Percutaneous debulking strategy for severe nodular calcification in common femoral artery
Abstract Background Despite marked progress in endovascular treatment (EVT) techniques and devices, calcified lesions remain one of the toughest obstacles to EVT success. Moreover, because the common femoral artery (CFA) is known as a “non-stenting zone,” endovascular strategies for this area are co...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-05-01
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| Series: | CVIR Endovascular |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42155-022-00301-6 |
| _version_ | 1817989644117082112 |
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| author | Tetsuya Nomura Issei Ota Satoshi Tasaka Kenshi Ono Yu Sakaue Keisuke Shoji Naotoshi Wada |
| author_facet | Tetsuya Nomura Issei Ota Satoshi Tasaka Kenshi Ono Yu Sakaue Keisuke Shoji Naotoshi Wada |
| author_sort | Tetsuya Nomura |
| collection | DOAJ |
| description | Abstract Background Despite marked progress in endovascular treatment (EVT) techniques and devices, calcified lesions remain one of the toughest obstacles to EVT success. Moreover, because the common femoral artery (CFA) is known as a “non-stenting zone,” endovascular strategies for this area are controversial. Case presentation Here we describe the technical tips for a novel, less invasive, and effective debulking strategy for severe nodular calcification using an endovascular maneuver. This technique was demonstrated in a 73-year-old man with severe calcified stenosis of the CFA. To complete a stent-less strategy for CFA, we conducted aggressive debulking of the nodular calcification, established a bidirectional approach from the radial artery and the superficial femoral artery (SFA), and inserted a balloon-guiding catheter in the SFA. Under distal protection provided by this catheter, we crushed the nodular calcification 43 times using myocardial biopsy forceps. After achieving a volume reduction of nodular calcification through this maneuver, we completed the procedure by inflating a 6-mm drug-coated balloon catheter. Final angiography demonstrated a reduced filling defect of the contrast medium in the CFA and favorable blood flow as far as the ankle. The puncture site on the SFA was closed with a vascular suture assisted by balloon inflation inside the vessel, which allowed the patient to be ambulatory immediately after the procedure without requiring bed rest. Conclusions Severely calcified lesions in the CFA are usually difficult to treat using an endovascular strategy, but our novel and less invasive method may become a promising technique for managing these lesions. |
| first_indexed | 2024-04-14T00:49:00Z |
| format | Article |
| id | doaj.art-99effc1f3879449fb82ab92c5341e085 |
| institution | Directory Open Access Journal |
| issn | 2520-8934 |
| language | English |
| last_indexed | 2024-04-14T00:49:00Z |
| publishDate | 2022-05-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj.art-99effc1f3879449fb82ab92c5341e0852022-12-22T02:21:51ZengSpringerOpenCVIR Endovascular2520-89342022-05-01511510.1186/s42155-022-00301-6Percutaneous debulking strategy for severe nodular calcification in common femoral arteryTetsuya Nomura0Issei Ota1Satoshi Tasaka2Kenshi Ono3Yu Sakaue4Keisuke Shoji5Naotoshi Wada6Department of Cardiovascular Medicine, Kyoto Chubu Medical CenterDepartment of Cardiovascular Medicine, Kyoto Chubu Medical CenterDepartment of Cardiovascular Medicine, Kyoto Chubu Medical CenterDepartment of Cardiovascular Medicine, Kyoto Chubu Medical CenterDepartment of Cardiovascular Medicine, Kyoto Chubu Medical CenterDepartment of Cardiovascular Medicine, Kyoto Chubu Medical CenterDepartment of Cardiovascular Medicine, Kyoto Chubu Medical CenterAbstract Background Despite marked progress in endovascular treatment (EVT) techniques and devices, calcified lesions remain one of the toughest obstacles to EVT success. Moreover, because the common femoral artery (CFA) is known as a “non-stenting zone,” endovascular strategies for this area are controversial. Case presentation Here we describe the technical tips for a novel, less invasive, and effective debulking strategy for severe nodular calcification using an endovascular maneuver. This technique was demonstrated in a 73-year-old man with severe calcified stenosis of the CFA. To complete a stent-less strategy for CFA, we conducted aggressive debulking of the nodular calcification, established a bidirectional approach from the radial artery and the superficial femoral artery (SFA), and inserted a balloon-guiding catheter in the SFA. Under distal protection provided by this catheter, we crushed the nodular calcification 43 times using myocardial biopsy forceps. After achieving a volume reduction of nodular calcification through this maneuver, we completed the procedure by inflating a 6-mm drug-coated balloon catheter. Final angiography demonstrated a reduced filling defect of the contrast medium in the CFA and favorable blood flow as far as the ankle. The puncture site on the SFA was closed with a vascular suture assisted by balloon inflation inside the vessel, which allowed the patient to be ambulatory immediately after the procedure without requiring bed rest. Conclusions Severely calcified lesions in the CFA are usually difficult to treat using an endovascular strategy, but our novel and less invasive method may become a promising technique for managing these lesions.https://doi.org/10.1186/s42155-022-00301-6Endovascular treatmentCommon femoral arteryNodular calcificationDebulkingMyocardial biopsy forceps |
| spellingShingle | Tetsuya Nomura Issei Ota Satoshi Tasaka Kenshi Ono Yu Sakaue Keisuke Shoji Naotoshi Wada Percutaneous debulking strategy for severe nodular calcification in common femoral artery CVIR Endovascular Endovascular treatment Common femoral artery Nodular calcification Debulking Myocardial biopsy forceps |
| title | Percutaneous debulking strategy for severe nodular calcification in common femoral artery |
| title_full | Percutaneous debulking strategy for severe nodular calcification in common femoral artery |
| title_fullStr | Percutaneous debulking strategy for severe nodular calcification in common femoral artery |
| title_full_unstemmed | Percutaneous debulking strategy for severe nodular calcification in common femoral artery |
| title_short | Percutaneous debulking strategy for severe nodular calcification in common femoral artery |
| title_sort | percutaneous debulking strategy for severe nodular calcification in common femoral artery |
| topic | Endovascular treatment Common femoral artery Nodular calcification Debulking Myocardial biopsy forceps |
| url | https://doi.org/10.1186/s42155-022-00301-6 |
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