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Long Femoral Occlusion (35 cm)

Case of the month: July 2017

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. WATCH IT NOW!

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



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