Long Femoral Occlusion (35 cm) - Subintimal crossing and extra long stenting

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

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