CFA occlusion: an unexpected strategy

A 56-year-old man with multiple cardiovascular risk factors presents with recent-onset rest pain, raising concern for acute limb ischemia on right side.

Imaging reveals extensive multilevel disease, including occlusion at the right common femoral artery and diffuse involvement of the right femoropopliteal and infragenicular segments.

Faced with this complex anatomy and high-risk profile, the key question is clear: which revascularisation strategy offers the best chance to restore flow and preserve the limb?

Several options can be considered, each with its own implications.

What would be your approach?

Gustavo A. Basso

Leforte Hospital – São Paulo, Brazil

Part I - Case presentation

Patient profile and risk factors

Bilateral peripheral neuropathy
Rest pain for the last 24h – Fontaine IIa
A 56-year-old male patient
Obese, hypertension, type 2 diabetes (DM 2)
Bilateral retinopathy,
Non-dialysis-dependent renal dysfunction,
Previous myocardial infarction
💊 Poor medical adherence

CTA findings

Common femoral artery (CFA) with signs of occlusion
Superficial femoral artery (SFA) and deep femoral artery (DFA) with atherosclerotic disease. Occlusion and stenosis of the proximal third of the SFA, with signs of recanalisation in the middle and distal thirds.
DFA with occlusion and recanalisation in the distal third.
Popliteal artery with atherosclerotic changes and occlusion.
Infragenicular arteries show normal anatomical distribution. The anterior tibial (AT), posterior tibial (PT), and fibular arteries show sequential stenoses and occlusions.