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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

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  • Mehmet E. nice work... thanks for sharing.

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    • Segal D. Nice job!

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      • 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?

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        • Rabindranath Kowlessur J. nice case

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          • narayana reddy B. Nice case,well done

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            • 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.

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              • venkatesa reddy D. good learning

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

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                  • mohamad ali A. Well done

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                    • Popeski P. .

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                      • Popeski P. .

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

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                          • Majed A. Sehr schön

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                            • Chakyarpoyil A. well done

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