Author + information
- Received March 5, 2018
- Revision received March 14, 2018
- Accepted March 20, 2018
- Published online August 6, 2018.
- aDepartment of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- bDepartment of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
- ↵∗Address for correspondence:
Dr. Bor-Hsin Jong, Department of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, 95, Wen-Chang Road, Taipei 11101, Taiwan.
A 77-year-old man presented with intermittent severe claudication (Rutherford grade 3) in his left leg for months. The left lower extremity ankle-brachial index (ABI) was measured at 0.69. He underwent initial endovascular treatment (EVT) in 2004, with 4 WALLSTENTs placed in retrograde fashion from the popliteal artery to the proximal left superficial femoral artery (SFA). Unfortunately, his symptoms were not alleviated; duplex ultrasound obtained thereafter revealed total occlusion of the left SFA, and the ABI was measured at 0.69. Therefore, he was referred for rehabilitation therapy.
However, symptoms progressed in 2012, and the patient reported left leg pain both during walking and at rest (Rutherford grade 4). Angiography revealed a total occlusion extending from the proximal stent site of the left SFA. Only the stent within the distal SFA was not in the subintimal space (Online Video 1).
A second attempt at left SFA EVT was arranged 1 month later. With a bidirectional approach, and using a pull-through technique to advance the guidewire from proximal SFA to distal SFA, we were able to dilate the strut of the previous stent in the distal SFA. Angiography thereafter revealed a recanalized SFA with only the lower SFA covered by the previous stent.
We deployed 3 Zilver PTX 6.0 × 120 mm drug-eluting stents (Figure 1).
Final angiography showed no residual stenosis with very good flow (Online Video 2). The patient felt relief after EVT and was discharged 2 days later. The ABI after EVT was measured at 1.01.
In 2015, the ABI was measured at 0.99; follow-up angiography showed no residual stenosis and good flow (Online Video 3). We rotated the C-arm to check the status of the stents and saw that 2 groups of stents were interlacing together, like the shape of a double helix (Figure 2, Online Videos 4 and 5).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 5, 2018.
- Revision received March 14, 2018.
- Accepted March 20, 2018.
- 2018 American College of Cardiology Foundation