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External Iliac Angioplasty and SFA Sub-Intimal Recanalization

19/11/2019 -  

Royal Liverpool University Hospital
Liverpool, UK
Operators: Tze Chan 

Clinical History:

A 54-year-old diabetic patient presented with right foot ulcer. The CT angiography revealed long critical stenosis of the right EIA and a long SFA occlusion.


Risk Factors:

Arterial hypertension, IDDM, schizophrenia

Procedure:

Left retrograde CFA access with a 6 Fr crossover sheath was used to treat both lesions in one setting. The EIA was angioplastied with a 6x80mm PTA balloon catheter with good angiographic results. The sheath was advanced with the tip parked within the common femoral artery. A subintimal recanalization of the SFA was performed with a 0.035" Terumo Radifocus wire and was supported with a 5Fr straight catheter. The occlusion was crossed with a wire but the catheter would not track through the re-entry point due to lack of pushability. The catheter was exchanged for a 5x40mm PTA balloon catheter but attempts to track through the re-entry point were unsuccessful.


The PTA balloon catheter was exchanged for a NaviCross® which successfully tracked through the re-entry point into the lumen. The Terumo wire was exchanged for a 0.035" Bentson wire and the entire SFA was angioplastied to 6mm with significant recoil of both the entry and re-entry points. The sites which recoiled were stented with self-expanding stents with good results.


Conclusion:

The NaviCross® support catheter has excellent trackability and pushability which are essential in difficult cases especially with contralateral up and over access.