scholarly journals Increased collateral flow by rescue femorofemoral bypass dissolved residual thrombus in implanted iliofemoral artery stents: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Tatsuo Haraki ◽  
Taichi Kondo ◽  
Izaya Kamei ◽  
Takahiro Tanabe
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Femoropopliteal Bypass ◽  
Bypass Grafts ◽  
Deep Femoral Artery ◽  
The Right ◽  
Femorofemoral Bypass

Abstract Background Failed aortofemoral and femoropopliteal bypass grafts in the lower extremity artery usually result in acute limb ischemia. Endovascular treatment and surgical revascularization have been reported for limb salvage. Case presentation A 72-year-old Japanese man was admitted with acute limb ischemia due to failed aortofemoral and femoropopliteal bypass grafts. Endovascular treatment with balloon angioplasty, thrombectomy, and stent implantation in the long chronic total occlusion from the right common iliac artery to the superficial femoral artery did not result in efficient flow due to thrombus transfer from a failed aortofemoral bypass graft. However, a rescue femorofemoral bypass (the left femoral to the right deep femoral artery) improved his symptoms, and implanted in-stent flow was gradually recovered. Lower extremity angiography performed 5 months later confirmed the patency of the iliofemoral in-stent flow. However, the femorofemoral bypass graft was unfortunately occluded due to the progression of left external iliac artery stenosis. The patency of the iliofemoral in-stent flow was confirmed at 1 year by ultrasonography. Conclusions Improvement of the deep femoral artery flow plays an important role in the treatment of acute limb ischemia due to failed aortofemoral and femoropopliteal bypass grafts. Thus, increased collateral circulation to the periphery through the deep femoral artery dissolved the remaining in-stent thrombus in the iliofemoral artery.

Advanced treatment of acute femoropopliteal bypass graft occlusion with Fogarty catheter guidance

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 262-266 ◽  
Author(s):  
Gokhan Albayrak ◽  
Koray Aykut ◽  
Mehmet Guzeloglu ◽  
Aytac Gulcu ◽  
Eyup Hazan
Keyword(s):  
Bypass Graft ◽  
Limb Ischemia ◽  
Graft Patency ◽  
Transluminal Angioplasty ◽  
Acute Limb Ischemia ◽  
Graft Occlusion ◽  
Fogarty Catheter ◽  
Femoropopliteal Bypass ◽  
Conventional Angiography ◽  
Stent Grafting

Purpose The guiding role of the Fogarty catheter was investigated among patients suffering from limb ischemia due to acute femoropopliteal bypass graft occlusion. Methods A total of 27 patients with a history of femoropopliteal bypass operation who was admitted with acute limb ischemia were enrolled in this retrospective study. In cases in which the Fogarty catheter could not be passed through the popliteal anastomosis, the popliteal region was explored and a new bypass or patch plasty was performed for the distal anastomosis. The cases in which the blood circulation was observed in the graft, but in which the Fogarty catheter balloon was stuck in the native vessels on the proximal and distal side of the graft and the balloon could be withdrawn by deflation, were referred to conventional angiography. The stenosis observed in native vessels was managed by endovascular stent grafting and/or balloon dilatation. Findings Graft patency was achieved in all patients. In 11 patients, conventional angiography was implemented following embolectomy. In these patients, all the occlusions found as significant on angiography were removed by percutaneous transluminal angioplasty. Conclusion Effective use of Fogarty catheter is safe in acute femoropopliteal bypass graft occlusions and in particular, in the planning of further treatment following thrombectomy.

Abstract 275: Angioscore Balloon in the Treatment of Collagen Plug Occlusion and Acute Limb Ischemia: Case Report

2012 ◽  
Vol 32 (suppl_1) ◽  
Author(s):  
Pooja M Swamy ◽  
Abeer Berry ◽  
Mahir D Elder
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Closure Device ◽  
Acute Limb Ischemia ◽  
Access Site ◽  
Left Lower Extremity

