[MO-59] Effectiveness of Improved Inflow for Occluded VIABAHN Stent Graft in Superficial Femoral Artery
A 64-year-old female on dialysis was admitted with a gangrene of her left lower limb. She visited a previous hospital and was diagnosed with critical limb ischemia (CLI) (Rutherford Ⅴ). The primary endovascular treatment for severe stenoses of left common iliac artery (CIA) and superficial femoral artery (SFA) was planned. Stenting with a bare metal stent in left CIA and ballooning after using CROSSER for left SFA was performed. Even after 3 months of the procedure, the gangrene was not improved. The restenosis of left SFA and the progression of popliteal artery (POPA) were admitted. Only percutaneous old balloon angioplasty (POBA) for left SFA-POPA was performed. More 2 weeks later, the gangrene suddenly got worsening (Rutherford Ⅵ). The occlusion of the previous treated SFA-POPA with thrombus occurred. The previous doctor consulted our hospital and we selected a strategy using VIABAHN. After reserving adequate outflow by POBA for left anterior tibial artery, VIABAHN was deployed in left SFA-POPA(P2). However, after only 3 days of the procedure, the VIABAHN was totally occluded with thrombus. All the below knee progressive lesions were treated, thrombectomy for the VIABAHN site was performed and stenting with a bare metal stent in the proximal left SFA was added on. Nevertheless, the gangrene was not improved because the occlusion of the VIABAHN with thrombus was repeated. The Fogarty strategy was planned, but a Fogarty catheter could not be advanced because of the moderate stenosis of left common femoral artery. Then, thromboendarterectomy (TEA) was performed and the Fogarty strategy was successful. After the procedure, ABI has never gone down and the gangrene is getting improved. We strongly felt that not only outflow but also enough inflow should be required for revascularization of CLI.