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Case Reports
. 2023 May 25;9(3):101234.
doi: 10.1016/j.jvscit.2023.101234. eCollection 2023 Sep.

Off-label use of the Gore Excluder iliac branch endoprosthesis in association with the Rotarex S catheter to achieve total endovascular recanalization of an occluded aortobifemoral bypass

Andrea Maria Terpin  1 , Luigi Baccani  1 , Gianbattista Parlani  1 , Giacomo Isernia  1 , Gianluigi Fino  1 , Gioele Simonte  1
Affiliations
Case Reports

Off-label use of the Gore Excluder iliac branch endoprosthesis in association with the Rotarex S catheter to achieve total endovascular recanalization of an occluded aortobifemoral bypass

Andrea Maria Terpin et al. J Vasc Surg Cases Innov Tech. .

Abstract

We describe a successful case of hybrid revascularization of a totally occluded aortobifemoral bypass with retrograde use of the Rotarex S catheter (BD) and complete relining with a Gore Excluder iliac branch endoprosthesis (W.L. Gore & Associates). The repair procedure was performed with femoral surgical access and percutaneous brachial access. Despite left renal artery endoclamping, after the final angiography, deployment of a covered stent in the left renal artery was needed because of residual thrombotic material at the vessel ostium. The procedure was completed with reconstruction using a common femoral artery Dacron graft and bilateral complete iliac surgical branch relining using self-expanding covered stents, with recovery of distal pulses.

Keywords: Aortic occlusion; Aortoiliac; Athero-thrombectomy; Endovascular thrombectomy; Rotarex.

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Figures

Fig 1
Fig 1
Preoperative computed tomography angiography (A) and intraoperative diagnostic angiography (B) showing patency of the paravisceral aorta and both renal arteries, with total occlusion starting from the native infrarenal aorta just below the left renal artery (LRA) and involving the entire previous aortobifemoral (ABF) bypass. Preoperative planning and centerline reconstruction were based on a previous computed tomography angiography scan demonstrating the length from the LRA to the flow divider (C).
Fig 2
Fig 2
A and B, Images showing 10F Rotarex S catheter advancement from the femoral access, with left renal artery (LRA) endoclamping and a protective filter opened in the right renal artery (RRA). C, Bypass lumen reconstitution before relining.
Fig 3
Fig 3
A and B, Total bypass relining with Gore Excluder iliac branch endoprosthesis (IBE) and Viabahn covered stents, with kissing balloons. C, Follow-up angiography demonstrating aortobifemoral (ABF) bypass recanalization.
Fig 4
Fig 4
A, Follow-up angiography showing the presence of residual thrombotic material in front of the left renal artery (LRA) ostium. B and C, LRA stenting with a BeGraft covered stent deployed over a Rosen 0.035-in. guidewire.
Fig 5
Fig 5
Total aortobifemoral (ABF) bypass recanalization images at final angiography (A) and postoperative computed tomography angiography (B). C, Detail of LRA stenting and bilateral iliac relining. D, LRA stenting and bilateral iliac relining.
See this image and copyright information in PMC

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