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SFA Subintimal Angioplasty
- Operator: Seung-Whan Lee. MD
Clinical Information

- Relevant clinical history and physical exam:
The patients was a 55-year old man with claudication for 2 years. The pulsation of right dorsalis pedis could not be palpable. He had a diabetes mellitus and dyslipidemia. He was a 30 pack-year smoker. He underwent CABG for three vessel disease 6 months ago.

- Relevant test results prior to catheterization:
CT angiography showed diffuse severe stenosis of right external iliac artery (EIA) and occlusion of right anterior tibial artery (ATA) and right superficial femoral artery(SFA). Moderate to severe stenosis of left SFA and occlusion of left ATA.
Segmental limb pressure with doppler revealed severely decreased right ankle-brachial index (0.29) and moderately decreased left ankle-brachial index (0.65). Pressure drop was noted at right aorto-iliac and left femoro-popliteal segments.

- Relevant angiography findings:
Total occlusion of right SFA and diffuse severe stenosis of right EIA (Figure 1).

Interventional Management
- Procedural step:
We decided to perform angioplasty for right EIA because of result of segmental limb pressure and symptom. A 7 Fr sheath was inserted into the left femoral artery. We crossed right EIA lesion using 0.018 Roadrunner wire. Percutaneous transluminal angioplasty was performed using a 40 x 5.0 mm Rider balloon (Figure 2). SMART stent (100 x 7.0 mm) was successfully deployed (Figure 3). Adjunctive ballooning using Powerflex 40 x 7.0 was performed. Good patency was achieved in right EIA (Figure 4). Then, we crossed total occluded right SFA lesion via subintima using 0.032 Terumo wire. Ballooning using Rider 5.0 x 80 was performed (Figure 5). Good patency was achieved in right SFA (Figure 6).
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