Abstract
BackgroundSurgical endarterectomy for common femoral artery (CFA) disease is still considered the gold standard for treatment. Development of various techniques and devices has improved the clinical results of endovascular therapy (EVT) for CFA. However, severe conditions remain, especially for occlusive lesions owing to calcified plaque. We developed a useful technique for passing a lesion by directly penetrating the calcified plaque of the CFA using a bare metal needle and then passing through a balloon or dilating it. We named this technique “direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography” or “BAMBOO SPEAR.”Main textThis report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the CFA using a needle. We report a case of a 73-year-old male with hemodialysis who presented with cyanosis and ischemic rest pain of both lower limbs. Control angiography showed total occlusion of the left CFA with a calcified plaque. We advanced a 21-G metal needle that was slightly curved into the blood vessel from where the lumen of the distal CFA was located. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide. We succeeded in advancing the needle into the lumen of the distal external iliac artery. After guidewire crossing, intravascular ultrasound (IVUS) showed that guidewire was able to completely pass through the center of the calcified plaque. We could dilate the lesion by scoring balloon and drug-coated balloon. The final angiography showed sufficient results. We named this technique “direct BAre Metal needle puncture and BallOOn angioplaSty in calcified PlaquEs of the common femoral ARtery guided by angiography” (BAMBOO SPEAR).ConclusionsThe BAMBOO SPEAR technique may be considered a useful option in EVT for occlusive CFA with calcified plaques.
Highlights
This report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the common femoral artery (CFA) using a needle
The BAMBOO SPEAR technique may be considered a useful option in endovascular therapy (EVT) for occlusive CFA with calcified plaques
A 0.014-in. guidewire (Gladius MGES® guidewire; Asahi Intec) was inserted from behind the needle and the guidewire was advanced into the guiding sheath to BAMBOO SPEAR technique A slightly curved 21-G or 20-G metal needle was inserted from distal true lumen and advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide (Fig. 4a–d)
Summary
A 73-year-old man had hemodialysis owing to diabetes mellitus with coronary artery disease and old cerebral infarction. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide (Fig. 2a, b). BAMBOO SPEAR technique A slightly curved 21-G or 20-G metal needle was inserted from distal true lumen and advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide (Fig. 4a–d). The metal needle on the externalized guidewire was coaxially placed in and out several times to puncture the lesion (Fig. 4e, f) We advanced another guidewire in the direction of the SFA. The lesion was dilated with an antegrade balloon At this time, the metal needle was removed, but by covering and expanding the puncture site, hemostasis could be achieved from inside the blood vessel at the same time (Fig. 4h). Using the results of angiography after balloon dilatation, we decided to finish with conventional balloon angioplasty alone, a DCB, or deploying a stent if recoil or dissection was severe (Fig. 4i, j)
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