×
It looks like you're using an obsolete version of internet explorer. Internet explorer is no longer supported by Microsoft since the end of 2015. We invite you to use a newer browser such as Firefox, Google Chrome or Microsoft Edge.
41263 views

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. 

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

Shooting date : 2016-10-19
Last update : 2021-05-11

Our Cases of the Month

The case of the month is a new way for our users to watch, learn, and share with incathlab. They can watch a video that highlights an innovative case and uses excellent pedagogical techniques, lear...

Share
14 comments
Join the Discussion
See previous comments (10)
  • Mehmet E. nice work... thanks for sharing.

      Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
      Your browser doesn't have Flash, Silverlight or HTML5 support.


    • Segal D. Nice job!

        Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
        Your browser doesn't have Flash, Silverlight or HTML5 support.


      • mohamed D. Thank you Sir
        I usually use not less than 6mm balloon for SFA
        I usually make only 5mm stent overlap
        What Do you think Sir?

          Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
          Your browser doesn't have Flash, Silverlight or HTML5 support.


        • Rabindranath Kowlessur J. nice case

            Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
            Your browser doesn't have Flash, Silverlight or HTML5 support.


          • narayana reddy B. Nice case,well done

              Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
              Your browser doesn't have Flash, Silverlight or HTML5 support.


            • Ralf L. As for the overlap in Standard Nitinol stents 5 mm is an appropriate overlap, but for Supera it should be longer. It is a closed cell design stent and the wires are independently moving and have the possibility to even out over time. There still can be some movement and a sepeation of the to stents should be avoided.

                Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                Your browser doesn't have Flash, Silverlight or HTML5 support.


              • venkatesa reddy D. good learning

                  Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                  Your browser doesn't have Flash, Silverlight or HTML5 support.


                • Oleksandr Z. Perfect job, thanks a lot for experience

                    Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                    Your browser doesn't have Flash, Silverlight or HTML5 support.


                  • mohamad ali A. Well done

                      Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                      Your browser doesn't have Flash, Silverlight or HTML5 support.


                    • Popeski P. .

                        Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                        Your browser doesn't have Flash, Silverlight or HTML5 support.


                      • Popeski P. .

                          Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                          Your browser doesn't have Flash, Silverlight or HTML5 support.


                        • Ante K. Very nice job!
                          In 15.33 of movie I see stenosis of PFA what is disappears in another projection.

                            Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                            Your browser doesn't have Flash, Silverlight or HTML5 support.


                          • Majed A. Sehr schön

                              Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                              Your browser doesn't have Flash, Silverlight or HTML5 support.


                            • Chakyarpoyil A. well done

                                Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                                Your browser doesn't have Flash, Silverlight or HTML5 support.


                              Suggestions

                              February 2017
                              Honolulu : Wednesday, February 15th 2017 from 01:30am to 03am (GMT-10)
                              San Francisco : Wednesday, February 15th 2017 from 03:30am to 05am (GMT-8)
                              New York : Wednesday, February 15th 2017 from 06:30am to 08am (GMT-5)
                              Buenos Aires : Wednesday, February 15th 2017 from 08:30am to 10am (GMT-3)
                              London / Dublin : Wednesday, February 15th 2017 from 11:30am to 01pm (GMT)
                              Paris / Berlin : Wednesday, February 15th 2017 from 12:30pm to 02pm (GMT+1)
                              Istanbul : Wednesday, February 15th 2017 from 01:30pm to 03pm (GMT+2)
                              Moscou / Dubaï : Wednesday, February 15th 2017 from 03:30pm to 05pm (GMT+4)
                              Bangkok : Wednesday, February 15th 2017 from 06:30pm to 08pm (GMT+7)
                              Shanghai : Wednesday, February 15th 2017 from 07:30pm to 09pm (GMT+8)
                              Tokyo : Wednesday, February 15th 2017 from 08:30pm to 10pm (GMT+9)
                              Sydney : Wednesday, February 15th 2017 from 09:30pm to 11pm (GMT+10)
                              Wellington : Wednesday, February 15th 2017 from 11:30pm to 01am (GMT+12)

                              New frontiers of complex SFA angioplasties

                              Conquering the Complex lesions with step-by-step approach

                              Share
                              Scroll Up