Case presentation critical limb ischemia
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Strategies on the Frontline. Case presentation: Critical Limb Ischemia. Subhash Banerjee, MD VA North Texas Health Care & UT Southwestern Med. Ctr. Dallas, TX. Case presentation. 77 year old diabetic male Veteran with presents with c/o a “deep sensation of pain” in his right calf

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Case presentation: Critical Limb Ischemia

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Case presentation critical limb ischemia

Strategies on the Frontline

Case presentation:Critical Limb Ischemia

Subhash Banerjee, MD

VA North Texas Health Care &

UT Southwestern Med. Ctr.

Dallas, TX


Case presentation

Case presentation

  • 77 year old diabetic male Veteran with presents with c/o a “deep sensation of pain” in his right calf

  • Partial relief is often obtained by taking a short walk around the room

  • Right coronary artery PCI 6 months ago

  • Continues to smoke cigarettes

  • ABI: 0.5 (B/L); ankle pressure 52 mm Hg


Diagnostic angiographic images

Diagnostic angiographic images


Diagnostic angiographic images1

Diagnostic angiographic images


Initial unsuccessful attempt

Initial unsuccessful attempt

Contralateral CFA access

6F Crossover sheath

Primary GW/support

catheter crossing

Escalation of symptoms

after failed attempt


Repeat attempt in 4 weeks

Repeat attempt in 4 weeks

Antegrade access with 6F

45 cm sheath


Primary crossing with viance catheter

Primary crossing with Viance catheter

Right lateral view


Viance blunt microdissection catheter

(a)

Viance blunt microdissection catheter

Torque Handle

135 cm shaft (2.3F)

0.035 OD: compatible with most support catheters

0.014” guidewire (300 cm)

Distal Catheter Tip (rounded, atraumatic, 1 mm)

(b)

Torque Handle


Subintimal passage and re entry with enteer

Subintimal passage and re-entry with Enteer

Successful TP trunk re-entry with Enteer catheter & wire

Followed by IVUS confirmation


Ivus confirmation of distal true lumen access

IVUS confirmation of distal true lumen access

Sub-intimal space s/p balloon dilation

Compressed true lumen atheroma


Enteer re entry catheter

Enteer re-entry catheter

Orienting balloon with radio-opaque markers

indicating wire-exit ports on diametrically

opposite sides of the balloon

Stingray GW with 0.0035” distal taper


Final result after distal sfa tp trunk stenting

Final result after distal SFA & TP trunk stenting

6x40mm nSES

Two 3x38mm DES

Significant improvement in patient symptoms at 3m F/U


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