Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A patient is a known case of Type 2 Diabetes Mellitus, Hypertension presented with C/O pain in left foot with non healing ulcer with severe rest pain and diminished peripheral pulse (Ant. Tibial Art.)
ECG-Sinus Rhythm, ST-T Changes in V2-V4
ECHO-Hypokinetic Anterior Wall, LVEF-50%
Relevant test results prior to catheterization
CT Peripheral Angiography
Complete occlusion of right superficial femoral artery at it’s origin with distal superficial femoral artery reformed by collaterals. Complete occlusion of left proximal superficial femoral artery at it’s origin with distal superficial femoral artery reformed by collaterals.
Relevant catheterization findings
Common Iliac Artery-Multiple minor plaque
External Iliac Artery-Minor plaque present
Common Femoral Artery-Minor plaque present
Superficial Femoral Artery-Occluded shortly after origin. It is being reformed in lower of femur through collaterals
Common Iliac Artery-30% stenosis present
External Iliac Artery-minor plaque present
Common Femoral Artery-minor plaque present
Superficial Femoral Artery-Occluded in mid thigh
It is being reformed over the femoral condyles through collaterals.
Approach: Right Femoral Artery
Crossing Technique: Mother and Child Catheter technique was adopted to cross the lesion.
Mother catheter: 8F CONTRA 2 guide catheter
Child Catheter: 5F Heartrail catheter
Pilot 150 crossed the lesion & pre dilated with coronary balloon.
Coronary wire was exchanged with 0.018 x 300 cm SV-5 guide wire.
Again the lesion was pre dilated with peripheral 6.00 mm balloon.
Entire segment was covered with self expandable stent 6.00 X 150 cm and followed by 7.00 X 150 cm.
Overlapping segment was post dilated with 6.00 mm peripheral balloon.
Extrapolating from principles of coronary revascularization, a symptom driven approach to extensive obstructive peripheral arterial disease may help simplify while avoiding unnecessary complications in non-symtomatic lesions. Peripheral CTO produce gross ischemia for remote circulation if not colateralized properly. However, peripheral CTO revascularization is technically challenging with ample scope of getting perforation or dissection particularly in distal locations. In addition, re stenosis leading to repeat procedures is common particularly in patients having comormid condition.