Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
He had by pass surgery from right femoral artery (FA)to above knee bypass surgery using synthetic graft 5 year sago. The by pass graft occluded soon, but he had no pain. He had second by pass surgery from FA to below the knee using saphenous vein graft (SVG) 3 months ago because he felt right leg pain at rest. And he felt leg pain again. His right popliteal artery and distal side artery were pulse less and his right ankle brachial index was low at 0.55.
Relevant test results prior to catheterization
We diagnosed that SVG had been occluded in enhanced computed tomography.
Relevant catheterization findings
His superficial femoral artery and SVG occluded and good collateral was flowing from deep femoral artery to poplitial artery. And his poplitial artery. And there was good blood flow from the popliteal artery to the posterior tibial artery (PTA).
Using cross-over approach from left femoral artery, we tried to cross the occluded SVG antegradely under IVUS guidance, however, we could not find anastomotic part of SVG. We punctured PTA and successfully crossed the lesion retrogradely. We performed IVUS and found that SVG was shrink partially. After ballooning with Angiosculpt®4.0 mm × 40 mm, we found SVG perforation. At the same time asantagonizing heparin, we performed long inflation with Coyote® 3.0 mm× 150 mm, however, we could not attain hemostasis. We decided to used GRAFTMATER® stent graft for coronary artery. We implanted GRAFTMATER® 2.8 mm × 19 mm and 3.5 mm × 16 mm, and successfully attained hemostasis.
We report this rare complication case of EVT for SVG and successfully bailed out using GRAFTMATER®. A scoring balloon is not useful at EVT for SVG, and GRAFTMATER® is useful tool of hemostasis at SVG perforation.