Abstract
BackgroundThe ideal method for recanalization of complex peripheral lesions has not been determined, despite the use of the latest endovascular devices. We describe a novel method for a fully percutaneous anatomical bypass, named the “needle bypass” technique, for treatment of complex vascular lesions with failed previous surgical therapy.Main textA 68-year-old male patient with chronic limb-threatening ischemia presented to our department. He previously had received surgical treatment 10 years prior that included the removal of the right distal common femoral artery and two surgical bypasses, an axillary-femoral bypass and an iliofemoral bypass, because he had repeated infections. He was referred to our center in order to have peripheral interventions. Since the previous conventional bridging/revascularization of the removed common femoral bifurcation had failed, the “needle bypass” technique was then used. With this novel technique, the tips of two percutaneous and bidirectional inserted needles were aligned (“needle rendezvous”) for the externalization of a guidewire in a through-and-through manner. Once this was achieved, an endovascular stent graft and an interwoven stent were deployed to cover and connect the lesion. This new technique is a minimally invasive anatomical bypass that directly connects artery to artery without any disturbance of the venous flow, and this technique, as the only option available, was performed successfully in our no-option patient.ConclusionsThe “needle bypass” technique is an effective percutaneous treatment method in patients with no other surgical options.
Highlights
A 68-year-old male patient with chronic limb-threatening ischemia presented to our department
Some cases are more difficult to treat with endovascular therapy (EVT) after the failure of a surgical bypass due to the complexity of the anatomy involved
He had a history of right common femoral artery (CFA), an axillary-femoral bypass, and an iliofemoral bypass transection due to repeated methicillinresistant Staphylococcus aureus infections after a Miles’ operation and a lymphadenectomy for anal cancer 10 years prior
Summary
Wire supported with a 4-Fr catheter (Tempo®, Cardinal Health Inc., USA) into the lesion and into the tissue near the vessel due to the scar tissue formed from the repeated infections and the previous surgical procedures Since these lesions were too difficult to treat with a conventional intervention, the “needle bypass” technique was attempted as a novel percutaneous anatomical bypass. A 4.0 × 20-mm semicompliant balloon (Sterling®, Boston Scientific Co., USA) was used to dilate the tissue in front of the 6-Fr guiding sheath to create a space, and a third 18-gauge needle was used to puncture the tissue from the proximal site through the mentioned space into the SFA lumen where the retrograde 4-Fr catheter was positioned (Fig. 2B). After the 6.5 × 150-mm interwoven stent implantation and the postballoon dilation with a 7.0-mm noncompliant balloon by using the highest pressure, an angiogram and an intravascular ultrasound demonstrated the
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