Diffuse in-stent restenosis (ISR) in long-stented segment in the superficial femoral artery (SFA)

angiogram

Challenge

  • 59-year-old female with right calf claudication
  • Relevant patient history:
    • Diabetes, hypertension, hyperlipidemia, former smoker
    • Previous bare-metal stenting of the right SFA for diffuse disease
    • Recurrent severe right calf claudication six months later

Image: Diffuse SFA in-stent restenosis in long-stented segment in the SFA
Images courtesy of Robert Minor, MD. Used with permission.

angiogram

Procedure

  • Atherectomy with distal embolic protection was used to debulk the lesion
  • Stent graft diameters (inflow and outflow) were selected based on the measured diameter of the healthy vessel proximal and distal to the bare-metal stents
  • Stent grafts extended a minimum of 1 cm beyond bare-metal stents

Images (from left to right): Atherectomy device with distal embolic protection; Result after atherectomy; Placement of two 6 mm and one 7 mm stent grafts
Images courtesy of Robert Minor, MD. Used with permission.

angiogram

Result

  • No distal embolization
  • GORE® VIABAHN® Devices in both limbs are patent through follow-up at nine months

Image: Completion angiogram after placement of GORE® VIABAHN® Devices for ISR in the SFA
Images courtesy of Robert Minor, MD. Used with permission.

Case takeaways

  • The use of the GORE® VIABAHN® Endoprosthesis with PROPATEN Bioactive Surface* provides an excellent treatment option for ISR in the SFA, particularly when it involves a long stented segment
  • Atherectomy can be used as an adjunct to provide debulking of the restenotic tissue, and optimize stent graft expansion


*PROPATEN Bioactive Surface is synonymous with the CBAS Heparin Surface.

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.

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