Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Oct 16:41:20-23.
doi: 10.1016/j.ejvssr.2018.08.005. eCollection 2018.

Substent Anchor Technique for Recanalisation of a Full Metal Jacket Femoropopliteal In-Stent Occlusion

Gabriele Testi  1 , Tanja Ceccacci  1 , Mauro Cevolani  1 , Silvia Acquati  2 , Fabio Tarantino  3 , Giorgio Ubaldo Turicchia  1
Affiliations
Case Reports

Substent Anchor Technique for Recanalisation of a Full Metal Jacket Femoropopliteal In-Stent Occlusion

Gabriele Testi et al. EJVES Short Rep. .

Abstract

Purpose: To report the endovascular treatment of a full metal jacket (FMJ) femoropopliteal chronic total occlusion (CTO) using a new ancillary retrograde technique.

Case report: An 80 year old woman with type 2 diabetes presented to the Diabetic Foot Clinic with critical limb ischaemia with tissue loss in the right leg. Her comorbidities included coronary artery disease, morbid obesity, hypertension, dyslipidaemia, and active smoking habit. The patient had been treated at another hospital by femoropopliteal FMJ stenting six years before this presentation. The duplex ultrasound showed a full length in-stent re-occlusion. An antegrade recanalisation was attempted via contralateral femoral access, but was unsuccessful. An ultrasound guided retrograde puncture of the popliteal artery in the P2 segment was performed very close to the distal occluded stent. A 0.018 guidewire was pushed in the substent plane, functioning as an anchor to achieve a stable system. The FMJ was then retrogradely recanalised with a second guidewire. The procedure was completed by antegrade angioplasty with drug coated balloons.

Conclusion: The substent anchor technique can help to achieve stability even if close to the occluded stents, and spares the distal landing zone for surgical revascularisation if the endovascular approach fails. This technique could be useful in retrograde treatment of long in-stent CTO.

Keywords: Critical limb ischaemia; Full metal jacket; Retrograde popliteal access; Stent recanalisation; Substent anchor technique.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Pre-procedural angiogram shows the full metal jacket (A), the proximal superficial femoral artery occlusion (B), the distal recanalisation (C), and the below the knee outflow (D).
Figure 2
Figure 2
Percutaneous retrograde popliteal puncture with substent guidewire positioning (a) and sheath introduction (b); interrogation of the distal occlusion cap with Berenstein II catheter and a second 0.018 inch guidewire (c); recanalisation of the full metal jacket (d–h); re-entry into the popliteal artery with the antegrade 0.014 guidewire (i); and sequential angioplasty (j,k).
Figure 3
Figure 3
Completion angiograms before (a,b) and after sheath removal (c).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Duterloo D., Lohle P., Lampmann L. Subintimal double-barrel restenting of an occluded primary stented superficial femoral artery. Cardiovasc Intervent Radiol. 2007;30:474–476. - PMC - PubMed
    1. Tosaka A., Soga Y., Iida O., Ishihara T., Hirano K., Suzuki K. Classification and clinical impact of restenosis after femoropopliteal stenting. J Am Coll Cardiol. 2012;59:16–23. - PubMed
    1. van den Berg J.C. In-stent restenosis management: the best is yet to come. J Cardiovasc Surg (Torino) 2017;58:508–517. - PubMed
    1. Grotti S., Liistro F., Angioli P., Ducci K., Falsini G., Porto I. Paclitaxel-eluting balloon vs standard angioplasty to reduce restenosis in diabetic patients with in-stent restenosis of the superficial femoral and proximal popliteal arteries: three-year results of the DEBATE-ISR study. J Endovasc Ther. 2016;23:52–57. - PubMed
    1. Yang X., Lu X., Li W., Huang Y., Huang X., Lu M. Endovascular treatment for symptomatic stent failures in long-segment chronic total occlusion of femoropopliteal arteries. J Vasc Surg. 2014;60:362–368. - PubMed

Publication types

LinkOut - more resources