A case of PTA/Stent for both CIA and total occlusion of superficial femoral artery with retrograde approach

- Operator : Richard R. Heuser

A case of PTA/Stent for both CIA and total occlusion of superficial femoral artery with retrograde approach
- Operator: Richard R. Heuser, MD
Clinical information

- Relevant clinical history and physical exam:
A 70-year-old man presented with severe claudication which started two years ago. He had the operation of CABG one year ago and underwent on hemodialysis. His medical history was significant for hypertension, diabetes mellitus and hypercholesterolemia. His current medications were antihypertensive medications, lipid lowering agents and using subcutaneous insulin injection. He had left hemiparesis after lacunar infarction on brain stem since 1993.

- Relevant test results prior to catheterization:
The CT angiography showed the stenosis of both ICA and total occlusion of right superficial femoral arteries (SFA).

- Relevant angiography findings:
The stenosis of both ICA and total occlusion of right SFA with heavy calcification was shown ( Movie 1).

Interventional management

- Procedural step:
Doctor Heuser inserted into the left femoral artery (retrograde approach) with a 6 Fr sheath. The 0.032¡± Terumo wire was crossed from left common iliac artery to right iliac artery by using right JR 4.0 (6 Fr). (Figure 1) The shuttle (7Fr) could pass through the right CIA after ballooning stenotic lesion with Synergy 5.0(40) at left CIA and Powerflex 4.0(20), Rider 6.0(40) at right CIA. (Figure 2) Therefore he could start angioplasty with overlapping self expandable Smart control stent 6(100) and 6(120) at right SFA. ( Movie 2) Then, percutaneous transluminal angioplasty was done with using Palmaz cornithian stent (40 x 7.0) at right CIA and self expandable Smart control stent (40 x 7.0) at left CIA. (Figure 3, Figure 4) This case was successfully done without complication.

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