Peripheral
Femoral bifurcation

PAD with highly selective treatment for CLTI

This case was presented at JIF Periph Live on 14 December 2024 by the University Hospital of Bordeaux

Gilles Goyault
Gilles Goyault
Strasbourg, France
Interventional radiologist
Éric Ducasse
Éric Ducasse
Hospital Pellegrin - Bordeaux, France
Professor of vascular surgery

Professor of vascular surgery
Head of unit of vascular surgery CHU Bordeaux - France

Conflicts of interest:

Honoraria from: COOK Médical, Térumo-Vascutek, Siemens, GORE

Part I - Case presentation

An 83-year-old patient with:

  • Coronary disease / valvular disease / atrial fibrillation / diabetic status / dyslipidaemia
  • Previous EVAR in 2011/ TEVAR in 2013/ complete femoro-popliteal stenting in 2017/ TAVI in 2023
  • Clinical worsening status with Rutherford IV on left side
  • Recent investigation with angio CT scan and per operative angiography showing:
    • Aorto-ilio-femoral patency associated with profonda thrombosis to distal reinjection branches, and superficial femoral and popliteal arteries thrombosis with reinjection on tibial arteries

Per operative angiogram of the left leg

  • CFA patent
  • Stump for SFA
  • Thrombosis of the PFA ostium
  • Collaterals for distal perfusion

Per operative angiogram for the left leg

  • Very slow flow
  • Distal reinjection on BTK arteries
  • TTP reinjection with peroneal artery
  • TA reinjection with slow flow

Powered by Quiz Maker

 

Part II - Our decision
  • Brachial access for endo treatment of the left leg (through previous EVAR)
  • PFA recanalisation
  • +/- SFA recanalisation
First attempt with Asahi Gladius® 0.018 – 300 = failure
Second attempt with Asahi MGPV 0.018 + Passeo-18® 5 x 6 mm 0balloon to add more push = failure
Third attempt with Asahi Halberd® 0.018 – 300: crossing of proximal cap = distal re-entry failure
Fourth attempt with Asahi MGPV 0.018 = distal re-entry failure
Fifth attempt with Asahi Gladius® 0.014 – 300 = successful crossing!
Angioplasty with Passeo-18®, 0.018 5 x 60 mm balloon = first angioplasty 2 mm
New angioplasty with Armada­™ ABBOTT 0.014 4 x 60 mm balloon, during 2 minutes, at 12 atm = second angioplasty
Control with PFA permeability but lesions remaining
New angioplasty with DEB: Passeo® -18 Lux® BIOTRONIK 5 x 80 during 3 minutes, at 8 atm
Control post-angioplasty with good result on the main trunk recanalisation with 2 distal main branches
Distal angioplasty on bifurcation with Armada­™ 0.014 3 x 40 mm balloon, during 3 minutes, at 10 atm
Control with good result and addition of 1 mg Risordan to reduce arterial spasm
New control post-Risordan
Control with oblique view
  • Distal control at reinjection zone with improved flux
  • Decision to stop at this point without SFA recanalisation after a 56-minute procedure
  • Patient discharged at D+1 with Rutherford Class IV to RC II/III at 1 month and same RC II status at 6 months post intervention (mai 2024)