Case studies

See how the Auryon system worked in real practice with diverse lesion types.

These case study outcomes are unique to the individual patient undergoing atherectomy procedures under the care of qualified healthcare professionals trained in the use of the Auryon system. Individual results may vary.

The AURYON system succeeds below the knee

See how the Auryon system was used to restore patency through atherectomy of the tibial and peroneal arteries.

Doctor
Dr. Jason Yoho, Interventional Cardiologist
Hospital
Heart & Vascular Institute of Texas
Location
Seguin, Texas

Patient history

A 50-year-old male with a past medical history of hypertension, hyperlipidemia, insulin-dependent diabetes mellitus, presented with a chronic ulcer to left great toe which was cool to the touch. The patient was recently hospitalized, was seen by podiatry for wound care, and presented wearing a boot on the left foot. Stated that he has been experiencing a ‘pulsating’ pain in his foot. The decision was made to proceed with a PTA procedure in an attempt to improve blood flow and wound healing.
He was brought to the cardiac catheterization lab where diagnostic angiography showed a heavily calcified SFA. The left popliteal artery in the P1 segment had a flow-limiting lesion with approximately 15 to 20 mmHg gradient across the lesion. The left anterior tibial artery was a moderate-size vessel with a focal 50% stenotic lesion and a tubular 50% to 60% stenotic lesion. The left peroneal artery revealed a 50% stenosis proximally with a subtotal 99% stenosis in the mid to distal aspect and left posterior tibial artery revealed a 20% diffuse stenosis.
Due to the angiographic findings, the decision was made to proceed with improving inflow and outflow as well as improving flow to the digital vessels.
Image of occluded infrainguinal arteries before treatment with the Auryon system for peripheral atherectomy

Pre-treatment with the Auryon system

Image of infrainguinal arteries with restored patency after treatment with the Auryon system for peripheral atherectomy

Post-treatment with the Auryon system

Procedure notes

After angiography was performed, excellent flow into the digital vessels to the dorsalis pedis artery was confirmed. Attention was given to improving flow in the left anterior tibial artery. A second SION black guide wire (Asahi Intecc, Seto, Japan) was then advanced, and the 1.5 x 8 Apex over-the-wire balloon (Boston Scientific, Marlborough, MA) was advanced across the lesions in the left peroneal artery into the distal vessel. The vessel tapered significantly at the level of the ankle, with very poor outflow. At this aspect, a 0.9 mm AURYON laser atherectomy catheter [(AURYON Atherectomy System, AngioDynamics, Queensbury, NY)] was inserted over the wire and advanced to the left anterior tibial artery. Atherectomy was performed at 50 mJ/cm2. The 0.9 mm AURYON laser atherectomy catheter was then exchanged onto the wire of the peroneal artery for 50 mJ/cm2. After atherectomy was performed, the AURYON catheter was exchanged for an Armada 14 XT OTW 2 mm x 200 mm balloon (Abbott Vascular Inc., Redwood City, CA) which was inserted into the left peroneal artery and inflated to 5 atmospheres for 2 minutes. After balloon angioplasty was performed, there was significant improvement in flow distally. A 6 mm x 120 mm Chocolate balloon catheter, Chocolate OTW Percutaneous Transluminal Angioplasty (PTA) Balloon (Medtronic Corporation, Minneapolis, MN), was inserted in the left peroneal artery and gently inflated to 5 atmospheres for 2 minutes. There was no gradient across the peroneal artery post inflation, and final angiography revealed less than 10% stenosis of the popliteal artery. There were sequential 20% stenotic lesions of the left anterior tibial artery.
The proximal peroneal artery and mid-peroneal artery revealed excellent flow. There was a taper to a very small caliber vessel with poor distal flow and small caliber vessels. There was now excellent flow into all the digital vessels and confirmation of excellent flow into both the medial and lateral aspects of the 1st digit. The patient will continue with clopidogrel (Plavix, Sanofi-Aventis US LLC, Bridgewater, NJ) and will be given a 300 mg dose overnight.
THE AURYON SYSTEM SUCCEEDS IN 1 PASS

See how the Auryon system was used to restore patency through atherectomy of the anterior tibial artery and the popliteal artery in 1 pass.

