68 year old female with Rutherford class III, nonsmoker, CAD, CABG -1997, DM Type 2, Hyperlipidemia, HTN, PAD. - Full Case

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Full Description: 

Case #1: January 4, 0800
Performing physicians: Mustapha/Karenko
68-year-old female with Rutherford class III, nonsmoker, CAD, CABG -1997, DM Type II, hyperlipidemia, HTN, PAD,
Physical exam: No wounds (HbA1c: 7; BMI 36.6)
Diagnostics:
• Pre-procedure ABI: R 0.45, L 0.78
• CTA: abnormal suggesting R SFA occlusion; L AT occlusion.
• Angiogram Left SFA: 80% focal calcified stenosis proximal vessel, 50% discrete calcified stenosis mid vessel 30% proximal stent/mid stent ISR. L AT: occluded 100% proximal vessel, very faint distal filling. R SFA: 100% occluded proximal vessel, long occlusion, reconstitutes via collaterals just proximal to Hunter’s canal. Tubular 90% calcified stenosis distal SFA, R popliteal: 70% distal just proximal to takeoff of L AT, R AT: 100% occluded proximal, faint distal filling via collaterals from the peroneal. R PT: Severely stenosed proximal, 100% occluded distal. R peroneal: 70% tubular proximal stenosis. Impression: Severe multi-vessel PAD, 100% occlusion R SFA with two-vessel runoff (peroneal, very faint reconstitution of the R AT) 80% focal proximal L SFA with two-vessel runoff (occluded AT).
Dr. Karenko’s treatment plan: Staged procedure to the right SFA, right Infrapopliteal antegrade/retrograde access with attempts at opening the right anterior tibial. Patient will also need intervention to the 80% focal stenosis in the L SFA and L AT.
Dr. Jihad A. Mustapha’s (JAM) treatment plan:
• L common femoral artery
• Regular on the table
• I will stand by the wall
• 5F Terumo MicroSheath
• 7F Terumo Pinnacle Destination sheath
• Advantage wire
• Navicross and Glidecross 0.35” catheter.
Goal:
• CLI therapy for patient with long CTOs
• SFA plus tibial intervention
• The importance of staging the patient
• To have therapeutic plan based on Angiosome-directed therapy

Facility Name: 
Presenter Name: 

Jihad A. Mustapha, MD, FACC, FSCAI

Presenter Title: 

Director of Peripheral Intervention & Cardiovascular Research

Metro Health Hospital

Wyoming, Michigan