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Mustafa A, Wei C, Cinelli M, Khan S, Khan D, Tamburrino F, Maniatis G, Spagnola J. Balloon valvuloplasty and transcatheter aortic valve replacement via aortofemoral bypass grafts: A case report and review of literature. World J Cardiol 2025; 17:101709. [PMID: 40161562 PMCID: PMC11947954 DOI: 10.4330/wjc.v17.i3.101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 01/27/2025] [Accepted: 02/21/2025] [Indexed: 03/21/2025] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) can be performed through multiple access sites with the preferred approach being transfemoral. In patients with severe peripheral arterial disease and previous grafts, the safety of transfemoral access via direct graft puncture, especially when performed twice within a short period, remains unclear compared to alternative access methods. We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty (BAV) and TAVR. CASE SUMMARY An 82-year-old man presented with dyspnea on exertion. Echocardiogram was significant for severe aortic stenosis. Following a heart team discussion, the patient was scheduled for a balloon valvuloplasty followed by staged TAVR. Based on pre-TAVR computed tomography angiogram, the aortobifemoral graft was deemed as an appropriate access site. Micropuncture needle was used to access the right femoral artery graft, and the sheath was upscaled to 10 Fr. He underwent successful intervention to ostial left anterior descending and left circumflex arteries, and BAV with 22 mm Vida BAV balloon. Hemostasis was achieved using Perclose. For TAVR, an 8 Fr sheath was inserted via the right femoral bypass graft. The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal. A 5Fr sheath was used for left femoral bypass graft access. Patient underwent successful TAVR with 29 mm CoreValve. Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications. CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.
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Affiliation(s)
- Ahmad Mustafa
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States.
| | - Chapman Wei
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Michael Cinelli
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Shahkar Khan
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Danyal Khan
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Frank Tamburrino
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Gregory Maniatis
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
| | - Jonathan Spagnola
- Department of Cardiology, Northwell Health, New Hyde Park, New York, NY 11042, United States
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Tsuchida Y, Hayakawa N, Miwa H, Ichihara S, Maruta S, Kushida S. Endovascular therapy via a femoro-femoral crossover bypass graft for chronic total occlusion of the superficial femoral artery: Two case reports. SAGE Open Med Case Rep 2024; 12:2050313X241299959. [PMID: 39569398 PMCID: PMC11577463 DOI: 10.1177/2050313x241299959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 10/28/2024] [Indexed: 11/22/2024] Open
Abstract
In patients with a femoropopliteal chronic total occlusion (CTO) after femoro-femoral (FF) bypass surgery, it is often difficult to perform endovascular therapy because of access site problems. We have treated two patients with CTO of the superficial femoral artery (SFA) using an FF crossover bypass graft. The two cases were a man with intermittent claudication and acute limb ischemia, respectively. Enhanced computed tomography showed occlusion of the left SFA and the FF bypass previously performed was patent in both cases. We punctured the right common femoral artery and a guiding sheath was inserted to the left common femoral artery. A guidewire successfully passed through the intraplaque lesion by intravascular ultrasound-guided wiring in both cases. Revascularization was successfully achieved using drug-coated balloons and using drug-eluting stents, respectively. An FF crossover bypass graft may be a good access route for complex femoropopliteal cases, such as CTO lesions.
