75-year-old female patient with past medical history of hypertension, dyslipidemia, diabetes mellitus type II, and prior MI, came in with complaints of right calf pain on minimal exertion (Rutherford class I category 3, Fontaine IIb) on cilostazol. MRA showed bilateral SFA occlusion with distal reconstitution. Peripheral angiogram performed showed borderline stenosis of the right external iliac artery, severe calcified long segment CTO (chronic total occlusion) of proximal/mid/distal right superficial femoral artery (SFA), distal reconstitution of the proximal right popliteal artery via the profunda collaterals (shown in picture 1, 2, & 3), CTO of the mid right anterior tibial artery with distal reconstitution of the right dorsalis pedis artery via the peroneal artery collaterals, CTO of mid left SFA with distal SFA reconstitution, CTO of the mid left anterior tibial artery with distal reconstitution of the left dorsalis pedis artery via the peroneal artery collaterals. Patient is currently planned for an endovascular intervention of the long segment calcified SFA CTO (TASC D lesion). We will discuss the endovascular indications and approach towards the long segment calcified TASC D SFA lesions.
Prior failed intervention of the Left SFA ISR, Re-attempt via Pedal Access – January 2020
Tags: ISR | Left SAF | Pedal Access
Case and Plan: 67 Male with HTN, DM, HLD and PAD (prior stent of the left SFA), who presented with life style limiting claudication (L>R). Non-invasive workup revealed in-stent re-stenosis of the prior SFA stent. A subsequent attempt to intervention was unsuccessful from the CFA, now referred for a re-attempt to intervention via pedal approach.
Popliteal Artery CTO Intervention w/ failed prior attempt
Tags: CTO | Peripheral | Popliteal Vein Access
Case and Plan: 68 M with Hypertension, hyperlipidemia, smoking and known history of PAD, presents with worsening R > L claudication, that has progressed to pain at rest. He had a subsequent angiogram done that showed complete occlusion of the popliteal artery that reconstitutes at the level of TP trunk. He had a prior attempt […]
Left SFA In-stent Restenosis Intervention – Nov 27
Case and Plan: 68 year-old female with HTN, DM, hyperlipidemia and currently smokes. Presents with BL (L>R), lifestyle limiting claudication (Rutherford 4) that has progressed to pain at rest despite OMT. Noninvasive workup showed an ABI with exercise of (R): 0.95 and 0.89 (L): 0.92 and 0.67 . Subsequent US showed in-stent restenosis of the […]
Left SFA CTO – Oct. 2019
68 year old female with HTN, DM, HLD who presents with life style limiting claudication, that has progressed to pain a rest. She had a non invasive workup done revealing abnormal ABI. She had a subsequent peripheral angiogram done revealing mid Left SFA total occlusion and referred for further intervention.