MP-1

A case of bilateral highly calcified bilateral renal artery lesions withrefractory heart failure treated by bi-stage PTRA and EVT○‌Saburo Kusumoto，Masayoshi Takeno，Tatsuya Nunohiro，Yoshiyuki Doi，
Keita Iyama，Kensho Baba，Nobu Yamamoto，Akito Setoguchi
Nagasaki Harbor Medical Center【Case overview】
Previous RCTs have shown no advantage of percutaneous transluminal renal artery angioplasty（PTRA）
over medical therapy for renal artery stenosis（RAS）. However, observational studies have demonstrated theefficacy of renal artery stents in certain critically ill patients. We report here a case of a patient with bilateralrenal artery stenosis who had a favorable outcome after PTRA. A 74-year-old woman was initially hospitalized
for coronary artery bypass grafting（CABG）and mitral valvuloplasty（MVR）. Even after CABG and MVR,
the patient easily developed worsening heart failure.
【Procedure summary】
The patient had coral reef aorta around the renal artery, and severe stenosis at the origin of the bilateral renalarteries. The bilateral common iliac arteries were obstructed by nodular calcification. In the second session,
the left renal artery was successfully dilated and stented. Later, EVT was performed for bilateral CIA-EIAlesions.
【Clinical time course and implication（or perspective）】
Postoperatively, renal function improved（Cre 2.5 to 1.5 mg/dL）, furosemide dose could be reduced from‌
200 mg to 10 mg, NT-proBNP >35000 to 3000 pg/mL, and the patient had no worsening of heart failure afterdischarge. We report here the possibility that PTRA may be effective in the treatment of severe RAS withrepeated heart failure and refractory hypertension.

MP-2

Effectiveness of trans-radial approach for emergency hemostasis atfemoral arteries compared with trans-femoral approach○‌Yotaro Fujii，Natsumi Yanaka，Atsuya Murai，Yusuke Setonaga，Toshihiko Kishida，Tomoya Fukagawa，Kohei Yamaguchi，Masafumi Mizusawa，Masakazu Tsutsumi，
Shinsuke Mori，Norihiro Kobayashi，Yoshiaki Ito
Saiseikai Yokohama City Eastern Hospital【What’s known?】
Background
Trans femoral approach（TFA）often causes puncture site related bleeding complications. Recently, we selected transradial approach（TRA）to treat peripheral vascular lesions especially in iliac arteries and common femoral arteries. It is still
unclear TRA is an effective way to stop puncture site related bleedings caused by transfemoral interventions.
【What’s new?】
Methods
We evaluated 39 interventions performed to stop puncture-site related bleedings from January 2019 to December 2023.
Primary endpoint was a success rate of hemostasis with no additional approach.
Results
16 interventions were performed by TRA and 23 interventions were performed by TFA. There was no difference between
TRA and TFA about the success rate of hemostasis with no additional approach（n=TRA 75%, TFA 86%, p=0.42）. In TRA
cases, we needed 4 additional approaches from opposite common femoral arteries to insert stent grafts. The frequency ofafter procedure events such as hematoma, infection and rebleeding was similar in TRA and TFA（n=TRA 18.8%, TFA 13%,p=0.67）.
Conclusion
Trans-radial approach showed equal results of hemostasis of puncture-site with trans-femoral approach. Trans-radial
approach for puncture-site related bleeding is an attractive alternative way to trans-femoral approach.

MP-3

Clinical performance of spot DES for FP lesions in our institution○‌Shunta Taminishi，Yoshinori Tsubakimoto，Takashi Mabuchi，Takashi Okura，
Yumika Tsuji，Makoto Saburi，Masao Takigami，Keiji Inoue，Jyun Shiraishi
Japanese Red Cross Kyoto Daini Hospital【What’s known?】
Recently, favorable outcomes have been reported for EVT（Endovascular Therapy）using DCB（Drug-CoatedBalloon）in the FP（Femoropopliteal）region. However, a definitive consensus regarding the efficacy of spotDES（Drug-Eluting Stent）has not been established.
【What’s new?】
A total of 273 consecutive cases underwent EVT for de novo FP lesions between 2019 and 2022 were enrolled
in this study. Of these, 72 cases, treated with Ranger-DCB（82.9%）or a combination of DCB with spot DES（17.1%）, were divided into two groups for analysis. The primary endpoint was the one-year Freedom fromTarget Lesion Revascularization（TLR）rate.
The mean lesion length was 192 mm in the Ranger-DCB group and 214 mm in the spot DES group（p=0.53）.
CTO cases were 35.7% in the Ranger-DCB group and 57.1% in the spot stent group（p=0.13）. The rate of
freedom from TLR was 73.8% for the Ranger-DCB group and 57.1% for the spot stent group（p=0.028）.
The clinical outcomes of a combination of DCB with spot DES for FP lesions in our institution were insufficientcompared to DCB alone.

