Case 05 – Right superficial femoral diffuse severe disease
Center:
New York
Case 05 – NY 01: female, 66 years (E-M)
Operators:
Prakash Krishnan,
Karthik Gujja,
S. Singla,
Rheoneil Lascano
CLINICAL DATA
- Patient presents with 2 block life-style limiting lower extremity claudication
- over last 6 months. Progressively worsening. Rutherford Category 3.
- No history of ulcer. Failed maximal medical therapy.
- ABI: right 0.71, left 0.92
RISK FACTORS
- Hypertension, ex smoker, dyslipidemia
- CAD s/p CABG
- PVD - s/p left fempop bypass
PROCEDURAL STEPS 1. Left groin access with retrograde cross over approach
- UF 4F diagnostic catheter (ANGIO DYNAMICS)
- 0.035" SupraCore guidewire, 300 cm (ABBOTT VASCULAR)
- 7F–45 cm Pinnacle sheath (TERUMO) 2. Passage through the right SFA stenosis
- 0.035" Tempo Aqua Vert support catheter, 125 cm (CORDIS)
- 0.014" Fielder guidewire, 300 cm (ABBOTT VASCULAR)
- Exchange to 0.014" Spartacore guidewire, 300 cm (ABBOTT VASCULAR) 3. Filter placement
- Exchange to a Barewire through the support catheter (ABBOTT VASCULAR)
- Emboshield Nav 6 filter placement (ABBOTT VASCULAR) 4. Plaque modification
- Chocolate balloon 5 x 120 mm (MEDTRONIC) 5. PTA with drug-coated balloon
- In.Pact Admiral 6.0 x 150 mm DCB (MEDTRONIC)
Case 08 – Right superficial femoral artery occlusion – calcified
Center:
New York
Case 08 – NYo2: male, 80 years, (H-P)
Operators:
Prakash Krishnan,
Vishal Kapur,
Karthik Gujja,
S. Singla,
Rheoneil Lascano
CLINICAL DATA
- Progressively worsening right leg claudication x 1 year
- No history of rest pain or ulceration
- Has failed maximal medical therapy
- Current claudication distance <1 block (Rutherford stage 3)
- ABI: right 0.82, left 0.94
RISK FACTORS
- Type 2 diabetes mellitus, hypertension, dyslipidemia, ex smoker
- History of CAD s/p CABG
PROCEDURAL STEPS 1. Left groin access with retrograde cross over approach
- UF 4F diagnostic catheter (ANGIO DYNAMICS)
- 0.035" SupraCore guidewire, 300 cm (ABBOTT VASCULAR)
- 6F–45 cm Pinnacle sheath (TERUMO) 2. Passage through the right SFA occlusion
- 0.035" Tempo Aqua Vert support catheter, 125 cm (CORDIS)
- 0.018" Connect 250 T guidewire, 300 cm (ABBOTT VASCULAR)
- If unable to cross with 0.018" guidewire, switch to an 0.035" stiff angled glidewire (TERUMO) 3. Filter placement
- Exchange to a Barewire through the support catheter (ABBOTT VASCULAR)
- Emboshield Nav 6 filter placement (ABBOTT VASCULAR) 4. Jetstream atherectomy of the right SFA calcified disease
- Jetstream 2.4/3.4 mm atherectomy (BOSTON SCIENTIFIC) 5. PTA with drug-coated balloon
- In.Pact Admiral 6.0 x 120 mm DCB (MEDTRONIC) 6. PTA with a non-compliant balloon
- Dorado 6 x 100 mm balloon (BARD) 7. Stenting and post-dilatation
- 5.5 x 150 mm Supera interwoven self-expanding Nitinol stent (ABBOTT)
- Dorado 6 x 100 mm balloon (BARD)