Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2017; 9(12): 842-847
Published online Dec 26, 2017. doi: 10.4330/wjc.v9.i12.842
Successful recanalization of long femoro-crural occlusive disease after failed bypass surgery
Grigorios Korosoglou, Tom Eisele, Dorothea Raupp, Christoph Eisenbach, Sorin Giusca
Grigorios Korosoglou, Tom Eisele, Sorin Giusca, Cardiology and Vascular Medicine, GRN Academic Teaching Hospital, Weinheim 69469, Germany
Dorothea Raupp, Christoph Eisenbach, Diabetology and Gastroenterology, GRN Academic Teaching Hospital, Weinheim 69469, Germany
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at University Hospital Heidelberg, Heidelberg, Germany.
Informed consent statement: The patients involved in this study gave their written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Grigorios Korosoglou, Professor, Cardiology and Vascular Medicine, GRN Academic Teaching Hospital, Roentgenstrasse 1, Weinheim 69469, Germany. grigorios.korosoglou@grn.de
Telephone: +49-6201-892142 Fax: +49-6201-892507
Received: September 10, 2017
Peer-review started: September 13, 2017
First decision: October 23, 2017
Revised: November 1, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: December 26, 2017
Abstract

Patients with critical limb ischemia necessitate immediate intervention to restore blood flow to the affected limb. Endovascular procedures are currently preferred for these patients. We describe the case of an 80-year-old female patient who presented to our department with ischemic rest pain and ulceration of the left limb. The patient had history of left femoral popliteal bypass surgery, femoral thromboendarterectomy and patch angioplasty of the same limb 2 years ago. Doppler sonography and magnetic resonance angiography revealed an occlusion of the left superficial femoral artery (SFA) and popliteal artery and of all three infra-popliteal arteries. Due to severe comorbidities, the patient was scheduled for a digital subtraction angiography. An antegrade approach was first attempted, however the occlusion could not be passed. After revision of the angiography acquisition, a stent was identified at the level of the mid SFA, which was subsequently directly punctured, facilitating the retrograde crossing of the occlusion. Thereafter, balloon angioplasty was performed in the SFA, popliteal artery and posterior tibial artery. The result was considered suboptimal, but due to the large amount of contrast agent used, a second angiography was planned in 4 wk. In the second session, drug coated balloons were used to optimize treatment of the SFA, combined with recanalization of the left fibular artery, to optimize outflow. The post-procedural course was uneventful. Ischemic pain resolved completely after the procedure and at 8 wk of follow-up and the foot ulceration completely healed.

Keywords: Critical limb ischemia, Chronic occlusion, Duplex sonography, Lower limb

Core tip: Herein, we present a patient with critical ischemia of the lower limb, due to long occlusive disease of the femoro-popliteal and below-the-knee arteries who was successfully treated using an endovascular approach after failed bypass surgery and using the direct stent puncture technique. This case demonstrates that an endovascular approach may be extremely valuable even in very long, complex occlusive peripheral artery disease. This may further shift treatment from surgical to endovascular treatment in the near future.