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Mustafa A, Wei C, Cinelli M, Khan S, Khan D, Tamburrino F, Maniatis G, Spagnola J. Balloon valvuloplasty and transcatheter aortic valve replacement via aortofemoral bypass grafts: A case report and review of literature. World J Cardiol 2025; 17:101709. [PMID: 40161562 PMCID: PMC11947954 DOI: 10.4330/wjc.v17.i3.101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 01/27/2025] [Accepted: 02/21/2025] [Indexed: 03/21/2025] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) can be performed through multiple access sites with the preferred approach being transfemoral. In patients with severe peripheral arterial disease and previous grafts, the safety of transfemoral access via direct graft puncture, especially when performed twice within a short period, remains unclear compared to alternative access methods. We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty (BAV) and TAVR. CASE SUMMARY An 82-year-old man presented with dyspnea on exertion. Echocardiogram was significant for severe aortic stenosis. Following a heart team discussion, the patient was scheduled for a balloon valvuloplasty followed by staged TAVR. Based on pre-TAVR computed tomography angiogram, the aortobifemoral graft was deemed as an appropriate access site. Micropuncture needle was used to access the right femoral artery graft, and the sheath was upscaled to 10 Fr. He underwent successful intervention to ostial left anterior descending and left circumflex arteries, and BAV with 22 mm Vida BAV balloon. Hemostasis was achieved using Perclose. For TAVR, an 8 Fr sheath was inserted via the right femoral bypass graft. The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal. A 5Fr sheath was used for left femoral bypass graft access. Patient underwent successful TAVR with 29 mm CoreValve. Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications. CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.
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Affiliation(s)
- Ahmad Mustafa
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States.
| | - Chapman Wei
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Michael Cinelli
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Shahkar Khan
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Danyal Khan
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Frank Tamburrino
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Gregory Maniatis
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Jonathan Spagnola
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
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Tsuchida Y, Hayakawa N, Miwa H, Ichihara S, Maruta S, Kushida S. Endovascular therapy via a femoro-femoral crossover bypass graft for chronic total occlusion of the superficial femoral artery: Two case reports. SAGE Open Med Case Rep 2024; 12:2050313X241299959. [PMID: 39569398 PMCID: PMC11577463 DOI: 10.1177/2050313x241299959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 10/28/2024] [Indexed: 11/22/2024] Open
Abstract
In patients with a femoropopliteal chronic total occlusion (CTO) after femoro-femoral (FF) bypass surgery, it is often difficult to perform endovascular therapy because of access site problems. We have treated two patients with CTO of the superficial femoral artery (SFA) using an FF crossover bypass graft. The two cases were a man with intermittent claudication and acute limb ischemia, respectively. Enhanced computed tomography showed occlusion of the left SFA and the FF bypass previously performed was patent in both cases. We punctured the right common femoral artery and a guiding sheath was inserted to the left common femoral artery. A guidewire successfully passed through the intraplaque lesion by intravascular ultrasound-guided wiring in both cases. Revascularization was successfully achieved using drug-coated balloons and using drug-eluting stents, respectively. An FF crossover bypass graft may be a good access route for complex femoropopliteal cases, such as CTO lesions.
