Abstract:

Introduction: Chronic limb-threatening ischemia (CLTI) is a remarkably morbid condition that causes significant mortality, limb loss, pain, as well as reduce health-related quality of life in those who are affected. The cornerstone of CLTI therapy is revascularization, which can lower the amputation rate. Case description:  A diabetic type II 68-year-old female patient presented with complaints of pain, swelling, and itching in the left leg that was felt for approximately 1 month ago. The wound persists although the ankle was already amputated. CT-angiography showed total occlusion in 1/3 distal of left femoral artery and no visualization of left popliteal artery. She was diagnosed as left CLTI femoral popliteal Rutherford VI TASC II type D with ischemic rest pain. The patient planned for an endovascular revascularization procedure. Victory 14 wire 0.014” was inserted but recanalization did not penetrate, continued with Victory 18 wire the lesion could penetrate. Digital Subtract Angiography (DSA) evaluation found significant residual stenosis, thus continued using Abbott Supera peripheral stent system. The patient was successfully treated showed left femoral artery was seen well visualized with TIMI flow 3, left popliteal artery was still seen 50% no significant residual stenosis with TIMI flow 2. Followed up after 3 months, she did not complain any ischemic pain at left leg. Discussion: The Supera peripheral stent system was developed to withstand the femoropopliteal artery's unique stressors. There have been few studies on the use of supera stenting in complex CLTI, and the primary patency at 1 year was 77% in lesions measuring 92-236 mm. In this case report, the procedure was successfully applied in complex CLTI (mean length >200mm) with no restenosis and repeat target limb revascularization after one year of procedure. Conclusion: We successfully performed revascularization using supera stenting, and the femoropopliteal artery showed good TIMI flow results. In CLTI patients, stenting may be an option to lower the risk of major lower limb amputation.

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