Crossing the Calcified CTO Lesion

Figure 1.  Angiogram of the right lower extremity revealing severely diseased anterior tibial artery and 100% occlusion (arrow) of the tibioperoneal trunk.

Figure 1. Angiogram of the right lower extremity revealing severely diseased anterior tibial artery and 100% occlusion (arrow) of the tibioperoneal trunk.

In this month’s Case Files by Dr. George, Jon C. George, MD, presents a case of an 82-year-old male patient with critical limb ischemia (CLI) and calcified infrapopliteal chronic total occlusion (CTO) who had a nonhealing ulcer on his right heel. Patients with CLI often also have calcified infrapopliteal CTOs. Intra-arterial calcium distribution has been observed to be disproportionate, with only 10% suprainguinal and 90% infrainguinal; and 75% of the infrainguinal calcium resides in the infrapopliteal vessels.

Because intervention for these lesions is complex, vascular specialists must use access sites, techniques, and devices that are uncommon to revascularize CTOs, specifically infrapopliteal lesions.

In this case, a TruePath CTO Device (Boston Scientific) was used to cross the lesion, and at 4-week follow-up, the patient returned with no symptoms and a completely healed ulcer.

Figure 4. Angiogram post revascularization with atherectomy and balloon angioplasty.

Figure 4. Angiogram post revascularization with atherectomy and balloon angioplasty.

Read “Revascularization of Calcified Infrapopliteal Chronic Total Occlusion” to learn more about this case and about the ReOpen study, which evaluated the efficacy of the TruePath  catheter.

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