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Affiliation(s)
- Yasuyuki Tsuchida
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Hiromi Miwa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Shinya Ichihara
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Shunsuke Maruta
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
| | - Shunichi Kushida
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Chiba, Japan
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Sugihara M, Ueda Y, Yano Y, Miura SI. Successful case of direct puncture of a prosthetic bypass graft in endovascular treatment for long superficial artery chronic total occlusion: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 33442613 PMCID: PMC7793119 DOI: 10.1093/ehjcr/ytaa391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/02/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
Background The access site for endovascular therapy (EVT) is often limited because of multi-vascular diseases. Prior lower limb bypass can potentially limit the availability of common femoral artery access when EVT is required. Case summary An 88-year-old woman who presented with non-healing ulceration in the dorsalis pedis of the left foot despite treatment for several months was admitted to our hospital. She had undergone axillo-bilateral femoral bypass surgery for right critical limb ischaemia 3 years previously. Ultrasound and contrast computed tomography demonstrated bypass graft occlusion, left superficial femoral artery (SFA)-popliteal artery long chronic total occlusion from the origin with severe calcification and severe stenosis in the bilateral common femoral artery close to the anastomotic site. EVT for the left SFA occlusion was necessary to save the left foot, but access sites for EVT were limited. We decided to puncture an occluded axillo-femoral prosthetic bypass graft. It is difficult to cross the wire with only an antegrade approach. Therefore, it was necessary to use a bi-directional approach with dorsalis pedis artery puncture and the Rendez-vous technique. Finally, angiogram demonstrated improved blood flow to the wound site, and haemostasis at the puncture site could be achieved by manual compression. The ulceration healed within a month. Discussion Direct puncture of a prosthetic bypass graft and additional techniques resulted in complete revascularization. Thus, direct puncture of a bypass graft could be a useful EVT strategy for patients with complex and extremely long chronic total occlusion.
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Affiliation(s)
- Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Fukuoka, Japan
| | - Yoko Ueda
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Fukuoka, Japan
| | - Yuiko Yano
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Fukuoka, Japan.,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
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Milnerowicz AI, Milnerowicz AA, Protasiewicz M, Kuliczkowski W. Use of vascular closure devices for endovascular interventions requiring a direct puncture of PETE grafts. VASA 2018; 47:119-124. [DOI: 10.1024/0301-1526/a000677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: Effectiveness of vascular closure devices during endovascular procedures requiring a direct puncture of a vascular prosthesis placed in the inguinal region is unknown. Patients and methods: The retrospective analysis included 134 patients with a history of polyethylene terephthalate (PETE) graft implantation in the inguinal region. In 20 (15 %) patients, haemostasis was achieved with manual compression, in 21 (16 %) with the StarClose™, and in 93 (69 %) with the AngioSeal™ device. Results: The incidence of vascular complications in the manual compression group was higher (at a threshold of statistical significance) than in the device closure group (45.0 vs. 24.5 %, p = 0.059). The difference was considered statistically significant when manual compression was compared with the AngioSeal™ closure group (45.0 vs. 13.9 %, p < 0.01). The vascular complication rate in the StarClose™ group was significantly higher than in the AngioSeal™ group (71.4 vs. 13.9 %, p < 0.000001). While haematomas were the only vascular complications observed after application of AngioSeal™, both haematomas and pseudoaneurysms were found in the StarClose™ group. Conclusions: The AngioSeal™ vascular closure device provides better local haemostasis than the StarClose™ device or manual compression during endovascular interventions requiring a direct puncture of PETE grafts
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Affiliation(s)
- Artur I. Milnerowicz
- Department and Clinic of Vascular, General and Transplantation Surgery, Division of Endovascular Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra A. Milnerowicz
- Department and Clinic of Vascular, General and Transplantation Surgery, Division of Endovascular Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Protasiewicz
- Department and Clinic of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Wiktor Kuliczkowski
- Department and Clinic of Cardiology, Wroclaw Medical University, Wroclaw, Poland
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Martínez-Quintana E, Rodríguez-González F. [Difficulties in the percutaneous approach of the acute coronary syndrome with associated axillobifemoral bypass]. CIR CIR 2016; 84:405-8. [PMID: 26738644 DOI: 10.1016/j.circir.2015.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peripheral arterial disease and coronary artery disease are frequently associated. The percutaneous approach may sometimes involve additional difficulties to the coronary artery disease. CLINICAL CASE The case is presented on an 82 year-old male patient with multiple cardiovascular risk factors, a Leriche syndrome and axillobifemoral bypass, who was admitted to hospital due to an inferior myocardial infarction. The procedure approach (radial, brachial, or femoral access routes for percutaneous coronary treatment) and associated complications from the procedure are discussed. CONCLUSION Although technical improvements and/or treatment of peripheral vascular lesions may allow percutaneous coronary intervention, individual risk and benefit in each patient must be assessed.