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Affiliation(s)
- Yasuyuki Tsuchida
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Hiromi Miwa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Shinya Ichihara
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Shunsuke Maruta
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Shunichi Kushida
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
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Verelst H, Bonne L, Mufty H, Claus E, Houthoofd S, Verhamme P, Fourneau I, Maleux G. Direct puncture versus contralateral femoral artery approach for catheter-directed thrombolysis of occluded infra-inguinal arterial bypass grafts. Clin Radiol 2023; 78:e1001-e1009. [PMID: 37806817 DOI: 10.1016/j.crad.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
AIM To compare the safety, effectiveness, and clinical outcome of percutaneous direct puncture approach versus contralateral femoral native vessel approach for catheter-directed thrombolysis of occluded infra-inguinal bypass grafts. MATERIALS AND METHODS A retrospective analysis was performed comprising a cohort of patients who underwent catheter-directed thrombolysis procedures of occluded infra-inguinal bypass grafts between January 2013 and January 2022, with a follow-up period until June 2022. This included 55 procedures via the native vessel approach and 18 procedures via the direct puncture approach. Primary outcomes were technical success and procedural safety; secondary outcomes included re-intervention rate, limb salvage, and mortality as assessed by log-rank testing and Kaplan-Meier curves. RESULTS There were no differences between the two groups with regard to patient demographics, except for the number of previous vascular procedures (n=6.83 ± 3.07 direct approach versus n=4.96 ± 2.79 native vessel approach, p=0.025). Thrombolysis was comparably successful in both groups (n=13/18; 72% direct approach versus n=42/55; 76%, p=0.723). There were no differences in the duration of thrombolysis administration. The rate of adverse events was slightly lower in the direct approach group, but without significance (p=0.092). There were no adverse events related to the puncture site in the direct approach group. No differences were found between the time-to-event values for re-occlusion, re-intervention, amputation, or mortality respectively (p=0.662; p=0.520; p=0.816; p=0.462). CONCLUSION The direct puncture approach seems to be a safe and efficient approach for catheter-directed thrombolysis procedures in infra-inguinal occluded bypass grafts, with clinical outcomes comparable to the native vessel approach.
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Affiliation(s)
- H Verelst
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - L Bonne
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - H Mufty
- Department of Vascular Surgery, University Hospital KU Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - E Claus
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - S Houthoofd
- Department of Vascular Surgery, University Hospital KU Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - P Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology and Vascular Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - I Fourneau
- Department of Vascular Surgery, University Hospital KU Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - G Maleux
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
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Sugihara M, Ueda Y, Yano Y, Miura SI. Successful case of direct puncture of a prosthetic bypass graft in endovascular treatment for long superficial artery chronic total occlusion: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 33442613 PMCID: PMC7793119 DOI: 10.1093/ehjcr/ytaa391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/02/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
Background The access site for endovascular therapy (EVT) is often limited because of multi-vascular diseases. Prior lower limb bypass can potentially limit the availability of common femoral artery access when EVT is required. Case summary An 88-year-old woman who presented with non-healing ulceration in the dorsalis pedis of the left foot despite treatment for several months was admitted to our hospital. She had undergone axillo-bilateral femoral bypass surgery for right critical limb ischaemia 3 years previously. Ultrasound and contrast computed tomography demonstrated bypass graft occlusion, left superficial femoral artery (SFA)-popliteal artery long chronic total occlusion from the origin with severe calcification and severe stenosis in the bilateral common femoral artery close to the anastomotic site. EVT for the left SFA occlusion was necessary to save the left foot, but access sites for EVT were limited. We decided to puncture an occluded axillo-femoral prosthetic bypass graft. It is difficult to cross the wire with only an antegrade approach. Therefore, it was necessary to use a bi-directional approach with dorsalis pedis artery puncture and the Rendez-vous technique. Finally, angiogram demonstrated improved blood flow to the wound site, and haemostasis at the puncture site could be achieved by manual compression. The ulceration healed within a month. Discussion Direct puncture of a prosthetic bypass graft and additional techniques resulted in complete revascularization. Thus, direct puncture of a bypass graft could be a useful EVT strategy for patients with complex and extremely long chronic total occlusion.
