer/2022040616/5f11e97d39ec6f33ac735b1c/html5/thumbnails/6.jpg)
Go Ugly Early
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Flexibility
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9
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IVUS
![Page 12: Endovascular Technique for Difficult Cases · Endovascular Technique for Difficult Cases Stephen Black Consultant Vascular Surgeon Reader in Venous Surgery. Guy's and St Thomas' NHS](https://reader030.vdocuments.us/reader030/viewer/2022040616/5f11e97d39ec6f33ac735b1c/html5/thumbnails/12.jpg)
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Patency
Technical Flow
Clotting
- Stent Choice
- Placement
- Inflow
- Stenosis
- APLS
- Behcet’s
- Vessel Wall
![Page 14: Endovascular Technique for Difficult Cases · Endovascular Technique for Difficult Cases Stephen Black Consultant Vascular Surgeon Reader in Venous Surgery. Guy's and St Thomas' NHS](https://reader030.vdocuments.us/reader030/viewer/2022040616/5f11e97d39ec6f33ac735b1c/html5/thumbnails/14.jpg)
Conclusion
• Keep it simple
• Straight and Curved Stiff Terumo/Roadrunner
• Tri-force Catheters Useful
• Access from above and below
• Balloon – both for crossing and predilation
• IVUS
• Lateral Views essential
![Page 15: Endovascular Technique for Difficult Cases · Endovascular Technique for Difficult Cases Stephen Black Consultant Vascular Surgeon Reader in Venous Surgery. Guy's and St Thomas' NHS](https://reader030.vdocuments.us/reader030/viewer/2022040616/5f11e97d39ec6f33ac735b1c/html5/thumbnails/15.jpg)
Endovascular Technique for Difficult Cases
Stephen Black
Consultant Vascular Surgeon
Reader in Venous Surgery