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Affiliation(s)
- Efrén Martínez-Quintana
- Servicio de Cardiología, Complejo Hospitalario Universitario Insular-Materno Infantil, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - Fayna Rodríguez-González
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
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Wilson RF. Coronary Angiography. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Katoh H, Nozue T, Michishita I. Direct puncture of the prosthetic bypass graft in the treatment of critical limb ischemia patient undergoing prior axillo-femoral bypass. Cardiovasc Interv Ther 2012; 28:123-7. [PMID: 23007698 DOI: 10.1007/s12928-012-0133-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 08/30/2012] [Indexed: 11/25/2022]
Abstract
A 76-year-old man presented with a non-healing ischemic ulceration of the left foot. He had undergone left axillo-femoral bypass surgery 4 years previously. Diagnostic angiography showed total occlusion from the left common iliac to the common femoral artery and the anterior and posterior tibial artery as well as severe stenosis of the superficial femoral and peroneal artery. Because there were no other access sites except for the axillo-femoral bypass graft, we performed endovascular therapy (EVT) by direct puncture of this bypass graft. Here, we have described the utility of direct puncture of axillo-femoral prosthetic bypass graft for EVT of the infrainguinal arteries.
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Affiliation(s)
- Hiromasa Katoh
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, 132 Katsura-cho, Sakae-ku, Yokohama, Japan.
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Hayashi K, Kitagawa N, Takai H, Nagata I. Carotid artery stenting via a femoral bypass graft: technical note. SURGICAL NEUROLOGY 2009; 71:720-724. [PMID: 18423541 DOI: 10.1016/j.surneu.2007.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Accepted: 12/18/2007] [Indexed: 05/26/2023]
Abstract
BACKGROUND We described a case of endoluminal stent placement for a cervical internal carotid artery stenosis in which access was obtained via the femoral bypass graft. CASE DESCRIPTION A 70-year-old man with known disease of the carotid, peripheral, and coronary arteries as well as congestive heart failure presented for endoluminal revascularization of a severe right internal carotid artery stenosis. Transradial access was complicated by the left subclavian artery occlusion and hypercalcified aortic arch. Bilateral femoral artery was replaced with bypass graft because of atherosclerosis obliterans. An alternative approach was attempted via the exposed left femoral bypass graft. The left inguinal region was incised, and the left common femoral-popliteal bypass graft was exposed. After placement of a purse string suture at the puncture site, the guiding sheath was introduced into the graft and positioned into the right common carotid artery. Stenting was successfully performed, and the suture was tied after withdrawing the sheath. CONCLUSIONS This novel approach should be considered for endovascular procedures for which access to the carotid artery is limited.
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Affiliation(s)
- Kentaro Hayashi
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan.
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9
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Wilson RF, White CW. Coronary Angiography. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Lee DE, Waldman DL, Sumida RK, Green RM. Direct graft puncture with use of a crossed catheter technique for thrombolysis of peripheral bypass grafts. J Vasc Interv Radiol 2000; 11:445-52. [PMID: 10787202 DOI: 10.1016/s1051-0443(07)61376-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the efficacy and safety of direct graft puncture of peripheral arterial bypass grafts with placement of retrograde and antegrade catheters within the graft for thrombolytic therapy. This study also evaluated potential clinical benefit to patients. MATERIALS AND METHODS A retrospective study was performed on 19 patients with 24 peripheral bypass grafts and lower extremity ischemia of less than 1 month duration. Thrombolysis was performed with a continuous high-dose infusion of urokinase. Successful lysis was defined as greater than 95% clot dissolution with antegrade flow within the graft. RESULTS Technical success was achieved in 17 of 19 patients (89%). The complexity of operative intervention was diminished in 12 of 19 patients (63%). The major complication rate (16%) was significantly higher and, therefore, this technique has a role for patients in whom traditional access is not optimal, such as in those in whom access cannot be achieved or in those with long bypass grafts. CONCLUSION Direct graft puncture with placement of catheters across the proximal and distal anastomoses of bypass grafts is a safe method of access, with a major complication rate similar to conventional access techniques. This mode of graft access demonstrates efficacious thrombolysis and acts as a conduit for ancillary procedures.
