Stent-graft Placement Research Articles

PP-527 - Endovascular Management of İatrogenic İliac Rupture during Atheterectomy Treatment for Steno-Occlusive Iliac Artery Disease: Case Report

Objectives: Rupture of an iliac artery during endovascular treatment for steno-occlusive ıliac artery disease is a rare but potentially devastating complication. We report a case of iatrogenic external iliac artery rupture that was successfully treated by temporary balloon occlusion followed by endovascular stent graft placement in an unusual manner.

Readmissions after thoracic endovascular aortic repair

ObjectiveThe care of patients undergoing thoracic endovascular aortic repair (TEVAR) can be resource intensive, which can be driven by readmissions. Our objective was to characterize index readmissions at 30, 90, and 180 days after TEVAR. MethodsA retrospective analysis of the Nationwide Readmissions Database was performed for patients who underwent TEVAR in 2013. Multivariable analysis identified independent predictors for index readmission at 30, 90, and 180 days. ResultsThere were 4045 TEVARs performed for descending thoracic aortic dissection (37.7%), nonruptured aneurysm (56%), and ruptured aneurysm (6.3%). There were 419 (11.1%) index readmissions at 30 days, 895 (23.6%) at 90 days, and 1131 (29.8%) at 180 days. The most frequent reason for index readmission was heart related at 30 days (15.5%) and aorta related at 90 days (18%) and 180 days (19.6%). Reinterventions were performed at 6.4%, 9.5%, and 9.7% of 30-, 90-, and 180-day readmissions, respectively. The majority of these included additional endovascular stent graft placement (51.9% of reinterventions at 30 days, 67.7% at 90 days, and 65.9% at 180 days). In multivariable analysis, 30-day index readmission was associated with initial ruptured presentation (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.1-3.5; P = .023) and diagnosis-related group (DRG) severity grades of moderate (OR, 1.42; 95% CI, 0.74-2.73), major (OR, 2.47; 95% CI, 1.28-4.74), and extreme (OR, 1.60; 95% CI, 0.76-3.36; P = .009). Index readmission at 90 days was independently associated with initial ruptured presentation (OR, 1.88; 95% CI, 1.18-3.01; P = .008), urgent/emergent TEVAR (OR, 1.41; 95% CI, 1.08-1.85; P = .014), and DRG severity grades of moderate (OR, 1.53; 95% CI, 0.95-2.47), major (OR, 2.27; 95% CI, 1.39-3.7), and extreme (OR, 2.45; 95% CI, 1.43-4.18; P = .002). Finally, at 180 days, initial ruptured presentation (OR, 1.66; 95% CI, 1.05-2.62; P = .029), urgent/emergent TEVAR (OR, 1.37; 95% CI, 1.08-1.79; P = .013), and DRG severity grades of moderate (OR, 1.55; 95% CI, 1.01-2.38), major (OR, 2.15; 95% CI, 1.38-3.33), and extreme (OR, 2.39; 95% CI, 1.47-3.89; P = .002) were, again, independently associated with index readmission. ConclusionsA large portion of patients treated with TEVAR were readmitted most commonly for heart-related reasons at 30 days and aorta-related reasons at 90 and 180 days. TEVAR performed to treat initial aortic rupture and greater DRG severity grade were independently associated with an index readmission at 30, 90, and 180 days. Urgent/emergent TEVAR was independently associated with an index readmission at 90 and 180 days. These factors are important to consider in using readmissions as a quality measure.

Abstract No. 613 Comparing patient radiation exposure in standard and intravascular ultrasound-guided transjugular intrahepatic portosystemic shunt (TIPS) creation procedures

This study compares radiation exposure in standard and intravascular ultrasound-guided (IVUS) TIPS procedures. Standard (N = 6) and IVUS TIPS procedures (N = 4) were analyzed via an audio-video procedure recording system synchronized to fluoroscopy imaging data. TIPS procedures were analyzed and divided into two phases: gaining portal vein access (PVA) followed by stent graft placement (SGP). The checkpoint separating these two phases was defined as the first instance when the guidewire was observed within the portal vein. For each phase, cumulative KAP, fluoroscopy time (FT), and phase time (PT) were compared. Cumulative KAP during PVA was higher in standard (55 ± 28Gy·cm2, N = 6) vs IVUS procedures (9 ± 6Gy·cm2, N = 4, p = 0.012). Wedged hepatic venography was determined to be an important contributor to total KAP for patients undergoing standard procedures (42 ± 12%, N = 5). Differences in cumulative KAP during SGP was not significant between standard (27 ± 16Gy·cm2, N = 6) and IVUS procedures (15 ± 5Gy·cm2, N = 4, p = 0.19). IVUS-guided TIPS procedures can significantly reduce patient radiation exposure. The key driving factor was avoiding the need for wedged hepatic venography.Tabled 1IVUS Patient #Age (yr)PVA: PT (min)PVA: FT (×102 sec)PVA: KAP (Gy·cm2)SGP: PT (min)SGP: FT (×102 sec)SGP: KAP (Gy·cm2)142254.07212.719267274.43323.77358459.616324.716458196.49453.718Standard Patient #161347.291232.640270418.069242.2293619020.0756710.1504673512.142314.717556406.925334.2761756014.625293.2201Wedged hepatic venography not employed. Open table in a new tab

