Endovascular treatment of chronic superficial femoral artery (SFA) occlusion for limb salvage

angiogram

Challenge

  • 83-year-old female with ischemic gangrene of right great toe (Rutherford 6)
  • Relevant patient history:
    • Diabetes, hypertension, dyslipidemia, obesity, coronary artery disease, atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease (COPD)
    • Ankle-brachial index (ABI) supra-systemic due to calcified tibial arteries
    • Pulse volume recordings demonstrated femoropopliteal occlusive disease

Image: Proximal SFA disease and mid-SFA occlusion
Images courtesy of James Persky, MD. Used with permission.

angiogram

Procedure

  • Contralateral approach to right SFA (March 05, 2013)
  • Lesion crossed using straight TERUMO GLIDEWIRE® Guidewire, followed by placement of SPECTRANETICS® QUICK‑CROSS Support Catheter
  • Percutaneous transluminal angioplasty (PTA) with 5 mm angioplasty balloon

Image: Lesion crossed
Images courtesy of James Persky, MD. Used with permission.

angiogram

Result

  • Proximal device placed successfully at the ostium of the SFA
  • Correct sizing with 5 mm device
  • Excellent radiographic result
  • Patient’s ulcer healed after intervention
  • Stent grafts patent through most recent follow-up in late 2014

Image: Post-placement of three 5 mm GORE® VIABAHN® Devices
Images courtesy of James Persky, MD. Used with permission.

Case takeaways

  • Limb salvage by endoluminal bypass in Rutherford 6 limb
  • While initial PTA demonstrated a good result, diabetic patients have diffuse disease and the arteriogram understates the plaque burden in these patients
  • Cover healthy-to-healthy to the extent possible

We opt for greater stent coverage beyond the segment of disease.
We also employ oblique views of the take-off of the SFA so we can treat the diseased artery at the take-off of the SFA without compromising flow in the profunda femoris artery.

 — James Persky, MD, Cleveland, Ohio

TERUMO and GLIDEWIRE® are trademarks of Terumo Medical Corporation.
SPECTRANETICS® and QUICK CROSS are trademarks of Spectranetics Corporation.

The outcomes and observations reported are based on individual case experience and the patients treated. The steps described here may not be complete, and are not intended to be a replacement for the Instructions for Use or the education, training and professional judgment of Healthcare Providers. Healthcare Providers remain solely responsible for making decisions about patient care and the use of medical technologies.

Visit our clinical uses page

Residents of some states have the right to opt-out of the “sharing” or “selling” of their personal information. Gore does not "sell" the personal information of website users. Gore may "share" the personal information of website users, as standard advertising practice meant to offer you a more personalized service.

If you want to opt-out from Gore “sharing” your personal information, click on Opt-Out of Sharing to turn off the targeting cookies that we share with our advertising partners in order to provide you with personalized information. Disabling sharing will stop the use of cookies to targeted advertising but you may still see generic Gore ads.

Please note that your exercising of the rights outlined will have no adverse effect on the price and quality of our goods or services.

Opt-Out of Sharing

You Have Successfully Opted Out of the Sharing of Your Personal Information

Please note that if you clear your cookies and then use another device or browser, etc. your opt-out status is not transferred to the new device or browser.