J Korean Soc Radiol.  2016 Jan;74(1):37-42. 10.3348/jksr.2016.74.1.37.

Target Balloon-Assisted Antegrade and Retrograde Approach for Recanalization of Thrombosed Fem-Pop Bypass Graft Using the Outback Catheter

• Kwak J
• Chung H
• Lee S
• Yeom S
• Cha S

• KMID: 2150461
• DOI: http://doi.org/10.3348/jksr.2016.74.1.37

Abstract

The subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique is reportedly effective in severe peripheral vascular disease that cannot be treated with standard endovascular techniques including subintimal angioplasty. In this report, we used a target balloon with the Outback catheter to recanalize a thrombosed bypass graft that could not be treated successfully with SAFARI.

MeSH Terms

Angioplasty
Angioplasty, Balloon
Blood Vessel Prosthesis
Catheters*
Endovascular Procedures
Graft Occlusion, Vascular
Peripheral Vascular Diseases
Transplants*

Figure

• 

  Fig. 1 On initial diagnostic angiogram, the old and new fem-pop bypass grafts are not visualized due to complete occlusion with thrombosis. Popliteal artery and tibioperoneal trunk are also totally occluded. Anterior tibial artery is completely occluded at upper calf level containing some amount of thrombosis in the lumen (black arrow). The posterior tibial artery (white arrow) reconstituted through collateral branches supplies the foot.

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  Fig. 2 Old fem-pop bypass graft (long black arrow) and new fem-pop bypass graft (long white arrow) are recanalized with Fogarty balloon and suction thrombectomy, respectively. However, multiple trials to pass the wire through occluded tibioperoneal trunk (short black arrow) failed. Some contrast material is noted in the extravascular space (short white arrow) through the perforation that was made during attempts at passing the wire through the occluded segment.

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  Fig. 3 Retrograde inserted 3 mm × 2 cm balloon catheter through posterior tibial artery access route at the ankle level (long black arrow) was targeted with Outback reentry catheter (long white arrow), which was inserted through recanalized old fem-pop bypass graft. Spillage of some contrast material from the balloon catheter into the adjacent soft tissue (short white arrows) right after accurate puncture of the balloon with Outback catheter, suggests that the balloon was located in the extravascular space instead of the subintimal space.

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  Fig. 4 On follow-up CT angiogram taken 8 days after procedure, good blood flow is visualized in the recanalized old fem-pop bypass graft (white arrow). Viabahn stent graft (black arrow) inserted through previous occluded segment is also highly patent, supplying good blood flow to the posterior tibial and peroneal arteries.

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