Patient Background

A 71-year-old man with diabetes mellitus since 2016 currently treated with an oral antidiabetic drug, well-controlled arterial hypertension, hyperlipidemia (currently treated with statins), and a history of smoking was sent to our outpatient clinic due to a unimproved ulcer on his fifth toe. He was under regular observation at our diabetic foot clinic because the ulcer on this toe had a necrosis on the tip, but the lack of improvement required an intervention. MRA showed multiple lesions in the left BTK arteries.

Approach

The posterior tibial artery was treated first with POBA, and the anterior tibial branch had two lesions that qualified for treatment with the Serranator. The lower lesion was a 120-mm-long total occlusion and was treated with a 2.5- X 120-mm Serranator (Figure 1). The final inflation was at 4 atm for 120 seconds, with good results. The more proximal second lesion was approximately 20-mm-long and was treated with a 3- X 40-mm Serranator balloon at 5 atm for 120 seconds (Figure 2).

Pre-Procedure: RVD: 2.2; Lesion Length: 81mm; Calcification: mild; 100% stenosis

Inflation: pre-dilatation: 1.5mmX120mm, Armada 14; 2.5 X 120 Serranator; max 4 atm

Post-Inflation: Residual stenosis: 19%

Discussion

This case is exciting because of the direct comparison between both POBA and the Serranator in the same
procedure. We observed a much better outcome with the Serranator-treated lesion (anterior tibial) compared
with the POBA-treated lesion (posterior tibial), where some recoil was visible. In addition, the flow down to the
foot was significantly better in the Serranator-treated vessel.