Endovenous Bypass for SFA Occlusion
Barath Badrinathan, MD, William Jordan, MD.
Emory University, Atlanta, GA, USA.
DEMOGRAPHICS: 63 year old male
HISTORY: 63 year old male presenting with ischemic rest pain of the right lower extremity. His pre-operative imaging demonstrated an SFA occlusion. His preoperative ABI was non-compressible but his toe pressures confirmed severe occlusive disease, consistent with his rest pain presentation.
PLAN: Our plan was to perform an endovascular revascularization of the SFA using laser atherectomy after crossing the lesion.
DISCUSSION:
We started by gaining percutaneous access to the contralateral common femoral artery, and attempted to cross the SFA lesion to perform a laser atherectomy. However, we perforated the superficial femoral artery proximally, into the adjacent femoral vein. We decided to perform an endovenous bypass to recannalize the SFA. The wire was passed through the femoral vein, and a re-entry device was used to gain access back into the distal SFA lumen. A Viabahn stentgraft was placed extending from the proximal SFA, through the femoral vein, and ending in the distal SFA. The patient was seen in clinic one month post-operatively and was found to have a patent stentgraft, with resolution of his symptoms. Thus, we were successful in performing an endovenous bypass using a covered stentgraft to recannalize the SFA.
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