Severely Calcified Proximal Superficial Femoral Artery Lesion Treated With Bamboo Spear Technique Under Complete Ultrasound Guidance: A Case Report

BACKGROUND Surgical endarterectomy remains the first-line treatment for revascularization of the femoral region. However, endovascular therapy becomes necessary in patients with comorbidities such as diabetes or poor tolerance to general anesthesia. Several endovascular therapy techniques have been developed for the femoral region, including the aggressive wire recanalization in calcified atheroma and dilatation technique, balloon-backed microcatheter technique, and fracking. The bamboo spear technique, which involves direct puncture of calcified plaque using a bare-metal needle to facilitate balloon passage and expansion, represents a valuable alternative. The addition of ultrasound guidance can enhance the precision and efficacy of this approach. CASE REPORT A 60-year-old man on chronic hemodialysis presented with severe intermittent claudication of the left leg. Angiography revealed a high takeoff of the left superficial femoral artery with severe stenosis in the proximal segment due to calcified plaque. The bamboo spear technique was utilized for revascularization of the femoral region. Under complete ultrasound guidance, both long- and short-axis views were used to advance a 20-G metal introducer needle precisely into the center of the vessel and the calcified plaque. A 0.014-inch guidewire was passed through the needle, after which balloon angioplasty was performed via scoring and drug-coated balloons. The procedure was successful, and the patient was discharged on postoperative day 4 after his ankle-brachial index and claudication symptoms improved. CONCLUSIONS The bamboo spear technique, performed under ultrasound guidance, enabled accurate penetration of the calcified plaque center and effective lesion expansion in the proximal superficial femoral artery.