This movie shows the graft of the ascending aorta and the interval placement of the endovascular stent graft of the descending aorta a few days after surgery

This movie shows the graft of the ascending aorta and the interval placement of the endovascular stent graft of the descending aorta a few days after surgery

After placement of endovascular stent graft, proximally overlapping with surgical graft

After placement of endovascular stent graft, proximally overlapping with surgical graft

Abstract No. 637 Stent-graft placement to treat central venous stenosis in hemodialysis patients: long-term results

Abstract No. 637 Stent-graft placement to treat central venous stenosis in hemodialysis patients: long-term results

Abstract No. 441 VIABAHN stent-graft placement for emergent/urgent cervical cerebrovascular artery disease: a single-center experience of 22 cases

To report our single-center experience of Viabahn stent-graft placement for acute bleeding or pseudoaneurysms of innominate, cervical carotid, or vertebral artery in emergent/urgent clinical conditions. A retrospective study was conducted between Jan 2003 and Sep 2017. A total of 22 patients (14 male, 8 female; age range 18–82 years, mean 55.8 years and median 56 years) were treated with 22 Viabahn stent grafts (9 carotid blow-out syndrome and 13 pseudoaneurysms with or without dissection: 4 innominate, 4 common carotid, 12 internal carotid, 1 both common and internal carotid, and 1 vertebral artery involvement). The stent-graft patency was evaluated by angiogram, contrast-enhanced CT, MRA, ultrasonography, or direct observation during surgery. The mean and median imaging follow-up periods were 740 and 193 days, respectively. Technical success was 100% (22/22). Dual antiplatelet agents were given in 20 patients either immediately before or after the deployment of the stent-grafts. No immediate procedure-related complications occurred. Two unstable patients with carotid blow-out syndrome died of severe systemic disturbance within 8 days, despite successful bleeding cessation by the procedure. Three patients underwent subsequent bypass surgery within 17 days for concern about infection. One stent-graft occlusion occurred 195 days after the procedure with unexpected cession of antiplatelet therapy. One significant hemorrhagic complication was observed and died 125 days after the procedure (esophagocutaneous fistula). Two patients were lost to follow-up. Among the remaining 13 patients, 11 patients demonstrated 6 months or longer stent-graft patency and 2 developed more than 50% stenosis. Viabahn stent-grafting may be safe and useful for the management of emergent/urgent arterial bleeding or pseudoaneurysms involving cervical cerebrovascular arteries.

Abstract No. 413 Long-term outcomes after the stent-grafts placement for treatment of postpancreatoduodenectomy arterial hemorrhage

Abstract No. 413 Long-term outcomes after the stent-grafts placement for treatment of postpancreatoduodenectomy arterial hemorrhage

Computational Analysis of Blood Flow Characteristics in an Aortic System with Abdominal and Left Common Iliac Aneurysm Pre- and Post-Stent Grafting

The aim of this study was to demonstrate how fluid dynamic parameters are affected by aortic geometry and flow condition in two cases. Case A included blood flow analysis in aortic system with abdominal aortic aneurysm and left common iliac aneurysm before stent graft placement, while in case B was included stent graft geometry, at the site of the aneurysms. An individual patient-specific geometry and a 3D finite element meshes were reconstructed, based on Computed tomography (CT) scan images. The analysis was performed using the possibilities of computational fluid dynamics. It uses numeric methods and algorithms for the simulation of blood flow by solving the Navier-Stokes equations on computational meshes. The computational simulations of cardiac cycles were performed for average blood properties and blood flow rate. The velocity field, pressure and shear stress, as main fluid dynamics parameters, were visualized and compared for cases A and B.

