This is a 76 y/o African female with diabetes, HTN, and dyslipidemia who presented to the clinic with complaints of severe left LE claudication and rest pain for several months. She also has had a non-healing ulceration of the left dorsal foot. The arterial dopplers in the office confirmed complete occlusion of the left external iliac artery, left common femoral artery and proximal SFA, so left antegrade access was not an option. She underwent left LE angiography initially on 8/5/2021 via a contralateral retrograde access approach common femoral access. Attempt was made to cross the occlusion with standard 0.18in and 0.14in wires without success. She was then brought back on 8/10/21 with repeat right common femoral access. I was able to place a 0.35in Glidewire through the left external iliac occlusion into the left CFA occlusion so that a 7Fr 45cm Destination sheath could be passed retrograde to the left external iliac artery. I then crossed the left CFA and CFA occlusions using a 5Fr Tigereye CTO catheter. A 0.14in Savvy wire was then passed through the occlusions into the distal left SFA. IVUS confirmed intra-luminal position throughout. The mid SFA by angio and IVUS revealed 90% stenosis. Atherectomy was then performed using a 7Fr Pantheris direction atherectomy catheter. This was followed by PTA using a Sterling 4/0 x 60mm balloon. Dissection of the proximal and mid SFA occurred despite prolonged balloon inflations, and a 5.0 x 60mm Innova stent was deployed with excellent angiographic results. This patient was seen in the office in 2 weeks for follow up and was symptom-free.
“These are before and after pictures of an occluded left distal external iliac, left CFA, and proximal left SFA I was able to cross with the new Avinger Tiger Eye CTO device. First lab to use this device in Phoenix and first lab to use in Modern Vascular. With full visualization of the CTO, this device will revolutionize how we cross antegrade CTOs.”
– Dr. Anthony Pozun
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