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Chapters (9)
Shooting date : 2018-10-09
Last update : 2018-12-20
Language(s) : English

This didactic procedure concerns a 62 years old man, presenting severe right limb intermittent claudication (Rutherford 3) &  long proximal SFA lesion with subsequent short occlusion.

It was treated by contralateral and retrograde approach, the lesion was prepared with directional atherectomy & a new cutting balloon (Chocolate-Medtronic). A good final result was obtained with  DCB angioplasty. 

Educational objectives

  • How to deal with extensive SFA disease.
  • How to performSFA  retrograde puncture, crossing and guidewire externalization. 
  • Effectivness of Directional atherectomy in long SFA lesions.
  • Optimal vessel preparation with combined atherectomy & cutting balloon.
  • How to leave Nothing behind.

Step-by-Step description

  • Left femoral access 7F (Contralateral approach).
  • Crossover approach with 6F long sheath assisted by Admiral 6x40mm balloon.
  • Approach lesion with 0.018" Command guidewire supported by Trailblazer microcatheter.
  • After Command & Connect guidewires failure, a retrograde approach is decided.
  • Retrograde puncture of the distal right SFA.
  • Retrograde crossing of the lesion & externalization of the command over a BER catheter.
  • Filter placment in the distal popliteal artery.
  • predilatation with 3.5mm balloon of the occluded zone.
  • Directional atherectomy using a HawkOne device 7F.
  • Balloon dilatation with a 5x80mm balloon : distal & proximal SFA.
  • Second directional atherectomy run.
  • Distal SFA dilatation with Chocolate 6x40mm balloon (Medtronic).
  • Multilevel dilatation with DCB : IN PACT Pacific 5x120mm (Medtronic)
  • Distal filter retreiving Spider 7mm (Medtronic).
  • Final angiographic control.


  • Procedure time: 90 min
  • Exposure time: 29 min
  • Exposure: 321 mGy
  • Contrast volume: 120 ml


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  • venkatesa reddy D. very good result

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    • Mangesh T. My few questions about about Long Calcified SFA Recanalisation-

      1.What was the prime aim of this Interventions to treat Proximal SFA Occlusion with Directional Atherectomy or Short segment occluded SFA?

      2.Is Pre-dilatation with Coronary balloons (1.5-3.5mm) always necessary before Debulking of Femoro-Popliteal lesion with Atherectomy device?

      3.Exact role of Chocolate Cutting balloon could not be understud? Why so many wires & balloons are used instead of doing Straightforward Hawkone Atherectomy and then Drug coated balloon plasty with In.pact Admiral?

      4.Is their any loss of Paclitexel drug while doing Balloon Plasty multiple times?

      5. After 'Inline flow' Recanalisation Why not below the knee Popliteo-tibial revascularisation Not attempted in same seating?

      6.Does ABI Improved after long SFA Recanalisation & return of triphasic waveform in tibial arteries?

      I feel Distal Embolisation protection device has No role in this Atherectomy + DEB Case!

      So many hardware material uses is Luxury for IR Consultant!!

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      Recanalization for limb salvage

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