Occluded Infrainguinal Bypass Graft: Potential Source of Limb-Threatening Emboli

Vascular ◽  
2006 ◽  
Vol 14 (3) ◽  
pp. 156-160
Author(s):  
Ankur Chandra ◽  
Niren Angle
Keyword(s):  
Bypass Graft ◽  
Limb Ischemia ◽  
Treatment Modalities ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Graft Occlusion ◽  
Graft Thrombosis ◽  
Peripheral Embolization ◽  
Surgical Bypass ◽  
Peripheral Arterial

Surgical bypass represents one of the chief treatment modalities for peripheral arterial occlusive disease. Despite improving techniques, graft occlusion accounts for the majority of these bypass failures. Once occluded, however, these grafts are thought to rarely pose a threat for future ischemic events. This report describes two patients with previously thrombosed grafts who subsequently presented with limb-threatening ischemia owing to peripheral embolization from the graft. Two patients with occluded grafts presented with ipsilateral limb-threatening acute ischemia. Both of these patients developed severe acute limb-threatening ischemia weeks to months after known graft thrombosis. Arteriography revealed peripheral embolization in each case. Both patients were operated on for disconnection of the thrombosed graft from the native circulation and have been free of recurrent symptoms. The occluded graft, although generally innocuous, can be a source of peripheral emboli, resulting in peripheral embolization and acute limb ischemia. Both patients in this report developed limb-threatening ischemia owing to embolization from the cul-de-sac of occluded prosthetic grafts. Due to the rarity of the condition and its associated morbidity and mortality, awareness and recognition of this phenomenon are critical. Operative disconnection is recommended if the embolism occurs downstream of the graft and no other embolic source can be identified.

Advanced treatment of acute femoropopliteal bypass graft occlusion with Fogarty catheter guidance

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 262-266 ◽  
Author(s):  
Gokhan Albayrak ◽  
Koray Aykut ◽  
Mehmet Guzeloglu ◽  
Aytac Gulcu ◽  
Eyup Hazan
Keyword(s):  
Bypass Graft ◽  
Limb Ischemia ◽  
Graft Patency ◽  
Transluminal Angioplasty ◽  
Acute Limb Ischemia ◽  
Graft Occlusion ◽  
Fogarty Catheter ◽  
Femoropopliteal Bypass ◽  
Conventional Angiography ◽  
Stent Grafting

Purpose The guiding role of the Fogarty catheter was investigated among patients suffering from limb ischemia due to acute femoropopliteal bypass graft occlusion. Methods A total of 27 patients with a history of femoropopliteal bypass operation who was admitted with acute limb ischemia were enrolled in this retrospective study. In cases in which the Fogarty catheter could not be passed through the popliteal anastomosis, the popliteal region was explored and a new bypass or patch plasty was performed for the distal anastomosis. The cases in which the blood circulation was observed in the graft, but in which the Fogarty catheter balloon was stuck in the native vessels on the proximal and distal side of the graft and the balloon could be withdrawn by deflation, were referred to conventional angiography. The stenosis observed in native vessels was managed by endovascular stent grafting and/or balloon dilatation. Findings Graft patency was achieved in all patients. In 11 patients, conventional angiography was implemented following embolectomy. In these patients, all the occlusions found as significant on angiography were removed by percutaneous transluminal angioplasty. Conclusion Effective use of Fogarty catheter is safe in acute femoropopliteal bypass graft occlusions and in particular, in the planning of further treatment following thrombectomy.

Acute Limb Ischemia

2012 ◽  
Author(s):  
Jovan N. Markovic ◽  
Cynthia K. Shortell
Keyword(s):  
Clinical Evaluation ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Heparin Therapy ◽  
Common Symptom ◽  
Acute Limb Ischemia ◽  
Graft Occlusion ◽  
Surgical Embolectomy

