CLINICAL DATA
PAOD Rutherford 3
Dm hypertension, hyperlipidemia, left SFA stent, left May Thurner stenting
Recent directional atherectomy to right SFA with DCB

PROCEDURAL STEPS
1. Antegrade right groin access
2. Passage of the lesion with hydrophilic wire
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 0.035" Terumo angled soft/stiff guidewire, 260 cm (TERUMO)
- 4F Ber II catheter (CORDIS)
3. Retrograde ATA/DP access in event of antegrade failure
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 2.6F CXI support catheter, 90 cm (COOK)
4. Predilatation and vessel preparation
5. PTA popliteal and ATA with DEB
- 3/4/5 mm Ranger DCB (BOSTON SCIENTIFIC)

CLINICAL DATA
Claudication right calf
s/p stent insertion at Rt. focal stenosis and Lt CTO, CIA (kissing stent) (2016.2.27)
Right ABI : 0.55 (2016.1.29) à 0.86 (2016.11.18) à 0.76 (2017.5.12) à 0.61 (2017.10.20)
Parkinsonism and neurogenic bladder

RISK FACTORS
Hypertension, hyperlipidemia

PROCEDURAL STEPS
1. Right groin antegrade approach
- 7F sheath
2. Guidewire passage and PTA
- 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO) and 5F Davis catheter 90 cm (TERUMO) for intraluminal or subintimal GW passage
- Jetstream (BOSTON SCIENTIFIC) with Emboshield (ABBOTT) or HalkOne (MEDTRONIC) with SpiderFX (COVIDIEN)
- 5.0 mm Ultraverse balloon (BARD)
- 5.0 or 6.0 mm Lutonix drug coated balloon (BARD)
3. (PRN) Bail-out stenting
- Innova stent (BOSTON SCIENTIFIC) or Supera stent (ABBOTT)

CLINICAL DATA
Left leg claudication, walking capacity 100 meters, Rutherford 3

RISK FACTORS
Smoking, diabetes

PROCEDURAL STEPS
1. Right femoral access and cross-over approach
- 6F 40 cm sheath (COOK)
2. Passage of the occlusion right SFA
- 0.018" V18 guidewire, 300 cm (BOSTON SCIENTIFIC)
- 0.018" Trailblazer support catheter, 135 cm (MEDTRONIC)
3. Retrograde approach via the right infrapopliteal artery in case of failure
4. PTA and DCB
- Savvy Long OTW balloon 5 x 200 mm (CORDIS)
- ORCHID DCB 6 x 200 mm (ACOTEC)

CLINICAL DATA
PAOD Rutherford 3, bilateral claudication
DM hypt, smoker, Cr 180, failed right leg angioplasty 2002

PROCEDURAL STEPS
1. Crossover access via left groin
- 6F Balkin sheath (COOK)
2. Passage of the lesion with hydrophilic wire
- 0.035" Terumo angled soft/stiff guidewire, 260 cm (TERUMO)
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 4F Ber II catheter (CORDIS)
3. Retrograde stent puncture in event of antegrade failure
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 0.035" Terumo angled soft/stiff guidewire, 260 cm (TERUMO)
4. Predilatation and vessel preparation, consider debulking
- 5.0 mm Pacific (MEDTRONIC)
- HawkOne (MEDTRONIC)
5. PTA with DEB and spot stent
- 5/6mm InPact Pacific (MEDTRONIC)
- Everflex 5/6 mm (MEDTRONIC)
6. Consider treatment of right CFA with HawkOne (MEDTRONIC)
7. Stenting of left and right iliac stenosis

CLINICAL DATA
TIA 09/17 (left arm palsy)

RISK FACTORS
Art. hypertension, nicotin abuse, diabetes mellitus type 2

PRESENT STATE
CAD, CABG 2002, ICM (LV-EF 45%)

PROCEDURAL STEPS
1. Right groin access
- 9F 25 cm Radiofocus introducer (TERUMO)
- 5F Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
- 0.035" soft angled glidewire, 190 cm (TERUMO)
- 0.035" SupraCore 190 cm guidewire (ABBOTT)
2. Cerebral protection
- MoMa proximal protection system, Mono-Balloon (MEDTRONIC)
3. Predilatation and stenting
- 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
- Roadsaver Carotid Micromesh stent 8 x 25 mm (TERUMO)
4. Aspiration of debris (if any) and declamping

