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Recanalization for limb salvage
Three occlusions: femoral, popliteal and posterior tibial arteries - Case of the month: December 2017
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This 18 minutes didactic procedure concerns a 78 years old male with extremely severe peripheral artery disease: a Left limb amputation and a Right limb trophic ulcer. He presents Three right consecutive artery occlusions: Mid-SFA, Popliteal, proximal and distal posterior tibial.
This extremely complex case was treated using different technics according to the arterial segment: Sub intimal angioplasty and long stenting for SFA, Drug coated balloon for Popliteal, DES for proximal posterior tibial and coronary technics for plantar arteries.
Step-by-Step Procedure
Right Antegrade femoral access
Pre-procedure discussion of strategy for a multilevel artery occlusion
Guide wire selection and escalation for crossing
Support micro-catheter selection
Pre-dilatation of more than 50cm with low profile long balloon
Technics to re--enter in foot arteries
DES for distal leg arteries
DCB for popliteal artery
Self-expandable drug eluting stent for dissection and residual stenosis of SFA
Learning points
Selection and feasibility of antegrade femoral access
Guide Wire and micro-catheter selection for multilevel crossing
Balloon angioplasty with low profile long balloons
Technics to re-enter in plantar artery
Use of DCB (Drug Coated Balloon) for popliteal artery
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Max A.Thank you for your comment. This patient requires a monthly follow up to maintain patency in order to assure ulcer healing . After 6 months the risk of restenosis and occlusion is high .
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Alaaeldin H. what is the expected patency for this long segment ,multilevel occlusion.
Max A. Thank you for your comment. This patient requires a monthly follow up to maintain patency in order to assure ulcer healing . After 6 months the risk of restenosis and occlusion is high .
marcus P. Set good
Sandeep S. why did we have to break the end of Eluvia stent towards the end of deployment.
Georgi G. Leave a new comment to the discussion
Max A. It appears to be more convenient in long ELUVIA stent.
Collu B. Congratulations for very informative case