90 year old male, former smoker, non-healing RLE Ulcer, severe tibial disease tendon 90-99% then 100% Performing Physicians: Mustapha/Diaz - Introduction

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Case #4: January 5, 0800
Performing physicians: Mustapha/Diaz
90-year-old male, former smoker, non-healing R lower extremity ulcer, severe tibial disease tendon 90-99%, then 100%.
PMH: Ischemic cardiomyopathy, CAD, MI, PAD, dementia, S/P COD with stent, NIDDM, NYHA class II CHF, hyperlipidemia.
Physical exam: Non-painful non-healing ulcer of right posterior calf X 3 months. Denies rest pain. Has stocking-type neuropathy, Rubor of second right toe with early signs of tissue loss. Monophasic DP/PT. Ambulates with a walker secondary to bilateral hip pain.
Echo: Moderate left concentric ventricular hypertrophy. EF 40-50%, severe hypokinesis in apical septal, apical inferior, and apical anterior wall segments.
Pre-procedure ABI: R ABI: 0.45; L ABI: 0.94.
Angiogram findings:
1. Abdominal aorta demonstrates mild distal aneurysmal change without stenosis.
2. Renal arteries are single bilaterally and are widely patent.
3. Common iliac arteries demonstrate moderate tortuosity, but mild atherosclerotic change.
4. The external iliac artery showed mild atherosclerotic change.
1. Severe below-the-knee disease with near total occlusion of all three vessels with only severely stenosed peroneal artery having antegrade flow. The rest are filled by collaterals at the level of the ankle. The remaining inflow vessels have mild sclerotic change, other than the right profunda femoris, which has a severe focal stenosis proximally.
2. Mild abdominal aortic aneurysm.
JAM’s treatment plan:
• Possible antegrade/retrograde
• Feet first on the table
• 5F Terumo MicroSheath
• 6F Terumo Pinnacle Destination
• 1.25 Stealth Diamondback
• Chocolate balloon 2.5X80 mm and 3.0X40mm**
**If not available, get 2.5X100 Vascutrack and 3X40 Vascutrack
Future: Plan for L LE antegrade Diamondback of TPT and PR arteries.

Facility Name: 
Presenter Name: 

Jihad A. Mustapha, MD, FACC, FSCAI

Presenter Title: 

Director of Peripheral Intervention & Cardiovascular Research

Metro Health Hospital

Wyoming, Michigan