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Successful Superficial Femoral Artery Intervention by DAART Technique
- Operator: Seung-Whan Lee, MD
Case Presentation
A 62 year-old man was admitted for management of claudication of both leg for 1 year. Ankle-Brachial Index finding was Rt 0.72/ Lt 0.69. The lower extremity CT angiography showed moderate to severe stenosis at both SFA(superficial femoral artery). We planned to treat the left SFA first.
Angiographic Findings
The left SFA showed critical stenosis due to an oval shaped heavy calcified atheroma. And there was diffuse and severe stenosis. ( Movie 1, Figure 1)
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. And then, with the use of Turbohawk LX-C, anterograde directional atherectomy was done several times. ( Movie 2). 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. ( Movie 3) The SFA was dilated using Mustang 5.0 x 150 mm balloon and minimal dissection was seen on post-angioplasty finding. ( Movie 4, Figure 2) And then, proximal SFA was sequentially dilated using IN PACT Admiral 5.0 x 150 mm (Drug-coated balloon). (Figure 3) Final angiogram showed a successful result and good blood supply to the left leg. ( Movie 5)
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