×

Become an Incathlab member and receive full access to its content!

You must be an Incathlab member to access videos without any restrictions. Register for free in one minute and access all services provided by Incathlab.You will also be able to log into Incathlab from your Facebook or twitter account by clicking on login on the top-right corner of Incathlab website.

Registration Login


Chapters (9)
Description
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 pro...

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.

Protocol

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

Biobliography

Linked playlists (2)

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
Comments(2)
Join the Discussion
  • venkatesa reddy D. very good result

      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.


    • 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!!

      Do you agree with my comments?

        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.


      Comment with Facebook

      Wednesday, October 10th 2018 from 12pm to 01:30pm (GMT+2)
      Honolulu : Wednesday, October 10th 2018 from 12am to 01:30am (GMT-10)
      San Francisco : Wednesday, October 10th 2018 from 03am to 04:30am (GMT-7)
      New York : Wednesday, October 10th 2018 from 06am to 07:30am (GMT-4)
      Buenos Aires : Wednesday, October 10th 2018 from 07am to 08:30am (GMT-3)
      Reykjavik : Wednesday, October 10th 2018 from 10am to 11:30am (GMT)
      London / Dublin : Wednesday, October 10th 2018 from 11am to 12:30pm (GMT+1)
      Paris / Berlin : Wednesday, October 10th 2018 from 12pm to 01:30pm (GMT+2)
      Istanbul : Wednesday, October 10th 2018 from 01pm to 02:30pm (GMT+3)
      Moscou / Dubaï : Wednesday, October 10th 2018 from 02pm to 03:30pm (GMT+4)
      Bangkok : Wednesday, October 10th 2018 from 05pm to 06:30pm (GMT+7)
      Shanghai : Wednesday, October 10th 2018 from 06pm to 07:30pm (GMT+8)
      Tokyo : Wednesday, October 10th 2018 from 07pm to 08:30pm (GMT+9)
      Sydney : Wednesday, October 10th 2018 from 09pm to 10:30pm (GMT+11)
      Wellington : Wednesday, October 10th 2018 from 11pm to 12:30am (GMT+13)

      Calcium, Dissections, No Stent Zones: How leading centers are fighting the last challenges in the SF...

      Live from University Hospital Leipzig

      Share
      Monday, November 30th -0001 from 12am to 12am (GMT+2)
      Honolulu : Monday, November 29th 1999 from 12pm to 12pm (GMT-10)
      San Francisco : Monday, November 29th 1999 from 02pm to 02pm (GMT-8)
      New York : Monday, November 29th 1999 from 05pm to 05pm (GMT-5)
      Buenos Aires : Monday, November 29th 1999 from 07pm to 07pm (GMT-3)
      London / Dublin : Monday, November 29th 1999 from 10pm to 10pm (GMT)
      Paris / Berlin : Monday, November 29th 1999 from 11pm to 11pm (GMT+1)
      Istanbul : Tuesday, November 30th 1999 from 12am to 12am (GMT+2)
      Moscou / Dubaï : Tuesday, November 30th 1999 from 02am to 02am (GMT+4)
      Bangkok : Tuesday, November 30th 1999 from 05am to 05am (GMT+7)
      Shanghai : Tuesday, November 30th 1999 from 06am to 06am (GMT+8)
      Tokyo : Tuesday, November 30th 1999 from 07am to 07am (GMT+9)
      Sydney : Tuesday, November 30th 1999 from 08am to 08am (GMT+10)
      Wellington : Tuesday, November 30th 1999 from 10am to 10am (GMT+12)

      Complex CTO: Ostial LAD CTO with ambiguous Proximal CAP

      Case of the month: May 2019

      Share

      Recanalization for limb salvage

      Three occlusions: femoral, popliteal and posterior tibial arteries - Case of the month: December 201...

      Share
      Scroll Up