CLINICAL DATA
Severe claudication right, walking capacity 50 meters, calf-pain
TEA both groins 2013; PTA/stent CIA left 2017
CAD with CABG 2015 and PTCA 2013
Minor stroke 2008 and 2009

RISK FACTORS
Diabetes mellitus, art. hypertension, former smoker

PROCEDURAL STEPS
1. Left femoral access and cross-over approach
- 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
2. Recanalisation left SFA
- 0.018" Advantage glidewire (TERUMO)
- 0.018" CXI support catheter (COOK)
Back-up material:
- Connect 250T CTO-wire (ABBOTT)
- Outback reentry system (CORDIS/CARDINAL HEALTH)
3. PTA
- Passeo18 balloon 5 x 150 mm (BIOTRONIK)
- 5 mm Passeo18 Lux DCB (BIOTRONIK)
4. Stenting on indication, spot-stenting
- Pulsar18 stent (BIOTRONIK)

CLINICAL DATA
Right calf claudication for one year, walking capacity 100 meters, Rutherford 3

RISK FACTORS
Diabetes, hypertension

PROCEDURAL STEPS
1. Left femoral access and cross-over approach
- 6F 40 cm sheath (COOK)
2. Passage of the occlusion right SFA
- 0.018" V18 guidewire, 300 cm (BOSTON SCIENTIFIC)
- 0.018" Trailblazer support catheter, 135 cm (MEDTRONIC)
3. Retrograde approach via the right infrapopliteal artery in case of failure
4. PTA and primary stent
- Passeo18 balloon 4 x 170 mm (BIOTRONIK)
- Pulsar18 stent 5 x 200 mm (BIOTRONIK)

CLINICAL DATA
PAOD Rutherford 3 R>L
AF on Warfarin, hypertension, hyperlipidemia

PROCEDURAL STEPS
1. Left brachial and left femoral approach
- 6 x 90 Flexor sheath (COOK)
2. Bi-directional wiring of left iliac CTO
- 0.0355 Terumo Glidewire or wire 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
3. Balloon angioplasty and stenting of left iliac system
4. Crossover access via left groin 6F sheath
5. Passage of the right SFA CTO
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 4F Ber II catheter or 4/5F Judkins (CORDIS) or CXI (COOK)
6. Retrograde SFA approach in event of antegrade failure
7. Predilatation and lesion preparation
8. PTA and stenting of SFA
- 6 mm Zilver PTX (COOK)
9. Stenting of right iliac system

CLINICAL DATA
Severe claudication right calf, walking capacity 150 meters
CAD, PTCA 2012
Hemicolectomy 2016
ABI right 0.63

RISK FACTORS
Diabetes mellitus, art. Hypertension

PROCEDURAL STEPS
1. Left groin retrograde and cross-over approach
- 0.035" SupraCore guidewire 190 cm (ABBOTT)
- 6F–40 cm Balkin Up&Over sheath (COOK)
2. Guidewire passage
- 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO)
- CXI support catheter, 0.035" 135 cm (COOK)
In case of failure to pass the CT from antegrade:
3. Retrograde approach via distal SFA
- 9 cm 21 Gauge needle (COOK)
- 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
- 0.018" CXI support catheter 90 cm (COOK)
4. Angioplasty
- Advance balloon 5.0/100 mm (COOK)
- Advance Enforcer 6.0/40 mm in case of focal residual stenosis (COOK)
5. Stenting
- Zilver PTX stent 6.0/140 mm (COOK)

CLINICAL DATA
Recurrent ulceration (mixed venous and arterial) right lower limb
PTA right popliteal artery 2012; recurrence of symptoms since 10/2017
Failed recanalization attempt right 1/2018,
Failure to reenter the posterior and anterior tibial artery
Art. Hypertension