MP-4

A case of chronic limb-threatening ischemia who underwent surgicalthrombectomy for recurrent stent thrombosis○‌Teruaki Wada，Hideki Kunimoto，Kentaro Honda，Akira Taruya，Masahiro Takahata，
Yuichi Ozaki，Yasutsugu Shiono，Hironori Kitabata，Yoshiharu Nishimura，Atsushi Tanaka
Wakayama Medical University【Case overview】
A 71-year-old woman was admitted to our hospital due to chronic limb-threatening ischemia. She was presented
with unhealed gangrene of her right achilles tendon. A contrast-enhanced computed tomography showed
total occlusion of the right proximal superficial femoral artery（SFA）to proximal popliteal artery（POP）, andperoneal trunk.
【Procedure summary】
Endovascular therapy（EVT）for the SFA lesion was performed using a bidirectional approach via the rightcommon femoral artery and dorsal artery. After passing the wire and ballooning, the SFA showed no reflow.
Drug-eluting stents（DESs）were implanted from the proximal SFA to the middle POP. Five days after theoperation, the stents were occluded. VIABAHN stent grafts were implanted in DESs. Two months later,
split thickness skin grafting and negative pressure wound therapy were performed. Three months afterEVT, covered stent grafts were totally occluded. Repeated POBA and thrombus aspiration were performed,
but reperfusion was not obtained. Therefore, surgical thrombectomy was performed for bail-out. After
thrombectomy, reperfusion was achieved and the wound was successfully healed.
【Clinical time course and implication（or perspective）】
Surgical thrombectomy is an essential treatment option for thrombosis after VIABAHN stent graft implantation.

MP-5

Development of a clinical and ultrasonic parameter based nomogram
predictive model for the prediction of restenosis after superficial
femoral artery stenting○‌Yiwei Wang
Beijing Luhe Hospital Affiliated to Capital Medical University【What’s known?】
Prediction of in-stent restenosis（ISR）is clinically important for patients with peripheral arterydisease（PAD）in the superficial femoral arteries（SFA）who were treated with stenting. Theaim of the study was to construct and validate a predictive model for ISR after SFA stenting
based on a series of clinical and ultrasonic parameters.
【What’s new?】This retrospective study included 381 patients who were treated with self-expanding barenitinol stents placement in SFA in our hospital. These patients were randomly allocated toa training cohort and a validation cohort. Clinical and ultrasonic parameters related to ISR（> 50%）in the SFA at 12 months were derived by the univariate and multivariate logistic
regression analysis. The risk prediction nomogram model was constructed using the R 4.1.0
software package.
Logistic regression analyses revealed that sex, echo of the target plaque, preoperative arterial
runoff score via the Society for Vascular Surgery criteria, preoperative popliteal artery flow
rate, lesion length, and residual diameter were risk factors for ISR, which were used toconstruct the nomogram model. This novel nomogram for identifying ISR after SFA stenting
demonstrated excellent discriminatory power, calibration capacity, and clinical usefulness.

MP-6

Pre-procedural color duplex ultrasound evaluation predicts restenosis
after long-segment superficial femoral artery stenting○‌Mingjie Gao
Beijing Luhe Hospital Affiliated to Capital Medical University【What’s known?】
Restenosis after stenting for superficial femoral artery（SFA）atherosclerotic disease remains
a significant clinical problem, especially for long-segment lesions. We assessed predictors ofin-stent restenosis（ISR）in patients with long-segment SFA disease, and hypothesized that‌pre-procedural ultrasound assessment would predict ISR.
【What’s new?】This single-center study retrospectively analyzed 283 limbs in 243 patients who treated withSFA nitinol stent placement for long-segment（≥ 15 cm）lesions between 2015 and 2018. Colorduplex ultrasound（CDU）was performed pre-procedure and post-procedure at 3, 6, 12, 24, and36 months. The endpoint was ≥ 50% ISR in the SFA. Primary patency rates were analyzed
with Kaplan-Meier survival analysis and compared using the log-rank test. A multivariable Cox
proportional hazards model was used to evaluate the risk factors for ISR.
The results indicate that pre-procedural CDU evaluation is helpful for the selection ofappropriate candidates for SFA stent placement. Cumulative lesion length ≥ 25cm, plaquecalcification, poor distal runoff, and chronic renal failure independently predicted ISR.