BACKGROUND: Complications of the vascular access-site (VAS) are not uncommon. With the evolution of hemostatic techniques used in the access site closure, in the last two decades, the rate of VAS related complications has significantly reduced from 6% to 2%. However, they still remain to be an important cause of morbidity following catheterization procedures. The most common complications encountered with closure of VAS are hematoma formation, arterio-venous fistula, dissection, pseudo -aneurysm and limb ischemia. According to two meta-analyses, the incidences of these complications were very low. The incidence of collagen plug from an Angioseal(™) device causing acute leg ischemia is low and upon occurrence, the use of an Angioscore(™) balloon in successful revascularization has never been reported. CASE PRESENTATION: A 62-year-old male with known severe peripheral artery disease, diabetes mellitus, hypertension and hypercholesterolemia had a successful angioplasty of a 100% chronically occluded right superficial femoral artery (SFA) via the left common femoral artery. An Angioseal (™) closure device was used to achieve hemostasis. The patient was discharged home after an uneventful post procedural course. Two days later, he presented to the ER with a cold and numb left lower extremity. On exam, the left lower extremity had no palpable pulse from below right femoral artery, confirmed by Doppler. The extremity was cold to touch with decreased sensory perception. Patient was found to have critical left lower extremity ischemia. He was emergently taken for a selective left lower extremity angiogram using the right common femoral artery for access. Fragments of the closure device and a collagen plug causing a total occlusion of the left common femoral artery were found. After a pre-dilatation with a 4.0x 40 balloon under prolonged inflations, a lesion reduction from 100 % to 30% with a TIMI 0 to TIMI 3 flow was achieved using an Angioscore (™) 5.0x 40 balloon inflated at 10 atmospheres. Subsequently, using laser 2.0 atherectomy of the left common femoral artery was performed. Flow in the dorsalis pedis artery was confirmed with Doppler. DISCUSSION: The Angio-Seal(™) device has a polylactide and polyglycolide polymer anchor, a collagen plug and a suture contained within a carrier system. Hemostasis is achieved by compressing the arterial puncture site between the anchor and the collagen plug. With newer studies, it appears that the occurrence of critical limb ischemia from collagen plug is under recognized. We therefore, with this case report urge the physicians to be aware of this serious though rare complication of closure devise and also highlight the successful use of Angioscore (™) balloon in the emergent treatment of non-athermatous vascular occlusion causing critical limb ischemia.

The deep femoral artery, a readily available inflow vessel for lower limb revascularization: a single-center experience

Vascular ◽  
2013 ◽  
Vol 21 (2) ◽  
pp. 75-78 ◽  
Author(s):  
Daniel Silverberg ◽  
Basheer Sheick-Yousif ◽  
Dmitry Yakubovitch ◽  
Moshe Halak ◽  
Jacob Schneiderman
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Lower Limb ◽  
Bypass Graft ◽  
Graft Patency ◽  
Primary Patency ◽  
Single Center ◽  
Deep Femoral Artery ◽  
Single Center Experience

The deep femoral artery (DFA) offers several advantages as an inflow vessel in lower-extremity bypasses. We report a single-center experience using the DFA as an inflow artery for lower-extremity revascularization. We reviewed all patients who underwent a lower-extremity bypass utilizing the DFA as the inflow vessel. Demographics, indications for surgery, indication for use of the DFA, type of conduits and target vessels were recorded. Follow-up data included resolution of symptoms, bypass graft patency, major amputations and survival. Over 2.5 years, 23 patients were treated with a DFA-inflow bypass. Eighteen (78%) suffered from wounds and five (22%) from rest pain. The proximal, middle and distal DFA was used in 8, 14 and 1 patients, respectively. Indications for using the DFA were limited vein conduit (16) and a hostile groin (5). All patients experienced initial resolution of their ischemic symptoms. The primary patency at two years was 93%. The survival rate was 83%. In conclusion, the DFA is an excellent and underutilized alternative inflow artery in patients requiring lower limb revascularization. It offers excellent patency rates and should be considered in patients with hostile groins or insufficient lengths of a vein conduit.

scholarly journals Cystic Adventitial Disease of the Common Femoral Artery: A Rare-Case Report

2022 ◽  
Vol 8 ◽  
Author(s):  
Qilong Wang ◽  
Zhihua Cheng ◽  
Liang Tang ◽  
Qi Wang ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Acute Limb Ischemia ◽  
Appropriate Treatment ◽  
Contrast Enhanced ◽  
Rare Case Report ◽  
The Right ◽  
Enhanced Computed Tomography

Herein, we report the case of a 59-year-old man with intermittent claudication of ~100 m, who complained of resting pain in his lower right extremity. A pelvic, contrast-enhanced, computed tomography scan showed the presence of cystic density in the lower segment of the right common femoral artery. Faced with the risk of acute limb ischemia, we navigated a challenging diagnostic procedure to choose an appropriate treatment for him. Additionally, we performed a pathological investigation of the excised common femoral artery following the excision bypass. On postoperative day 5, the patient was discharged from the hospital. During the 2-year follow-up, no new cysts were discovered, and the patient had favorable prognosis.

scholarly journals Arterial Thrombosis Induced By Coagulopathy Due To Coronavirus Infection Concomitant With Heparin Resistance: A Case Report

