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CASE STUDIES – peripheral artery disease

Empowering physicians with best-in-class solutions

GENDER: Female

AGE: 42 years old

DEVICE: Wingman™

PHYSICIAN: Siddhartha Rao, MD, RPVI

A 42-year-old female presented to the clinic with worsening claudication and rest pain of the right foot. An arterial duplex suggested popliteal artery stenosis and a possible chronic total occlusion (CTO). Patient has a history of type 2 diabetes, Rutherford class 3 disease, and smoking.

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GENDER: Male

AGE: 74 years old

DEVICE: Wingman™

PHYSICIAN: Siddhartha Rao, MD, RPVI

A 74-year-old male with a history of type 2 diabetes, hypertension, morbid obesity, and atherosclerosis of the bilateral extremities presented with an ulcer on the right plantar aspect and a gangrenous third digit on the right foot.

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GENDER: Female

AGE: 83 years old

DEVICE: Spex LP™

PHYSICIAN: Hassan Baydoun, MD, FACC

An 83-year-old woman with a history of peripheral artery disease (PAD), hypertension, dyslipidemia, paroxysmal atrial fibrillation, and diabetes was referred for evaluation of bilateral lifestyle-limiting claudication, with the left lower extremity more severe than the right. Peripheral angiogram showed bilateral superficial femoral arteries (SFA) chronic total occlusion (CTO) at the level of prior stents. We decided to proceed with intervention of the left SFA CTO

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GENDER: Female

AGE: 71 years old

DEVICE: coraForce™

PHYSICIAN: Joseph M. Griffin, MD

A 71-year-old woman whose diabetic foot ulcer appeared a week earlier, was referred to our facility with emergent I&D for sepsis of the right toe. The patient had an ABI of 0.61 and an arterial ultrasound showed right popliteal stenosis of 90%, and occlusion of all three tibial vessels.

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GENDER: Female

AGE: 87 years old

DEVICE: Wingman™

PHYSICIAN: Peter A. Soukas, MD, FACC, FSVM, FSCAI, FACP, RPVI

• Past history of high blood pressure, hyperlimidemia, CAD with prior coronary artery bypass graft surgery, ischemic cardiomyopathy with implantable cardioverter defribillator (ICD), stage 3 chronic kidney disease (CKD), S/P left carotid endarterectomy (CEA), Afib, diabetes mellitus, mitral regurgitation, prior smoking with COPD, S/P multiple LE interventions to the left SFA, popliteal, tibial-peroneal trunk, plaque rupture, AT stents

• Now with CLI manifested by rest pain, found to have occlusion of left SFA and pop stents by duplex

• Crossed with Wingman™ catheter after unsuccessful attempts with several wires

• Final angiograms show restored flow

GENDER: Female

AGE: 67 years old

DEVICE: Spex™

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Diabetes; Hypertension; Dyslipidemia

• Prior IVC Filter Placement 1 Year Ago

• Prior LE DVT

• Presents with Massive Bilateral Lower Extremity Swelling > 4 Weeks

GENDER: Female

AGE: 74 years old

DEVICE: Spex™

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Part of the First Response Team at Chernobyl

• Now Aggressive Metastatic Lung Cancer

• Recurrent SVC Syndrome

• Prior Left Innomoniate Stent.

• Prior PTA of Right Innominate/Subclavian.

• Recurrent Symptoms Consistent with Right Sided Occlusion

GENDER: Male

AGE: 60 years old

DEVICE: Spex™ 35 Catheter

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Severe bilateral LE swelling (recently worsening)

• Large varicosities

• Unable to walk across room without severe dyspnea

GENDER: Female

AGE: 60 years old

DEVICE: Spex 35 & Wingman 14C

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Severe RLE rest pain

• Ulcer on hallux

• Rutherford 5

• LE Duplex with 100% occlusion SFA with ABI 0.3

GENDER: Female

AGE: 72 years old

DEVICE: Spex 35 & Wingman 14C

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Severe RLE rest pain

• Rutherford 4

• LE Duplex with 100% occlusion SFA with ABI 0.4

GENDER: Female

AGE: 70 years old

DEVICE: Spex 35 & Wingman 14C

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Severe RLE rest pain

• Rutherford 5

• Ulceration of the calf

• LE Duplex with 100% occlusion SFA with ABI 0.4

GENDER: Male

AGE: 72 years old

DEVICE: Wingman™

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Moderate to heavily calcified >250 mm SFA occlusion.

• Time to cross <5 minutes.

