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Endovascular / Lower limbs / Btk-bta / Case in the box
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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 
  • Use of balloon DES in tibial artery 
  • Self -expandable DES at the femoral level

Biobliography

 

Shooting date : 2016-12-05
Last update : 2018-01-31
Max Amor
Essey-lès-Nancy, France
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Luis Mariano Palena
Abano Terme, Italy
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7 comments
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See previous comments (3)
  • Alaaeldin H.

    Alaaeldin H. what is the expected patency for this long segment ,multilevel occlusion.

    2017-12-09, 22h41
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    • Max A.

      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 .

      2017-12-11, 10h42
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      • marcus P.

        marcus P. Set good

        2017-12-17, 10h58
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        • Sandeep S.

          Sandeep S. why did we have to break the end of Eluvia stent towards the end of deployment.

          2017-12-28, 17h53
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          • Georgi G.

            Georgi G. Leave a new comment to the discussion

            2018-09-05, 12h07
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            • Max A.

              Max A. It appears to be more convenient in long ELUVIA stent.

              2018-09-05, 12h36
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              • Collu B.

                Collu B. Congratulations for very informative case

                2019-12-16, 20h18
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