Percutaneous Transluminal Angioplasty for the Deep Femoral Artery Instead of Failed Intervention for the Superficial Femoral Artery Total Occlusion

- Operator : Andrej Schmidt

Percutaneous Transluminal Angioplasty for the Deep Femoral Artery Instead of Failed Intervention for the Superficial Femoral Artery Total Occlusion

- Operator: Andej Schmidt, MD

Case Presentation

A 71 year old man was admitted for Lt. femoropoliteal and BTK intervention. About 1 year ago, he underwent both CIA and Rt. SFA intervention and at that time, severe disease of Lt femoropoliteal and BTK arteries was diagnosed. He was suffering from claudication. His cardiovascular risk factors were diabetes, hypertension, hyperlipidemia and chronic kidney disease.

Relevant test results prior to catheterization

Segmental limb pressure with Doppler revealed significant decreases of ankle-brachial indicies and pressure drop at the level of Lt iliac and popliteal segments.

Relevant angiography findings

The peripheral angiogram showed total occlusion and severe calcification of Lt SFA ( Movie 1) and all BTK arteries and severe stenosis of Lt DFA (deep femoral artery) ( Movie 2). Previous stents were relatively patent.

Procedure

A 5F sheath was inserted into Rt femoral artery. We passed the calcified and tortuous arteries and previous stents using a 0.032 soft terumo wire with 5F JR4 diagnostic catheter and replaced it with a 0.035 Amplatz stiff wire. And then we removed the sheath and inserted a 7F shuttle through Rt femoral artery to the Lt side. After insertion of the shuttle, we tried to pass the lesion using a 0.035 and 0.018 wires, but we could not advance anymore at distal part of the Lt SFA. So, we decided to treat the lesion of the Lt DFA for the development of collaterals instead. Percutaneous transluminal angioplasty (PTA) was performed using a 7 x 40 mm Powerflex balloon at proximal part of the Lt DFA (Figure 1). Final angiogram showed a good result of PTA for the Lt DFA ( Movie 3).