Overview
Dr. Imraan Ansaarie used JADE® PTA Balloons via radial artery access to successfully treat Acute Limb Ischemia of the right lower extremity.
Dr. Imraan Ansaarie used JADE® PTA Balloons via radial artery access to successfully treat Acute Limb Ischemia of the right lower extremity.
A 68-year-old male presented with cold right foot with ischemic rest pain of the lower extremity. Patient has history of advanced atherosclerotic peripheral vascular disease status post bilateral lower extremity interventions done recently. Left iliac stent was placed in the recent past. Patient also has hypertension, and dyslipidemia with ongoing tobacco use.
The radial artery was visualized under ultra-sound guidance. Flow in the proximal and distal segment as well as the intended access site was visualized in detail with color flow. The radial artery was completely occluded (Figure 1). It was a less than ideal site of access, but the groin access was difficult due to a recent stent placement in the left common iliac artery. There was no viable access in the right foot. The radial artery was accessed using a modified Seldinger technique under ultrasound guidance. Once the needle was visualized entering the anterior wall of the left radial artery, there was no blood return. This confirmed our suspicion that the left radial artery was completely occluded. A micro wire was passed slowly. Then using a modified Schmidt technique*, the completely occluded radial artery was traversed and a 5 Fr sheath was placed in the left radial artery without any complications.
After placing a catheter in the left radial artery, an angiogram of the left upper extremity was performed with a hand injection of the contrast to visualize the patency of the vessel.
Over the 0.035″ guidewire, a 4 Fr pigtail catheter was placed in the right external iliac artery. Angiogram of the right lower extremity was performed with an automated injector.
The angiogram showed completely occluded right common femoral, superficial femoral (Figure 2 and 3), and infrapopliteal (Figure 4) vessels. Over the 0.035″ guidewire, the 5 Fr sheath was exchanged for a 6 Fr 119 cm radial sheath which was placed from the left radial artery into the right common iliac artery under radiographic guidance without any complications. The patient was appropriately anticoagulated. The lesion was traversed with a 0.014″ wire and the help of a 6.0 mm JADE® balloon. The wire was successfully placed in the right anterior tibial artery. Then a 6.0 X 100 mm JADE balloon was placed in the distal right external iliac and entire right common femoral artery. Balloon angioplasty was performed using a maximum inflation pressure of 8 atm for 3 minutes. Repeat angiography showed a widely patent right external and common femoral artery (Figure 5).
After successful angioplasty of the common femoral artery, a 6.0 x 200 mm JADE balloon was placed in the right superficial femoral artery. Balloon angioplasty was performed using a maximum inflation pressure of 8 atm for 3 minutes (Figure 6 and 7). Final angiogram showed flow in the right superficial femoral artery all the way to the right anterior tibial artery.
* The Schmidt Technique is commonly used in CTOs of tibial arteries and was able to be used in the radial artery for this case.
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Results may vary.
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