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Case Reports
. 2024 Nov 19:12:2050313X241299959.
doi: 10.1177/2050313X241299959. eCollection 2024.

Endovascular therapy via a femoro-femoral crossover bypass graft for chronic total occlusion of the superficial femoral artery: Two case reports

Yasuyuki Tsuchida  1 , Naoki Hayakawa  1 , Hiromi Miwa  1 , Shinya Ichihara  1 , Shunsuke Maruta  1 , Shunichi Kushida  1
Affiliations
Case Reports

Endovascular therapy via a femoro-femoral crossover bypass graft for chronic total occlusion of the superficial femoral artery: Two case reports

Yasuyuki Tsuchida et al. SAGE Open Med Case Rep. .

Abstract

In patients with a femoropopliteal chronic total occlusion (CTO) after femoro-femoral (FF) bypass surgery, it is often difficult to perform endovascular therapy because of access site problems. We have treated two patients with CTO of the superficial femoral artery (SFA) using an FF crossover bypass graft. The two cases were a man with intermittent claudication and acute limb ischemia, respectively. Enhanced computed tomography showed occlusion of the left SFA and the FF bypass previously performed was patent in both cases. We punctured the right common femoral artery and a guiding sheath was inserted to the left common femoral artery. A guidewire successfully passed through the intraplaque lesion by intravascular ultrasound-guided wiring in both cases. Revascularization was successfully achieved using drug-coated balloons and using drug-eluting stents, respectively. An FF crossover bypass graft may be a good access route for complex femoropopliteal cases, such as CTO lesions.

Keywords: Endovascular therapy; acute limb ischemia; chronic limb-threatening ischemia; chronic total occlusion; drug-eluting balloon; femoral artery; femoro–femoral crossover bypass; intravascular ultrasound.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Endovascular therapy via a femoro–femoral crossover bypass graft in case 1. (a) The femoro–femoral crossover bypass graft was patent. (b) Puncture from the right common femoral artery as distal as possible. (c) The femoro–femoral crossover bypass graft was contrasted. (d) A 4-Fr JR 4.0 guiding catheter was successfully passed through the femoro–femoral crossover bypass graft. (e) The distal left SFA was contrasted by collateral. (f) The guidewire was successfully passed into the chronically occluded lesion. (g) The proximal portion of the SFA after dilation with drug-coated balloon. (h) The distal portion of the SFA after dilation with a drug-coated balloon. SFA: superficial femoral artery.
Figure 2.
Figure 2.
Endovascular therapy via a femoro–femoral crossover bypass graft in case 2. (a) The left iliac artery and the femoropopliteal bypass graft, the left SFA and the left popliteal artery were occluded. (b) A 0.014-inch guidewire and Glidecath were successfully passed through the femoro–femoral crossover bypass graft. (c) The left SFA was occluded from the proximal portion. (d) The left popliteal artery and tibioperoneal trunk were occluded. (e) The proximal SFA after deploying a drug-eluting stent. (f) The popliteal artery after deploying a drug-eluting stent. SFA, superficial femoral artery.
See this image and copyright information in PMC

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