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Intervention of left anterior tibal artery (ATA) via right femoral artery approach
- Operator: Seung-Whan Lee, MD
Clinical Information

- Relevant clinical history and physical exam:
A 60-year-old man presented with diabetic foot and ulceration of toe. His history is significant for diabetes, hypertension. He had suffered from ulcer on right great toe after driving long time. The bone scan showed definitively the characteristics of osteomyelitis. He was getting well after being treated with antibiotic agents and stenting at right ATA.

- Relevant test results prior to catheterization:
The CT angiography showed distally occluded at Lt ATA & multiple severe stenosis at PTA.

- Relevant angiography findings:
The angiogram showed diffuse significant stenosis in the left ATA. ( Movie 1)

Interventional Management

- Procedural step:
A 7 Fr sized femoral sheath was inserted into the left femoral artery. The operator could pass through the stenosis of ATA with NEO’s (Xtreme) 0.014”-175cm wire after failing to go through with Roadrunner 0.014”-300cm and NEO’s (Extension) 0.014”-175cm. ( Movie 2) He changed frome the Xtreme wire to BMW 0.014”-300cm. The proximal lesion of ATA was dilated with the Kaneka (1.5 * 15) and Sleek (2.0*200) balloon. (Figure 1) He decided to change from the femoral sheath to shuttle 7 Fr. Then he was able to make a good result with using Ultrasoft (2.0*40), Kaneka (2.0*40), Cutting balloon (2.5*10). (Figure 2) The last angiogram revealed good flow to distal part. ( Movie 3)

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