Successful Hybrid Revascularization of Rt. Iliac Axis and Common Femoral Artery Occlusion (TASC D) after Failing Femoro-femoral Crossover Bypass

Jaroen Cheewinmethasiri, Nuttapon Arayawdhikul, Boonsap Sakboon, Angsu Chartrungsan

Lampang hospital, Lampang, Thailand

Date, time and location: 2018.05.26 15:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective: we describe the hybrid revascularization technique for treatment of TASC D aortoiliac occlusive disease after failing Femoro-femoral crossover bypass for 2 times.

Method: Review technique of this case, as well as review of the literature

Results: A 64 year-old male with history of coronary artery disease s/p PCI present with rest pain of his Rt. leg after two attempt of femoro-femoral crossover bypass. CTA showed total occlusion of ring PTFE bypass graft with CTO of Rt. external iliac artery (EIA) and common femoral artery (CFA) with bilateral common iliac artery (CIA) stenosis. We performed Rt. iliac axis reconstruction with hybrid-endovascular technique. We access with cross over technique from Lt.CFA via 6 Fr sheath. We used 0.035 hydrophilic guidewire to make U-shaped loop by continually rotating and advancing guidewire and 5-Fr catheter subintimally through the occlusion into Rt.CFA. Rt.CFA was cut down. Rt.EIA was predilated with Admiral balloon then Fluency plus stent graft was deployed in Rt.EIA (retrogradely from Rt.CFA). Complete SE stent was also deployed in Rt.CIA. Femero-fermoral bypass with interposition PTFE graft was performed because of long total occlusion with heavily calcification of Rt.CFA. Completion angiography showed technically successful of this hybrid revascularization. At outpatient unit (2 weeks after revascularization ), the patient was doing well no rest pain or claudication. CTA at 3 month after operation show patent of stent and bypass graft. At nine-month follow-up, ABI of Rt. Leg and Lt.Leg were 1.0 and 0.91, respectively.

Conclusions: Hybrid revascularization is safe for TASC D aortoiliac occlusive disease with good early outcome.