Anastomotic Stenosis with Thrombosis Due to Stump Syndrome During Lower Extremity Revascularization with Autovein Grafting

Abstract

Thromboembolism caused by an occluded vessel has been reported in stump syndromes, such as axillofemoral stump syndrome, carotid stump syndrome, and vertebral stump syndrome. However, it was unclear whether thromboembolism caused by an occluded vein graft actually occurred during lower extremity revascularization. A 41-year-old man was admitted for anastomotic stenosis with thrombosis that occurred during lower extremity revascularization. Seven years earlier, the patient had undergone bypass grafting, using an autogenous saphenous vein, from the femoral artery to the tibioperoneal trunk. Three years after the initial operation, he developed thrombosis at the distal site of the autogenous vein graft and underwent an additional bypass grafting with a veno-venous anastomosis, using another autogenous saphenous vein from the saphenous vein graft to the anterior tibial artery. Thrombosis in the vein graft, between the femoral artery and the tibioperoneal trunk, gradually collected from the distal anastomosis, and a stenosis finally developed in the veno-venous anastomosis. We closed the stump of the vein graft using patch angioplasty after thrombectomy. We then performed patch angioplasty with an autogenous vein for anastomotic stenosis. Because the thrombus was fresh and unstable at the site of the veno-venous anastomosis, it may have embolized the distal vessel. Herein, we report that an occluded vein graft can cause thromboembolism during lower extremity revascularization in patients with stump syndrome.