Author + information
- Shinji Tayama1
Patient initials or identifier number
Relevant clinical history and physical exam
A Case was an 80 years-old woman, has a history of high blood pressure and permanent atrial fibrillation. She had a history of heart failure with preserved left ventricle function and early re-occlusion 4 weeks after first EVT for right CFA.
Relevant test results prior to catheterization
She had a complaint of intermittent claudication of right lower limb. The ABI has recognized a decrease in the right side, 0.64/1.00. The duplex and MRA revealed chronic obstructive lesions of 4 cm at the right common femoral artery. The target lesions were fibrous mainly and less calcified.
Relevant catheterization findings
DSA image of right external iliac artery and proximal superficial femoral artery was obtained. CFA occluded for four cm, and its CTO end was bifurcation of deep and superficial femoral artery.
I obtained left femoral artery access, then cross-over approach was adapted. Treatment initiated in combination with Gladius14 3g guide wire and 6F-55 cm Mach 1 straight guide catheter. Eagle Eye IVUS observation was done from pseudo lumen of CFA. Under the IVUS navigation, Astato XS 9-40 advanced to the CTO true lumen. Then, IVUS was switched on the Astato guide wire. Using parallel wire with Jupitor Tapered 45 guide wire and IVUS navigation, wire could pass through the true lumen of CTO. Distal CTO cap was very difficult to cross, therefore, we use the CXI2. 6F-90 cm penetration catheter. Then we use the Sterling 6.0 x 60 mm balloon, we could obtain the satisfactory result.
Treatment of chronically obstructed CFA is often difficult due to the inability to place a stent. Balloon treatment with the wire that passed the false lumen last time resulted in a blockage in 1 month. True cavity passage of the wire was essential for successful re treatment. It is a case that was effective for sure passage of the true lumen using the parallel wire with the IVUS navigation.