1. FMRP 2011 | BEC 2011 1 Popliteal case K. Deloose M. Bosiers

2. FMRP 2011 | Patient presentation Demographics –Gender : male –Age: 78 years –Race : White/Caucasian –Length : 165 cm –Weight : 100 kg Risk Factors –Previous smoker –Hypertension (under medication) –Diabetes Mellitus type II –Hypercholesterolemia –Obesitas (BMI 36)

3. FMRP 2011 | Patient presentation Medical history –26/07/2004 EVAR (Gore Excluder) –04/04/2006 Deep vein thrombosis Erysipelas –14/04/2006 PTAS Anterior tibial artery right leg –19/04/2006 PTA Fibular artery left leg

4. FMRP 2011 | Patient presentation Clinical presentation Right leg pain, deteriorated last week Surinfected wound on right third toe Rutherford classification 5 –Ankle brachial index Right : 0.45 Left : 0.73 –Duplex investigation Occlusion right popliteal artery Occlusion on right anterior tibial artery Multiple high grade stenoses on right anterior tibial artery and posterior tibial artery

5. FMRP 2011 | Pre-op angiography Right ipsilateral anterograde superficial femoral access Duplex UltraSound guided puncture Advantage wire (Terumo) 4F Brite Tip introducer (Cordis)

6. FMRP 2011 | Pre-op angiography Advancement Advantage wire to the popliteal level

7. FMRP 2011 | Pre-op angiography

8. FMRP 2011 | Pre-op angiography

9. FMRP 2011 | Procedure Terumo 0.035’’ straight stiff wire Very smooth passage!!!

10. FMRP 2011 | Placement thrombolysis catheter Unifuse infusion system + cooper wire (Angiodynamics) –4F infusion catheter –Occluding ball guide wire assembly

11. FMRP 2011 | Position thrombolysis catheter

12. FMRP 2011 | Fixation thrombolysis catheter

13. FMRP 2011 | 24 hours later

14. FMRP 2011 | Post-op angiography

15. FMRP 2011 | Post-op angiography Terumo 0.035’’ straight stiff wire 6F Brite Tip introducer, 11cm (Cordis)

16. FMRP 2011 | Procedure PTA –Passeo-35 PTA catheter, 5 x 120mm (Biotronik)

17. FMRP 2011 | Procedure Control angiography

18. FMRP 2011 | Procedure Control angiography

19. FMRP 2011 | Procedure Control angiography –Minnie support catheter 0.035’’ / 150 cm (Vascular solutions )

20. FMRP 2011 | Procedure Cruiser wire 0.018’’/300 cm (Biotronik)

21. FMRP 2011 | Procedure PTA –Passeo 0.018’’ 2.5 x 170 mm (Biotronik)

22. FMRP 2011 | Procedure Control angiography

23. FMRP 2011 | Procedure

24. FMRP 2011 | Procedure Glidecath 4F/120 cm (Terumo) Cruiser 0.018’’/300 cm (Biotronik)

25. FMRP 2011 | Procedure Cruiser 0.018’’/300 cm (Biotronik) Minnie support catheter 0.035’’/150 cm (Vascular solutions )

26. FMRP 2011 | Procedure Angiography

27. FMRP 2011 | Procedure PTA –Passeo 0.018’’ 2.5 x 170 mm (Biotronik)

28. FMRP 2011 | Post-op PTA –Passeo 0.018’’ 2.5 x 170 mm (Biotronik)

29. FMRP 2011 | Post-op Angiography

30. FMRP 2011 | Post-op Angiography

31. FMRP 2011 | Disappeared pain Healing ulceration Dorsalis Pedis pulse ABI right = 0.94 Final Clinical state