Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
The Medication history of Coronary artery disease, triple vessel disease, post stenting for LAD, LCX and RCA; Diabetes mellitus with OHA control; Dyslipidemia; Hypertensive cardiovascular disease Bilateral lower limbs claudication for 2 years. Symptom exacerbated in recent 2 months. Lower limbs numbness and claudication was complained.
Ankle/brachial pressure index: Right: 0.68; Left: 0.75
Relevant test results prior to catheterization
Pulse Volume Record:Total occlusion of bilateral superficial femoral artery.
Relevant catheterization findings
Left SFA total occlusion, long lesion.
1. V-18 and CXI-90 antegrade looping to distal SFA
2. Hard point at distal SFA try ASTATO XS 20 but still failed
3. Popliteal puncture, retrograde wiring with V-18, antegrade wiring with ASTATO XS 20
4. Retrograde wiring to 7.0 shadow sheath and externalization
5. Admiral 5.0 x 80 mm balloon for proximal to distal SFA POBA
6. No reflow after balloon dilatation C/W tight lesion with total thrombus occlusion
7. Stenting with Zilver 6.0 x 200 mm for middle to distal SFA
8. Zilver 6.0 x 170 mm for middle to proximal SFA
9. No reflow after SFA stenting
10. Thrombus suction
11. After urokinase 12000U IA and thrombus suction. Keep urokinase maintenance for 1 day
A case of left SFA with long CTO lesion. We tried antegrade wiring but failed and finally successfully retrograde wiring with access of supine popliteal puncture. After balloon dilatation, there was no reflow. Stenting for left SFA long lesion but still no reflow and showed a picture of much thrombus burden. Thrombus suction followed by IA. Urokinase injection. Finally, the result showed improved left SFA blood flow. We presented with a case of left SFA CTO long lesion and much thrombus burden, which was successfully management by retrograde wiring via supine popliteal artery puncture.