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Affiliation(s)
- Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Fukuoka, Japan
| | - Yoko Ueda
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Fukuoka, Japan
| | - Yuiko Yano
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Fukuoka, Japan.,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
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Vanheer R, Laenen A, Bonne L, Cornelissen S, Verhamme P, Houthoofd S, Fourneau I, Maleux G. A comprehensive report of long-term outcomes after catheter-directed thrombolysis for occluded infrainguinal bypass grafts. J Vasc Surg 2019; 70:1205-1216. [PMID: 30922746 DOI: 10.1016/j.jvs.2018.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to assess the technical and short- and long-term clinical outcomes of catheter-directed thrombolysis (CDT) with urokinase for occluded infrainguinal bypass grafts. In addition, factors associated with technical success and amputation-free survival were assessed. METHODS A retrospective analysis of a cohort of patients treated with catheter-directed urokinase-based thrombolysis for occluded infrainguinal bypass grafts was conducted between January 2000 and December 2015. Demographics, procedural data, and short- and long-term outcome data, including patency rates of the bypasses, limb salvage, and overall survival, were collected. Statistical models for clustered data were applied to assess predictive factors. RESULTS In 177 patients, 251 CDTs were performed on 204 bypasses. In 209 procedures (83.3%), the occluded bypass was reopened; clinical disappearance of ischemic symptoms occurred after 157 procedures (62.6%). Premature cessation of thrombolysis occurred in 33 procedures (13.2%), and periprocedural and postprocedural complications were noted in 91 patients (36.3%). Factors associated with long-term limb salvage are fewer vascular interventions before CDT (P = .0003), higher number of patent outflow vessels before start of CDT (P < .0001), and higher number of patent outflow vessels after CDT (P < .0001). The 1- and 5-year patency rates of bypasses after successful CDT were 64.6% and 48.9%; amputation-free survival after 1 year, 5 years, and 7 years was 81.5%, 71.3%, and 70.5%, respectively. CONCLUSIONS Clinical success after CDT was observed in 62% of procedures with an associated complication rate of 36%. Patent outflow vessels before and after CDT are factors associated with long-term limb salvage. Amputation-free survival after 5 years is 71.3%.
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Affiliation(s)
- Ruben Vanheer
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Catholic University of Leuven, Leuven, Belgium; Interuniversity Centre for Biostatistics and Statistical Bioinformatics, University Hasselt, Hasselt, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
| | - Sandra Cornelissen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiology and Vascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium.
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Milnerowicz AI, Milnerowicz AA, Protasiewicz M, Kuliczkowski W. Use of vascular closure devices for endovascular interventions requiring a direct puncture of PETE grafts. VASA 2018; 47:119-124. [DOI: 10.1024/0301-1526/a000677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: Effectiveness of vascular closure devices during endovascular procedures requiring a direct puncture of a vascular prosthesis placed in the inguinal region is unknown. Patients and methods: The retrospective analysis included 134 patients with a history of polyethylene terephthalate (PETE) graft implantation in the inguinal region. In 20 (15 %) patients, haemostasis was achieved with manual compression, in 21 (16 %) with the StarClose™, and in 93 (69 %) with the AngioSeal™ device. Results: The incidence of vascular complications in the manual compression group was higher (at a threshold of statistical significance) than in the device closure group (45.0 vs. 24.5 %, p = 0.059). The difference was considered statistically significant when manual compression was compared with the AngioSeal™ closure group (45.0 vs. 13.9 %, p < 0.01). The vascular complication rate in the StarClose™ group was significantly higher than in the AngioSeal™ group (71.4 vs. 13.9 %, p < 0.000001). While haematomas were the only vascular complications observed after application of AngioSeal™, both haematomas and pseudoaneurysms were found in the StarClose™ group. Conclusions: The AngioSeal™ vascular closure device provides better local haemostasis than the StarClose™ device or manual compression during endovascular interventions requiring a direct puncture of PETE grafts
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Affiliation(s)
- Artur I. Milnerowicz
- Department and Clinic of Vascular, General and Transplantation Surgery, Division of Endovascular Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra A. Milnerowicz
- Department and Clinic of Vascular, General and Transplantation Surgery, Division of Endovascular Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Protasiewicz
- Department and Clinic of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Wiktor Kuliczkowski
- Department and Clinic of Cardiology, Wroclaw Medical University, Wroclaw, Poland
