PAD with in-stent restenosis and calcified crossing management
PAD with in-stent restenosis and crossing remains a challenge. Study the case of a 62-year-old patient with coronary disease, obesity, diabetes, and dyslipidemia, who has a history of RCIA, LCIA, and SFA stenting, along with thromboendarterectomy of the RCFA. Presenting with Rutherford III claudication, predominantly on the left side, recent angiography revealed aorto-iliac femoral patency, significant SFA lesions, and popliteal artery thrombosis on the left. Analyze the perioperative angiogram for the left leg and share your insights on the best treatment approach.
Professor of Vascular Surgery
President of the association of the french university hospitals for clinical research
Conflicts of interest:
Research funding from Predisurge, Biotronik, WL Gore, GE Healthcare
Honoraria from Abbott, BD, Bentely, Biotronik, Boston Scientific, Cook, Eclevar Medtech, GE Healthcare, Ivascular, Medtronic, Penumbra, Sensome, Shockwave medical, WL Gore (consulting, medical advisory board, educational course, speaking)
A 62-year-old patient with :
- Coronary diseases / obesity / diabetic status / dyslipidemia
- Previous RCIA, LCIA + SFA stenting and thromboendarterectomy of RCFA
- Clinical worsening status, with Rutherford III on both sides and predominant on left side
- Recent investigation with Angio CT scan and per operative angiography showing:
- Aorto-ilio femoral patency associated with important SFA lesions and thrombosis on popliteal artery on left side
Crossover 5Fr 45 Cm, per operative angiogram for the left leg
- CFA patent, proximal ISR in SFA, further stent patent
- Very slow flow, mid and distal 1/3 of SFA patent with no ISR or calcified lesions
- Very slow flow, popliteal lesions with pre thrombotic calcified lesion on P2-P3
- Very slow flow, multi-lesions on BTK predominant on TTP
- Very slow flow, ATA and PTA remaining patent till the foot
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