Re-opening total left SFA obstruction

These images belong to a 48-year-old woman with insulin-requiring type 2 diabetes and long history of heavy cigarette smoking, who was referred to my interventional radiology clinic because of new pain in her left foot that substantially limited her life style, associated with color change. Her diabetes was uncontrolled and the pain seemed neuropathic in character, but the arterial doppler ultrasound of her lower limbs (not shown) uncovered insufficient perfusion of her left lower extremity. This was confirmed with computerized tomographic angiography (CTA) of her abdominal aorta with lower extremity runoffs to be due to chronic occlusive disease of her left superficial femoral artery. All the other examined vessels including her leg and pedal arteries were normal.

Faced with 3 possible reasons for her excruciating left foot pain – uncontrolled diabetes, arterial insufficiency, and smoking- I decided to improve her left foot perfusion and her serum glycemic values in addition to assisting her quit cigarette smoking. Puncturing the opposite common femoral artery, I crossed over the aortic crotch to the left external iliac artery and used several devices including a stent-graft, to reopen her diseased left SFA. Her left foot pain and color change quickly resolved and at her last clinic visit for follow up she wore high-heel shoes – a thing she could not do before the intervention. She received prescriptions for Aspirin 81 mg daily, Plavix 75 my daily (6 months) and more help to cease smoking.

The top-row images illustrate her left SFA before treatment, while the lower-row images show the reopened vessel.