[MP-26] Percutaneous transluminal angioplasty with graft approach for superficial femoral arterial stenosis and proximal anastomosis stenosis of axillobifemoral grafts in a patient with lower extremity claudication
The case is a 65-year-old female with a bilateral lower extremity claudication. She had a medical history of hemodialysis for 18 years and axillobifemoral graft bypass 10 years ago.
Ankle brachial index indicated a score of 0.92 on the right and 0.62 on the left. Bypass graft angiogram showed the axillary anastomosis stenosis and the left distal superficial femoral artery (SFA) stenosis. Right limb of the axillobifemoral bypass graft was not visualized. Abdominal aortogram showed occlusion of left common (CIA) to external iliac artery (EIA), a stenosis at an ostium of right CIA, and also showed retrograde arterial blood flow of right limb of the graft.
At first, angioplasty for the ostium of right CIA stenosis was performed with right common femoral arterial approach. However, the stenosis could not be dilated well with balloon catheter (6mm in diameter) due to sever calcified stenosis and the claudication was not improved. Then, the angioplasty for both the graft anastomosis stenosis and the distal SFA stenosis was planned. Arterial access was obtained in the graft at right side of abdomen, that was exposed by surgeon under the local anesthesia. The 6 Fr sheath was inserted toward axillary artery and the balloon angioplasty (6mm/20mm balloon) was performed for the axillary anastomosis. Another 6Fr sheath was inserted toward left femoral artery and self-expandable stent (6mm/40mm) was placed at left SFA. After the procedure, the symptom was improved and the ABI elevated to 0.83 on the left.
Bypass approach is one of the useful access routes in PTA for both proximal anastomosis stenosis and SFA stenosis in the patient after axillobifemoral bypass grafting.
Ankle brachial index indicated a score of 0.92 on the right and 0.62 on the left. Bypass graft angiogram showed the axillary anastomosis stenosis and the left distal superficial femoral artery (SFA) stenosis. Right limb of the axillobifemoral bypass graft was not visualized. Abdominal aortogram showed occlusion of left common (CIA) to external iliac artery (EIA), a stenosis at an ostium of right CIA, and also showed retrograde arterial blood flow of right limb of the graft.
At first, angioplasty for the ostium of right CIA stenosis was performed with right common femoral arterial approach. However, the stenosis could not be dilated well with balloon catheter (6mm in diameter) due to sever calcified stenosis and the claudication was not improved. Then, the angioplasty for both the graft anastomosis stenosis and the distal SFA stenosis was planned. Arterial access was obtained in the graft at right side of abdomen, that was exposed by surgeon under the local anesthesia. The 6 Fr sheath was inserted toward axillary artery and the balloon angioplasty (6mm/20mm balloon) was performed for the axillary anastomosis. Another 6Fr sheath was inserted toward left femoral artery and self-expandable stent (6mm/40mm) was placed at left SFA. After the procedure, the symptom was improved and the ABI elevated to 0.83 on the left.
Bypass approach is one of the useful access routes in PTA for both proximal anastomosis stenosis and SFA stenosis in the patient after axillobifemoral bypass grafting.