[MO-56] A case in which VIABAHN stent occlusion is thought to be caused by dissection of the proximal part of the stent in the acute phase.
Purpose: To report a case of a thrombosed VIABAHN endoprosthesis stent-graft in the femoral artery (SFA) may have caused occlusion by forming intravascular hematoma at the SFA entrance due to retrograde dissection during stent placement.
Case report: A 70’s female visited our hospital with complaint of recurrent lifestyle-limiting claudication of right leg. Right ABI was 0.58 and duplex revealed 15cm length complete occlusion and periphery was perfused from deep femoral artery (DFA). Crossover from left femoral artery approach was performed. DSA image revealed CTO progression to 22cm occlusion and no stenosis at the ostium of DFA. Although right PTA was occluded, the remaining 2branches were patent and the distal run-off was kept. We advanced Naveed4 Hard 30 wire and Crosser14S through the CTO successfully under the navigation with body surface duplex. After 3mm OTW balloon dilatation, TIMI3 flow was obtained.
The dissection of SFA entrance and stenosis of DFA ostium appeared after 6.0x100 balloon dilatation followed with VIABAHN 6.0x250mm. Even with expansion with a 4 mm cutting balloon, there was no improvement in DFA inlet. In order to maintain SFA blood flow, it was necessary to add SMART stent 7.0 x 40 mm with crossover manner from the common femoral artery. The DAPT treatment was ongoing. It was pointed out by an examination scheduled for 12 months after the EVT. There was no symptom and the SFA stent was occluded. Fortunately, the blood flow of DFA was preserved and it did not become an acute limb ischemia.
Conclusion: Since the mode of expansion of VIABAHN goes from the distal to the proximal, making dissection in the proximal part may form hematoma proximal to the stent. It was a case showing one possibility of occlusion mechanism.
Case report: A 70’s female visited our hospital with complaint of recurrent lifestyle-limiting claudication of right leg. Right ABI was 0.58 and duplex revealed 15cm length complete occlusion and periphery was perfused from deep femoral artery (DFA). Crossover from left femoral artery approach was performed. DSA image revealed CTO progression to 22cm occlusion and no stenosis at the ostium of DFA. Although right PTA was occluded, the remaining 2branches were patent and the distal run-off was kept. We advanced Naveed4 Hard 30 wire and Crosser14S through the CTO successfully under the navigation with body surface duplex. After 3mm OTW balloon dilatation, TIMI3 flow was obtained.
The dissection of SFA entrance and stenosis of DFA ostium appeared after 6.0x100 balloon dilatation followed with VIABAHN 6.0x250mm. Even with expansion with a 4 mm cutting balloon, there was no improvement in DFA inlet. In order to maintain SFA blood flow, it was necessary to add SMART stent 7.0 x 40 mm with crossover manner from the common femoral artery. The DAPT treatment was ongoing. It was pointed out by an examination scheduled for 12 months after the EVT. There was no symptom and the SFA stent was occluded. Fortunately, the blood flow of DFA was preserved and it did not become an acute limb ischemia.
Conclusion: Since the mode of expansion of VIABAHN goes from the distal to the proximal, making dissection in the proximal part may form hematoma proximal to the stent. It was a case showing one possibility of occlusion mechanism.