It was reported that restenosis and ischemia occurred.On (b)(6) 2023, the entire length of the superficial femoral artery to the mid-thigh was treated with a rotablator atherectomy device.This was done without complication.Patient was in a supine position under local anesthesia.A 5.0 x 200mm, 150cm ranger paclitaxel-coated pta balloon catheter was selected and passed to cover the distal right common femoral and the entire affected area of the superficial femoral artery.The balloon was inflated where there was a very significant waist in the more distal stenosis requiring increased pressure up to 12 atmospheres, but ultimately complete expansion was obtained.Inflation was held for 3 minutes, deflated and then removed.Repeat angiogram showed wide patency to the superficial femoral artery end through the previously placed stent with no evidence of a dissection.Runoff films showed no evidence of any distal embolization.Due to the significant scarring and obstructed disease in the left groin a closures device was not used.The patient was taken to recovery area in stable condition.On (b)(6) 2024, right common femoral and profunda femoral arteries had patency.Right superficial femoral artery patent proximally including superficial femoral artery stent located just past its origin though there is in-stent restenosis noted.Severe scattered disease throughout the superficial femoral and popliteal arteries with many areas of severe stenosis and complete occlusion just past hunters canal with reconstitution of the popliteal above the knee.Right superficial femoral and popliteal arteries were treated by atherectomy with balloon angioplasty, and additional selective catheter placement was done with elective angiography.The common femoral artery end popliteal was treated by atherectomy before angioplasty to provide plaque modification and minimize risk of dissection end therefore need for further peripheral stenting.The superficial femoral and popliteal arteries were treated with a rotablator without complications.A 5 x 3mm drug-coated balloon was advanced for balloon angioplasty.Wire and catheter taken up into the abdominal aorta end aortogram performed.Wire and catheter taken over the aortic bifurcation and down into the right common femoral artery and right leg angiogram performed.Heparin bolus administered; sheath exchanged for a 6 french by 45 synovator long sheath.Wire and catheter taken down the superficial femoral and popliteal arteries with selective angiography performed at each level.Superficial femoral/popliteal occlusions grossed and catheter taken down to the below-knee popliteal artery, angiogram performed confirming that we were in fact in the popliteal flow lumen.Completion angiogram performed.Groin soft and hemostatic at completion.
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