92 - Postersitzung
17. Mai 2019, 12:30 - 14:00, Bellavista 2, 6. OG
Off-label use of a re-entry device as a bail-out procedure for stent-induced aortoiliac dissection: Technical note
P. Deslarzes, E. Psathas, E. Monnard, M. Menth, B. Egger, D. O. Mayer, Presenter: P. Deslarzes (Fribourg)
Retrograde iliac stenting combined with open patch angioplasty of the femoral artery is a well-established and less invasive procedure for patients with tandem iliofemoral lesions. We provide technical details of the unusual use of a re-entry device for subintimal peripheral angioplasty in a case of accidental placement of a stent-graft in the false lumen of the common iliac artery.
A 67 years old male patient was admitted to the emergency department with subacute right lower limb pain one month after bilateral femoral artery patch angioplasty with concomitant right common iliac stent-grafting. Clinical examination revealed absent right femoral pulses with a monophasic cw-Doppler signal on the right ankle. Emergency CT-Angiography revealed right aortoiliac dissection occluding most of the inflow to the patent stent-graft placed in the false lumen (Fig. 1). Repair was done under local anesthesia. A 4-French introducer sheath was advanced to the endarterectomy site via right superficial artery access distal to the surgical site. Then, a 0.035 hydrophilic guidewire was advanced under roadmap into the false lumen and through the stent-graft up to the level of the proximal dissection flap (Fig. 2a). A re-entry catheter (OUTBACK Ltd Reentry Catheter, Cordis, USA) was then advanced to the estimated proximal dissection flap. Thereafter, the tip was oriented towards the intraluminal re-entry site in the distal aorta utilizing the T and L-shaped fluoroscopic marker in orthogonal views. The 22G nitinol curved needle component was then fired through the side port, allowing the advancement of a 0.014 wire into the aortic lumen (Fig. 2b). Sequential dilatation of the fenestrated dissection flap was performed using 3, 6 and 8mm angioplasty balloons, respectively. Control angiography revealed bilaterally a rapid contrast flow in the aortoiliac axis (Fig. 2c-e).
Immediately after the procedure, restoration of right femoral and distal pulses was documented and plethysmography revealed a toe pressure of 85mmHg versus 17mmHg before the procedure.
The off-label use of a re-entry catheter for peripheral subintimal angioplasty in our case proved to be a useful adjunct for rapid revascularization of a critically threatened limb .