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.
Complex Multilevel Intervention of CFA, SFA and AT – October 2020
Case and Plan: 80 year old female with history of diabetes, hypertension, hyperlipidemia, former smoker, PAD with prior right SFA and more recently left SFA stent placement in May 2020 (Eluvia 6.0x120mm) presenting with left sided claudication that has progressed to pain at rest.
Management of Aortoiliac Disease (CERAB Technique) – September 2020
Case and Plan: 72 year-old female with hypertension, hyperlipidemia, COPD, hypothyroidism, former smoker with several months of bilateral, severe lifestyle limiting claudication with less than 1/2-1 block of exertion that has progressed to pain at rest. Pain involves her bilateral thighs, legs and feet. Noninvasive studies severely reduced ABIs bilaterally with monophasic waveforms in the […]
LEFT SFA CTO REVASCULARIZATION – August 2020
Case and Plan: 55 year-old-male with mutliple comorbidities, who presents with ongoing, bilateral lifestyle-limiting claudication now progressed to rest pain (L>R) who is status post R SFA CTO intervention and now planned for L SFA CTO intervention via femoral approach.
Transradial Approach for CFA Intervention Involving Fem-Fem Bypass Graft – July 2020
Case and Plan: 70 year-old male with a PMHx of HTN, HLD, asthma, NIDDM, CKD Stage III, HFpEF (55%), MGUS, CAD s/p 2vCABG and PAD s/p bilateral common iliac stent c/b left common iliac artery stent occlusion s/p R->L fem-fem bypass who is presenting with progressive claudication now present at rest (Rutherford 4). Lower extremity […]