Superficial Femoral Artery Stenting and Acute Thrombosis

- Operator : Seung-Whan Lee

Superficial Femoral Artery Stenting and Acute Thrombosis
- Operator: Seung-Whan Lee, MD
Clinical Information

- Relevant clinical history and physical exam:
The patients was a 70-year old man with tingling sense of both legs for 2 years. The pulsation of both dorsalis pedis could not be palpable. He was a 50 pack-year smoker and had a hypertension and he underwent PCI for three coronary arteries disease 6 years ago.

- Relevant test results prior to catheterization:
CT angiography showed diffuse stenosis of right external iliac artery (EIA) and superficial femoral artery (SFA) and left SFA and total occlusion of left EIA and both peroneal arteries (Figure 1). Segmental limb pressure with doppler revealed severely decreased both ankle-brachial indices and pressure drop was noted at both aorto-iliac segments.

- Relevant angiography findings:
Severely diffuse stenosis of right EIA and SFA and total occlusion of right peroneotibial trunk were revealed (Figure 2, Figure 3).

Interventional Management

- Procedural step:
A 7 Fr sheath was inserted into the left femoral artery. We tried through right EIA-SFA lesions using BMW wire but failed, so using conquest wire, then could pass the lesion. First target was right SFA lesion. After pre-dilation using Pleon 20 x 5 mm, Synergy 20 x 4 mm, Rider 40 x 3.5 mm, and 80 x 8 mm, we inserted 3 SMART-COMTROL stents (150 x 6 mm (x2) and 60 x 7 mm). After then, we performed post-dilation using Rider 80 x 6 mm (Figure 4, Figure 5, Figure 6, Figure 7). However, we found unfortunately thrombus formation at stent site and no-reflow was observed (Figure 8). We decided to inject urokinase 400,000 IU bolus via catheter and infused 100,000 IU/hour for 3 hours. After that, finally the flow was recovered (Figure 9). So we continued the next procedures for right EIA lesions. After direct stenting with SMART-CONTROL 100 x 8 mm, post-dilatation was performed using Rider 40 x 7 mm (Figure 10). Finally, we could achieve good patency (Figure 11).

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