Complex SFA CTO Intervention Live Case Study - 11/29/2023

A 72-year-old gentleman with severe RLE claudication referred for evaluation. Despite medical therapy, he experiences rest pain. Past medical history includes diabetes, hypertension, hyperlipidemia, hypothyroidism, and prior PAD intervention. The case details the patient's presentation, vital signs, vascular examination, lab results, ABI, and the planned approach for right SFA CTO intervention.

• SFA
• CTO
• Intervention
• Live Case Study
• PAD

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Uploaded on Apr 19, 2024 | 1 Views

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1. Complex SFA CTO Intervention Live Case 11/29/2023

2. Case Presentation 72 year old gentleman referred for evaluation of severe RLE claudication progressing to rest pain (Rutherford class 4) despite maximal medical therapy and community based SET PMH: Diabetes Mellitus , HTN, HLD, hypothyroidism, CKD stage 2 , PAD with prior LLE intervention at outside facility (SFA and posterior tibial artery) Social History: current smoker 2 cigs/day Medications: Levothyroxine, MetforminEnalapril, HCTZ, Rosuvastatin 40 mg, Cilostazol, Aspirin 81 mg

3. Case Presentation VS : BP 115/65, HR 65, Temp 98.4 F, Sao2 98% on RA Pertinent vascular exam : No carotid or abdominal bruits , 2+ DP and PT bilaterally Labs: Hgb 14.7, Plts 248 K, Cr 1.5 , BUN 24 , LDL 65 mg/dl

4. Case Presentation Resting ABI prior to LLE intervention : 0.25 ( right) and 0.3 (Left) Arterial Duplex US: Absent flow in right mid and distal SFA Monophasic flow pattern in right proximal SFA, proximal AT , proximal PT and DP

5. Case Plan Right SFA CTO intervention Approach: LFA access (Up and over) , right transpedal access (ATA) for CTO crossing if needed and treat from above 7 fr 45 cm Terumo destination sheath Bivalirudin for anticoagulation IVUS for vessel sizing and plaque characterization Vessel Prep : PTA / Atherectomy (DA vs Orbital vs IVL) Destination therapy: DCB vs DES (Zilver PTX / Eluvia)