Acute limb ischemia (ALI) is one of the most challenging conditions in vascular surgery and carries a high risk of amputation and mortality when treatment is delayed. Limb ischemia occurs when there is abrupt interruption of blood supply to an extremity because of either embolic or in situ thrombotic arterial or bypass graft occlusion. The goals of management include limb salvage, minimization of morbidity, and prevention of death. However, given that no objective markers of limb viability are currently available, the initial determination of whether a limb is likely to be viable must be made on clinical grounds. An early clinical evaluation is crucial for the diagnosis and identification of the underlying etiology of the ALI. As ALI is a clinical diagnosis, this review describes all aspects of the clinical evaluation as essential: patient history, staging of limb ischemia, and investigative studies. Atheromatous embolization is also discussed in depth. The characteristic signs of ALI may be summarized as the “six p’s”: pulselessness, pain, pallor, poikilothermia, paresthesia, and paralysis. Pain is the most common symptom in an ischemic limb and progresses along with the ischemia. As ischemia continues to progress, severe pain can be replaced by anesthesia of the limb, which can confound the examiner. Thus, pain should be documented with regard to severity, localization, and progression. ALI therapies covered are heparin therapy, thrombolytic therapy, thrombectomy, and surgical embolectomy and revascularization. The pathophysiology of limb ischemia is related to the progression of tissue infarction and irreversible cell death. Compared with other organs and tissues (e.g., the brain and the heart), the extremities are relatively resistant to ischemia. However, the various tissue types of which an extremity is composed have different metabolic rates. This review has 2 figures, 6 tables, and 165 references.

The Trellis Thrombectomy System in the Treatment of Acute Limb Ischemia

2003 ◽  
Vol 10 (2) ◽  
pp. 317-321 ◽  
Author(s):  
Karthikeshwar Kasirajan ◽  
Venkatesh G. Ramaiah ◽  
Edward B. Diethrich
Keyword(s):  
Thrombolytic Agent ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Graft Thrombosis ◽  
Percutaneous Mechanical Thrombectomy ◽  
Flow Restoration ◽  
Drug Dispersion ◽  
Thrombectomy Device ◽  
Distal Occlusion

Purpose: To report the use of a new percutaneous mechanical thrombectomy device in the treatment of acute limb-threatening ischemia. Technique: The Trellis Thrombectomy System is a 7-F drug dispersion catheter that features a treatment segment isolated by proximal and distal occlusion balloons, which help prevent distal embolization and systemic release of the infused thrombolytic agent. After inflating the distal balloon, the thrombolytic agent is infused and held at the target site by inflation of the proximal balloon. An oscillating dispersion wire optimizes dispersal of the thrombolytic agent as the thrombus is mechanically fragmented. The liquefied thrombus is then aspirated. Four consecutive patients with acute lower extremity ischemia secondary to bypass graft thrombosis were treated with the Trellis thrombectomy catheter. Overall, 95% of thrombus was successfully removed from the treatment zone, with no device-related complications. Only one patient required adjunctive thrombolytic therapy after thrombectomy with the Trellis device. Conclusions: The Trellis thrombectomy device is a safe and effective technique to isolate the infused thrombolytic agent in association with mechanical fragmentation for rapid blood flow restoration.

Antithrombotic therapy for postinterventional management of peripheral arterial disease

2020 ◽  
Vol 77 (4) ◽  
pp. 269-276
Author(s):  
Daria Zavgorodnyaya ◽  
Tamara B Knight ◽  
Mitchell J Daley ◽  
Pedro G Teixeira
Keyword(s):  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Acute Limb Ischemia ◽  
Increased Risk ◽  
Peripheral Arterial ◽  
Quality Evidence

Abstract Purpose Evidence on the use of antithrombotic pharmacotherapy in patients undergoing revascularization of lower extremities for symptomatic peripheral arterial disease (PAD) is reviewed. Summary Individuals with PAD can experience leg pain, intermittent claudication, critical limb ischemia, and acute limb ischemia. In such patients, revascularization may be indicated to improve the quality of life and to prevent amputations. Antithrombotic therapy is often intensified in the postrevascularization period to prevent restenosis of the index artery and to counteract the prothrombotic state induced by the intervention. Therapeutic modalities include dual antiplatelet therapy (DAPT), anticoagulation, a combination of antiplatelet and anticoagulation therapy, and addition of cilostazol to single antiplatelet therapy. Subgroup analyses of data from randomized clinical trials provided low-quality evidence for the use of DAPT in patients with a below-knee prosthetic bypass graft and anticoagulation for those with a venous bypass graft. Cilostazol, when added to aspirin therapy, has been shown to prevent index vessel reocclusion after an endovascular intervention in patients at low risk for thrombosis in several small randomized trials. Conclusion There is a considerable paucity of high-quality evidence on the optimal antithrombotic regimen for patients undergoing lower extremity revascularization, with no particular therapy shown to consistently improve patient outcomes. The decision to initiate intensified antithrombotic therapy should include a close examination of its risk–benefit profile. The demonstrated benefit of such treatment is restricted to the prevention of index artery reocclusion, while an increased risk of bleeding may lead to significant morbidity and mortality.

