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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
- 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
Shooting date : 2016-10-19
Last update : 2021-05-11
Last update : 2021-05-11
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Mehmet E. nice work... thanks for sharing.
Segal D. Nice job!
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?
Rabindranath Kowlessur J. nice case
A. Nice case,well done
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.
A. good learning
Oleksandr Z. Perfect job, thanks a lot for experience
mohamad ali A. Well done
Popeski P. .
Popeski P. .
Ante K. Very nice job!
In 15.33 of movie I see stenosis of PFA what is disappears in another projection.
Majed A. Sehr schön
Chakyarpoyil A. well done