Single Pedal Access for Treatment of Ipsilateral Superficial Femoral Artery and Anterior Tibial Artery

Purpose: Peripheral artery disease is a common condition that affects about 200 million people in the world. Treatment options include balloon angioplasty, bare-metal stents, drug-eluting stents, atherectomy, and distal tibial bypass surgery. Single retrograde access in the posterior tibial artery allows for precise deployment of self-expanding stents at the origin of the superficial femoral artery (SFA) when there are ostial lesions; however, it is challenging when it is necessary also to treat the ipsilateral anterior tibial artery. We present a successful case of angioplasty of the SFA and anterior tibial artery through a single access in posterior tibial artery.

Materials and Methods: A 60-year-old woman with a history of high blood pressure, smoking for more than 15 years complained of rest pain in the left lower limb. Physical examination showed absence of anterior and posterior tibial artery pulses of the left lower limb. Computed tomography angiography revealed ostial occlusion of SFA and stenosis of 90% of the anterior tibial artery. After the patient signed informed consent, she was taken to the catheterization laboratory. Ultrasound guidance access of the left posterior tibial artery was performed with a micropuncture kit (Cook Medical). A 6-Fr sheet was placed. Command 0.018-inch wire (Abbott Vascular) and Catheter Sergeant 0.018-inch (iVascular) were used to cross the lesion in the SFA. Oceanus Balloon Pro 3 mm × 200 and 5 mm × 150 mm (iVascular) were used for vessel preparation. Then a 5-mm × 150-mm Supera stent (Abbott Vascular) and 5-mm × 200-mm iVolution stent (iVascular) were deployed proximal and distal, respectively, in the SFA. A hydrophilic vertebral catheter and Asion blue wire 0.014 × 300 cm (Asahi) were used to cross the anterior tibial artery lesion, and plane balloon angioplasty was performed.

Results: Final arteriography showed satisfactory results with adequate blood flow. The patient left the catheterization laboratory with an anterior tibial artery palpable pulse.

Conclusions: Single retrograde access in posterior tibial artery allows precise deployment of a self-expanding stent in the ostium of SFA and ipsilateral anterior tibial artery angioplasty in the same intervention, decreasing surgical time and use of contrast.