PROCEDURAL STEPS
1. Right groin antegrade access
- 6F 55 cm sheath (COOK)
2. Guidewire passage antegrade
- 0.018" Command-18 guidewire, 300 cm (ABBOTT)
- Seeker 0.018" support catheter, 90 cm (BARD)
In case of repeat failure to pass from antegrade: retrograde access via PTA
- Pedal 2.9F sheath (pedal puncture set) (COOK)
- 0.014" CTO-Approach 25 gramm guidewire, 300 cm (COOK)
- 0.018" CXI support catheter 90 cm (COOK)
3. PTA
- VascuTrak scoring balloon 4.0/120 mm (BARD)
- Lutonix 4.0/150 mm DCB (BARD)
4. Stenting on indication
- Supera Interwoven Nitinol Stent (ABBOTT)

CLINICAL DATA
Severe claudication left calf, walking capacity 100 meters

IMPORTANT ITEMS
Quit smoking 1 year ago after 90-pack-years
ABI : unavailable
Bladder cancer (UCC) with M/bone (T7)
s/p Radical Cystectomy ('12.11.6) & T7 transverse tumorectomy ('13.3.27)
EGC, s/p LADG ('16.5.18)
Old Tbc; GB stone, s/p L-Cholecystectomy (30YA)
Rt. leg neural damage (after TA, >20Y)

PROCEDURAL STEPS
1. Right groin retrograde and cross-over approach
- 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO)
- 7F 40 cm Balkin Up&Over sheath (COOK)
2. Left groin retrograde approach
- 0.035" Radiofocus guidewire 190 cm (TERUMO)
- 6F 10 cm Super sheath (BOSTON SCIENTIFIC)
--> 8F sheath after passage
3. Guidewire passage and PTA
- 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO) and 5F Davis catheter 70 cm (TERUMO) for intraluminal or subintimal GW passage
- 4.0/40 mm Armada 35 balloon (ABBOTT)
- 6.0 or 7.0/100 mm Armada balloon (ABBOTT)
- Bail-out usage of Goose neck snare (EV3) or Outback (CORDIS)
4. Stenting
- 8 mm/60 mm Lifestream balloon-expandable covered stent (BARD)
- Consider bilateral common iliac kissing stent
- 7 mm/120 mm self-expandable stent for left external iliac segment

CLINICAL DATA
PAOD Rutherford 3
DM, HT, smoker, CAD s/p multiple PCI 2006, 2013, 2014
Bilateral PVD s/p multiple interventions, left popliteal stent 2014,
DCB for in-stent occlusion 2016
CTA excluded entrapment syndrome, recent stent re-occlusion

PROCEDURAL STEPS
1. Contralateral cross-over access via right groin
- 6F 40 cm long Balkin sheath (COOK)
2. Antegrade passage of the lesion with hydrophilic wire
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 0.035" Radiofocus Terumo angled soft guidewire, 250 cm (TERUMO)
3. Retrograde tibial access in event of antegrade failure
4. Mechanical thrombectomy and debulking
- Predilatation with 2/3 x 120 balloon
- 6F Rotarex (STRAUB MEDICAL)
5. Treatment with In.Pact 5 mm DCB

CLINICAL DATA
Left calf claudication, walking capacity 100 meters, Rutherford 3

RISK FACTORS
Smoking, hypertension

PROCEDURAL STEPS
1. Right femoral access and cross-over approach
- 6F 40 cm sheath (COOK)
2. Passage of the occlusion left SFA
- 0.018" V18 guidewire, 300 cm (BOSTON SCIENTIFIC)
- 0.018" Trailblazer support catheter, 135 cm (MEDTRONIC)
3. Retrograde approach via the left infrapopliteal artery in case of failure
4. PTA and DCB
- Pacific OTW balloon 5 x 200 mm (MEDTRONIC)
- ORCHID DCB 6 x 200 mm (ACOTEC)

CLINICAL DATA
Severe claudication right calf, 100 m

IMPORTANT ITEMS
Hypertension
s/p Thrombectomy, Lt. CFA to crural a.. Rt. CFA, DFA, SFA, Endarterectomy, both CFA
Fem-Fem bypass (Lt to Rt) with 7 mm PTFE graft (2015.11.19)
Right ABI : 0.33 (2016.2.4) --> 0.58 (2016.10.31) --> 0.60 (2017.8.18) --> 0.65 (2018.2.6)
In hospital cardiac arrest, idopathic (2015.11.19)
DVT in Rt. popliteal vein, on astrix, pletaal, berasil, podox, roisol

