Case

Common Femoral Artery Plaque Excision using Directional Atherctomy platform

- Operator : Seung-Whan Lee

Common Femoral Artery Plaque Excision using Directional Atherctomy platform
- Operator: Seung-Whan Lee, MD
Case Presentation
This 68-year old women was admitted to our hospital for the treatment of recently aggravated claudication (Fontaine stage IIb, Rutherford category 3) and the gangrenous wound at right 1,3th toe (WIfI score 4) which occurred 1 year ago. She had diabetes and hypertension and a history of cerebral infarction. The right ankle-brachial index value was severely decreased (0.52).
Baseline Peripheral Angiography
The right CFA showed critical focal stenosis due to an oval shaped artheroma. (Figure 1). And there was diffuse and severe stenosis from distal SFA to distal popliteal artery (P3) with heavy calcification (Figure 2). Beyond the patent segment of the TP trunk, posterior tibial artery, peroneal artery and the anterior tibial artery revealed to be totally occluded (Figure 3).
Procedure
A 5F sheath was inserted into the left femoral artery for the contralateral retrograde approach. After angiography, the sheath was exchanged to the 7F Ansel guiding sheath. For protection of embolic event, Spider FX 5.0mm protection device was placed at proximal popliteal artery (Figure 4). And then, with the use of Turbohawk LX-C, anterograde directional atherectomy was done several times ( Movie 1). Lots of plaque debris were removed from the atherectomy and protection device. After atherectomy, the size of focal atheroma was reduced in to half of its original size (Figure 5). The CFA was dilated using Evercross 6.0 (80) balloon (Figure 6) and a small dissection was seen on post-angioplasty finding (Figure 7). And then, with the support of Armada 35- 4.0/80mm balloon, antegrade intimal tracking to the popliteal artery was successfully done by Winn(Command) 1.0/0.014 inch-300cm peripheral-guidewire. Distal SFA to distal popliteal artery was sequentially dilated using Armada 35- 4.0/80mm and Peripheral cutting 5.0/20mm and AMPHIRION DEEP 4.0/150mm balloon (Figure 8, Figure 9, Figure 10). Final angiogram showed a successful result and good blood supply to the right leg. (Figure 11, Figure 12).

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