1. LIVE CASE PRESENTATION MOUNT SINAI CARDIAC CATH LAB
APRIL 19, 2017

2. HISTORY OF PRESENT ILLNESS
Patient is a 51 year old male with CAD, diabetes mellitus, hypertension, hyperlipidemia, and tobacco use
Has peripheral arterial disease s/p previous stents in the right and left superficial femoral artery
Presents with 1 block lifestyle limiting severe right lower extremity claudication (Rutherford Grade 1, Category 3; Fontaine Stage IIB)
Claudication symptoms have been progressive Symptoms have been persistent despite exercise program and medical therapy
No rest pain or ischemic ulcers noted

3. CAD s/p PCI LAD with DES (9/2015) Ischemic Cardiomyopathy EF 40-45%
PAST MEDICAL HISTORY
Diabetes Mellitus
Hypertension
Hyperlipidemia
CAD s/p PCI LAD with DES (9/2015)
Ischemic Cardiomyopathy EF 40-45%
Peripheral arterial disease
Intervention left superficial femoral artery- Lutonix DCB/ Zilver stent/ Supera stent (1/2016 and 11/2016)
Intervention right superficial femoral artery- Lutonix DCB/ Zilver stent/ Supera stent (12/2015)

4. MEDICATIONS
ASA
Ticagrelor (Brilinta)
Metoprolol
Lisinopril
Atorvastatin
Insulin
ALLERGIES
NKMA
SOCIAL HISTORY
Smoking: 40 pyh Quit 5 years ago
Alcohol Use: None
Drug Use: None
FAMILY HISTORY
None
ROS
Negative aside from above

5. PHYSICAL EXAMINATION
Vital- BP 130/70 Pulse 70 Resp 14 Afebrile
Neck- No carotid bruits
CV- RRR no murmurs/rubs/gallops
Resp- CTAB
Ext- Diminished 1+ right DP and PT pulses. 2+ right DP and PT pulses. No ischemic ulcers on RLE. Healing ulcer left plantar foot.
LABS
HGB 12.8
PLT 315
CR 1.25
INR 1.1

7. Lower Extremity Arterial Duplex Ultrasound
Right Superficial Femoral Artery:
The superficial femoral artery (proximal) is occluded. The stents within the superficial femoral artery (mid to distal) are occluded.
There is reconstitution of flow within the distal stent in the proximal popliteal artery.

15. CASE PRESENTATION SUMMARY
51 year old male with CAD, diabetes, hypertension, hyperlipidemia, and tobacco use
Has PAD s/p stenting of the right and left superficial femoral artery
Patient presents with 1 block lifestyle limiting right lower extremity claudication
Abnormal right ABI of 0.68
Peripheral angiogram reveals occlusion of the right superficial femoral artery
Plan: Right superficial femoral artery intervention

16. PLAN OF INTERVENTION Procedural Steps
Left groin access with retrograde cross over approach
UF 4Fr diagnostic catheter (ANGIODYNAMICS)
0.035” SupraCore guidewire, 300 cm (ABBOTT VASCULAR)
7 Fr – 45 cm Pinnacle Sheath (TERUMO)
Passage through the right SFA disease and instent restenosis
0.038” Tempo Aqua Vert catheter, 125 cm (CORDIS)
0.035” Stiff Angled Glidewire, 260cm (TERUMO)
PTA of the diseased SFA tract
Exchange to a 0.014” Spartacore wire
PowerCross 4 x 200mm balloon (MEDTRONIC)
Filter placement
Exchange to a Barewire (ABBOTT VASCULAR)
Emboshield Nav 6 Filter placement (ABBOTT VASCULAR)
Mechanical Thrombectomy
Angiojet Aspiration Mechanical Thrombectomy (BOSTON SCIENTIFIC)
Laser Atherectomy of the right SFA disease
Turbo-Elite Laser Atherectomy 2.0mm Catheter (SPECTRANETICS)
Drug Coated Balloon therapy of the instent segment
In-Pact Admiral 6 x 150 mm balloons (MEDTRONIC)
Stent Placement in the proximal right SFA segment if needed
Zilver PTX Drug-Eluting Stent 6 x 120 mm (COOK MEDICAL)