PMC5573116_01
(A,B) Non-healing gangrene of the left second toe, and an ulcer in the left lower leg overlying the fibula, after occlusion of the infra-inguinal autologous saphenous vein graft. (C,D) The ulcer and gangrene have gradually healed after endovascular treatment. (E) Baseline angiography showed occlusion of the common femoral to mid superficial femoral artery (SFA) bypass graft (small arrow) and the distal arterial anastomosis in mid SFA (large arrow). (F) The small arrow indicates occlusion of the native SFA, and the large arrow indicates the proximal arterial anastomosis.
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There was gangrene of the left second toe, and an ulcer in the left lower leg overlying the fibula (Fig. 1A and B). Angiography identified the resected proximal SFA and complete occlusions in the bypass graft and mid-SFA (Fig. 1E and F). The ulcer and gangrene gradually healed with the assistance of intensive wound care, and the treated vessel has remained patent with no further intervention for 15 months (Fig. 1C and D).
(A) 0.014 in hydrophilic soft guidewire (small arrow) supported by a 4F internal mammary artery (IMA) diagnostic catheter (large arrow) was advanced into the occluded bypass graft. (B) The occlusion was crossed successfully. (C) Intravascular ultrasound showed vein graft shrinkage with no evidence of thrombus formation. (D) Serial dilatation of the occluded graft and mid-superficial femoral artery with a 3.0 x 150 mm balloon catheter. (E) Implantation of three self expanding nitinol stents (6 x 80 mm, 6 x 100 mm, 6 x 150 mm). (F) Completion angiogram showed excellent revascularization of the bypass graft.
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Tokai Medical Products, Kasugai, Japan) was advanced via the graft into the mid-distal SFA occlusion (Fig. 2A). IN) successfully retrogradely penetrated the distal cap of the distal obstructed SFA lesion using multi-directional angiography (Fig. 2B). The guidewire was advanced intraluminally. Intravascular ultrasound (IVUS) showed vein graft shrinkage with no evidence of thrombus formation (Fig. 2C). The whole length of the occlusion was dilated with a balloon catheter (3.0 x 150 mm) (Fig. 2D), and then three self expanding nitinol stents (SMART, 6 x 80 mm, 6 x 100 mm, 6 x 150 mm, Cordis) were consecutively implanted from the distal SFA to the distal CFA throughout the vein graft (Fig. 2E). These stents were subsequently post-dilated with a balloon catheter (4.0 x 150 mm). The final angiogram showed excellent recanalization of the bypass graft without distal embolization (Fig. 2F).