Presenter: Selim Aydin

Affiliation: Acibadem University, Turkey

Abstract

This article describes a 62-year-old male with CLTI and very long in-stent occlusion (SFA to popliteal artery) treated by combined rotational atherectomy (Jetstream) and drug-coated balloon (Ranger DCB) angioplasty via double retrograde pedal access. Post-procedural ABI improved from 0.26 to 0.98, achieving limb salvage.

Introduction

Long in-stent occlusions pose significant challenges in peripheral interventions. This case demonstrates the efficacy of hybrid techniques in complex scenarios.

Case Study

The patient had diabetes, dialysis-dependent renal failure, and a non-healing foot ulcer. Imaging revealed SFA CTO and popliteal occlusion.

Intervention included:

Contralateral Femoral Access: 7F sheath with Rubicon catheter and V18/V14 wire.

Double Pedal Access: Sheathless retrograde cannulation of ATA and peroneal arteries.

Therapy: Jetstream atherectomy followed by Ranger DCB angioplasty.

Follow-up showed restored perfusion and wound healing.

Conclusions

1.Dual retrograde access enhances success in challenging CTOs.

2.Combination therapy reduces restenosis in calcified lesions.

3.Multimodal approaches optimize outcomes in comorbid CLTI.