Peripheral Cases

70 years old Female patient known with systemic hypertension, mixed dyslipidemia, type 2 diabetes mellitus, history of ischemic stroke, who consults for signs of critical ischemia in 3 first toes on her left foot (PHOTO). She underwent coronary angiography and of her lower limbs. In coronary system critical injuries on Anterior Descending Artery and on Circumflex Artery are shown. She underwent a percutaneous angioplasty with implantation of three medicated stents in both critically injured arteries. The Peripheral Angiography revealed total occlusion of superficial femoral artery in its origin. Evaluated for Cardiovascular Surgery, knee amputation is recommended urgently. The patient refuses to be amputated and once discussed with her relatives and the patient herself, through percutaneous option, the salvage of the limb was attempted being it a successful procedure. The following day it is noted that the patient was resistant to Clopidogrel through the “Veryfy Now” method. The decision of switching to Prasugrel is made, with a loading dose of 60 mg stat then 10 mg po od in the next 2 following days and then 5 mg po od since the patient weighs 56 kg. Monitoring of antiplatelet with Veryfy Now has demonstrated adequate level of antiplatelet of P2Y12. After a month of having achieved revascularizing or permeabilizing successfully the superficial Femoral, it was only necessary to amputate the first 3 toes on her left foot. The patient maintains appropriate mobility on both leg and left foot after 8 months of follow-up and can walk with aid. The procedure was to permeabilize the left femoral artery using hydrophilic guidewires 0.035, “BMW angioplasty guidewires 0.014″, Predilatation with coronary and peripheral balloons and using large medicated balloons initially failed to maintain vessel permeability. Finally it was necessary to put 3 large stents overlapping one after another, 2/3 proximal to the left femoral artery. The procedure had excellent results as shown on the video.