[MO-18] Management of Superficial Femoral Artery Rupture with VIABAHN Implantation
A 81 year-old female suffered from rest pain and gangrane of her right toe. Angiography showed a long chronic total occlusion (CTO) with heavy calcification in the right superficial femoral artery (SFA). We performed endovascular treatment (EVT) with bi-directional approach from right femoral and popliteal artery. After the antegrade guidewire (Astato XS9-40) passage and pull through the guidewire, we debulked the calcified lesion with Crosser. IVUS findings revealed the guidewire existed in all true lumen, and reference vessel diameter was estimated about 6mm. After non-compliant balloon (SHIDEN-HP 4mm) dilatation, self-expandable stents (SMART control, 6/150mm and 6/80mm) were deployed SFA lesion. Post balloon dilatation was performed by SHIDEN-HP 6mm. However, after the procedure, the rupture revealed at the SFA distal site. It was so difficult to cope with the hemorrhage by ballooning that we implanted covered stents (VIABAHN, 6/25mm and 6/50mm) to the rupture site. Final angiogram showed hemostasis and optimal result. 3 month later, she was admitted to our hospital again because of her left lower leg ulceration. Left SFA showed a long CTO with the same heavy calcification as the right site, hence, we performed EVT in a similar procedure. SMART control 6/150mm was deployed SFA lesion. After post dilatation (SHIDEN-HP 6mm), the rupture revealed again at the SFA mid and distal sites. Though VIABAHN 6/150mm was deployed with an enough margin, the bleeding didn’t stop. Finally, VIABAHN 6/50mm and 6/25mm were added to get a complete hemostasis. We succeeded bailout of SFA rupture with VIABAHN implantation in that time, but multiple stenting was needed to cope with the complication. We should consider a choice of device and a method of implantation.