Author + information
- Sang-Ho Park1
Patient initials or identifier number
Relevant clinical history and physical exam
A 77 year-old man with the history of hypertension, dyslipidemia, and smoking presented with the claudication of Ruthorford category 3 in right leg. His creatinine level was 1.5 to 2.0 mg/dL and creatinine clearance had the range of 20 to 35 ml/min. His ankle-brachial index was 0.54. His symptom did not improved although, intensive medical treatment including cilostazol was tried. Therefore, periepheral intervention was planned.
Relevant test results prior to catheterization
Extremity angio CT showed the chronic total occlusion of right superficial femoral artery with collaterals to distal superficial femoral artery from deep femoral artery and the intermediate stenotic lesion in P2 area.
Relevant catheterization findings
The cross-over approach was chosen and left femoral artery with 6Fr sheath punctured. The baseline angiography was consistent with extremity angioCT finding.
The astato 20g and Command-es as guide wires were used. As showed in figure, intralumen of CTO lesion was confirmed by intravascular ultrasound (IVUS) step by step and finally, the passage of guide wire was successfully performed. The balloon angioplasty with plain balloon was done but the result of the balloon response was sub optimal. Next, the stent deployment with bare self-expand albe stent was successfully done without immediate complication. We used just the contrast-dye of less than 30 ml; baseline angiography, after ballooning, and after stenting and adjutant ballooning. The diameter of vessel and length of lesion were measured by using IVUS.
IVUS can be useful in terms of saving of the amount of contrast-dye and the accurate measure of the diameter of vessel and length of lesion in SFA CTO lesion with renal insufficiency. However, the use of IVUS in more complex lesion such as heavy calcified lesion may still be limited.