- August 5, 2021
- Posted by: cmcdonald
- Categories: Case Study, Peripheral Arterial Disease
Patient History and Consultation
- 80-year-old patient with severe claudication and rest pain of the LLE. The patient was only able to walk 50 ft before the onset of severe calf cramps and a burning sensation in the foot requiring rest. Wakes at night with calf and foot pain relieved by dependent positioning. Long vascular history with prior SMA and celiac stents, iliac stents, and RLE angioplasty
CAD s/p MI x3
- Physical Exam. The left foot is cool to the touch. Normal femoral pulse. No popliteal or distal pulses. Mild rubor with no ulceration
Physical Non-Invasive Evaluation
- Preliminary Evaluation
- PVR with a severe reduction in left ABI and marked loss of pulsatility below the knee
- Duplex with occlusion of SFA and Popliteal arteries with low-velocity monophasic flow in distal tibial vessels
- Patient maximized medically
- Poor candidate for surgery due to comorbidities
- Proceed with endovascular intervention with possible atherectomy/angioplasty and stent
Occlusion of left SFA and Popliteal artery with reconstitution of isolated tibial vessels. Poor collateralization noted
Distal Anterior Tibial and Peroneal arteries are patents, but diseased
Subintimal angioplasty through SFA to Peroneal with SFA and Popliteal stents
Subintimal angioplasty extended into Anterior Tibial artery with angioplasty of distal Peroneal artery and Anterior Tibial Artery
- Complete resolution of LLE claudication and rest pain
- Normalized PVR in the left leg
- Percutaneous revascularization of the leg with long segment occlusions and poor target vessels in a patient who is a poor surgical candidate.
- Patient to continue with Statins and dual antiplatelet therapy.
- Complex endovascular interventions are now feasible for distal vessel disease. Emerging technologies such as catheter-based optical coherent imaging to visualize the former lumen of vessels will continue to extend the ability to recanalize long segment occlusions.