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

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.

COMPARATIVE STUDY OF FEMORO-FEMORAL CROSSOVER BYPASS AND AORTO-UNIFEMORAL BYPASS

Iliac artery occlusions can produce Chronic limb-threatening ischemia and these patients need early revascularization procedures for their limb salvage which is usually established by Aorto-unifemoral bypass. But in patients with poor general conditions femoro-femoral crossover bypass is an alternate option. Ours is Comparative study of Femoro-femoral crossover bypass and Aorto-unifemoral bypass in patients with Iliac occlusion and Chronic limb-threatening ischemia. Total of 22 patients were included in which femorofemoral bypass performed in 10 patients and Aorto-unifemoral bypass in 12 patients. Indications for femorofemoral bypass were poor cardiac/respiratory functions and old age with poor performance. Stable patients were subjected to Aorto-unifemoral bypass. Patency rates and limb salvage rate were 100% with no perioperative mortality in both of these procedures. This shows femorofemoral bypass is an effective revascularization procedure in patients with Iliac occlusion and Chronic limb-threatening ischemia with associated poor general conditions.

Renal Transplant Artery Inflow Stenosis Treated with Femorofemoral Bypass

In this case report we describe a novel and successful revascularization approach in instances of allograft and distal limb ischemia after kidney transplantation. Stenosis proximal to transplant renal artery anastomoses is a complication leading to allograft dysfunction and/or loss. We present a femorofemoral bypass graft with ringed polytetrafluoroethylene (PTFE). In this occasion, revascularization was achieved by a backflow mechanism. The approach described achieved its goal of revascularizing the allograft as well as the distal extremity, with both short- and long-term successful outcomes. Benefits of this approach when compared with re-implantation or procedures directly involving the transplant renal artery include minimization of ischemic time, no need to repair the stenosis, anastomoses with vessels of greater diameter, no need to perfuse the kidney, no need to take down the renal artery anastomosis, no need to dissect the transplanted kidney, and no further lower extremity ischemia. This approach does not require any proximal temporary inflow occlusion (as seen with stent placement) or clamping of the arterial inflow to the kidney. This procedure was completed without having to infuse any preservation fluid into the kidney.

Pseudoaneurysm of Ascending Aorta with Sternal Erosion after Double Valve Replacement—A Case Report

Pseudoaneurysm of ascending aorta is a rare complication after aortic surgery. Predisposing factors can be infection, chronic hypertension, connective tissue disorders, or dissection. Chest pain, sternal erosion, dysphagia, or stridor can be the modes of presentation. It can also present as a pulsatile mass. Redo sternotomy in a case of pseudoaneurysm of aorta can cause fatal hemorrhage or air embolism. In such a scenario, femorofemoral bypass and hypothermic circulatory arrest help to simplify the approach to the pseudoaneurysm. The authors present a case of a 23-year-old female with pseudoaneurysm of the ascending aorta causing sternal erosion. Ascending aortic repair was done using Dacron patch with femorofemoral bypass and hypothermic circulatory arrest. Sternum was repaired using pectoralis major muscle flap.