Intervention of Right Lower Extremity with OAS and the Jade® PTA Balloon

Patient History

The patient, an 83-year-old male, presented with bilateral lower extremity claudication and rest pain. He had recently undergone atherectomy and angioplasty of his left anterior tibial artery, resulting in significant symptom relief. However, symptoms persisted in the lower right extremity, and he sought treatment.

Treatment Summary

Access via the left groin was prepared; the left common femoral artery was located with ultrasound guidance and accessed. A 5 Fr sheath was used for the initial arteriogram. Due to the recent procedure on the right lower extremity, contrast media was rationed and monitored. The 5 Fr sheath was removed and replaced with a 90 cm 6 Fr sheath.

The arteriogram showed 100% occlusion of the right anterior tibial artery (ATA), with collateral flow and reconstitution at the ankle. Both the right posterior tibial artery (PTA) and peroneal artery showed 90% distal stenosis.

Dr. Davis selected the Diamondback 360 Peripheral Orbital Atherectomy System with a 1.5 Classic Crown and a ViperWire Advance® Peripheral Guide Wire. Attempts to cross the chronic total occlusion of the ATA were unsuccessful, causing the wire to go extravascular in these attempts. The PTA was wired successfully and was treated with the 1.25 Classic Crown at low, medium, and high speeds. Then the PTA was treated with a 014 2.5 mm x 240 mm JADE PTA Balloon inflated at 12 atmospheres for three minutes. After the treatment, no significant residual stenosis was noted.

The 1.25 Diamondback 360 Classic Crown was used, and the ViperWire Advance Peripheral Guide Wire was retrieved and redirected down the right peroneal artery, crossing the stenosis. Multiple passes were made at low, medium, and high speeds. Then the right peroneal artery was treated with a 014 3.0 mm x 120 mm JADE PTA Balloon. The balloon was inflated at 14 atmospheres for three minutes, after which there was no significant residual stenosis found.

Final imaging, as well as the comparison of pre- and post-operative images, showed no significant residual stenosis.

Key Takeaways

• After attempts to cross the total occlusion of the ATA unsuccessful, the PTA was wired successfully and treated with the Diamondback 360 Peripheral Orbital Atherectomy System and the JADE PTA Balloon.
• The ViperWire Advance Peripheral Guide Wire was successfully used to cross the stenosis and access the right peroneal artery.