Author + information
- Received November 20, 2017
- Accepted November 28, 2017
- Published online February 14, 2018.
- Ryota Kaichi, MD,
- Osami Kawarada, MD, PhD∗ (, )
- Takeshi Yagyu, MD,
- Teruo Noguchi, MD, PhD and
- Satoshi Yasuda, MD, PhD
- ↵∗Address for correspondence:
Dr. Osami Kawarada, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
Approximately 10% to 20% of patients with iliac artery disease treated with aortobifemoral bypass (AFB) experience graft occlusion potentially with extensive common femoral artery (CFA) occlusion (1).
A 65-year-old man who had undergone AFB 8 years ago was referred to our institution for the treatment of recurrent severe claudication. Enhanced computed tomography (CT) demonstrated iliofemoral occlusions consisting of right common iliac artery (CIA)–external iliac artery (EIA) occlusion, left EIA occlusion, and extensive bilateral CFA occlusions associated with the bypass occlusions (Figure 1). Multidisciplinary discussion led to the decision to attempt endovascular intervention for the iliac–CFA occlusions, followed by thromboendarterectomy for CFA occlusions. Following confirmatory aortography via the right brachial artery (Figure 2A) and retrograde puncture of the left proximal superficial femoral artery (SFA) (Figure 2B), we crossed the occlusion from the left EIA to the CFA using the parallel wire technique. Self-expanding stents were implanted from just above the EIA to the proximal CFA. Following balloon dilatation of the CFA and proximal SFA for hemostasis of the puncture site, angiography revealed successful recanalization (Figure 2C). In addition, the right CIA-EIA-CFA occlusion was crossed via retrograde puncture of the right proximal SFA and the kissing wire technique (Figure 2D). Self-expanding stents were implanted from the ostium of the CIA to the proximal CFA. Following balloon dilatation of the CFA and proximal SFA for hemostasis of the puncture site, angiography revealed successful recanalization (Figure 2E). Following thromboendarterectomy for the remaining lesions in both CFAs, enhanced CT confirmed bilateral iliofemoral recanalization (Figure 3). The patient’s ankle brachial index increased from 0.4/0.5 to 0.7/0.7 with significant resolution of claudication although occlusive lesions in the right SFA and left popliteal artery remained untreated. At the 12-month follow-up, no recurrence of claudication was observed.
Native artery recanalization could be a viable option even in the setting of AFB occlusion.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 20, 2017.
- Accepted November 28, 2017.
- 2018 American College of Cardiology Foundation