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Nasr B, Albert B, David CH, Khalifa A, El Aridi L, Badra A, Braesco J, Gouny P. Endovascular Treatment of Atherosclerotic Iliac Stenosis: Local and Systemic Complications of the Open Brachial Access. Ann Vasc Surg 2016; 33:45-54. [PMID: 26802290 DOI: 10.1016/j.avsg.2015.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The femoral access is the approach of reference for iliac angioplasty. In the current context of an early ambulation and a minimization of in-hospital stay period, the brachial access seems to be an appropriate approach, especially that long and small diameter equipments are available. Furthermore, it is extremely useful in case of inappropriate or unavailable femoral access. The aim of this study was to evaluate the complication risk factors of the brachial approach in the treatment of iliac stenosis. METHODS Between January 2012 and December 2013, we performed 281 iliac transluminal angioplasties of which 57 (20%) consecutive left brachial artery accesses were performed in 54 patients. The choice of brachial access was justified in 68% of the cases by an unavailable femoral access, in 29% of the cases by the presence of bilateral iliac lesions, and in 3% of the cases after failure of retrograde femoral approach. RESULTS The patients were of a male majority (81%) with a mean age of 66 ± 9 years. The procedure was performed under local anesthesia in 65% of the cases. No upper limb ischemia or nervous complications had been reported. No cerebrovascular stroke has been identified. One patient presented with dysarthria associated with disorientation without the presence of cerebrovascular ischemia on the computed tomography scan and on the magnetic resonance imaging. There were 3 major hematomas at the brachial access site, which required reoperation; these 3 patients were on dialysis. There was no statistically significant relationship between a complication occurrence and the diameter or length of the introducer. The mean in-hospital stay period was 2 days. The procedure was considered successful in 91% of the cases. We reported 5 cases of failure: 4 of which was due to a difficulty in crossing the lesion and 1 due to a very short material. The only significant risk factor of failure was the thrombosis of the iliac axis (odds ratio 23.3, 95% confidence interval 2.5-264.6, P = 0.003). CONCLUSIONS The femoral access remains the recommended approach for the treatment of iliac occlusive lesions. However, brachial artery access seems to provide a safe and secure alternative approach for patients when femoral artery access is unavailable. It allows a rapid ambulation and an ambulatory care.
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Affiliation(s)
- Bahaa Nasr
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.
| | | | | | - Ahmed Khalifa
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Layal El Aridi
- CHU de Brest, Centre Regional de Pharmacovigilance, Brest, France
| | - Ali Badra
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Jacques Braesco
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Pierre Gouny
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France
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Katoh H, Nozue T, Michishita I. Direct puncture of the prosthetic bypass graft in the treatment of critical limb ischemia patient undergoing prior axillo-femoral bypass. Cardiovasc Interv Ther 2012; 28:123-7. [PMID: 23007698 DOI: 10.1007/s12928-012-0133-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 08/30/2012] [Indexed: 11/25/2022]
Abstract
A 76-year-old man presented with a non-healing ischemic ulceration of the left foot. He had undergone left axillo-femoral bypass surgery 4 years previously. Diagnostic angiography showed total occlusion from the left common iliac to the common femoral artery and the anterior and posterior tibial artery as well as severe stenosis of the superficial femoral and peroneal artery. Because there were no other access sites except for the axillo-femoral bypass graft, we performed endovascular therapy (EVT) by direct puncture of this bypass graft. Here, we have described the utility of direct puncture of axillo-femoral prosthetic bypass graft for EVT of the infrainguinal arteries.
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Affiliation(s)
- Hiromasa Katoh
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, 132 Katsura-cho, Sakae-ku, Yokohama, Japan.
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Hayashi K, Kitagawa N, Takai H, Nagata I. Carotid artery stenting via a femoral bypass graft: technical note. SURGICAL NEUROLOGY 2009; 71:720-724. [PMID: 18423541 DOI: 10.1016/j.surneu.2007.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Accepted: 12/18/2007] [Indexed: 05/26/2023]
Abstract
BACKGROUND We described a case of endoluminal stent placement for a cervical internal carotid artery stenosis in which access was obtained via the femoral bypass graft. CASE DESCRIPTION A 70-year-old man with known disease of the carotid, peripheral, and coronary arteries as well as congestive heart failure presented for endoluminal revascularization of a severe right internal carotid artery stenosis. Transradial access was complicated by the left subclavian artery occlusion and hypercalcified aortic arch. Bilateral femoral artery was replaced with bypass graft because of atherosclerosis obliterans. An alternative approach was attempted via the exposed left femoral bypass graft. The left inguinal region was incised, and the left common femoral-popliteal bypass graft was exposed. After placement of a purse string suture at the puncture site, the guiding sheath was introduced into the graft and positioned into the right common carotid artery. Stenting was successfully performed, and the suture was tied after withdrawing the sheath. CONCLUSIONS This novel approach should be considered for endovascular procedures for which access to the carotid artery is limited.
