Abstract
BackgroundCurrently, the success rate of EVT for treating CTO of the SFA is high; however, EVT is still found to be insufficient in treating CTOs with severely calcified lesions. Even if the guidewire crosses the lesion, the calcifications may still cause difficulties during stent expansion.Main textA 78-year-old male had been reported to have intermittent claudication with chronic total occlusion (CTO) of the right superficial femoral artery (SFA). Angiography revealed severely calcified plaque (Angiographic calcium score: Group4a [1]) at the ostium of the SFA. Stenting posed a risk of underexpansion, causing the plaque to shift to the deep femoral artery. we decided to remove the calcified plaque using biopsy forceps. After removing the extended calcified plaque, the guidewire could cross easily, and the self-expandable stent was well dilated without causing the plaque to shift to the DFA.ConclusionsBiopsy forceps may be used in some endovascular cases to remove severely calcified lesions.To ensure the safety of the patient, the physician must be adept at performing this technique before attempting it.
Highlights
The technical success rate of endovascular therapy (EVT) for treating chronic total occlusion (CTO) of the superficial femoral artery (SFA) has been recorded to be over 95 % [1]
Biopsy forceps may be used in some endovascular cases to remove severely calcified lesions
To ensure the safety of the patient, the physician must be adept at performing this technique before attempting it
Summary
A 78-year-old male, suffering from diabetes mellitus, presented with intermittent claudication (IC) of his right leg. Intravascular ultrasound (IVUS) (Vision PV; Philips, Amsterdam, Holland) was performed from the deep femoral artery (DFA) to confirm the lesion at the ostium of the SFA. It showed that the calcified plaque had protruded into the CFA (Fig. 1). The jaw of biopsy forceps could not open due to the narrow space in the hollow We stopped these steps and begun inserting the guidewire. To control the direction of the biopsy forceps, it is efficient to make a gentle curve near the tip Embolic protection devices, such as Filtrap® (Nipro, Osaka, Japan) and Parachute® (Tri-med, Osaka, Japan), are generally recommended for use during this procedure due to the risk of fragment fail. For the safety of the patient, the physician must be capable of performing this technique before attempting it
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