PROCEDURAL STEPS
1. Right groin antegrade approach
- 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO)
- 6F 10 cm Supersheath sheath (BOSTON SCIENTIFIC)
2. (PRN) Right ATA retrograde approach
- 0.018" V-18 guidewire (BOSTON SCIENTIFIC)
- CXI supporting catheter 90 cm (COOK)
3. Guidewire passage and PTA
- 0.018" V-18 guidewire (BOSTON SCIENTIFIC) and CXI catheter 90 cm (COOK) for intraluminal or subintimal GW passage
- (PRN) Jetstream artherectomy (BOSTON SCIENTIFIC) with embolic protection device, if intraluminal passage achieved
- (PRN) reverse-CART if subintimal passage was made
- 5.0 mm Armada balloon (ABBOTT)
4. Stenting
- Multiple 6 mm Eluvia drug eluting stent (BOSTON SCIENTIFIC)

CLINICAL DATA
PAOD Rutherford 3
Smoker, PVD s/p popliteal balloon angioplasty 2012, recurrent claudication
Resting ABI: 0.58 / 1.14

PROCEDURAL STEPS
1. Contralateral cross-over access via Left groin
- 6F 40 cm long Balkin sheath (COOK)
2. Antegrade passage of the lesion with hydrophilic wire
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 0.014 COMMAND ES (ABBOTT VASCULAR)
3. Retrograde tibial access in event of antegrade failure
4. Consider debulking if true lumen, otherwise vessel prep and predilatation
5. Treatment of SFA/Pop and tibials
- Ranger DCB (BOSTON SCIENTIFIC)
6. Spot stenting on indication

CLINICAL DATA
Hemodialysis via Permcath
Left arm swelling (+)

PATIENT HISTORY
2017.3.9 AVF formation (Br-Br), Lt.
2017.4.24 Lt. autogenous brachial-brachial upper arm transposition (2nd)
2017.8.16 – 8.19 wound care
2017.9.20 First use(+)
2017.10.11 Stent placement for Lt. innominate vein occlusion
2017.12.14 PTA for brachial vein stenosis
using 7*40 mm Mustang balloon & 6 mm*2 cm Cutting balloon

PROCEDURAL STEPS
1. US guided brachial vein access
- 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO)
- 7F 10 cm Supersheath sheath (BOSTON SCIENTIFIC)
2. Guidewire passage and PTA
- 0.035" Radiofocus soft angled guidewire 150 cm (TERUMO) and Kumpe catheter 65 cm (COOK) for intraluminal GW passage
- 6 mm, 7 mm/40 mm Conquest high-pressure balloon (BARD)
- 6 mm, 7 mm/40 mm Lutonix drug coated balloon (BARD)
3. (PRN) Stenting
- 10 mm Niti-S stent (TAEWOONG)

CLINICAL DATA
Severe claudication right leg and restpain at night, Rutherford class 4
ABI right 0.6
Renal impairment, atrial fibrillation

IMPORTANT ITEMS
PTA of right SFA 01/18
PTA of right popliteal artery, ATA and peroneal artery 07/2017
Angiography during PTA right 01/18:
High-grade stenosis right SFA and reocclusion of the right popliteal arteries
and of proximal BTK-arteries

PROCEDURAL STEPS
1. Left groin retrograde and cross-over approach
- 6F 55 cm Check-Flo Performer, Raabe Modification (COOK)
2. Guidewire passage of the occlusion
- 0.035" stiff, angled glidewire, 260 cm (TERUMO)
- 0.035" Seeker support catheter, 135 cm (BARD)
- 0.018" Command 18 guidewire, 300 cm (ABBOTT)
3. In case of failure antegrade approach via anterior tibial artery
- 0.018" Command 18 guidewire, 300 cm (ABBOTT)
- 0.018" Seeker support catheter (BARD)
4. PTA with scoring balloons and DCBs
- Vascutrak 3.0/150 mm and 4.0/120 mm (BARD)
- Lutonix-BTK DCB (BARD)

