Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 65 year-old-female referred to our hospital because of a right lower limb ulceration. Past medical history included chronic renal failure and hemodialysis. A clinical examination showed her right leg pale with ulceration at right lower limb. She had absent pulses in dorsalis pedis artery and posterior tibial artery on both sides. And her ABI showed 0.54 at right lowerlimb.
Relevant test results prior to catheterization
A computerized tomography (CT)angiography revealed the right anterior tibial artery (ATA) occluded and the right posterior tibial artery (PTA) narrowing accompanied with severe calcification.
Relevant catheterization findings
Arteriography showed total occlusion of the right ATA and 50% stenosis of the right PTA.
We tried to perform endovascular treatment(EVT) for the right ATA, and passed Command® guide wire (AbbottVascular) through he CTO lesion of the ATA. After wiring, we dilated the lesion with 1.2-15 mm Coyote® balloon (Boston Scientific), which resulted in rupture at the middle of the lesion because of severe calcification. Then, we tried to dilate the lesion with 2.0-20 mm Coyote® balloon (Boston Scientific), but which couldn’t pass the lesion. Next, we adopted Crosser®to debulk the calcified lesion and succeeded in passing across the calcified lesion of ATA. After crossing, we could deliver 2.0-20 mm Coyote®balloon (Boston Scientific) and could dilate the lesion. Angiography showed the insufficient result, then we adopted 2.0∼2.5-210 Rapid cross ®balloon.However, Rapid cross ®balloon could not be pulled out because of failurein deflating. We tried to take out the balloon in some way,but the balloon shaft broke off. Then we tried to puncture the undeflated balloon via trans dermal with 18G needle (Im 39). Consecutively, we inflated a 2.5-150 mm Crosperio ® balloon inside the guiding catheter (Partent ®)and succeeded in extracting the remained balloon shaft.
In this case, the balloon shaft was torn off and the balloon remained undeflated below the knee lesion. Trans dermal balloon puncture with 18G needle was effective to retrieve the un-deflated trapping balloon below the knee lesion.