Peripheral

How to manage CFA lesions with an endovascular approach?

Find out about the medical history of this 79-year-old man and tell us which option you would choose to treat him.

 

Koen Deloose
Koen Deloose
Dendermonde, Belgium
Hospital: AZ Sint Blasius
Part I - Medical History

History  

  • 2017 CABG 
  • 2018 CAS 
  • Moderate to severe COPD 

Risk factors 

  • Obesity (BMI 31) 
  • Hypercholesterolemia 
  • NIDDM type 2 

Present state 

  • Claudication 75 m left leg : Rutherford 3 
16x16
Azéma L. et al. EJVEVS, 41, 6 : June 2011 ; 787-793
Azéma L. et al. EJVEVS, 41, 6 : June 2011 ; 787-793
 

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Part II – Treatment & Conclusion

Getting access & passage

  • Contralateral, cross-over approach 
  • RIM catheter, Glidewire 0,035”, Destination 6F,45cm 
  • Intraluminal passing 
  • 0,018” Advantage guidewire 
  • Fast spinning/drilling 
Video 1
Video 2

Vessel preparation

  • Low profile, high pressure  balloons 
  • Scoring – cutting – sculpting 
  • (debulking) 
8-40 mm balloon
8-40 mm balloon

Vessel treatment 

  • Implantation SUPERA stent 7.5-40mm 
  • Meticulous nominal implantation 
Video 3

Treatment deep femoral artery – final result

Advantage 0,018”-300cm
Armada 18 5-40mm
Video 6
Treatment deep femoral artery

Answer 

  • Supera-stenting is a safe and effective endovascular alternative for surgery for a majority of CFA lesions treatment  
  • Vessel prep up to a 1(,1):1 RVD is mandatory ; if impossible, contra-indication for this technique 
  • Definitive treatment : Meticulous sizing & nominal implantation of SUPERA in perfect imaging circumstances 
  • The VMI-CFA trial showed good safety and efficacy results @24months with this technique. 
  • The SUPERSURGE RCT will offer more scientific insights in this topic -> an update will be expected during the upcoming PVI2023