SOLACI PERIPHERAL | 3rd Clinical Case: Femoral PCI

angioplastia femoral

In keeping with its Clinical Case Discussion Program, SOLACI’s peripheral interventions department, SOLACI Peripheral, presents the third clinical case, to promote knowledge exchange across the entire Latin American hemodynamics community. 

Share your thoughts on case and resolution in the comments and answer the questions at the end of the article.


Femoral PCI


Authors: MD Mauricio Cavalieri Machado / MD Caiser T. S. Junior / MD Thiago José de Assis

Contact: mcavmachado@gmail.com

Healthcare centerLuxemburgo Hospital, Belo Horizonte/ MG. Brazil.


– Patient: 75-year-old woman. Stenting of right and left femoral arteries in 2018.

– Patient informs intermittent claudication after 100 m walk is back, with pain in lower right and left limbs (Fontaine IIB, Rutherford 4).

– History of hypertension, hypothyroidism, dyslipidemia, and atrial fibrillation. Use of losartan 50 mg BID, amlodipine 10 mg MID, simvastatin 40 mg MID, Hidantal, rivaroxaban 20 mg MID, amiodarone, Puran t4 75 mcg/day, fluoxetine 20 mg/day.

– Lower limb echo-doppler shows new occlusions in both femoral arteries. Distal bed is good.

These are the angiography images. TASC D occlusions.

Left lower limb

Right lower limb

Question… What course of action should we recommend?

Case Solution

– We treated both lower limbs percutaneously. We stopped using rivaroxaban and started ASA and clopidogrel 48hrs before procedure.

– To treat the left SFA, we performed a contralateral retrograde right CFA puncture and placed a 6F sheath, 45 cm long. We attempted crossing proximal occlusion into stent lumen, but the guidewire would go to false lumen.

– We then opted for distal SFA approach, with a 4F inductor and retrograde puncture through the thigh.

– We crossed the occlusion and exteriorized the guidewire

– We performed balloon dilation and successfully completed with drug coated balloon.

– One month after first intervention, we treated the right SFA.

– We now puncture the left CFA using contralateral femoral sheath placement. We successfully penetrated proximal stent occlusion but when exiting, there was vessel dissection and the guidewire stayed in false lumen, which prevented advancing along the popliteal.

12- Guidewire in popliteal false lumen

– Once more we opted for the retrograde approach in leg. This time punctured the anterior tibial artery (images 13, 14), advanced the 0,014 guidewire in a retrograde fashion, and exteriorized it (video 2).

– Guidewire snaring.

– Balloon dilation successfully completed with drug coated balloon (images 15,16).

Devices used:

  • 6F Sheath
  • 4F Sheath
  • 0,035 260 cm stiff hydrophilic guidewires
  • IM catheter
  • Long sheath 50 cm Destination
  • Oceanus 35 4 X 80 and 5 X 150 balloon
  • 3,5 X 60 OTW balloon
  • Admiral 6 X 150 cm paclitaxel coated balloon
  • 0,014 PT2 300 cm guidewire
  • 5F Glidecath catheter

Question: what measurements would you use to prevent repeat stent thrombosis?


Conclusions

  • Endovascular treatment can be used in TASC A to D lesions
  • The most popular bailout technique for challenging rechannelization is the retrograde approach which, in addition to good outcomes, has excellent cost-benefit ratio.
  • Drug coated balloons can be used for stent restenosis.

Discover other SOLACI Peripheral clinical cases

 


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

TCT 2024 | SIRONA: Randomized Study Comparing Sirolimus-Coated vs Paclitaxel-Coated Balloon Angioplasty in Femoropopliteal Disease

This prospective, randomized, multicenter, investigator-initiated non-inferiority study compared the use of sirolimus-coated balloon (MagicTouch) vs paclitaxel-coated balloon in endovascular treatment.  The primary objective was to...

TCT 2024 | PEERLESS: Mechanical Thrombectomy with FlowTriever vs Catheter-Directed Thrombolysis in Intermediate Risk PTE

Pulmonary embolism (PE) continues to be the third cause of cardiovascular mortality. The current clinical guidelines recommend anticoagulation in intermediate risk patients presenting right...

The El Salvador 2024 Sessions are coming soon

The XLIX SOLACI 2024 Regional Sessions (17th Central America & the Caribbean) are approaching, and will take place in the city of San Salvador (El Salvador)....

Check out the best images of the Arequipa 2024 Sessions

Review the highlights of the XVIII SOLACI Regional Sessions held at the Hanan Hotel in Arequipa, Peru between October 3 and 4, 2024. <!-- wp:tw/bwg...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...