Below Knee Intervention in Chronic Critical Limb Ischemia

- Operator : Bryan Ping-Yen Yan

Below Knee Intervention in Chronic Critical Limb Ischemia

- Operator: Bryan Ping-Yen Yan, MD

Relevant Clinical History and Physical Exam

A 58 year old man was admitted for right BTK intervention. About 6months ago, he was hospitalized for left diabetic foot wounds and underwent left BTK intervention and amputation of Lt. 4-5th toes. At that time, he was diagnosed with Rt. Lower extremity artery disease by CT angiography.

Relevant Test Results Prior to Catheterization

The ankle-brachial index showed right 0.8 and left 0.65. 3D CT angiography showed diffuse severe stenosis of the posterior tibial artery.

Relevant Angiography Findings

Right anterior tibial artery was diffuse severe stenosis and posterior tibial artery was totally occluded and its distal run-off vessel of PTA was slow flow( Movie 1, Movie 2, Movie 3). The proximal portion of arterial system in right lower limb was healthy.

Procedure

The left femoral artery was punctured with 7 Fr Sheath using antegrade approach. The 0.014 inch Choice PT guidewire (182cm length) with FINECROSS® 0.014 inch 1.8Fr microcatheter system was inserted into right PTA. He exchanged Choice PT to BMW 0.014 inch -300cm wire. Percutaneous balloon angioplasty using Advance 14LP 2.5 X 120 mm was performed(Figure 1). And then, he tried to advance the anterior tibial artery with the 0.014 inch Choice PT guidewire. After wire crossing, Advance 14LP 2.5 X 120 mm balloon dilatation was performed(Figure 2). The final result were good( Movie 4).