Featured Case:
Dr. Jean-Baptiste: 66 Year Old Patient

Overview

This case is about a 66-Year-old woman with past medical history significant for hypertension, hyperlipidemia, Type 2 diabetes, 60 pack per year history of smoking (quit 10 years ago), and prior Left SFA stenting who presents with recurrent rest pain and 1 block claudication. 

 

Left lower extremity angiogram demonstrated patent SFA stent with occlusion of the mid and distal SFA beyond the stent. Popliteal artery, Anterior Tibial, and Posterior tibial arteries are also occluded. There is filling of the medial plantar artery via peroneal artery collaterals. 

 

I was able to recanalize PT and to the middle of the Lateral plantar artery but in trying to reconstruct the pedal loop, I damaged the tip of the whisper wire. In an attempt to retrieve the whisper wire in its entirety I removed the 2.0mm balloon and went back down over the damaged but still intact whisper wire with a navicross and a V18 buddy wire. This combination allowed enough support to push the 0.018 wire around the loop into the DP and up the occluded AT. 

The tip of the whisper was shown to be in a subintimal space, unretrievable, and left in the patient.

The AT, PT, CP and LP, SFA, and pop were treated with ATH and angioplasty.