1. Left common femoral arterial access with sheath placement
2. Right pedal access with sheath placement
3. Catheter placement abdominal aorta
4. Selective catheterization third order arterial branch leg
5. Arteriogram aortogram bilateral lower externally runoff
6. Angioplasty right common iliac artery utilizing a 6 mm x 6 cm angioplasty balloon
7. Angioplasty right external iliac artery utilizing a 6 mm x 16 mm drug-coated angioplasty balloon
8. Angioplasty and stent placement of the right superficial femoral and popliteal artery utilizing a 5 mm x 120 mm Supera stent followed by a 5 mm x 120 mm angioplasty balloon

Both right and left groins and right foot were then prepped and draped in routine sterile fashion.

Beginning on the left groin this was locally anesthetized with 1% lidocaine without epinephrine. Using duplex ultrasound were able to access the left common femoral guidewire advanced and a 5 French sheath placed over the guidewire. Left lower extremity runoff was then performed using the side port of the sheath.

Next guidewire was advanced to the L1-2 level Omni Flush catheter was reformed over a guidewire aspirated blood and flushed out with heparinized saline solution diagnostic aortogram iliofemoral arteriogram was then performed in AP and oblique positions. Attempts were then made to cross over to the contralateral right external iliac artery segment. As noted above our wire would preferentially travel into the right internal iliac artery. Despite a number of catheter and guidewire combinations we were not able to adequately navigate into the external iliac artery segment.

Next, we got access in the right pedal region at the ankle utilizing the posterior tibial artery guidewire was advanced and a 5 French sheath placed at this location. A guidewire was then navigated through the posterior tibial artery across the popliteal. Utilizing a combination of catheter and guidewire were able to navigate through the popliteal and SFA occlusion. We placed our catheter in the more proximal SFA and common femoral region to confirm luminal location. We then advanced our guidewire into the external and common iliac artery segment.

Both right and left groins and right foot were then prepped and draped in routine sterile fashion.

Beginning on the left groin this was locally anesthetized with 1% lidocaine without epinephrine. Using duplex ultrasound were able to access the left common femoral guidewire advanced and a 5 French sheath placed over the guidewire. Left lower extremity runoff was then performed using the side port of the sheath.

Next guidewire was advanced to the L1-2 level Omni Flush catheter was reformed over a guidewire aspirated blood and flushed out with heparinized saline solution diagnostic aortogram iliofemoral arteriogram was then performed in AP and oblique positions. Attempts were then made to cross over to the contralateral right external iliac artery segment. As noted above our wire would preferentially travel into the right internal iliac artery. Despite a number of catheter and guidewire combinations we were not able to adequately navigate into the external iliac artery segment.

Next, we got access in the right pedal region at the ankle utilizing the posterior tibial artery guidewire was advanced and a 5 French sheath placed at this location. A guidewire was then navigated through the posterior tibial artery across the popliteal. Utilizing a combination of catheter and guidewire were able to navigate through the popliteal and SFA occlusion. We placed our catheter in the more proximal SFA and common femoral region to confirm luminal location. We then advanced our guidewire into the external and common iliac artery segment.

Treatment then consisted of a combination of angioplasty and angioplasty and stent placement. As described above we treated first the common iliac artery segment followed by the right external iliac artery segment. The right external iliac artery segment utilized a drug-coated balloon. Finally the SFA and popliteal were treated with a combination of balloon angioplasty and stent placement. We utilized a 5 mm x 120 mm stent followed by 5 mm x 120 mm angioplasty balloon. Final completion showed excellent in-line flow on the right leg. This was also demonstrated through a pigtail catheter run in antegrade fashion from the aorta distally. Following our intervention, the right posterior tibial sheath was removed and a tibial band placed for hemostasis. The left groin sheath was removed and the puncture controlled with a minx closure which was hemostatic. Patient tolerated procedure well.