Right Superficial Femoral Artery In-stent Restenosis Treated by Drug-Eluting Balloon(DEB)

- Operator : Seung-Whan Lee

Right Superficial Femoral Artery In-stent Restenosis Treated by Drug-Eluting Balloon(DEB)

- Operators: Seung-Whan Lee, MD, Kazushi Urasawa, MD

Case Presentation

The patient was a 62 year-old man with recurrent claudication. He was already performed stent insertion in Rt SFA in 2009. His cardiovascular risk factor was diabetes mellitus, hypertension and ischemic heart disease (3VD s/p PCI). He had also history of infrarenal AAA(35mm) which is stationary.

Baseline Conventional Angiography and CT Angiography

The conventional angiography showed a total occlusion of previously inserted stent at right superficial femoral artery ( Movie 1). CT angiography showed total occlusion of superficial femoral artery stent. Segmental limb pressure with Doppler revealed decreased right ankle-brachial index (ABI 0.62) and pressure drop was noted at right iliofemoral segment.

Procedural Step

A 6-Fr parent plus sheath was inserted into the right femoral artery. A tefron 0.032 inch wire, NEO’s(Conquest Pro 12) 0.014 inch wire, and Regalia XS 1.0 0.014 inch wire were used attempting to pass through the right superficial femoral artery in-stent restenosis lesion via antegrade approach. Finally, a Regalia XS 1.0 0.014 inch wire was passed through the lesion (Figure 1). Pre-ballooning with SLEEK PTA 4.0 x 150 mm sized balloon upto 4.15 (10 atm), SAVVY 6.0 x 150 mm sized balloon upto 6.0 (6 atm) was performed at right superficial femoral artery. Angiogram showed some dissections and arteriovenous fistula after pre-ballooning. ( Movie 2). Stenting with self expandable SMART CONTROL 6.0 x 150 mm sized stent was performed at the dissection site (Figure 2). Post-deployment balloon dilatation with SAVVY 6.0 x 150 mm sized balloon upto 6.2 (10atm) was performed. Residual stenotic lesion was treated by IN.PACT ADMIRAL 6.0 x 120 mm sized drug-eluting balloon (Figure 3). Final angiogram showed well-positioned stent in left common iliac artery ( Movie 3).