percutaneous renal intervention for chronic total occlusion of renal ...

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percutaneous renal intervention for chronic total occlusion of renal ...

Mahavir Heart InstituteSurat, IndiaPERCUTANEOUS RENALINTERVENTION FOR CHRONIC TOTALOCCLUSION OF RENAL ARTERYAtul AbhyankarHarish VyasHitesh RaatMahavir Heart Institute, Surat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, IndiaCurable Hypertension orReversible/Preventable Renal functiondeterioration• Moderate to severe hypertension due to fibrous dysplasia ofrenal artery• Bilateral renal artery stenosis• Renal artery stenosis in solitary kidney• Recent onset hypertension with unexplained azotemia withdecement in renal size due to RAS• Unilateral stenosis with positive lateralizing study


Mahavir Heart InstituteSurat, IndiaDecrease in sizedecline of glomerularfiltration rate (GFR)worsening of serumcreatinineCompensatory increase in GFRand hyperfiltrationnephroangiosclerosissegmental glomerulosclerosis


Mahavir Heart InstituteSurat, IndiaDifficulties• Aorto ostial location• Lack of support• Unknown angle of origin• Unknown course of renal artery (no collateral filling likecoronaries)• Finding true lumen in larger diameter• Ostial calcification


Mahavir Heart InstituteSurat, IndiaTechnical Difficulties• Directing guiding catheter angle• Maintaining support• Lack of specifically designed equipment


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, IndiaDemographicsGender Age Diabetes Hypertension Hyperlipidemia1. Male 65 Yes Yes Yes2. Male 59 No Yes Yes3. Male 50 No Yes No4. Female 26 No Yes No5. Female 69 Yes Yes Yes6. Male 74 No Yes No


Mahavir Heart InstituteSurat, IndiaRenal DiseaseLocation Index Contralateral EtiologyVesselVessel1. Ostial Total Normal Atherosclerosis2. Ostial Total 30% stenosis Atherosclerosis3. Ostial Total Normal Atherosclerosis4. Ostial Total occ. Total occlusion Aorto-arteritis5. Ostial Total 60% stenosis Atherosclerosis6. Ostial Total 30% stenosis Atherosclerosis


Mahavir Heart InstituteSurat, IndiaRenal InvestigationsS. Creatinine Kidney size CM differentiation1. 1.9 Normal Normal2. 2.1 Normal Normal3. 1.2 Normal Normal4. 2.8 Normal Affected5. 2.2 Normal Normal6. 1.8 Normal Normal


Mahavir Heart InstituteSurat, IndiaProcedural DataSuccessful wireStent length1. Crossit 100 15 mm2. Shinobi 12 mm3. Miracle 15 mm4. Nil --5. Cross it 200 28 mm6. Cross it 100 18 mm


Mahavir Heart InstituteSurat, IndiaSuccess1255100% success rate in CTO of atherosclerotic originNo complications


Mahavir Heart InstituteSurat, IndiaOutcomeHypertensionControlRenal scanContribution to GFR>30%By affected kidney1. ++ Yes2. ++ Not done3. +++ Yes5. ++ Yes6. ++ No


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India


Mahavir Heart InstituteSurat, India• Lesions were not as hard as we thought they could be.• Distal vessels were fairly well preserved.• Did not encounter no flow / slow flow except in one patient.• Nephrogram was visible in 2 patients immediately afteropening the artery.• Nephrologists did not burn my effigy.


Mahavir Heart InstituteSurat, IndiaConclusion• Renal CTOs can be successfully treated by percutaneoustechnique.• Complexities of renal disease should be taken intoconsideration before selecting the patients

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