Radial Artery Access Treatment of CFA

Patient History

A 69-year-old male patient presented with severe claudication in his left lower leg. The patient had multiple previous coronary interventions, including coronary bypass surgery. Because of the left radial harvest for the previously performed CABG, this procedure was done via the patient’s right radial artery.

The primary care doctor for the patient noticed a loss of pulse in the left upper extremity. Since the patient had a left internal mammary graft to the left anterior descending artery, this was concerning. Additional symptoms included numbness in the patient’s upper left leg if he walked further than 50 feet, accompanied by discomfort in the left calf.

Pre-procedure the patient was classified as Rutherford Class 3, indicating severe claudication. The angiogram revealed 70% calcified stenosis in the left common femoral artery (CFA).

Treatment Summary

The right radial artery was accessed using a 5 fr access kit. A .035 guide wire was advanced to the abdominal aorta. The radial sheath was then exchanged for a 149 cm sheath. This was positioned in the left common iliac to access the left common femoral artery and used to perform the left lower extremity angiography. The angiography revealed 70% calcified stenosis in the proximal CFA with reduced blood flow to the lower leg.

A 475 cm ViperWire^® Advance Guide wire was advanced across the CFA lesion. A Diamondback 360 Orbital Atherectomy System 1.50 Solid crown, 200 cm length was used to prep the vessel before ballooning. The Diamondback 360^® was advanced to the proximal left CFA and into the proximal superficial femoral artery (SFA) to perform orbital atherectomy of the left SFA lesion, using low, medium, and high speeds for a total of 180 seconds. The orbital atherectomy resulted in brisk blood flow to the lower extremity. A 6 mm balloon catheter, 135 cm length, was then advanced across the SFA lesion with full balloon expansion noted at 2.5 atm and inflated to 8 atm for 90 seconds.

The final angiography revealed 0% stenosis with complete filling of all vessels to the foot with brisk blood flow. The patient was symptom-free post-procedure, with no angina or angina equivalent and no claudication.

Key Takeaways

• The ease of radial access, versus groin, for the above-the-knee intervention has made this approach the first choice for future procedures for Dr. Hull.
• Previous radial access experience is helpful when handling longer length equipment.
• Left radial artery access provides approximately 10 cm of additional reach compared to right radial access — this is important if the extra length is needed to reach target lesion site.
• Prepping a secondary access site pre-procedure minimizes disruption in the case if the device cannot reach the lesion site via the radial artery.