Three Vessel Treatment for PAD


Sadeem Mahmood, MD FACC

Patient History

An 88-year-old female complained of bilateral lower extremity pain with exercise and right lower extremity pain at rest. After multiple antegrade access attempts, retrograde access was achieved under ultrasound guidance and successful Orbital Atherectomy System (OAS) treatment of multi-stage vessel disease was performed.

Patient presented with bilateral lower extremity pain with exercise and right lower extremity pain at rest. She was diagnosed with Peripheral Arterial Disease (PAD) and classified as Rutherford category 4 with past medical history of diabetes mellitus, renal insufficiency, hypertension and coronary artery disease. An angiogram revealed 80% stenosis in the right superficial femoral artery, 75% stenosis in the proximal popliteal artery and 100% stenosis [chronic total occlusion (CTO)] of the right anterior tibial artery.

Treatment Summary

4 Fr. 60cm Diamondback 360® Peripheral Orbital Atherectomy System (OAS) facilitated retrograde treatment of multi-vessel disease.

Retrograde access of the right anterior artery was successfully achieved using ultrasound guidance after multiple failed attempts to cross the lesion through the antegrade approach. A 60cm Diamondback 360®Peripheral 1.25mm Solid Crown was used for retrograde orbital atherectomy treatment of lesions in the right anterior tibial, popliteal, and superficial femoral arteries. Lesions were treated with low, medium, and high speed OAS passes. This was followed by low-pressure percutaneous transluminal angioplasty (PTA) at 6 ATM in each of the lesions treated. PTA was also used to treat the tibial peroneal trunk and peroneal artery through an antegrade approach.

Key Takeaways

Final results showed less than 5% residual stenosis in all target lesions. Excellent blood flow to the foot was present. No complications occurred and the patient was discharged on the same day.

  • Diamondback 360® 60cm device facilitated treatment of multiple vessels through 4 Fr. platform.
  • Retrograde access through the right anterior tibial artery was successfully achieved after multiple attempts to cross the lesion from an antegrade approach.
  • OAS and low-pressure adjunctive balloon angioplasty procedures resulted in less than 5% residual stenosis in all target lesions with no complications.

Results may vary.

Pre & Post Procedure Images

Right SFA Before Treatment. 80% stenosis.
Right SFA Post OAS and PTA. <5% stenosis.
Right Anterior Tibial CTO Before Treatment. 100% stenosis.
Right Anterior Tibial Post OAS and PTA. <5% stenosis.

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