2019 Volume 28 Issue 4 Pages 335-339
A 66-year-old man underwent endovascular treatment (EVT) for acute occlusion of the right femoropopliteal (FP) bypass graft 1 year after bilateral FP bypass surgery for arteriosclerosis obliterans. Endovascular recanalization for the occluded graft failed; therefore, stent implantation for the right superficial femoral artery (SFA) was performed. Moreover, because a floating thrombus was observed in the right common femoral artery (CFA), an additional stent was implanted from the proximal SFA to the CFA, covering the deep femoral artery (DFA) orifice. Although the limb ischemia was relieved, dissection of the SFA also occurred during this procedure. Four months later, acute thrombosis of all the stents occurred, resulting in the right SFA occlusion. At the same time, it turned out that the proximal end of the additional stent had been positioned in the false lumen of the right CFA. For the occluded SFA, endovascular recanalization was tried but unsuccessful. Although EVT for the right DFA was added, the limb ischemia worsened after these interventions. As pharmacological therapy did not improve the ischemia, the patient was transferred to our hospital. We performed sequential aorto-DFA and DFA-above knee popliteal bypass grafting. The postoperative course was uneventful. The most appropriate and effective strategy for revascularization, including EVT or surgical bypass, should be considered on each occasion.
