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Severely Calcified Distal SFA/Popliteal to the TPT/Peroneal with SilverHawk™ DS and TurboHawk™ SX-C

  • Device: SilverHawk DS, TurboHawk SX-C
  • Morphology: Calcified
  • Vessels: Peroneal, Popliteal, Superficial Femoral (SFA), Tibia Peroneal Trunk
  • Patient Age: 67
  • Patient Gender: Female
  • Presentation:
    • Non-healing ulcers
    • Tissue loss on large toe
  • Existing Condition(s):
    • Diabetes
    • Smoking
    • Chronic limb ischemia
  • % Pre-Treatment Stenosis: 70%
  • Physician: Dr. William Thomas
  • Facility: St. Mary's Hospital
  • Location: Tucson, AZ
  • Treatment Approach: Right femoral
  • Distal Run-Off: Single vessel in the peroneal
  • Ancillary Devices Used:
    • Cook Medical 7F Balkan sheath
    • Covidien 0.035" TrailBlazer™ Support Catheter
    • Covidien 0.014" NanoCross™ PTA Balloon Catheter

Case Overview

A 67-year-old female patient presented with non-healing ulcers and tissue loss on her large toe. She had a history of diabetes and smoking. Examination revealed a 70% stenosed, severely calcified 18 cm lesion in the left distal SFA/popliteal to the TPT/peroneal.

The patient was referred to Dr. Thomas by a vascular surgeon who was unsuccessful at crossing the lesion. She was not a candidate for bypass as there was only single vessel runoff from the peroneal to the ankle. The patient was at risk of losing her large toe.

Technique

Access was obtained via a 6F device into the right femoral. Dr. Thomas wired for almost an hour and was successful in crossing the lesion.

In order to avoid dissection, Dr. Thomas chose not to pre-dilate with a balloon. He performed plaque excision with a SilverHawk DS device, making three insertions and six passes.

For treatment of the TPT/peroneal, a TurboHawk SX-C device was used, followed by post-dilatation with a 3.5 x 120 mm tapered NanoCross balloon. The result was very impressive. Residual stenosis was 10%.

Dr. Thomas stated that the key to success in this case was taking time with the wire to finesse and maintain intraluminal positioning. He felt it was important to find a tiny lumen across the calcified lesion instead of prolapsing the wire and forcing it across, as this could lead to a subintimal plane or perforation, thereby ending the case and the patient's chance at restored flow.

    Individual results may vary.

    Indications, contraindications, warnings, and instructions for use can be found in the product labeling supplied with each device.
    CAUTION: Federal (USA) Law restricts this device to sale by or on the order of a physician.

    Covidien