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Crush Deformation of a Balloon-Expandable Stent Implanted in an Infrainguinal Bypass Graft
Nida Ahmed1, Rym El-Khoury1, Moustafa N Sabri2
11 Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
Insights
A patient experienced recurring critical limb ischemia after femoro-anterior bypass grafting. A subsequent stent implantation failed, leading to graft revision due to stent restenosis and deformation.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Peripheral artery disease (PAD) management often involves bypass grafting.
- Vein graft stenosis is a common complication, leading to symptom recurrence.
- Endovascular interventions, including stenting, are used to treat graft stenosis.
Observation:
- A 59-year-old man with critical claudication underwent left femoro-anterior bypass grafting.
- Symptoms recurred due to critical stenosis at the anterior tibial arterial anastomosis.
- A zotarolimus-eluting balloon-expandable stent was implanted to treat the stenosis.
Findings:
- The patient experienced recurrent claudication one year after stenting.
- Diagnostic angiography revealed crush, deformation, and restenosis of the balloon-expandable stent.
- Surgical revision of the bypass graft was required due to stent failure.
Implications:
- This case highlights the potential for complex complications with balloon-expandable stents in femoro-anterior bypass grafts.
- Crush, deformation, and restenosis underscore the challenges of long-term stent patency in this anatomical location.
- Further research into stent design and material may be warranted for improved outcomes in complex bypass reconstructions.
Abstract:
A 59-year-old man with critical claudication underwent left femoro-anterior bypass grafting, which was uneventful. The graft was tunneled medially across the knee, then anterior to the tibia. His symptoms recurred 1 year later and he was found to have critical stenosis of the vein graft just proximal to the anterior tibial arterial anastomosis. This was treated with scaffolded balloon angioplasty and implantation of a coronary, zotarolimus-eluting balloon-expandable stent, which was also uneventful. However, his claudication again recurred 1 year later. Diagnostic angiography revealed crush, deformation and restenosis of the balloon-expandable stent requiring surgical revision of the bypass graft.