GENDER: Male

AGE: 37 years old

DEVICE: Wingman™

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Heavily calcified > 100 mm iliac occlusion

• Time to cross < 5 minutes

GENDER: Male

AGE: 79 years old

DEVICE: Wingman™

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Moderately calcified > 150 mm SFA occlusion

• Time to cross < 5 minutes

GENDER: Male

AGE: 68 years old

DEVICE: Wingman™

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Heavily calcified > 200 mm SFA occlusion

• Time to cross < 5 minutes

GENDER: Male

AGE: 75 years old

DEVICE: Wingman™

PHYSICIAN: S. Jay Mathews, MD, MS, FACC

• Heavily calcified > 75 mm SFA occlusion (retrograde approach)

• Time to cross < 5 minutes

GENDER: Male

AGE: 57 years old

DEVICE: Wingman™

PHYSICIAN: Peter A. Soukas, MD, FACC, FSVM, FSCAI, FACP, RPVI

• Smoker with high blood pressure, hyperlimpidemia

• S/P traversal of left popliteal/TPT occlusion with stent placed in 2017

• Recurrent left calf claudication with duplex confirming occluded stent

• Wingman™ intraluminal crossing; laser PTA and DCB

• CTA of restored distal runoff

GENDER: Male

AGE: 86 years old

DEVICE: Wingman™

PHYSICIAN: Peter A. Soukas, MD, FACC, FSVM, FSCAI, FACP, RPVI

• Smoker with high blood pressure, hyperlipidemia; CAD with remote stents in the past and known abdominal aortic aneurysm

• Referred by podiatrist for non-healing ulcer of the left foot

• Angiogram shows severe iliac tortuosity; antegrade CFA access to occluded popliteal aneurysm; severe 3VD

• Wingman™ used to cross pop aneurysm; IVUS indicated thrombosis, DES stents dilation

• Restored 2-vessel runoff to foot

GENDER: Male

AGE: 65 years old

DEVICE: Wingman™

PHYSICIAN: Peter A. Soukas, MD, FACC, FSVM, FSCAI, FACP, RPVI

• Smoker with high blood pressure, hyperlipidemia presented with severe left calf claudication that progressed to rest pain of the left hallux

• PVRs showed severe popliteal and infra-popliteal disease; referred for angiography

• Wingman™ used to cross the popliteal; IVL with integrated balloon

• Performed PTA and placed Tigris® stent

• Final angiography shows no residual stenosis and brisk flow

GENDER: Female

AGE: 62 years old

DEVICE: Wingman™

PHYSICIAN: Peter A. Soukas, MD, FACC, FSVM, FSCAI, FACP, RPVI

• Prior tobacco use, high blood pressure, hyperlimidemia, gastroesophageal reflux disease (GERD), hypothyroidism

• Presented with severe right calf claudication and right ABI of 0.5 duplex showing right popliteal occlusion

• Wingman™ catheter successfully crossed into anterior tibial enabling laser angioplasty

• Angiogram showing good result after percutaneous transluminal angioplasty (PTA) with drug-coated balloon (DCB) and stenting

GENDER: Male

AGE: 75 years old

DEVICE: Wingman™

PHYSICIAN: Peter A. Soukas, MD, FACC, FSVM, FSCAI, FACP, RPVI

• Former smoker with high blood pressure, hyperlimidemia, prostate cancer, NIDDM, CAD with prior right occluded artery percutaneous coronary intervention (PCI) in 2011

• S/P left CFA endarterectomy in 2016 but severe left calf claudication due to long-calcified SFA CTO

• Wingman™ catheter used to traverse densely calcified SFA/AK popliteal CTO

• PTA SFA/pop to deliver re-entry device; DCB

• Final angiograms show distal runoff

GENDER: Male

AGE: 57 years old

DEVICE: Wingman™

PHYSICIAN: Peter A. Soukas, MD, FACC, FSVM, FSCAI, FACP, RPVI

• Smoker with high blood pressure, hyperlipidemia, moderate CAD; by cath, presents with severe right calf claudication that has progressed to occasional nocturnal rest pain

• Seen by local vascular surgeon who performed angiography confirming right popliteal occlusion

• Fem-tib bypass recommended; came for a second opinion

• Successful Wingman™-assisted antegrade AT access

• Laser Pop/AT, PT wire crossing, laser TPT/PT

• IVL, balloon, drug-eluting stent and DCB

• Successful 3-vessel runoff on what was previously completely occluded

“If you can’t cross it, you can’t fix it!” Thank you, Wingman!

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