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Kurniawan, Catur Rizky
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An alternative retrograde access puncture for EVLA: a case report Kurniawan, Catur Rizky; Kurnianingsih, Novi; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.18

Abstract

Background: CVI manifests with a variety of clinical symptoms, spanning from varicose veins to venous ulcers, significantly impacting patients' daily lives. While traditional treatments such as compression therapy and surgery remain options, on endovenous laser treatment (EVLT) has emerged as a viable alternative.  This article delves into the management of CVI, with a particular focus EVLT as a minimally invasive intervention. Through two case illustrations, it sheds light on the difficulties encountered when accessing the great saphenous vein (GSV) using the conventional antegrade approach, particularly in cases involving obesity and vasospasm. Consequently, a retrograde EVLT technique utilizing proximal GSV access, resulting in successful vein ablation with minimal complications. Overall, this approach presents a promising addition to the management of CVI, offering enhanced patient care and improved outcomes. Case Presentation: Two patients with CVI and challenging antegrade GSV access underwent retrograde EVLT using proximal GSV access. Despite initial difficulties, including obesity and vasospasm, successful vein ablation was achieved with minimal complications. Post-procedural evaluations demonstrated significant symptomatic improvement, highlighting the efficacy of the retrograde technique. Conclusion: Retrograde EVLT utilizing proximal GSV access proves to be a safe and effective alternative in cases where antegrade access is challenging. The technique offers simplicity, minimal complications, and high patient satisfaction, with outcomes comparable to traditional approaches. Extended follow-up studies are needed to confirm the long-term effectiveness of retrograde EVLT compared to antegrade methods. Overall, retrograde EVLT presents a valuable option for managing CVI, particularly in patients with anatomical complexities or vasospasm, contributing to improved patient care and outcomes.
Sebuah Penundaan Pemasangan Stent pada Beban Trombosis Tinggi Kurniawan, Catur Rizky; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 4 No 3 (2025): Volume 4 No 3, Juni 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.3.5

Abstract

Deferred stenting is a revascularization strategy that involves two stages of implementation, where stent placement is delayed for a predetermined period after stable coronary blood flow is achieved. This approach aims to reduce the risk of complications such as slow-flow or no-reflow phenomena, particularly in patients with high thrombus burden (HTB). This study seeks to explore the benefits and limitations of deferred stenting in HTB cases, as well as its impact on long-term clinical outcomes. The primary benefits of deferred stenting include significant reduction in thrombus burden, improved myocardial perfusion quality, and decreased risk of complications such as distal embolization and slow-flow phenomena. Research indicates that this technique can enhance left ventricular ejection fraction (LVEF) and reduce infarct size. However, deferred stenting also carries potential complications, including the risk of re-occlusion, need for unplanned revascularization, and increased bleeding risk due to prolonged use of parenteral anticoagulants. Evaluation of various studies reveals inconsistent results regarding the effectiveness of deferred stenting. Some studies report significant benefits in reducing thrombus burden and improving clinical outcomes, while others highlight a higher risk of complications without meaningful short-term improvements. The CRUSADE score is used to assess bleeding risk in HTB patients, with scores >20 indicating a high bleeding risk and contraindicating the use of GPIIb/IIIa inhibitors. Overall, deferred stenting offers potential benefits in HTB cases, its implementation should be carefully considered due to associated risks and additional costs. Further research is needed to determine the optimal protocols and assess the long-term benefits of this technique.
An alternative retrograde access puncture for EVLA: a case report Kurniawan, Catur Rizky; Kurnianingsih, Novi; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.18

Abstract

Background: CVI manifests with a variety of clinical symptoms, spanning from varicose veins to venous ulcers, significantly impacting patients' daily lives. While traditional treatments such as compression therapy and surgery remain options, on endovenous laser treatment (EVLT) has emerged as a viable alternative.  This article delves into the management of CVI, with a particular focus EVLT as a minimally invasive intervention. Through two case illustrations, it sheds light on the difficulties encountered when accessing the great saphenous vein (GSV) using the conventional antegrade approach, particularly in cases involving obesity and vasospasm. Consequently, a retrograde EVLT technique utilizing proximal GSV access, resulting in successful vein ablation with minimal complications. Overall, this approach presents a promising addition to the management of CVI, offering enhanced patient care and improved outcomes. Case Presentation: Two patients with CVI and challenging antegrade GSV access underwent retrograde EVLT using proximal GSV access. Despite initial difficulties, including obesity and vasospasm, successful vein ablation was achieved with minimal complications. Post-procedural evaluations demonstrated significant symptomatic improvement, highlighting the efficacy of the retrograde technique. Conclusion: Retrograde EVLT utilizing proximal GSV access proves to be a safe and effective alternative in cases where antegrade access is challenging. The technique offers simplicity, minimal complications, and high patient satisfaction, with outcomes comparable to traditional approaches. Extended follow-up studies are needed to confirm the long-term effectiveness of retrograde EVLT compared to antegrade methods. Overall, retrograde EVLT presents a valuable option for managing CVI, particularly in patients with anatomical complexities or vasospasm, contributing to improved patient care and outcomes.
Co-Authors Kurnianingsih, Novi Widito, Sasmojo