63-year-old male patient with past medical history of hypertension, dyslipidemia, ex-smoker presents with complaints of left calf pain at rest (Rutherford class II category 4). Patient ABI showed 0.80 in right and 0.65 in left lower extremity. Peripheral angiogram showed borderline obstructive disease of the right common femoral artery, popliteal artery with significant stenosis of the proximal right anterior tibial and distal posterior tibial artery. Significant stenosis in the left external iliac artery, chronic total occlusion of the mid-left superficial femoral artery (SFA) with significant calcification and obstructive disease of the left anterior tibial artery. Patient is currently planned for an endovascular intervention of the long segment left superficial femoral artery CTO. We will discuss the endovascular indications and approach towards the calcified long segment SFA CTO.
