Atherectomy With Drug-Eluting Balloon for Common Femoral Artery Occlusive Disease: Short-Term Experience

Purpose: Chronic limb-threatening ischemia has associated morbidity, mortality, and impact on quality of life. This endovascular case had a high-complexity target path anatomy with retrograde access to allow treatment. Objective: Presenting an endovascular case of high complexity with medial artery calcification (MAC) and management with a coronary stent in the posterior tibial artery (PTA).

Materials and Methods: Case report: Male, 57 years old, with diabetes mellitus for a long time with 7 days of ischemic lesion in the first and fifth toes of the right foot. There was an absence of pulses in the foot and behind the knee, as well as congestive heart failure with a reduced ejection fraction of 25%. In the classification system Wound, Ischemia, and foot Infection (WIfI): wound 2, infection 1, ischemia 3, with Stage 4 given a high risk of amputation and high revascularization benefit. Computed tomography angiography showed multiple stenotic lesions with continuous, thin, and annular calcifications. This corresponds to a dominant medial calcification pattern. The endovascular management was planned, finding in the Global Limb Anatomic Staging System (GLASS) femoropopliteal disease grade 4, infrapopliteal (IP) disease grade 4, and pedal disease grade 2. As the anterograde was not possible, the retrograde access in the posterior tibial with ultrasound guidance was used. The wire was snared to create a through-wire; after passing the lesion, an angioplasty was performed with a drug-eluting balloon in the superficial femoral artery, popliteal artery, anterior tibial, and posterior tibial. The persistent injury of occlusion at the level of the PTA due to stent placement managing to permeabilize. The patient has been followed for 3 months to date with primary patency.

Results: MAC has an impact on the risk of extremity loss associated with a worse limb outcome and complex disease. The use of IP stents has been debated. Different studies show higher patency immediately; technical success, however, is not clear for the long term.

Conclusions: It is necessary to have an endovascular strategy for revascularization of the IP vessel to secure an optimal vessel. This provides a good runoff of flow to the foot given greater durability, permeability, and a decrease in major complication and amputations.