MP-7

A case of long CTO in which the stent fractured at two sites due tooverstretching deployment○‌Yuya Mitsuhashi，Toshiaki Isogai，Ken Kato，Hiroyuki Tanaka
Tokyo Metropolitan Tama Medical Center【Case overview】
A man in his 70s came to our department with a complaint of intermittent claudication of his left foot. Contrast-enhanced CT
revealed chronic total occlusion（CTO）lesion in the two separate location（superficial femoral artery（SFA）and popliteal artery）.
【Procedure summary】
Endovascular treatment was performed using two Eluvia（6.0*120mm）and low-dose DCB（6.0*60mm）with IVUS-guidwd wiring.
Claudication resolved after treatment, but at his 12-month outpatient visit, a recurrence of claudication was found. During theinterview, it was found that the patient had self-interrupted antiplatelet medication.
Angiography was performed again, suspecting re-occlusion of the treated area due to drugdiscontinuation, and the stent in the treated area had re-occluded, but the distally implanted
stent had fractured in two places. Eluvia was re-implanted to cover the fractured stent.
【Clinical time course and implication（or perspective）】
Retrospective evaluation showed that the distal stent was stretched and implanted when
covering the whole SFA-CTO lesion with a stent during the initial treatment（about 25%elongation）,which may have caused the fracture.
Although stenting in the treatment of SFA long CTO lesions may be limited in terms of thenumber of stents from an insurance perspective, overstretching of the stent during stenting
should be considered as a potential cause of structural failure.

MP-8

Retrograde In-situ Fenestration of Left Subclavian Artery using BeBack
Crossing Catheter and Physician-Modified Steerable Sheath for
Treatment of Complicated Type B Aortic Dissection○‌Malcolm Mak，Enming Yong，Justin Kwan，Bien Peng Tan，Lester Chong，Li Zhang，Lawrence Quek，Uei Pua，Glenn Tan
Tan Tock Seng Hospital【Case overview】
43-year-old male presented with back pain and ischemic left lower limb. CT angiogram demonstrated complicated type B aortic dissection
with entry tear at the left subclavian artery（LSA）,extending to the bilateral iliac arteries with absent distant flow in the left limb.
【Procedure summary】
Urgent thoracic endovascular repair（TEVAR）was indicated. Proximal landing in Ishimaru Zone 2 was required for adequate seal.‌
In-situ fenestration to preserve the LSA was performed to reduce risk of arm ischemia and stroke. Zenith TX2 Endograft was deployedin Zone 2, covering the LSA. BeBack crossing catheter was used for thoracic stent-graft re-entry to create an in-situ fenestration, withsequential balloon dilatation followed by 10.0x37mm BeGraft stent-graft for bridging. Physician-modified steerable sheath was required
for steerability of crossing catheter. Entry tear was successfully sealed and thoracic
stent was extended with Zenith Dissection stent. Bilateral common iliac 8mm BeGraft
stent-grafts were used to reperfuse the lower limbs.
【Clinical time course and implication（or perspective）】
Early post-operative CT showed persistent leak, requiring extension of LSA stent
with additional 8.0x57mm BeGraft. Patient recovered fully with no symptoms. CTat 6-months shows no leak or complications. The techniques described are useful inemergent situations for LSA preservation in TEVAR when custom-made devices arenot readily available.

MP-9

Stent placement for iliac vein occlusion/DVT displaced by tumor○‌Yuta Tajiri，Takashi Komatsu，Takuro Takagi，Testuo Ree
Tokyo Shinagawa Hospital【Case overview】
The 78 year old man with prostate cancer lymph node metastasis. His left iliac vein was compressed by theswollen lymph nodes and tumor, resulting in acute DVT, which resulted in stasis and swelling of the left lower
leg, making it difficult to walk. We attempted to improve the condition with endovascular treatment.
【Procedure summary】［Methods］
Thrombus aspiration was repeated 45 times using a 6Fr guiding catheter. Afterwards, the flow limit of thetumor exclusion area was also confirmed with balloon expansion. Therefore, a self-expanding stent was placed
to obtain good blood flow. Postoperatively, anticoagulant therapy was continued. Final angiogram was shownin Figure.
［Results］
All of the massive DVT disappeared and he was discharged from the hospital. Radiation therapy was given to
the lymphnodes and enlarged tumor.
【Clinical time course and implication（or perspective）】
In the treatment of symptomatic iliofemoral venous outflow
obstruction, it is useful to place a self-expanding stent in theiliofemoral vein to secure the venous lumen.

MP-10

Withdrawn