CLINICAL DATA
PAOD Rutherford 3, painfree walking distance 50 m, ABI right 0.67
PTA/Stent right SFA 2010

RISK FACTORS
Smoker, arterial hypertension, diabetes mellitus type 2

PROCEDURAL STEPS
1. Left groin retrograde and cross-over approach
- IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
- 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
- 0.035" SupraCore guidewire, 190 cm (ABBOTT)
- 8F Balkin Up&Over sheath, 40 cm (COOK)
2. Guidewire passage and thrombectomy
- Rotarex 8F (STRAUB MEDICAL)
3. PTA with DCBs
- 5.0 and 6.0 mm In.Pact Admiral drug-eluting balloons (MEDTRONIC)

CLINICAL DATA
Critical limb ischemia left, ulceration lateral forefoot, restpain during night
Rutherford class 5
Severe claudication left calf, walking capacity 50 meters
ABI left 0.37
PTA both iliac arteries 2/2018
CAD, MI and PTCA 2010

RISK FACTORS
Art. hypertension, smoker

PROCEDURAL STEPS
1. Right groin and cross-over approach
- 7F 55 cm sheath (COOK)
2. Guidewire passage
Antegrade:
- 0.018" Command 18 or Connect 250 T guidewire, 300 cm (ABBOTT)
- 4.0/40 mm Pacific balloon (MEDTRONIC)
Retrograde in case of antegrade failure via proximal ATA left:
- 0.018" Command 18, 300 cm (ABBOTT)
- 0.018" Seeker 90 cm support catheter (BARD)
3. PTA and stenting
- 4.0, 5.0 and 6.0/40 mm Pacific balloon (MEDTRONIC)
- Potentially Conquest high pressure balloon (BARD)
- Supera Interwoven Nitinol Stent (ABBOTT)

CLINICAL DATA
CLI with ulceration dig 2 and 3 right, severe claudication right leg
Rutherford class 5, ABI right 0.3
Minor stroke 2013

RISK FACTORS
Smoker (30PY), arterial hypertension, hyperlipidemia

PROCEDURAL STEPS
1. Left groin retrograde and cross-over approach
- IMA diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
- 0.035" angled soft Radiofocus guidewire, 190 cm (TERUMO)
- 0.035" SupraCore guidewire, 190 cm (ABBOTT)
- 6F Balkin Up&Over sheath, 40 cm (COOK)
2. Passage of the occlusion right SFA
- 0.018" Advantage guidewire (TERUMO)
- 0.018" CXI support catheter (COOK)
3. Vessel preparation right SFA
- Sterling 5.0/100 mm balloon (BOSTON SCIENTIFIC)
4. Primary stenting
- Eluvia DES (BOSTON SCIENTIFIC)

CLINICAL DATA
PAOD Rutherford 5 left, forefeet ulcerations, ABI 0.35 left
PTA left peroneal artery 01/2018, failled recanlisaton attempt left ATA 01/2018
CAD, AMI 2008 and 2009, PTCA

RISK FACTORS
Diabetes mellitus type 2, arterial hypertension, hyperlipidemia, former smoker

ANGIOGRAPHY
During PTA left: distal occlusion of left ATA

PROCEDURAL STEPS
1. Left antegrade access
- 6F 55 cm Flexor Check-Flo Introducer, Raabe Modification (COOK)
2. Guidewire passage of the ATA-CTO
- 0.014" Command ES guidewire, 300 cm (ABBOTT)
- 3.5/120 mm Armada 14 balloon (ABBOTT)
3. Arterial wall injection of dexamethason
- BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)

CLINICAL DATA
Abdominal mass found one month ago

RISK FACTORS
Hypertension, smoker

PROCEDURAL STEPS
1. Bilateral femoral access
- Proglide preclose techniques (ABBOTT)
2. Angiography and planning
3. Fenestrated stentgrafts (COOK)
4. Stenting of renal artery (GORE)
5. Closure of femoral access

