Multilevel Stenosis with Shockwave via Pedal Approach – January 2023

CASE & Plan:
HPI: 73-year-old woman who is a house keeper with PMHx of CAD (s/p PCI to RCA in 2011 + mLAD in 2019), T2DM, PAD (s/p aorto-bifemoral bypass graft in 2013, unsuccessful right CIA intervention in 2013), left subclavian stenosis (s/p stent in 2019), carotid artery stenosis (s/p left CEA in 2015), HTN, HLD, T2DM, TIA, ex-smoker, presents with c/o bilateral LE (R>L) claudication walking ~<1/2 block. She has not been able to work and has been debilitated for >2 months now. Had diagnostic study done 11/2022 and brought back for intervention today.

Meds: Clopidogrel 75mg, Bisoprolol 10 mg QD, Atorvastatin 80mg, Zetia 10 mg QD, Farixga 10 mg QD, Metformin 1000 mg QD

Exam: Doppler AT pulses bilaterally

Heart/Vascular Team Discussion: Despite maximal tolerated medical therapy, exercise therapy and persistent lifestyle limiting claudication plan for endovascular treatment for multi-level stenosis/CTO (distal SFA, popliteal artery) and treatment of the CFA with shockwave and DCB via pedal approach.

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