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This 20-minute case concerns a 70-year-old man with recent left intermittent claudication presenting a very long superficial femoral occlusion with no past endovascular procedure.
He is treated contra-laterally by subintimal recanalization and long femoral stenting.
Step-by-Step Procedure
- Presentation of the case, description of the angiography and the planned procedure
- Subintimal angioplasty initiation from contra-lateral approach
- Description of subintimal angioplasty and re-entry in the true lumen
- Pre-balloon angioplasty with long balloon (5.5 mm x 200 cm) and evaluation of results
- Selection and careful deployment of the first 20 cm long stent
- Stent shaft retrieval
- Vessel preparation and deployment of the second 15 cm long stent
- Assessment of the results after stenting
- Closing of the right femoral puncture site with a STARCLOSE device
Learning points
- Contra lateral approach of an occluded SFA from the ostium to the Hunter canal
- Initiating subintimal crossing with 0.035 inches hydrophilic guidewire
- Re-entry in the true lumen distally
- Balloon angioplasty, pre-stenting, and vessel preparation for stenting
- Careful placement of the first Supera long stent
- Overlapping and placement of the second Supera stent at the ostium level
- Evaluation of the final results
- Closing with a STARCLOSE device
Bibliography
- State of the art lecture for endovascular management of long SFA lesion - Video
- How to use DET based on clinical data review in 2016 - Video
- Feasibility and 1-Year outcomes of subintimal revascularization with Supera stenting of long femoropopliteal occlusions in critical limb ischemia - Article
- Subintimal angioplasty for lower limb arterial chronic total occlusions - Article
- Drug-eluting stents in superficial femoral artery treatment: could they be the standard of care? - Article
- A Real-World Experience With the Supera Interwoven Nitinol Stent in Femoropopliteal Arteries - Article
Shooting date : 2016-10-19
Last update : 2021-05-11
Last update : 2021-05-11
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October 2016
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Conquering complex femoropopliteal cases
New techniques and clinical evidences
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Mehmet E. nice work... thanks for sharing.
Segal D. Nice job!
mohamed D. Thank you Sir
I usually use not less than 6mm balloon for SFA
I usually make only 5mm stent overlap
What Do you think Sir?
Rabindranath Kowlessur J. nice case
narayana reddy B. Nice case,well done
Ralf L. As for the overlap in Standard Nitinol stents 5 mm is an appropriate overlap, but for Supera it should be longer. It is a closed cell design stent and the wires are independently moving and have the possibility to even out over time. There still can be some movement and a sepeation of the to stents should be avoided.
venkatesa reddy D. good learning
Oleksandr Z. Perfect job, thanks a lot for experience
mohamad ali A. Well done
Popeski P. .
Popeski P. .
Ante K. Very nice job!
In 15.33 of movie I see stenosis of PFA what is disappears in another projection.
Majed A. Sehr schön
Chakyarpoyil A. well done