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Published on: March 27, 2018
Endovascular Revascularization of a Chronic Occluded Aortobifemoral Bypass
Erik Pasveer1, Randolph G S van Eps1, Jan J Wever1
1Department of Vascular Surgery, HagaZiekenhuis, The Hague, The Netherlands.
Insights
A novel minimally invasive technique successfully treated a patient with a long-standing occluded aortobifemoral (ABF) bypass. This approach, involving aortic re-entry and stenting, offers a new option for managing bilateral ABF occlusion.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Biomedical Engineering
Background:
- Bilateral limb occlusion is a rare but serious complication following aortobifemoral (ABF) bypass surgery, occurring in 1-3% of patients.
- Existing treatment options for occluded ABF bypasses include redo bypass surgery, axillobifemoral bypass, endovascular recanalization, and thrombectomy.
Observation:
- A patient presented with a long-standing occluded ABF bypass (since 2001).
- A novel endovascular approach was employed, involving aortic re-entry and traversal of occluded limbs with stiff wires.
Findings:
- Kissing balloon angioplasty facilitated safe stent deployment across the occluded ABF limbs.
- Kissing Viabahn balloon-expandable stents were placed proximally, extended with self-expandable Viabahn stents.
Implications:
- This minimally invasive endovascular strategy represents a new potential treatment for occluded ABF bypasses.
- It expands the armamentarium for managing complex aortobifemoral graft occlusions.
Abstract:
Bilateral limb occlusion after aortobifemoral (ABF) prosthesis occurs in 1-3% patients. Multiple remedial choices are known in literature to manage a bilateral occluded ABF such as "redo" ABF bypass, axillobifemoral bypass, endovascular recanalization of the native aortoiliac system, and thrombectomy. We present a patient with an occluded ABF bypass since 2001. A new minimal invasive treatment strategy was performed by traversing the occluded limbs with aortic re-entry using stiff Terumo wires. To make way for safe passing of the stents, kissing balloon angioplasty was performed of the entire ABF bypass. Kissing Viabahn (W. L. Gore & Associates, Flagstaff, AZ) balloon-expandable stents were placed in the proximal part of the ABF bypass and extended with a Viabahn self-expandable stent (standard Viabahn). This option should be added to the known multiple remedial choices in case of bilateral limb occlusion of an ABF.
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