Case Spotlight: Dr. John Phillips

A patient presenting with severe chronic limb-threatening ischemia (CLTI) and extensive comorbidities required a highly strategic and adaptable endovascular approach. This case highlights how a structured, stepwise methodology can support successful outcomes in even the most complex anatomies.

Patient Profile

  • WIfI Stage 4 CLTI
  • Severe arterial calcification (intimal + medial) 
  • Popliteal artery occlusion
  • Prior CABG
  • Heart failure with reduced ejection fraction (HFrEF)

Review the case below, then join Dr. John Phillips at AMP 2026 to learn more about advanced strategies for treating complex CLTI and heavily calcified disease.

John Phillips, MD

John Phillips, MD

AMP 2026 Course Director
System Director, OhioHealth Heart & Vascular Institute
Riverside Methodist Hospital

Dr. John A. Phillips, MD is a cardiology and peripheral vascular interventionalist in Columbus, Ohio. He is affiliated with OhioHealth, Riverside Methodist Hospital and has been in practice there for 9 years. Dr. Phillips is the system director for the OhioHealth Vascular Institute, the medical director for endovascular medicine and the clinical operations council chief for the heart and vascular service line at Riverside Methodist.

The Challenge

Popliteal Occlusion & Calcification

Severe calcification and total occlusion of the popliteal artery created significant barriers to lesion crossing and effective vessel preparation. Traditional crossing strategies were insufficient, requiring escalation and precise technique to establish a viable treatment pathway.

Approach

1. Assess

Careful imaging and duplex evaluation confirmed:

  • Extensive calcified disease
  • Popliteal occlusion
  • Limited distal runoff (AT to DP)

This informed the need for an advanced vessel preparation strategy.

AT to DP Runoff

2. Modify

A stepwise calcium modification approach was used:

  • Wire escalation: Required a 30g tip wire to cross the lesion
  • Channel creation: 1.0 mm balloon used to establish initial passage
  • Orbital atherectomy (OAS): Addressed heavy intimal and medial calcium
  • Intravascular lithotripsy (IVL): Further modified calcium to improve vessel compliance

This combination enabled optimal lesion preparation prior to definitive therapy.

Intervention - IVL

3. Perform

With the vessel adequately prepared:

  • Drug-coated balloon (DCB) therapy was delivered
  • Stenting reserved only as a bailout strategy

Intervention - Post IVL & Post DCB

Outcome

Intervention - Final Runoff

  • Successful revascularization
  • Improved distal flow with strong runoff
  • No immediate complications reported

Why This Case Matters

This case demonstrates the importance of:

  • Thoughtful procedural planning
  • Effective calcium modification strategies
  • A staged approach to complex disease

By aligning technique with this framework, physicians can better navigate challenging lesions and optimize procedural success.

About AMP in Action

AMP in Action showcases real-world cases that demonstrate how physicians apply structured, evidence-based approaches to complex peripheral interventions—focusing on assessment, vessel preparation, and optimized treatment delivery.

As we look ahead to AMP 2026, these case-based insights reflect the types of discussions, techniques, and clinical decision-making you’ll experience at the meeting. From advanced vessel preparation strategies to managing heavily calcified disease, AMP 2026 will highlight how leading physicians are tackling today’s most challenging cases.

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