67 year old female presented with severe bilateral lower extremity claudication (less than 1 block, Rutherford Category 3). On evaluation noted to have ABI of 0.68 in the left leg. Angiogram done at outside hospital revealed tight calcified stenosis of the distal left SFA (TASC II type D lesion). Her pre procedure hemoglobin, platelets, INR and renal parameters were within normal limits.
Right CFA access, with placement of 45 cm crossover sheath. Lesion crossing with 0.014 wire. This would be followed by Shockwave lithoplasty and dru coated balloon angioplasty. Bailout stenting for flow limiting dissection would be considered.