Introducing the patient
76 yrs, male - Risk factors for CAD/PAD - Diabetes type II, High blood pressure
• History
Long standing claudicant with initially good response to supervised walking training
• Current presentation
Recent slow but steady progression of severity of complaints despite adequate supervised walking training with pain-free walking distance < 200 mtr
• Starting angiography/echo doppler/test results
Severily calcified occlusion of the superficial femoral artery (SFA) on the right to be treated with recanalization and most likely (bail-out) stenting
Procedure
• Procedural steps
An antegrade approach was chosen in a calcified common femoral artery (CFA) to have optimal manoeuvrability and no restrictions regarding device selection and length.
• Devices
Considering the aim of this case study: a 6 French 11 cm radiopaque tip access sheath was inserted in the CFA.
• Procedural challenges
Considering the severe back-pain and limited ability of the patient to lay still post-procedurally there was a strong encouragement from both the patient and the referring physician to use a closure device to seal the access post-procedurally. However, as with many cases, the calcifi ed plaques in the common femoral artery are a challenge (if not a contra-indication) when introducing and in particular fixating a closure device to seal the access point.
• Devices
To seal the access we opted for the 6F Angio-Seal VIP device.
What happend to the patient?
The result of the intervention was that the patient managed to increase his walking distance significantly. Closure with the Angio-Seal device was a success, reducing the required post-procedural bedrest to a minimum allowing for quick ambulation and discharge the day of the procedure.
My tips and tricks
When deciding on the access point in (a severely calcified) common femoral artery, as well as when positioning and fixating the Angio-Seal closure device, performing these steps under ultrasound can further reduce the risk of mal-positioning the device. In particular it allows for a more controlled pull back manoeuvre for the anchor, which won’t get stuck behind calcified plaques since you can control the moment around it. To seal the access we opted for the 6F Angio-Seal VIP device.
Carsten W.K.P. Arnoldussen, M.D.
Interventional Radiologist
VieCuri Medical Centre, Venlo, Netherlands
