Aorto Femoral Bypass Graft in Chronic Limb Ischemia Patient

A 44-year-old man was admitted to hospital to be performed re-thrombectomy after previously performed thrombectomy at the referring hospital but did not show clinical improvement. CT angiography results before re-thrombectomy showed a central thrombus measuring 1.1 cm in diameter, and an impression of 2.6 cm long at the branching of the right external Iliaca artery which caused total obstruction of the right illiaca external artery to the distal. Aortofemoral bypass graft surgery is a procedure utilized commonly for the treatment of aortoiliac occlusive disease. The treatment given to manage symptoms if medical management or minimally invasive therapy, such as balloon angioplasty and stenting, was unsuccessful or unsuitable for the patient. Aortofemoral bypass graft surgical procedure was performed on the patient. However, post procedure angiography showed no visible flow through the newly placed graft. A repair graft procedure was planned for the patient, but the patient refused to undergo further surgical procedures.

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Successful Off-Label Use of an Iliac Branch Device to Rescue an Occluded Aortofemoral Bypass Graft

Journal of Endovascular Therapy ◽

10.1177/1526602818815699 ◽

2018 ◽

Vol 26 (1) ◽

pp. 128-132 ◽

Cited By ~ 4

Author(s):

Mario D’Oria ◽

Marco Pipitone ◽

Francesco Riccitelli ◽

Davide Mastrorilli ◽

Cristiano Calvagna ◽

...

Keyword(s):

Bypass Graft ◽

Limb Ischemia ◽

Aortofemoral Bypass ◽

Off Label ◽

Alternative Approach ◽

Aortic Thrombus ◽

Endovascular Device ◽

Completion Angiography ◽

Antegrade Catheterization

Purpose: To report an alternative approach for rescue of an occluded aortofemoral bypass using the Gore Excluder Iliac Branch Endoprosthesis (IBE). Case Report: A 52-year-old man presented with acute right limb ischemia because of displaced and occluded iliac stents and was treated with aortofemoral bypass. On the third postoperative day, there was early bypass failure due to distal embolization from aortic thrombus. After fluoroscopy-guided balloon thrombectomy of the bypass, an endovascular bailout strategy was used. The Gore Excluder IBE was deployed below the renal arteries (with the external iliac limb opening in the surgical prosthesis and the gate opening within the aortic lumen). After antegrade catheterization of the gate, a Gore Viabahn endoprosthesis was inserted as the bridging endograft and deployed so that it landed just above the preimplanted aortoiliac kissing stents without overlapping them. Completion angiography showed technical success without complications; results were sustained at 1-year follow-up. Conclusion: The Gore Excluder IBE may represent a versatile solution for the rescue of complex cases when open surgery would be associated with a considerable risk. This off-label application of a well-recognized endovascular device is safe and feasible and may prove useful as a valuable alternative in properly selected patients.

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Initial Experience With Covered Endovascular Reconstruction of the Aortic Bifurcation in Conjunction With Chimney Grafts

Journal of Endovascular Therapy ◽

10.1177/1526602816673824 ◽

2016 ◽

Vol 24 (1) ◽

pp. 19-24 ◽

Cited By ~ 8

Author(s):

Martijn L. Dijkstra ◽

Peter C. J. M. Goverde ◽

Andrew Holden ◽

Clark J. Zeebregts ◽

Michel M. P. J. Reijnen

Keyword(s):

