Back to 2026 Abstracts
Transmural Artery Bypass With Detour System For Patient With Proximal Arterio-venous Stent Through SFA Stent Interstices
Andre Critsinelis, M.D.,
Rahul Rodrigues, B.S., Brandon Madris, M.D., Kumudini Myla, B.A., Oleg Orlov, M.D., Stephanie Talutis, M.D., Payam Salehi, M.D., Prashanth Palvannan, M.D., Shivani Kumar, M.D..
Tufts Medical Center, Boston, MA, USA.
DEMOGRAPHICS: A 68-year-old female presented with critical limb-threatening ischemia (CLTI) of her right lower extremity in the form of rest pain. She had multiple comorbidities, including non-alcoholic fatty liver disease, coronary artery disease, obesity, hypertension, hyperlipidemia, insulin-dependent diabetes mellitus, and severe COPD with prior left lower lobectomy for adenocarcinoma.
HISTORY: Our patient had history of peripheral artery disease, previously a lifestyle-limiting claudicant, with several prior endovascular interventions, most recently a right SFA stent. Her symptoms had progressed to rest pain, and her ankle-brachial index declined to 0.45 on the affected limb. CTA showed long-segment right SFA occlusion, including occlusion of her previous stent. She underwent several unsuccessful endovascular attempts at crossing the SFA occlusion, including antegrade access as well as retrograde/pedal access. She was offered open bypass. After discussing all treatment options and going through shared decision-making, the patient declined open intervention given her extensive comorbidities. She opted for a complex endovascular attempt at resolving her rest pain.
PLAN: Her anatomy appeared favorable for percutaneous transmural arterial bypass (PTAB) with the DETOUR (
Endologix, Irvine CA, USA) system. Notably, the proximal arteriovenous connection (Figure 1) was created through the interstices of her previous SFA stent, a technique that has not been previously described. The ENDOCROSS system was able to easily cross the stent interstices into the femoral vein, and serial balloon dilation allowed for passage of the ENDOCROSS to the femoral vein for creation of the distal arterio-venous tract. Following the procedure, completion angiography demonstrated patent PTAB with improved distal perfusion, in-line pedal flow, and no evidence of endoleak. She was discharged on post-operative day 1 without complications. At four-month follow-up, she had resolution of rest pain, patent PTAB stents on duplex, and no deep venous thrombosis.
DISCUSSION: This case demonstrates the feasibility of using the DETOUR system to create the proximal arterio-venous tract through stent interstices, with serial balloon dilation to allow for passage of the ENDOCROSS system to the femoral vein for creation of the distal arterio-venous tract. DETOUR may offer a promising option for high-risk comorbid patients, expanding the therapeutic toolkit available for managing complex peripheral artery disease.
Back to 2026 Abstracts
