In this video, a patient with significant symptomatic left leg claudication presents with diagnostic studies suggestive of left sided iliac disease. In this patient with previous right-sided graft insertions, the access in the right groin is slightly modified by using the stiffer micropuncture kit.

The diagnostic iliac arteriogram demonstrated an apple core lesion in the proximal left iliac artery and almost complete occlusion of the profunda. Given this finding, a decision was made to complete the popliteal arteriogram and plan for a hybrid femoral endarterectomy, profundaplasty, and insetion of a left iliac stent.