Successful Treatment of Common Femoral Artery Lesion with Diamondback 360® Peripheral OAS Exchangeable Series and New 2.00 Max Crown

Patient History

The patient was a 93-year-old male with a past medical history significant for Peripheral Arterial Disease. History includes below-the-knee amputation and left fem-pop bypass grafting, hypertension, hyperlipidemia, and prior tobacco abuse. He was status post-intervention for occlusion of his left fem-pop bypass graft approximately six months prior to presentation. He presented with a nonhealing, necrotic left great toe wound. This was refractory to conservative care and wound care. He was compliant with clopidogrel monotherapy and compliant with wound care management. Given the rapid progression of his left great toe wound, he presented to the hospital for further evaluation and management.

Treatment Summary

On examination, the patient had a non-palpable left common femoral pulse with strongly palpable right common femoral pulse. Pedal pulses were nonpalpable in the left lower extremity with a necrotic great toe. Successful treatment of the common femoral artery lesion was accomplished using the Diamondback 360® Peripheral Orbital Atherectomy System — Exchangeable Series and the New 2.00 Max Crown.

Given this constellation of findings, the decision was made for transradial angiography and intervention to minimize procedural access site risk. The right radial artery was accessed under ultrasound guidance, and a 119 cm sheath was advanced into the left external iliac artery. Angiography confirmed occlusion of the left common femoral artery with widely patent left fem-pop bypass graft and single vessel runoff to the left foot via the peroneal artery. The tibioperoneal trunk also had severe (80-90%) stenosis.

The total occlusion was successfully crossed with a crossing catheter and guidewire. Once true luminal placement was confirmed in the left fem-pop bypass graft via injection through the transit catheter, a ViperWire Advance® Peripheral Guide Wire was advanced into the distal left peroneal artery. The Diamondback 360® Peripheral Orbital Atherectomy System – Exchangeable Series with a 2.00 Max Crown was selected and crossed the total occlusion at low and medium speeds with unobstructed reconstitution of flow into the left lower extremity. This was followed by prolonged 3 mm angioplasty to the left tibioperoneal trunk and prolonged 6 mm balloon angioplasty to the fem-pop bypass graft as well as the left common femoral artery with JADE® Non-Compliant PTA Balloon Catheters. Excellent procedural results were noted with brisk runoff to the left foot via the peroneal artery, which reconstitutes dorsal as well as plantar flow into the left foot with excellent digital perfusion. The left common femoral artery was noted to be widely patent without residual flow-limiting stenosis.

The patient underwent subsequent amputation of the left great toe, and the surgical site healing was excellent.

Key Takeaways

• Patient presented with occlusion of the left common femoral and tibioperoneal trunk.
• The 2.00 Max Crown for the Diamondback 360® Peripheral Orbital Atherectomy System – Exchangeable Series was selected and used to treat the left common femoral artery.
• Angioplasty was performed with JADE® Non-Compliant PTA Balloon Catheters in the tibioperoneal trunk, fem-pop bypass graft, and common femoral.
• Following treatment, brisk runoff to the left foot via the peroneal artery was achieved. The left common femoral artery was noted to be widely patent without residual flow-limiting stenosis.