Isolated pharmaco-mechanical thrombectomy (IPMT) for the endovascular treatment of acute axillofemoral graft occlusion

2013 ◽  
Vol 18 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Siddharth Wayangankar ◽  
Jigar Patel ◽  
Thomas A Hennebry
Keyword(s):  
Mechanical Thrombectomy ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Anastomotic Site ◽  
Acute Limb Ischemia ◽  
Graft Occlusion ◽  
Distal Embolization ◽  
Clot Burden ◽  
Endovascular Devices

Since the long-term patency of axillofemoral (AXF) grafts is inferior to aorto-bifemoral (ABF) grafts, limb salvage procedures are crucial in this group of patients. Emerging endovascular devices have helped in the successful restoration of flow for acute limb ischemia in both native arteries as well as bypass grafts. One such device, the Trellis™ thrombectomy system is being used more frequently in this setting. The device has previously been used in veins, native arteries, and rarely in aortofemoral grafts. We present its first successful use for the treatment of occluded AXF bypass graft. The use of this device helped to isolate the treatment zone in the occluded graft, which allowed the use of a lower dose of thrombolytics, less systemic release of thrombolytics, and less distal embolization. Resolution of extensive clot burden was achieved and, with subsequent stenting of the graft at the distal anastomotic site, arterial flow to the leg through the AXF graft was restored and a revision surgery was avoided.

scholarly journals Preserved Renal Function in Kidney Transplantation over a Thrombosed Aortobifemoral Bypass Graft: The Role of Retrograde Flow and Early Thrombolysis

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Saúl Pampa-Saico ◽  
Sara Jiménez-Alvaro ◽  
Fernando Caravaca-Fontán ◽  
Ana Fernández-Rodríguez ◽  
Maite Rivera-Gorrín ◽  
...  
Keyword(s):  
Renal Function ◽  
Severe Renal Impairment ◽  
Imaging Techniques ◽  
Bypass Graft ◽  
Graft Loss ◽  
Previous History ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Retrograde Flow ◽  
Aortobifemoral Bypass

Aortobifemoral bypass (ABFB) thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries. This unusual situation not previously reported in a kidney transplant setting, together with an early diagnosis, allowed graft survival until an early local thrombolysis resolved the problem. Two years later, renal function remains normal.

scholarly journals Embolism to the main limb arteries in patients with atrial fibrillation

2022 ◽  
Vol 20 (4) ◽  
pp. 14-20
Author(s):  
M. V. Mel’nikov ◽  
A. V. Sotnikov ◽  
D. S. Kozhevnikov ◽  
M. V. Solov’yeva ◽  
S. A . Boldueva
Keyword(s):  
Atrial Fibrillation ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Surgical Department ◽  
The Past ◽  
Group 3 ◽  
Group 1