Renal Artery ◽

Limb Ischemia ◽

Occlusive Disease ◽

Left Renal Artery ◽

Aortic Bifurcation ◽

Aortoiliac Occlusive Disease ◽

The One ◽

The Right ◽

Chimney Graft

Purpose: To show feasibility of the covered endovascular repair of the aortic bifurcation (CERAB) technique in conjunction with chimney grafts in aortic side branches for complex aortoiliac occlusive disease. Methods: Two European centers and one facility located in New Zealand participated in a retrospective observational study that enrolled 14 consecutive patients (mean age 61.2±8.9 years; 11 men) treated with CERAB in conjunction with chimney graft(s) between December 2012 and May 2015. Indications for treatment included disabling claudication in 9 and critical limb ischemia in 5. Lesions were classified as TransAtlantic Inter-Society Consensus II B (n=1), C (n=1), or D (n=12). Results: A total of 15 chimney grafts were used to perfuse the inferior mesenteric artery (n=8), the right renal artery (n=4), and the left renal artery (n=3). Technical success was achieved in all cases. Procedural complications included 5 unintended dissections and 1 vessel thrombosis, all of which were successfully treated intraoperatively. Five patients developed access-site hematoma/ecchymosis (3 at the brachial access). Mean follow-up was 12 months (range 6–24) without death or loss to follow-up. One patient suffered occlusion of a CERAB limb and an IMA chimney graft; the former was recanalized, but the IMA graft was not; there were no signs of bowel ischemia. Ankle-brachial indices significantly increased from 0.54 (range 0.47–0.60) preoperatively to 0.97 (range 0.90–1.00) in 11 patients examined at 12 months, and all patients had an improvement in the Rutherford category. All CERAB limbs, including the one recanalized, were patent at the most recent follow-up, as were 14 of 15 chimney grafts. Conclusion: Chimney-CERAB is technically feasible and may offer an alternative to open surgery for complex aortoiliac occlusive disease. Further prospective studies are needed to confirm these findings.

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Aortoiliac occlusive disease associated with an ectopic pelvic kidney

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319883527 ◽

2019 ◽

Vol 28 (2) ◽

pp. 108-111

Author(s):

Bilel Derbel ◽

Myriam Terzi ◽

Faker Ghedira ◽

Mohamed Ali Koubaa ◽

Jalel Ziadi ◽

...

Keyword(s):

Lower Limb ◽

Aortic Surgery ◽

Limb Ischemia ◽

Occlusive Disease ◽

Pelvic Kidney ◽

Aortofemoral Bypass ◽

Aortoiliac Occlusive Disease ◽

Lower Limb Ischemia ◽

Abdominal Aortic ◽

Left Lower Limb

A pelvic kidney is a rare congenital anomaly. In patients requiring aortic surgery, the diagnosis of associated pelvic kidney is always challenging. This anomaly is best known for being associated with abdominal aortic aneurysm and rarely, with aortoiliac occlusive disease. We report the case of a 59-year-old man who presented with critical left lower limb ischemia secondary to bilateral iliac occlusion associated with pelvic kidney. He underwent aortofemoral bypass with an uneventful outcome.

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

Journal of Medical Case Reports ◽

10.1186/s13256-021-02794-6 ◽

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.

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Pulsatile flow through an idealized arterial bypass graft: an application of the constructal design method

Journal of the Brazilian Society of Mechanical Sciences and Engineering ◽

10.1007/s40430-021-03048-8 ◽

2021 ◽

Vol 43 (8) ◽

Author(s):

A. N. Impiombato ◽

F. S. F. Zinani ◽

L. A. O. Rocha ◽

C. Biserni

Keyword(s):

Pulsatile Flow ◽

Design Method ◽

Bypass Graft ◽

Arterial Bypass ◽

Constructal Design ◽

Flow Through ◽

Arterial Bypass Graft

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Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

Journal of Endovascular Therapy ◽

10.1177/1526602821989330 ◽

2021 ◽

pp. 152660282198933

Author(s):

Pablo V. Uceda ◽

Julio Peralta Rodriguez ◽

Hernán Vela ◽

Adelina Lozano Miranda ◽

Luis Vega Salvatierra ◽

...

Keyword(s):

Superior Vena Cava ◽

Esophageal Varices ◽

Superior Vena ◽

Vena Cava ◽

Central Venous Catheters ◽

Dialysis Patients ◽

Central Venous ◽

Endovascular Recanalization ◽

Flow Through ◽

The Right

The health care system in Peru treats 15,000 dialysis patients annually. Approximately 45% of patients receive therapy using catheters. The incidence of catheter-induced superior vena cava (SVC) occlusion is increasing along with its associated significant morbidity and vascular access dysfunction. One of the unusual manifestations of this complication is bleeding “downhill” esophageal varices caused by reversal of blood flow through esophageal veins around the obstruction to the right atrium. Herein is presented the case of an 18-year-old woman on hemodialysis complicated by SVC occlusion and bleeding esophageal varices who underwent successful endovascular recanalization of the SVC. Bleeding from “downhill” esophageal varices should be considered in the differential diagnosis of dialysis patients exposed to central venous catheters. Aggressive endovascular treatment of SVC occlusion is recommended to preserve upper extremity access function and prevent bleeding from this complication.

