A Case of PTA/Stent for Heavily Calcified Total Occlusion of Iliofemoral Artery

- Operator : Ae-Young Her

A Case of PTA/Stent for Heavily Calcified Total Occlusion of Iliofemoral Artery
- Operator: Ae-Young Her, MD
Clinical Information

- Relevant clinical history and physical exam:
The patients was a 73-year old woman with claudication of right leg for 2 years. Right leg was cold and black colorization of right second toe was observed. The pulsation of right femoral, popliteal and dorsalis pedis artery could not be palpable. She had a diabetes mellitus and hypertension and experienced acute myocardial infarction 20 years ago.

- Relevant test results prior to catheterization:
CT angiography showed total occlusion of right external iliac artery (EIA) and diffuse severe stenosis of right common femoral artery (CFA) and superficial femoral artery (SFA) (Figure 1). Segmental limb pressure with doppler revealed severely decreased right ankle-brachial index and pressure drop at right aorto-iliac segments.

- Relevant angiography findings:
Total occlusion of right EIA with several collateral blood flow and heavily calcified both iliac arteries were revealed ( Movie 1).

Interventional Management

- Procedural step:
A 7 Fr sheath was inserted into the left brachial artery. We crossed through right EIA-SFA lesion using 0.035 Terumo wire ( Movie 2). Percutaneous transluminal angioplasty was performed using a 60 x 6.0 mm UDT balloon ( Movie 3). But, balloon and guide catheter could not pass through right CFA ( Movie 4). After using 0.018 Terumo wire and 60 x 3.0 mm Savvy balloon, then ballooning with 60 x 6.0 and 40 x 7 mm UDT balloon, blood flow was improved ( Movie 5, Movie 6, Movie 7). Finally, we could achieved good patency ( Movie 8, Movie 9).

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