[MO-58] A case of critical limb ischemia rescued by replacing a stent graft in the femoral-popliteal bypass occlusion using the saphenous vein
A 61-years-old male had recurrence of ischemic ulcers in his toes and heel (right second and third toes were already amputated, and new ulcers appeared in his first, fourth, fifth toes, and his heel, which defined as WifI high: Wound 2, Ischemia 3, foot infection 0). Risk factors he had were hypertension, dyslipidemia and hemodialysis. Approximately 2 years ago, femoral-popliteal bypass using the saphenous vein graft (SVG) was conducted for treating critical limb ischemia. Although bypass occlusion was had been already documented 1 year after bypass therapy, retreatment was not performed because he had been free from any symptom. In this session, he was hospitalized for the treatment of ischemic ulcers under multidisciplinary approach. His skin perfusion pressure was 13 mmHg of the right dorsal and 9 mmHg of the right plantar, which shows insufficient value to heal ulcers. We subsequently diagnosed as critical limb ischemia (CLI) and planned infrainguinal revascularization. Recanalization for total occlusion of SVG bypass was treated with traditional balloon dilation. However, early re-occlusion were repeated.
The toe ulcers gradually worsened and enlarged, and had no choice but to consider major limb amputation, but he strongly refused. So we alternatively planned to perform endconduit approach using stent graft for bypass occlusion. Intravascular ultrasonography (IVUS) was use for decision making of appropriate stent size and landing zone, and two stent grafts (both Viabahn 5.0mm*150 mm) were consequently replaced in the occluded femoral-popliteal artery bypass. The bypass with stent graft replacement satisfactorily had optimal gain, and the toe ulcers had almost healed during the hospitalization period. The heel ulcer also gradually decreased, and it is ongoing wound therapy at outpatient. We experienced a case of critical limb ischemia rescued by replacing a stent graft in the femoral-popliteal bypass occlusion using the saphenous vein. We will report with additional consideration
The toe ulcers gradually worsened and enlarged, and had no choice but to consider major limb amputation, but he strongly refused. So we alternatively planned to perform endconduit approach using stent graft for bypass occlusion. Intravascular ultrasonography (IVUS) was use for decision making of appropriate stent size and landing zone, and two stent grafts (both Viabahn 5.0mm*150 mm) were consequently replaced in the occluded femoral-popliteal artery bypass. The bypass with stent graft replacement satisfactorily had optimal gain, and the toe ulcers had almost healed during the hospitalization period. The heel ulcer also gradually decreased, and it is ongoing wound therapy at outpatient. We experienced a case of critical limb ischemia rescued by replacing a stent graft in the femoral-popliteal bypass occlusion using the saphenous vein. We will report with additional consideration