SFA Intervention via Retrograde Approach

- Operator : Seung-Whan Lee

SFA Intervention via Retrograde Approach
- Operator: Seung-Whan Lee. MD
Clinical Information

- Relevant clinical history and physical exam:
The patients was a 64-year old man with claudication for 2 years. He was an 80 pack-year smoker and had a diabetes mellitus and hypertension. Angioplasty was tried 3 months ago, however wire passage was failed. Leg pain was not improved by medication and exercise therapy. So he admitted for angioplasty again.

- Relevant test results prior to catheterization:
CT angiography showed segmental severe stenosis of left superficial femoral artery (SFA) and occluded anterior tibial artery.
Segmental limb pressure with doppler revealed moderately decreased both ankle-brachial index and pressure drop of both aorto-iliac and left femoro-popliteal segments

- Relevant angiography findings:
Total occlusion of left SFA and tortuous both iliac artery with heavy calcification were revealed (Figure 1).

Interventional Management
- Procedural step:
A 7 Fr sheath was inserted into the right femoral artery. We could not cross the total occluded lesion of left SFA using Shinobi, Miracle 12g, Conquest Pro12, BMW, Choice PT supported by FINECROSS catheter. Therefore we inserted another sheath into left popliteal artery. We crossed lesion using BMW via retrograde approach and externalized. Then, percutaneous transluminal angioplasty was performed using a 20 x 2.5 mm Sprinter balloon and 20 x 4.0 mm Ultra soft balloon (Figure 2). Next, two overlapping SMART stent (100 x 6.0 mm) were successfully deployed (Figure 3). Good patency was achieved (Figure 4).

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