CLINICAL DATA
Acute chest pain for two weeks

RISK FACTORS
Hypertension

PROCEDURAL STEPS
1. Right femoral access
- Proglide (ABBOTT)
2. Left brachial access for angiography
3. Stentgraft implantation in thoracic aorta
- Ankura-Stentgraft (LIFETECH)
4. In-situ fenestration
- Viabahn (GORE)
5. Femoral access closure

CLINICAL DATA
Severe claudication left leg, walking capacity 50 meters, ABI left 0.26
Liver cirrhosis CHILD A

RISK FACTORS
Former smoker, diabetes mellitus, art. Hypertension

ANGIOGRAPHY
Preinterventional angiography: severely calcified iliac arteries,
total occlusion left CIA, stenosis right CIA

PROCEDURAL STEPS
1. Left retrograde groin-access
- 7F 20 cm sheath (TERUMO)
2. Left brachial access
- 7F 90 cm Shuttle sheath (COOK)
3. Guidewire-passage left common iliac artery occlusion
antegrade:
- 5F 125 cm Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
retrograde:
- 5F 80 cm Multipurpose catheter (CORDIS/CARDINAL HEALTH)
- 0.035" stiff angled glidewire, 190 cm (TERUMO)
- Potentially CART-technique
4. Balloon dilatation and stenting in kissing technique
- Admiral 6/40 mm balloon (MEDTRONIC) bilateral
- LifeStream 8/38 mm and 8/57 mm covered stent (BARD)

CLINICAL DATA
Severe claudication left leg, walking capacity 20 meters, and restpain at night, ABI left 0.3
Femoro-popliteal bypass left 02/2014, bypass thrombectomy 04/2014 (now occluded)
TEA of the left CFA 02/16

RISK FACTORS
Current smoker (60PY), diabetes mellitus, art. Hypertension

PROCEDURAL STEPS
1. Right groin retrograde and cross-over approach
- IMA 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
- 0.035" soft angled Radiofocus guidewire, 190 cm (TERUMO)
- 0.035" SupraCore guidewire 190 cm (ABBOTT)
- 7F 55 Check-Flo Performer sheath, Raabe Modification (COOK)
2. Antegrade guidewire passage
- 0.035" stiff angled glidewire, 260 cm(TERUMO)
- CXC 0.035" support catheter, 135 cm (COOK)
3. Retrograde guidewire passage
Access via puncture of the occluded SFA
- 7 cm 21 Gauge needle (COOK)
- 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
- 4F 10 cm Radiofocus introducer (TERUMO)
- Pacific Plus 4.0/40 and 5.0/40 mm balloon, 90 cm (MEDTRONIC)
4. Antegrade GW passage and vessel preparation
- Command 18 and Armada 18 balloon (ABBOTT) or
- 0.035" Radiofocus soft angled guidewire, 260 cm (TERUMO) and 4.0/120 mm Armada 35 balloon (ABBOTT)
- 6.0/40 mm Armada 35 balloon (ABBOTT)
- Conquest high pressure balloon on indication (BARD)
5. Stenting
- proximal: Zilver-PTX DES (COOK)
- mid and distal: Supera Interwoven Nitinol Stent (ABBOTT)

CLINICAL DATA
POAD Rutherford 5, heel ulcerations and restpain at night
Walking capacity 20 m, ABI left 0.4
PTA left SFA 02/18, multiple interventions boths legs
Infrarenal AAA, bifurcated stentgraft 05/2015
CAD, atrial fibrillation

RISK FACTORS
Current smoker (40PY), diabetes mellitus, art. hypertension, renal impairment

PROCEDURAL STEPS
1. Left groin antegrade approach
- 6F 55 cm Flexor Check-Flo introducer, Raabe Modifcation (COOK)
2. Guidewire passage from antegrade
In case of failure retrograde approach via distal posterior tibial/plantar artery
- 2.9F sheath (pedal puncture set) (COOK)
- 0.014" CTO-Approach Hydro guidewire, 300 cm (COOK)
- 0.018" CXI support catheter 90 cm (COOK)
- Advance Micro-Balloon 3.0/120 mm, 90 cm (COOK)
3. PTA
- 2.5/100 m Amphirion Deep ballon catheter (MEDTRONIC)