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Recanalization of an occluded aortoiliac bypass graft with Palmaz stents
M C Soulen1, J Bonn, M J Shapiro
1Division of Cardiovascular/Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
Insights
Four Palmaz stents successfully recanalized an occluded aortoiliac bypass graft limb after other methods failed. This vascular intervention resolved patient rest pain and maintained graft patency for 8 months.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Aortoiliac bypass graft occlusion is a challenging clinical problem.
- Thrombolysis and conventional angioplasty can fail in treating complete graft limb occlusion.
- Recanalization of occluded bypass grafts is crucial for limb salvage.
Observation:
- A patient presented with a completely occluded aortoiliac bypass graft limb.
- Previous treatment attempts including thrombolysis and angioplasty were unsuccessful.
- Four tandem Palmaz balloon-expandable vascular stents were deployed.
Findings:
- The procedure successfully recanalized the occluded graft limb.
- The peak-systolic pressure gradient across the limb decreased significantly (68 to 13 mm Hg).
- The patient experienced resolution of rest pain and improved ankle-brachial index (0.54 to 0.78).
- No procedural complications like embolization were observed.
Implications:
- Tandem Palmaz stent deployment is a viable option for treating complex aortoiliac bypass graft occlusions.
- This technique can restore graft patency and improve clinical outcomes.
- Further studies may explore the long-term efficacy and safety of this approach.
Abstract:
Four tandem Palmaz balloon-expandable vascular stents were used to recanalize the completely occluded limb of an aortoiliac bypass graft after failure of thrombolysis and conventional angioplasty. The resting peak-systolic pressure gradient across the occluded limb was reduced from 68 to 13 mm Hg. The patient's rest pain resolved, and the ankle-brachial index rose from 0.54 to 0.78. No embolization or stent-related complications occurred. The graft remains patent as determined with noninvasive studies obtained 8 months later.