Author + information
- I-Ming Chen1
Endovascular therapy for superficial femoral artery (SFA) occlusive disease has become the first line treatment of choice. Bypass surgery is also another treatment of choice for SFA occlusive disease in selected patients. However, in clinical scenario, some extremely difficult chronic total occlusion (CTO) still could not be revascularized either by any endovascular techniques or bypass surgery. Here, we introduce a novel technique, hybrid Viabahn Assisted Bypass (VAB), to pass through these difficult CTOs of SFA with acceptable short-term outcomes.
This hybrid VAB technique combines extra-arterial flossing using antegrade-retrograde intervention via traditional open exposure of the middle SFA and deploying a Viabahn from the proximal true lumen through the subintimal lumen and extra-arterial space, and back into distal true lumen to restore flow. A retrospective chart review revealed that between March 2013 and October 2016 among 379 SFA interventions, we treated 15 legs in 15 patients (13 males and 2 females, all TASC D lesion) using the hybrid VAB technique to treat CTO lesions in the SFA.
The short-term results were acceptable, with 93.3% (14/15) 6-month primary potency rate, 100% 6-month secondary potency rate, 93.3% (14/15) limb salvage and overall survival at a median follow-up of 11 ± 5.2 months.
The hybrid VAB technique appears to be a useful alternative approach for recanalizing CTOs of the SFA when endovascular therapy fails and bypass surgery is not possible. Larger series and longer follow-up are necessary to evaluate the long-term success of the procedure.