Case and Plan:
HPI: 70-year-old male referred from OSH for bilateral lifestyle-limiting ischemic rest pain R > L as well as multiple non healing ulcers on R digits included R digit gangrene >3 months (Rutherford Grade 3, Category 6) despite GDMT and supervised exercise therapy. Patient referred from OSH. WiFi 2, Wagner 4
PMHx: NIDDM, HTN, HLD, HFrEF EF 30%, S/P TAVR 2025
Social Hx: Ex-smoker
Medications: Effient 10mg, aspirin 81mg, Empagliflozin, Metoprolol, atorvastatin (no cilostazol 2/2 CHF)
Revascularization Attempt:
Contralateral access 6 French 45 cm destination sheath
Lesion attempted to be crossed with multiple 0.014, 0.018 wires and 0.014, 0.018 support catheters along with balloon assisted crossing. However lesion unable to be fully crossed. Crossing also attempted w/ pedal access.
Decision was made to pursue DVA
