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.
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.
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