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Affiliation(s)
- Kentaro Hayashi
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan.
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Tshomba Y, Kahlberg A, Marone EM, Setacci F, Logaldo D, Chiesa R. Aortoenteric fistula as a late complication of thrombolysis and bare metal stenting for perioperative occlusion of aortofemoral bypass. J Vasc Surg 2006; 44:408-11. [PMID: 16890878 DOI: 10.1016/j.jvs.2006.04.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Accepted: 04/17/2006] [Indexed: 11/28/2022]
Abstract
We previously described the case of a 47-year-old man who experienced perioperative graft occlusion after infrarenal aortic endarterectomy and aortobifemoral expanded polytetrafluoroethylene bypass graft for occlusive disease. The patient was treated with local graft thrombolysis and stenting of an intimal flap at the level of the endarterectomized aorta next to the aortic anastomosis. An urgent laparotomy performed 6 years later showed aortic wall perforation by the stent with a large aortoenteric fistula. Surgical treatment included removal of the stent and the aortobifemoral graft, bowel repair, and extra-anatomic lower-limb revascularization by axillofemoral and cross-femoral bypass grafting. The patient was discharged 12 days later with no early complications. Although local thrombolysis and stenting may be a technically feasible technique instead of reoperation in early aortofemoral graft thrombosis, long-term results of this procedure may be affected by perigraft hematoma due to perioperative thrombolysis, increased risk of infection due to the prolonged intragraft cannulation, and risk of stent-related aortic injury, especially if an endarterectomy has been performed. All these issues may increase the risk of late aortoenteric fistula. More experience with hybrid, open/endovascular procedures, and more contemporary stent-based devices is needed to assess the efficacy and safety of this alternative treatment.
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Affiliation(s)
- Yamume Tshomba
- Division of Vascular Surgery, "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy.
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Lee DE, Waldman DL, Sumida RK, Green RM. Direct graft puncture with use of a crossed catheter technique for thrombolysis of peripheral bypass grafts. J Vasc Interv Radiol 2000; 11:445-52. [PMID: 10787202 DOI: 10.1016/s1051-0443(07)61376-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the efficacy and safety of direct graft puncture of peripheral arterial bypass grafts with placement of retrograde and antegrade catheters within the graft for thrombolytic therapy. This study also evaluated potential clinical benefit to patients. MATERIALS AND METHODS A retrospective study was performed on 19 patients with 24 peripheral bypass grafts and lower extremity ischemia of less than 1 month duration. Thrombolysis was performed with a continuous high-dose infusion of urokinase. Successful lysis was defined as greater than 95% clot dissolution with antegrade flow within the graft. RESULTS Technical success was achieved in 17 of 19 patients (89%). The complexity of operative intervention was diminished in 12 of 19 patients (63%). The major complication rate (16%) was significantly higher and, therefore, this technique has a role for patients in whom traditional access is not optimal, such as in those in whom access cannot be achieved or in those with long bypass grafts. CONCLUSION Direct graft puncture with placement of catheters across the proximal and distal anastomoses of bypass grafts is a safe method of access, with a major complication rate similar to conventional access techniques. This mode of graft access demonstrates efficacious thrombolysis and acts as a conduit for ancillary procedures.
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Affiliation(s)
- D E Lee
- Department of Radiology, University of Rochester Medical Center, NY 14642, USA.
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Gandini R, Maspes F, Pampana E, Sakr A, Simonetti G. Combined direct puncture of the PTFE graft and contralateral snare loop technique for catheterization of an occluded femoropopliteal graft. J Vasc Interv Radiol 1998; 9:241-4. [PMID: 9540906 DOI: 10.1016/s1051-0443(98)70263-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- R Gandini
- Department of Radiology, Tor Vergata University, S. Eugenio Hospital, Rome, Italy
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