A Common Femoral "Bounce Back‚"

A 63-year-old male smoker presented with bilateral claudication. He had resting pain in the left calf and an ankle brachial index of .3 on the left side. After recurrence in PVD symptoms 1 year ago, he had a profundoplasty and venous patch of his left common femoral artery. Angiography revealed a severe stenosis involving the common femoral and deep femoral artery on the left side (Figure 1: Still image of the lesion). 

Methods

We passed a 7 Fr Ansel (Cook Medical, Bloomington, Illinois) sheath into the left external iliac artery. We used a large SilverHawk atherectomy device (Fox Hollow) with four runs performed (Figure 2: The SilverHawk atherectomy procedure). Following the procedure, a large amount of material was removed (Figure 3: The single atherosclerotic plaque was about 6 mm in length). 

Following the atherectomy, we performed balloon angioplasty with the AngioScore balloon (AngioScore).  Because of a persistent lesion in the common femoral artery at a site just distal to a previously placed stent, we placed an 8 mm x 4 cm self-expanding stent (Medtronic) (Figure 4: Angiographic still of result). The patient is symptom free on the left side at this time.  He has for the first time made a serious effort to stop smoking.

Discussion

Normally, when a patient has a complex lesion at the femoral bifurcation and has failed percutaneous intervention, a surgical procedure is not only effective, but usually gives the patient at least a relatively long period free of recurrence.  In this gentleman’s case, in spite of him having what looked like an appropriate profundoplasty, he ended up requiring further percutaneous work.  This is one reason why it is imperative to continue to not only follow these patients, but also encourage them to modify their behaviors including stopping smoking.

View videos: Video 1 – Angiographic image of the common femoral artery. Video 2 – Angiographic image of the final result.

This case and procedures like this will be discussed in our course in Phoenix, Arizona, on October 10 and 11, entitled Cardiovascular Disease Management:  A Case-Based Approach.  We will have not only international experts in PVD, but experts discussing how to develop new devices in this environment, as well as experts discussing the new healthcare changes.  For further information, contact Laurel Steigerwald, lsteigerwald@promedicacme.com.