2021 ◽  
Vol 2 (4) ◽  
pp. 36-39
Author(s):  
Irma Kamelia ◽  
Heny Martini ◽  
Novi Kurnianingsih ◽  
Indra Prasetya
Keyword(s):  
Femoral Artery ◽  
Severe Pneumonia ◽  
Patient Discharge ◽  
Limb Ischemia ◽  
High Dose ◽  
Acute Limb Ischemia ◽  
Fogarty Catheter ◽  
Antegrade Approach ◽  
Heparin Resistance ◽  
The Right

Background : A newly emerging pandemic of Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 is responsible for significant morbidity and mortality worldwide. As one of the effects is hematological changes related to the COVID-19 infection causing patient tend to thrombosis than hemorrhagic. Current review of evidence and statements on management of coagulopathy and thrombotic complications related to this novel disease is needs to be explored Case : Male 53 years old referred from Private Hospital, due to Severe pneumonia due to COVID-19 and Acute Limb Ischemia. This patient was assessed as Pneumonia COVID-19 severe with acute limb ischemia bilateral grade IIB and performed bilateral surgical thrombectomy with antegrade approach using fogarty catheter with the result was thrombus 10cm along the left femoral artery and thrombus 2cm in the right femoral artery. Discussion : With consideration of atherosclerotic diseases in this patient, we decided to give rivaroxaban as an anticoagulant combined with aspilet and statin high dose. But due to lack of source in our hospital, and patient also denied for further management, treatment for the patient cannot be optimal, so the patient discharge with unresolved limb ischemia. Conclusion : This case showed that the increase risk of heparin resistance in SARS-CoV-2 patient, it is recommend- ed to monitor heparin activity of UFH treatment based on anti-Xa levels instead of aPTT alone.

Ilio-Deep Femoral Bypass – an Alternative Treatment Strategy to Critical Limb Ischemia (CLI)

2021 ◽  
Vol 6 (2) ◽  
pp. 108-111
Author(s):  
Vasile Adrian Muresan ◽  
Mircea Catalin Cosarca ◽  
Eliza Russu ◽  
Raluca Niculescu ◽  
Mihai Soimu
Keyword(s):  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
High Morbidity ◽  
Deep Femoral Artery ◽  
Femoral Arteries ◽  
Alternative Treatment Strategy ◽  
Management Of Complications ◽  
The Common ◽  
The Right

Abstract Background: Critical limb ischemia is considered the most severe form of peripheral artery disease. High morbidity and mortality rates are associated with this pathology due to poor economic management of complications. Case summary: A 68-year-old female patient underwent a routine Doppler ultrasound which revealed the obstruction of both the common and superficial right femoral arteries, as well as the right deep femoral artery. In this case, an iliofemoral bypass was performed using the right deep femoral artery as the outflow artery. Conclusion: Revascularization of the deep femoral artery has a reasonable chance of preserving the ischemic lower limb whenever the common and superficial femoral arteries suffer major atherosclerotic blockages.

Does Deep Femoral Artery Revascularization as an Isolated Procedure Play a Role in Chronic Critical Limb Ischemia?

2004 ◽  
Vol 11 (2) ◽  
pp. 119-124 ◽  
Author(s):  
Nicolas Diehm ◽  
Hannu Savolainen ◽  
Felix Mahler ◽  
Jürg Schmidli ◽  
Do-Dai Do ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Deep Femoral Artery ◽  
Chronic Critical Limb Ischemia

scholarly journals Endovascular therapy for severely calcified plaque at the superficial femoral artery using myocardial biopsy forceps

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Shojiro Hirano ◽  
Atsushi Funatsu ◽  
Shigeru Nakamura ◽  
Takanori Ikeda
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Calcium Score ◽  
Biopsy Forceps ◽  
Myocardial Biopsy ◽  
Deep Femoral Artery ◽  
Total Occlusion ◽  
Stent Expansion ◽  
Calcified Plaque ◽  
The Right

Abstract Background Currently, the success rate of EVT for treating CTO of the SFA is high; however, EVT is still found to be insufficient in treating CTOs with severely calcified lesions. Even if the guidewire crosses the lesion, the calcifications may still cause difficulties during stent expansion. Main text A 78-year-old male had been reported to have intermittent claudication with chronic total occlusion (CTO) of the right superficial femoral artery (SFA). Angiography revealed severely calcified plaque (Angiographic calcium score: Group4a [1]) at the ostium of the SFA. Stenting posed a risk of underexpansion, causing the plaque to shift to the deep femoral artery. we decided to remove the calcified plaque using biopsy forceps. After removing the extended calcified plaque, the guidewire could cross easily, and the self-expandable stent was well dilated without causing the plaque to shift to the DFA. Conclusions Biopsy forceps may be used in some endovascular cases to remove severely calcified lesions. To ensure the safety of the patient, the physician must be adept at performing this technique before attempting it.

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