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Affiliation(s)
- D E Lee
- Department of Radiology, University of Rochester Medical Center, NY 14642, USA.
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Vascular Graft Puncture. J Vasc Interv Radiol 1996. [DOI: 10.1016/s1051-0443(96)72871-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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Cowling MG, Belli AM, Buckenham TM. Evaluation and complications of direct graft puncture in thrombolysis and other interventional techniques. Cardiovasc Intervent Radiol 1996; 19:82-4. [PMID: 8662163 DOI: 10.1007/bf02563898] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate the value and complications of direct graft puncture in conducting interventional procedures in synthetic vascular bypass grafts. METHODS We retrospectively reviewed 65 direct graft punctures in 50 patients undergoing a variety of interventional vascular procedures. In two patients the grafts were found to be infected and the procedures abandoned. RESULTS Complications encountered included hematomas that did not require treatment in three patients, and four hematomas requiring surgical drainage. One graft became infected (despite prophylactic cefuroxime), after three consecutive punctures over a 10-day period for a variety of interventions. All the patients who developed hematomas had undergone pharmacological thrombolysis. CONCLUSION Direct graft puncture is a relatively safe technique, with a minimal risk of infection and hemostatic complications attributable to thrombolysis. In 31 of the 41 patients undergoing successful thrombolysis, additional percutaneous procedures were undertaken, and these were facilitated by the direct graft puncture route.
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Affiliation(s)
- M G Cowling
- Department of Diagnostic Radiology, St. George's Hospital, London, United Kingdom
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Page JE, Buckenham TM, Taylor RS. Accelerated thrombolysis facilitated by direct puncture of occluded prosthetic femoral grafts. AUSTRALASIAN RADIOLOGY 1992; 36:230-3. [PMID: 1445106 DOI: 10.1111/j.1440-1673.1992.tb03157.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Inability to access occluded grafts is a major limitation to successful thrombolysis and may even preclude it. This paper addresses the problem and offers a new technique of direct puncture of prosthetic grafts through which thrombolysis and angioplasty can be performed. These techniques resulted in accelerated thrombolysis in all 15 patients studied with no failures due to inability to attain graft access.
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Affiliation(s)
- J E Page
- Department of Diagnostic Radiology, St. George's Hospital, London
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Da Silva JR, Eckstein MR, Kelemouridis V, Waltman AC, Brewster DC, Abbott WM, Athanasoulis CA. Aortofemoral bypass grafts: Safety of percutaneous puncture. J Vasc Surg 1984. [DOI: 10.1016/0741-5214(84)90129-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gourtsoyiannis NC, Fletcher EW. A simple angiographic method for assessing aorto-femoral bypass grafts. Clin Radiol 1981; 32:117-9. [PMID: 6452243 DOI: 10.1016/s0009-9260(81)80270-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Direct puncture of femoral bypass grafts in the groin with retrograde injection of contrast was employed to assess the lower abdominal aorta, iliac and lower limb arteries. The technique was effective, simple, quick and safe.
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Marks WM, Akin JR, Eisenberg RL, Gooding GA. Direct puncture and angiographic evaluation of axillary-to-femoral bypass grafts. Br J Radiol 1977; 50:256-60. [PMID: 139960 DOI: 10.1259/0007-1285-50-592-256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Arteriography of patients with axillary-to-femoral bypass grafts can be performed by direct puncture of the graft and passage of a catheter through the graft. This article reviews some technical considerations as well as some potential complications and how they might be minimized. Three cases are presented.
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