1. Division of Endovascular Interventions
Mount Sinai Hospital
New York
08/15/2018

2. Presents with 1-2 Block claudication with Left>>R
Case presentation
71 year old male
HTN, DM, dyslipidemia, CAD s/p 3V CABG (1995), Ex smoker, s/p AAA repair (2006), Aorto-bifemoral bypass with mutilple PTA
Presents with 1-2 Block claudication with Left>>R
Medications: ASA, plavix, Lipitor, Lisinopril, Imdur, Metoprolol
Hb- 11.5, INR- 1.0, Creatinine- 1.1

3. Inflow Iliac angiogram

4. BTK RUNOFF LLE

5. Popliteal lesion

6. Left subclavian tortuosity

7. STRATEGY
Left pedal access with micro access and right radial for visualization
4/5 vs 5/6 cm crossover sheath
Therapeutic anticoagulation- Angiomax vs heparin
Atherectomy?
PTA followed by DCB

8. Alternate access for peripheral interventions
Who should be considered:
No option for traditional retrograte CFA access (previous aorto-bifemoral bypass graft, previous endovascular repair of abdominal aortic aneurysms, extreme angulations of the aorto-iliac bifurcation, iliac artery occlusion
Or for ipsilateral antegrade CFA access (morbid obesity, infected groin, extensive groin scars, patients with hip contractures)

9. Alternate access points
Antegrade femoral
Trans-radial
Trans-pedal
Brachial

10. Radial access for peripherals

11. Interventional Cardiology (2015) Volume 7, Issue 1

13. Access- radial sheaths

14. Dedicated peripheral radial equipment

15. Dedicated Radial Peripheral balloons

16. Transpedal access- pro

17. Transpedal access

18. Pedal Access Ultrasound guidance preferred
Micropuncture® Pedal Access Set consists of a 21-gage, 4-cm echogenic needle
7-cm Micropuncture® introducer engineered to increase control while gaining retrograde infrapopliteal access; and a inch nitinol wire guide and hemostasis valve
Check-Flo® hemostasis valve attaches directly to the Micropuncture introducer, allowing it to be used as an interventional introducer with a 2.9-F inner diameter
Nitro, heparin and verapamil for IA cocktail

19. Transpedal