ABSTRACT
A 45-year-old male smoker presented with extensive non-healing ulcerations and an occluded right common femoral artery. His left forearm had contractures from a prior stroke. We describe a combined radial-tibial access revascularization strategy.
Subject(s)
Arterial Occlusive Diseases , Catheterization, Peripheral/methods , Femoral Artery , Radial Artery/surgery , Tibial Arteries/surgery , Vascular Surgical Procedures/methods , Angiography/methods , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/physiopathology , Arterial Occlusive Diseases/surgery , Femoral Artery/diagnostic imaging , Femoral Artery/pathology , Femoral Artery/surgery , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
OBJECTIVE: We describe our experience in transradial recanalization of the superficial femoral artery (SFA), and we provide a stepwise approach accounting for the patient's height and optimizing the yield of currently available devices. METHODS AND RESULTS: Fifteen patients with simple SFA disease, including 4 patients with total SFA occlusions <15 cm, were selected for stand-alone transradial recanalization. A 6F, 125-cm multipurpose guiding catheter was used to cannulate the limb of interest and support device delivery. The procedure was successful in all patients and consisted of balloon angioplasty (using 0.014â³, 200-cm shaft monorail balloons) in all patients, and orbital atherectomy in 6 patients. We illustrate the steps and challenges of the transradial approach, namely the limited support in complex disease and the limited reach of current equipment. CONCLUSION: In patients with simple SFA disease, transradial recanalization appears feasible and safe but currently limited to balloon angioplasty ± orbital atherectomy. Proximal SFA stenting may be feasible in patients <160 cm in height.
Subject(s)
Angioplasty, Balloon/methods , Atherectomy/methods , Peripheral Arterial Disease/therapy , Radial Artery , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/instrumentation , Atherectomy/adverse effects , Atherectomy/instrumentation , Constriction, Pathologic , Feasibility Studies , Female , Femoral Artery/diagnostic imaging , Femoral Artery/physiopathology , Humans , Male , Middle Aged , New Orleans , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/physiopathology , Punctures , Time Factors , Treatment OutcomeABSTRACT
A 57-year-old man with diabetes mellitus, systemic arterial hypertension, and end-stage kidney disease came to the hospital because his arteriovenous fistula used for hemodialysis had clotted. His blood hemoglobin level was 12.8 g/dL (reference, 13.5-17.5); and serum chemistry levels were creatinine 6.7 mg/dL (0.7-1.3), sodium 132 mEq/L (136-146), potassium 4.0 mEq/L (3.5-5.1), chloride 94 mEq/L (98-106), carbon dioxide 24 mEQ/L (23-29), calcium 9.1 mg/dL (8.4-10.2), and phosphorus 9.1 mg/dL (2.7-4.5). An electrocardiogram was recorded (Figure 1).
