Percutaneous Endovascular Recanalization of a Thrombosed Aortic Graft Limb with Stent Placement

Abstract

Common practice in recanalization of a thrombosed prosthetic graft limb in an aortoiliac bypass focuses on balloon-catheter thrombectomy and angiographic exploration followed either by open surgical revision or endovascular management. This report describes the technique of percutaneous endovascular recanalization of an early thrombosed aortic graft limb with stent placement and subsequent restoration of patency and adequate limb perfusion, which remains patent after one year. Percutaneous intervention with stent placement and angioplasty for early graft limb recanalization avoids femoral incisions, and complications or morbidity associated with open surgery, while permitting rapid mobilization of the patient.

Keywords: Aorta; Atherosclerosis; Endovascular; Graft; Iliac artery.

Figure 1.

(A) Flush occlusion (arrow) of the left limb of an aortoiliac bifurcated bypass graft. (B) Hydrophilic guide wires (arrows) positioned within both graft limbs.

Figure 2.

(A) Deployment of a self-expanding stent within the occluded graft limb. The central end of the stent is placed within the lumen of the main body, above the bifurcation level (arrow), whereas its peripheral end (white arrowhead) is located in the external iliac artery, thus involving the peripheral anastomosis. (B) Successful recanalization is accomplished in the graft limb.

Figure 3.

(A) The peripheral end of the stent (arrow), located in the external iliac artery. The orifice of the internal iliac artery is directly perfused through the stent struts. (B) Unimpaired flow to the level of the common femoral artery.