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Long Femoral Occlusion (35 cm)
Case of the month: July 2017
This 20-minute case concerns a 70-year-old man with recent left intermittent claudication presenting a very long superficial femoral occlusion with no past endovascular procedure.
He is treated contra-laterally by subintimal recanalization and long femoral stenting. WATCH IT NOW!
Step-by-Step Procedure
- Presentation of the case, description of the angiography and the planned procedure
- Subintimal angioplasty initiation from contra-lateral approach
- Description of subintimal angioplasty and re-entry in the true lumen
- Pre-balloon angioplasty with long balloon (5.5 mm x 200 cm) and evaluation of results
- Selection and careful deployment of the first 20 cm long stent
- Stent shaft retrieval
- Vessel preparation and deployment of the second 15 cm long stent
- Assessment of the results after stenting
- Closing of the right femoral puncture site with a STARCLOSE device
Learning points
- Contra lateral approach of an occluded SFA from the ostium to the Hunter canal
- Initiating subintimal crossing with 0.035 inches hydrophilic guidewire
- Re-entry in the true lumen distally
- Balloon angioplasty, pre-stenting, and vessel preparation for stenting
- Careful placement of the first Supera long stent
- Overlapping and placement of the second Supera stent at the ostium level
- Evaluation of the final results
- Closing with a STARCLOSE device
Bibliography
- State of the art lecture for endovascular management of long SFA lesion - Video
- How to use DET based on clinical data review in 2016 - Video
- Feasibility and 1-Year outcomes of subintimal revascularization with Supera stenting of long femoropopliteal occlusions in critical limb ischemia - Article
- Subintimal angioplasty for lower limb arterial chronic total occlusions - Article
- Drug-eluting stents in superficial femoral artery treatment: could they be the standard of care? - Article
- A Real-World Experience With the Supera Interwoven Nitinol Stent in Femoropopliteal Arteries - Article
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Long Femoral Occlusion (35 cm) - Subintimal crossing and extra long stenting
Case of the month: July 2017
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