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Aortic dissection during transoesophageal echocardiography: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa333 ◽

2020 ◽

Author(s):

Rin Hoshina ◽

Hideyuki Kishima ◽

Takanao Mine ◽

Masaharu Ishihara

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Aortic Dissection ◽

Right Coronary Artery ◽

Bypass Graft ◽

Transoesophageal Echocardiography ◽

Ascending Aorta ◽

Maximum Diameter ◽

Abnormal Finding ◽

The Right

Abstract Background Transoesophageal echocardiography (TOE) is a safe and useful tool. In our case, we are presenting a rare case of a patient with aortic dissection during TOE procedure. Case summary A 79-year-old woman was referred to our hospital for recurrent paroxysmal atrial fibrillation (AF) with palpitation. Pre-procedural cardiac computed tomography (CT) showed slight dilated ascending aorta (maximum diameter: 40 mm). We decided to perform catheter ablation (CA) for AF, and recommended TOE before the CA because she had a CHADS2 score of 4. On the day before the CA, TOE was performed. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, there was no abnormal finding of the ascending aorta. At 5 min after the insertion, TOE showed ascending aortic dissection without pericardial effusion. After waking, she had severe back pain and underwent a contrast-enhanced CT. Computed tomography demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm). The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery. Discussion Transoesophageal echocardiography would have to be performed under sufficient sedation with continuous blood pressure monitoring in patients who have risk factors of aortic dissection. The risk–benefit of TOE must be considered before a decision is made. Depending on the situation, another modality instead of TOE might be required.

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Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions

Vascular ◽

10.1177/17085381211029819 ◽

2021 ◽

pp. 170853812110298

Author(s):

Görkem Yiğit

Keyword(s):

Critical Limb Ischemia ◽

Bypass Graft ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Rotational Atherectomy ◽

Total Occlusion ◽

The Mean ◽

Knee Pathology ◽

Drug Coated Balloon

Objectives In this study, perioperative properties and early outcomes of patients who underwent combined Temren rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty treatment for complex femoropopliteal lesions in a single center were reported. Methods Between June 2019 and February 2020, 40 patients who underwent combined Temren RA and DCB treatment due to critical lower limb ischemia or claudication-limiting daily living activities were retrospectively evaluated. Results The mean age of patients was 73.2 ± 7.8 years and the majority of the patients were male (65%). Of the patients, 17 had critical limb ischemia and 23 had lifestyle-limiting claudication. Pathologies were total occlusion in 33 limbs and critical stenosis in seven limbs. Nine patients previously underwent endovascular intervention or surgery. The mean total occlusion length was 140.9 ± 100.9 (range, 20–360) mm in patients with chronic total occlusion. There was an additional iliac artery pathology in 5 and below the knee pathology in 8 patients. Rotational atherectomy was possible in all cases. Flow-limiting dissection was seen in six patients (15%). Provisional stent was performed to these patients. Following Temren RA, all patients underwent DCB. Adequate vascular lumen (less than 30% stenosis) was provided in all patients and the symptoms regressed. No distal embolization was encountered. Access site complications (17.5%) were small hematoma in four patients, ecchymosis in two patients, and pseudoaneurysm of the femoral artery in one patient. The mean follow-up was 13.55 ± 4.2 (range, 1–18) months. Re-occlusion was seen in three patients (7.5%) ( n = 2 at 2 months and n = 1 at 4 months). Of these patients, two had required open revascularization via femoropopliteal bypass graft with common, superficial femoral, and popliteal artery endarterectomy and one had required femoro-posterior tibial artery bypass. Four minor toe amputations (10%) were performed to reach complete wound healing in the critical limb ischemia patients. A below-knee amputation was performed in a 94-year-old patient with long segment stenosis at the end of a 1-month follow-up period. There was no mortality after follow-ups. The Kaplan–Meier estimator estimated the rate of freedom from target lesion revascularization (TLR) which was 92.3%. The decrease in the Rutherford levels after the procedure was found to be statistically significant in 36 patients ( p < 0.001). The increase in the ankle–brachial index after the procedure was found to be statistically significant in 36 patients ( p < 0.001). Conclusions Combined use of Temren RA with adjunctive DCB is safe and effective method with high rates of primary patency and freedom from TLR and low rates of complication in the treatment of femoropopliteal lesions.

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