Doctor
Dr. Jason Yoho, Interventional Cardiologist
Hospital
Heart & Vascular Institute of Texas
Location
Seguin, Texas

Patient history

A 61-year-old male with a past medical history of coronary artery disease, hypertension, diabetes mellitus type 2, diabetic foot ulcers of the plantar forefoot of both feet (for 2 years) and peripheral neuropathy. The patient presented with bilateral swelling and pain in both feet which is usually controlled with Gabapentin (Amneal Pharmaceuticals LLC, Bridgewater, NJ) and Ultram (Tramadol, Janssen Pharmaceuticals, Inc., Raritan, NJ). On the day of admission both feet were more swollen and painful than usual and the patient self-treated with Gabapentin and Furosemide (LASIX, Pfizer, New York, NY) in hopes that the swelling would subside as well as the pain (no improvement). The patient’s pain increased until he could only walk on his heels. In agreement with podiatry the patient was referred to the Emergency Department and was subsequently admitted. A noninvasive imaging study demonstrated severe abnormalities and the patient was in extreme pain as previously reported.
The patient was brought to the cardiac catheterization lab where diagnostic angiography revealed bilateral iliac arteries with luminal irregularities. Bilateral superficial arteries were severely calcified with approximately 20% to 30% stenosis and diffuse disease. The right popliteal artery revealed a 60% stenosis in the mid-segment, and left popliteal artery revealed 50% stenosis with occlusion in the distal aspect. The right anterior tibial artery was completely occluded with no significant reconstitution and right tibioperoneal trunk was occluded with reconstitution of the peroneal artery. There was 100% total chronic total occlusion of the right popliteal and right posterior tibial arteries. All 3 tibial vessels appeared occluded on the left lower extremity with possible washout.
Image of occluded infrainguinal arteries before treatment with the Auryon PAD system

Pre-treatment with the Auryon system

Image of infrainguinal arteries with restored patency after treatment with the Auryon PAD system

Post-treatment with the Auryon system

Procedure notes

Due to the angiographic findings, the decision was made to proceed with intervention of the right lower extremity in an attempt to acquire straight inline flow to improve wound healing and minimization of limb ischemia.
A 0.9 mm Auryon laser atherectomy catheter [AURYON Atherectomy System, (AngioDynamics, Queensbury, NY)] was inserted over the wire in the anterior tibial artery. Atherectomy was performed at 1 pass at 50mJ/cm2. After atherectomy was performed, an Armada 14 XT OTW2 mm x 200 mm balloon (Abbott Vascular Inc., Redwood City, CA) was inserted and advanced, and advancement into the popliteal artery was successful. Sequential inflations were performed at gradually increasing pressures from proximal anterior tibial artery to the distal anterior tibial artery. The balloon was subsequently removed and exchanged for a 2.5 mm x 120 mm Chocolate balloon [Chocolate OTW Percutaneous Transluminal Angioplasty (PTA) Balloon (Medtronic Corporation, Minneapolis, MN)]. The balloon was advanced in the proximal anterior tibial artery and was inflated. Post-inflation a 2.0 AURYON laser atherectomy catheter was inserted over the wire in an antegrade fashion extending into the popliteal artery. Atherectomy was subsequently performed at 50mJ/cm2 times one pass. A 6.0 mm x 120 mm Chocolate balloon was then inserted to dilate the popliteal artery.
After dilation, attention was taken to attempt to maintain patency of the ostium of the anterior tibial artery by placing a stent, however it was unsuccessful in advancing across the proximal lesion. Angiography was then performed, which now revealed straight inline flow proximally with a patent anterior tibial artery. Given the significant improvement in flow in the posterior tibial artery and anterior tibial artery, significant improved collateralization of the peroneal artery was visualized. With the peroneal artery filling the distal vessels, there were now 2 vessels reaching the foot. There was significant collateralization filling the mid aspect of the posterior tibial artery. The goal for a staged intervention of his left lower extremity followed by improvement and acquisition of a second tibial vessel to minimize any risk that this occurs again.

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