Cath Lab Digest

Richard R. Heuser, MD, FACC, FACP, FESC, FSCAI and Makonnen Habtemariam, MD

A 53-year-old Native American gentleman presented with a non-healing ulcer in his left leg. Two years previously, he underwent an above-knee amputation on the right side and has brittle diabetes. The procedure was performed using a contralateral approach. The arteriogram showed that the iliac artery and superficial femoral artery (SFA) were widely patent; however, there was infrapopliteal disease including involvement of the pedal vessels. We crossed with a Quick-Cross catheter (Spectranetics, Inc., Colorado Springs, Colorado) and used a hydrophilic wire (Terumo Medical, Somerset, New Jersey). After exchange for a 0.014 inch Whisper wire (Abbott Vascular, Abbott Park, Illinois), we passed a 0.9 mm laser (Spectranetics, Inc., Colorado Springs, Colorado) into the posterior tibial and the pedal vessels. Following this, balloon angioplasty (Medtronic-Invatec, Minneapolis, Minnesota) was performed.

The foot ulcer is already healing and shows improved perfusion post procedure. This is a case where the laser was able to recanalize not only a relatively large posterior tibial artery, but also treat the pedal vessels successfully, resulting in excellent run-off.

Figure Legends:

Figure 1. Distal angiogram of the lower leg.

Figure 2. Later filling shows very little pedal vessel perfusion.

Figure 3. Late lighting of the pedal vessels shows very little flow to the digits.

Figure 4. A hydrophilic wire has been passed into the pedal arteries.

Figure 5. Angiogram confirms luminal placement of the catheter.

Figure 6. The 0.9 mm Spectranetics laser is passed into the posterior tibial and pedal arteries.

Figure 7. Balloon angioplasty is performed after laser atherectomy.

Figure 8. The angiogram shows much improved flow to the foot.

Figure 9. Pedal artery flow is much improved.

Figure 10. There is two-vessel run-off now present.

Figure 11. Even capillary filling is improved.

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Richard R. Heuser, MD, FACC, FACP, FESC, FSCAI, is an internationally-recognized cardiologist, inventor, educator and author. A diplomate of the American Board of Cardiovascular Diseases and American Board of Interventional Cardiovascular Diseases, Dr. Heuser is one of the early pioneers of angioplasty and is considered one of America’s top cardiologists. Dr. Heuser is currently in practice at the Phoenix Heart Center/Physicians Group of Arizona. He is Chief of Cardiology and Chief of Cardiac Catheterization Laboratory at St. Luke’s Hospital and Medical Center, Phoenix, Arizona, and Clinical Professor of Medicine at the University of Arizona College of Medicine, as well as Director of the Interventional Fellowship Program at the University of Arizona College of Medicine, Phoenix Campus. With 13 patents granted for different catheters, stents and other medical devices, Dr. Heuser has served as principal investigator to research the safety and/or effectiveness of more than 100 medical devices and 70 pharmaceutical products, and has participated in more than 150 research studies. He has authored over 400 articles, textbooks and medical manuscripts, and is frequently invited to international medical conferences to present the findings of research developed in Phoenix. Dr. Heuser received his medical degree from the University of Wisconsin School of Medicine in Madison, Wisconsin, and completed his medicine internship and residency, as well as his cardiology fellowship, at The Johns Hopkins Hospital in Baltimore, Maryland.