Introduction. Acute limb ischemia due to embolism in patients with atrial fibrillation remains poorly studied. Objective – to study the clinical significance and role of atrial fibrillation (AF) in the development of embolism to the bifurcation of the aorta and the main arteries of the limbs. Materials and methods. Treatment results of 1816 patients with acute ischemia of the extremities due to embolism treated at a specialized vascular surgical department for the past 30 years were analyzed. 1611 (88.7 %) of them had AF. The distribution into studied groups was according to the period time factor. Group 1 (n = 744) consisted of patients admitted in the period from 1991 to 2000; in group 2 (n = 568) – admitted in the period from 2001 to 2010, in group 3 (n = 299) – from 2011 to 2020. Methods included clinical examination, electrocardiography, Doppler-ultrasound, echocardiography. Results. The role of rheumatic heart disease as a cause of AF has decreased over the past decades by almost 10 times (from 19.5 % in group 1 to 2.0 % in group 3). Currently, the main background diseases for the development of AF are arterial hypertension and various forms of coronary artery disease. Embolism in patients with AF may develop in the arteries of all vascular areas of the systemic circulation, but in the practice of a vascular surgeon more often in the main arteries of minor caliber – the brachial (24.5 %) and popliteal (13.0 %). Multiple embolisms to various vascular areas were found in 2.8 % of patients. Urgent surgical revascularization of the limb by open embolectomy was performed in 1481 (91.9 %) patients that allowed 1348 (83.7 %) to be discharged with limb-sparing. Conclusion. In patients with acute limb ischemia of embologenic ethiology, comorbid AF has 88.7 % of them. Urgent embolectomy allows 83.7 % of patients to be discharged without limb amputation. Hospital mortality in the period 1991–2000 was 15.6 %, the last decade has been reduced to 7.4 %.

scholarly journals Bleeding complications at the access sites during catheter directed thrombolysis for acute limb ischaemia: Mini review

2021 ◽  
Vol 5 (1) ◽  
pp. 001-003
Author(s):  
Noory Elias ◽  
Böhme Tanja ◽  
Beschorner Ulrich ◽  
Zeller Thomas
Keyword(s):  
Treatment Options ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Bleeding Complications ◽  
Limb Ischaemia ◽  
Acute Limb Ischemia ◽  
Access Site ◽  
Catheter Directed Thrombolysis ◽  
Acute Limb Ischaemia ◽  
Surgical Bypass

Acute and subacute ischemia of the lower limbs represents a major emergency with a high in-hospital mortality, complication, and leg amputation rates. Treatment options for acute limb ischemia include systemic anticoagulation, followed by various catheter based options including infusion of fibrinolytic agents (pharmacological thrombolysis), pharmacomechanical thrombolysis, catheter-mediated thrombus aspiration, mechanical thrombectomy, and any combination of the above or open surgical intervention (thromboembolectomy or surgical bypass). Minor and major bleeding complication during catheter directed thrombolysis (CDT) especially at access site are frequent. Bleeding complications require often an interruption or termination of CDT affecting clinical outcome of the patients. Recently we examined a new access site bleeding protection device during CDT.

scholarly journals When the Uterus Competes for Perfusion: Management of a Pregnant Patient with Bypass Graft Occlusion

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Sarah McGriff ◽  
Paige Percer ◽  
Iberia Sosa ◽  
Hector Mendez-Figueroa ◽  
Joseph L. Mills ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Bypass Graft ◽  
Pregnant Patient ◽  
Arterial Disease ◽  
Graft Occlusion ◽  
Left Lower Extremity ◽  
Ct Angiogram ◽  
History Of ◽  
Peripheral Arterial ◽  
In Pregnancy

Background. Peripheral arterial disease (PAD) in pregnancy has serious implications and requires multidisciplinary management. This becomes even more complicated in the setting of active disease and history of prior vascular grafts. Case. A woman presented with increasing left lower extremity pain at 18 weeks of gestation with a complex history of PAD and a previous bifurcated aorta-left femoral, -right iliac bypass. CT angiogram demonstrated known occluded bypass graft. A multidisciplinary team of providers developed guidelines for potential surgical intervention based upon clinical symptoms. Conclusion. Pelvic PAD can worsen in pregnancy in the setting of the enlarging uterus, which can potentially deplete perfusion of existing collateral vessels. Symptomatic approach to worsening disease provided an effective management strategy in this case.

Endovascular Procedures For Lower Extremity Vascular Disease: Basics of Endovascular Intervention

2018 ◽  
Author(s):  
Lalithapriya Jayakumar ◽  
Mark Davies
Keyword(s):  
Lower Extremity ◽  
Vascular Disease ◽  
Endovascular Procedures ◽  
Vascular Diseases ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Surgical Approaches ◽  
Acute Ischemia ◽  
Acute Limb Ischemia ◽  
Access Complications

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details these techniques and therapies. Key words: access closure, access complications, acute limb ischemia, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, transcollateral access, transpopliteal access

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