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Endovascular Bypass creation SFA

70 yo man with mesenteric ischemia and Rutherford 5 both legs.
After successful endovascular treatment of the mesenteric arteries + Bowel resection we first treated 6 weeks later the right leg (wounds completely healed meanwhile) and now another 6 weeks later the left leg.
Pic 1 shows the CT with heavy calcified EIA stenosis, total SFA occlusion with extreme calcified occlusion of the distal SFA and P1.
Unfit for surgery we decided to bridge with an endovascular approach.
Cross over not possible due to kissing stents of the CIA into the aorta.

Pic 1: ct of the CTO
Pic 2: access in the left APF and in the mid portion of the occluded femoral artery near the vessel (US guided). Perivascular wirering with a 0.018 Advantage Track and a Trailblazer Cather until near the CFA.
Retrograde puncture of the CFA with a 4F GoBack catheter and exchange for a 7F Destination.

Pic 3:
Retrograde PTA of the EIA stenosis and CFA with 8mm and implantation of a 7.5/60 Supera
Access trough the Supera and wireing of the 7F sheath. Retraction of the sheath to the access site

Pic 4:
perivascular access to the patent P2.
Access to the popliteal artery with the GoBack catheter
PTA with 3mm. Implantation of a 7/25 Viabahn and a 7/15 Viabahn and PTA with 6mm distal and 7mm proximal. Supera 6/60 (whole size) and 6.5/150 reinforcement in the calcified area and in the distal CFA and proximal SFA

The result shows a complete recanalized EIA, CFA, SFA and Popliteal artery.

In 6 weeks we will do a second session to optimize the P2 and P3 Segment and crural arteries (Diamondback) and when he fully recoveres a TEA of the groin will finally remove the stents and treat the PFA stenosis.

Intervention was done under local anaesthesia of the groin and femoral artery. 5000IU heparin.
Popliteal block with the GoBack catheter (Lidocain 1%, 10ml.)

#Vascular #endovascular #interdisciplinary #interventional #radiology #clti