Stenting as a bail-out option after failed percutaneous transluminal angioplasty in infrainguinal vein bypass grafts

Five-Year Experience of Interwoven Self-Expanding Stent Implantation in Stenotic Kinking of Below the Knee Prosthetic Bypasses

PURPOSE

The purpose of this study was to evaluate the 5-year real-world results of Supera stent implantation in below the knee prosthetic bypasses (BKPBs). All the procedures were performed because of a history of recurrent thrombosis of the graft and significant stenotic kinking of the prosthesis during knee flexion. A Supera stent was implanted to prevent the next potential BKPB thrombosis.

MATERIALS AND METHODS

Fourteen patients were included in this single-center, retrospective observational cohort study. All patients underwent Supera stent implantation in infrainguinal prosthetic bypass between 2012 and 2017, due to a history of recurrent thrombosis and kinking of the prosthetic bypass.

RESULTS

Prior to Supera stent implantation procedure, all the patients had more than one episode of acute limb ischemia caused by thrombosis of the BKPB. The median number of BKPB thromboses prior to Supera stent implantation was 3 and ranged from 2 to 6. Technical success was achieved in all cases. Primary patency rates at 12, 24, 36 and 60 months were 71.4%, 57.1%, 57.1% and 14.3%, respectively. Secondary patency rates at 12, 24, 36 and 60 months were 78.6%, 64.3%, 64.3% and 35.7%, respectively. One stent fracture was reported during 60-month follow-up. Major amputation was performed in 6 patients in 5-year follow-up.

CONCLUSION

Supera stent in treatment of recurrent thrombosis of BKBP is a safe procedure with acceptable mid-term results. However, larger and comparable prospective studies are needed for broader analysis of this procedure.

Endovascular Treatment for Infra-inguinal Autologous Saphenous Vein Graft Occlusion Using Self Expanding Nitinol Stents

Introduction

For patients with infra-inguinal autologous vein bypass graft occlusion, conventional open surgical repair or endovascular treatment (EVT) for native vessel occlusion have generally been performed.

Report

A 73 year old female with non-healing ulcer and gangrene of the left lower leg was diagnosed as having infra-inguinal autologous saphenous vein graft occlusion. In this case, surgical repair such as patch angioplasty, interposition graft, or replacement graft did not seem promising because of repeated previous infection in the polytetrafluoroethylene (PTFE) vascular prosthesis and absence of available autologous vein due to past surgery. Moreover, there was no chance of crossing the native vessel, since the proximal superficial femoral artery (SFA) had already been resected. Thus, EVT was performed for the occluded autologous vein graft, implanting multiple self expanding bare nitinol stents throughout the vein graft achieving complete revascularization, good medium term patency, and dramatically improved wound healing.

Conclusion

Endovascular recanalization using multiple bare stents could be an alternative treatment for infra-inguinal autologous vein graft occlusion.

•

This report highlights EVT for infra-inguinal autologous vein graft occlusion.

•

Self-expanding nitinol bare stents were implanted throughout the vein graft.

•

Just after the procedure, we confirmed sufficient expansion of the nitinol stents.

•

The treated vessel had good patency without repetitive intervention for 15 months.

•

The ulcer and gangrene gradually healed.