Transpedal SFA revascularization using outback re-entry
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SFA revascularization. Transpedal access. CTO. Peripheral artery disease. Peripheral artery disease (PAD).
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If it¡¯s not Itch It¡¯s not Eczema
Eczema is a group of medical conditions which causes inflammation and irritation to skin.
It is also called as Dermatitis
Eczema is an itchy consisting of ill defined erythremotous patches. The skin surface is usually scaly and As time progress, constant scratching leads to thickened lichenified skin.
Several classifications of eczemas are available based on Etiology, Pattern and chronicity.
According to aetiology Eczema are classified as:
Endogenous eczema: Where constitutional factors predispose the patient to developing an eczema.
Family history (maternal h/o eczema) is often present
Strong genetic predisposition (Filaggrin gene mutations are often present).
Filaggrin is responsible for maintaining moisture in skin (hence all AD patients have dry skin.
Immunilogical factor-Th-2 disease, Type I hypersensitivity (hence serum IgE high)
e.g., Seborrheic dermatitis, Statis dermatitis, Nummular dermatitis, Dyshidrotic Eczema
Exogenous eczema: Where external stimuli trigger development of eczema,
e.g., Irritant dermatitis, Allergic Dermatitis, Neurodermatitis,
Combined eczema: When a combination of constitutional factors and extrinsic triggers are responsible for the development of eczema
e.g., Atopic dermatitis
Extremes of Temperature
Irritants : Soaps, Detergents, Shower gels, Bubble baths and water
Stress
Infection either bacterial or viral,
Bacterial infections caused by Staphylococcus aureus and Streptococcus species.
Viral infections such as Herpes Simplex, Molluscum Contagiosum
Contact allergens
Inhaled allergens
Airborne allergens
Allergens include
Metals eg. Nickle, Cobalt
Neomycin, Topical ointment
Fragrance ingredients such as Balsam of Peru
Rubber compounds
Hair dyes for example p-Phenylediamine
Plants eg. Poison ivy .
Atopic Dermatitis : AD is a chronic, pruritic inflammatory skin disease characterized by itchy inflamed skin.
Allergic Dermatitis: A red itchy weepy reaction where the skin has come in contact with a substance That immune system recognizes as foreign substances.
Ex: Poison envy, Preservatives from creams and lotions.
Contact Irritant Dermatitis: A Localized reaction that include redness, itching and burning where the skin has come In contact with an allergen or with irritant such as acid, cleaning agent or chemical.
Dyshidrotic Eczema: Irritation of skin on the palms and soles by
clear deep blisters that itch and burn.
Clinical Features; Acute Eczema:- Acute eczema is characterized by an erythematous and edematous plaque, which is ill-defined and is surmounted by papules, vesicles, pustules and exudate that dries to form crusts. A subsiding eczematous plaque may be covered with scales.
Chronic Eczema:- Chronic eczema is characterized by lichenification, which is a triad of hyperpigmentation, thickening markings. The lesions are less exudative and more scaly. Flexural lesions may develop fissures.
Pruritus
Characteristic Rash
Chronic or repeatedly occurring symptoms.HER2-Targeting Therapy in HER2+ MBC With and Without CNS Metastases: Selectio...
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Transpedal SFA revascularization using outback re-entry
- 2. Vascular Surgery failed in an attempt to recanalize the left SFA in a patient with limiting claudication. Occlusion extends from ostium to distal SFA. Previous attempts included antegrade subintimal angioplasty with front-runner device and attempts to re-enter with the outback device.
- 3. Given the previous attempts, we gained pedal access using palpation (I¡¯ve got sensitive fingers) and a Cook micropuncture kit. Wire was easily advance up to the occlusion
- 4. Both antegrade and retrograde wire were advanced. Both were subintimal. We attempted re-entry at both the proximal and distal caps without success.
- 5. We therefore brought a 4.0mm balloon up from the foot and an outback down from the femoral and punctured the balloon with the re-entry needle. We then brought the wire into the balloon and pulled the balloon and wire through the occlusion. We brought a balloon over the antegrade wire to confirm position.
- 6. We used a 4.0 and 6.0 balloon to predilate. We stented with iDev Supera stents.
- 7. FINAL RESULT IN THE SFA
- 8. FINAL RUNOFF