Ultrasound Guided Treatment | CSI360

Ultrasound Guided Treatment


Jihad Mustapha, MD FACC FSCAI

Patient History

A 72-year old female patient, fully independent, retired with a goal to be more active with her husband, was complaining of pain at rest in her left leg. Patient was treated using ultrasound-guided tibiopedal access and the total procedure time was 20 minutes.

Over the previous few months, the patient’s claudication symptoms had caused her to limit physical activity and she was experiencing left leg pain at rest. Past medical history included diabetes mellitus, hypertension, hyperlipidemia, and chronic renal disease (stage III).

She did not have a previous history of peripheral or coronary artery disease. She was classified as Rutherford category 4. An angiogram revealed stenosis in the left superficial femoral, popliteal, and anterior tibial arteries.

Treatment Summary

4 Fr. Diamondback 360® Orbital Atherectomy System allowed for unique retrograde treatment approach of three vessel disease.

Using ultrasound guidance, retrograde access was gained through the left anterior tibial artery with a 4 Fr. sheath. An 0.012″ ViperWire® was advanced through the left anterior tibial artery followed by crossing of the popliteal and superficial femoral arteries. A single, 60 cm Diamondback 360® 1.25 mm Micro Crown was used for retrograde treatment of all three lesions in the superficial femoral, popliteal and anterior tibial arteries. Each lesion was treated using two passes on low and two passes on medium speed with OAS. Low pressure adjunctive balloon angioplasty was performed at 4 ATM for 2 minutes in each lesion. Total procedure time was less than 20 minutes, radiation time was 4 minutes and only 16 cc of contrast was used.

Key Takeaways

  • Total procedure time was less than 20 minutes
  • Patient was discharged the same day and walked out of the hospital in less than 2 hours post-procedure
  • Total radiation time was 4 minutes
  • Total contrast used was 16 cc
  • OAS has a unique mechanism of action that allows you to treat multiple vessels with one crown, and also has the option for smaller sheaths

Results may vary.

Pre & Post Procedure Images

SFA Target Lesion. 5mm x 80mm. ~80% stenosis.
SFA Final. <5% stenosis.
Anterior Tibial Target Lesion. 3mm x 220mm. ~95% stenosis.
Anterior Tibial Final. >5% stenosis.
Popliteal Target Lesion. 4mm x 160mm. ~90% stenosis.
Popliteal Final. <20% stenosis.

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