Endovascular Treatment of Multilevel Chronic Total Occlusion Using a Stent Puncture Technique in Buerger's Disease

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Therapy

Background:

• Buerger's disease presents significant challenges due to diffuse arterial occlusions.
• Critical limb ischemia (CLI) in these patients often involves recurrent occlusions despite multiple treatments.
• Limited distal targets and prior interventions complicate revascularization strategies.

Purpose of the Study:

• To describe a novel endovascular technique for treating CLI in a patient with Buerger's disease.
• To address limitations in vascular access caused by multilevel occlusions and prior interventions.
• To evaluate the feasibility and safety of direct popliteal stent puncture for revascularization.

Main Methods:

• A patient with Buerger's disease and CLI underwent endovascular treatment.
• Direct puncture of a previously implanted popliteal stent was performed to gain vascular access.
• A guide wire was advanced through an occluded femoropopliteal bypass graft.
• Thrombus aspiration and recanalization down to the plantar arteries were achieved.

Main Results:

• Successful recanalization of the femoropopliteal and infrapopliteal arteries was accomplished.
• The novel stent puncture technique provided a viable access route for endovascular intervention.
• The patient's limb ischemia was addressed through successful revascularization.

Conclusions:

• Direct popliteal stent puncture is a feasible and safe technique for overcoming vascular access limitations in complex CLI cases.
• This approach offers a valuable alternative for patients with multilevel occlusions and failed prior treatments.
• The technique expands endovascular treatment options for severe Buerger's disease.