Endovascular Management of Ureteroarterial Fistula: Single Institution Experience and Systematic Literature Review.

Ureteroarterial fistula (UAF) represents an uncommon complication after urological surgery; however, this is a well-documented condition in patients with predisposing risk factors. The aim of the present study is to report and analyze the endovascular management of a series of patients with UAF, treated in authors' hospital, and to report and analyze the same data concerning patients retrieved from a systematic literature review. Authors conducted a retrospective analysis of prospectively collected data and a systematic literature review. The research was carried out through PubMed database searching the following keywords: "uretero arterial fistula" and "uretero iliac fistula." It includes only articles reporting the endovascular management. Forty-six articles were included in the present study for a total of 94 patients. Risk factors were as follows: chronic indwelling ureteral stents, pelvic surgery, radiotherapy, iliac artery pseudo-aneurysm, and chemotherapy. All patients had gross hematuria at presentation. Stent graft placement was performed in 89 patients, embolization in 5 patients, and iliac internal artery embolization combined with stent graft placement was performed in 24 patients. Four postprocedural complications were observed (4.2%). During a median follow-up of 8 months, 10 complications related to UAF were observed (10.6%): rebleeding (7 cases) and stent thrombosis (3 cases). Two patients died for causes related to UAF (2.1%): rebleeding (1) and retroperitoneal abscess (1). Based on the present data, endovascular treatment is feasible and safe with low postprocedural complications and mortality rate. Considering the increase in surgery and radiotherapy performed, UAF should be always debated in patients with massive hematuria.

Heparin-bonded stent graft treatment for major visceral arterial injury after upper abdominal surgery.

To analyse technical success, complications, and short- and intermediate-term outcomes after heparin-bonded stent graft implantation for the treatment of major abdominal vessel injury after upper abdominal surgery. This retrospective, IRB-approved analysis included 29 consecutive patients (female: n = 6, male: n = 23, mean age 65.9 ± 11.2 years). All patients underwent angiography and attempted heparin-bonded stent-graft implantation because of a major visceral arterial injury after upper abdominal surgery. Electronic clinical records, angiographic reports and imaging datasets were reviewed to assess technical success and complications. Telephone interviews were performed to obtain follow-up information and to estimate short- (> 30 days) and intermediate-term (> 90 days) outcomes. Successful stent graft placement was achieved in 82.8% (24/29). Peri-interventional complications were observed in 20.7% (6/29) and delayed, angiography-associated complications were observed in 34.5% (10/29) of the patients. Symptomatic re-bleeding occurred in 24.1% (7/29). Short-term survival (> 30 days) was 72.4% (21/29). Intermediate survival (> 90 days) was 37.9% (11/29). Treatment of major vascular injuries with heparin-bonded stent grafts is feasible with a high technical success rate. However, survival depends on the underlying surgical condition, making interdisciplinary patient management mandatory. • Stent graft implantation is challenging, but has a high technical success rate. • Complications are frequent but surgical conversion is rarely necessary. • Survival depends on the underlying surgical condition causing the vascular injury. • Interdisciplinary management is crucial for the survival of these patients.

Hybrid Reconstruction of the Aortic Arch Using a Double-Branched Stent-Graft in a Canine Model

ABSTRACTPurpose: To report the results of a hybrid approach to aortic arch repair using an innovative unibody double-branched stent graft in a canine model.Materials and methods: The stent-graft system consists of two parts: the main body and two branches for reconstruction of the supra-arch branches. There is a 2-cm-long suturing portion at the proximal end of the main body. Twenty adult German sheep dogs underwent a hybrid surgical treatment to place the stent-grafts into the proximal descending aorta and the supra-arch branches. Outcomes were assessed by operative mortality, complications, imaging studies, and histomorphometric analyses.Results: Placement of the stent-graft was performed successfully in all dogs without complications. One dog died of respiratory failure due to early extubation. The other dogs survived to 6 months without complications, at which time they were sacrificed. The mean cardiopulmonary bypass time was 80.3 ± 7.3 mins and hypothermic circulatory arrest time was 10.7 ± 1.9 min. The average blood loss was 373.5 mL. At 6 months, postoperative aortic imaging indicated that the main body and branches of the stent-graft were fully open and in satisfactory position. No migration, deformation, or endovascular leakage was observed. Histomorphometric results showed normal arrangement of medial and adventitial elastic fibers, moderately proliferated intima, with or without neo-microvessels, and microscopic morphological changes in internal elastic lamina.Conclusions: These results demonstrate that it is possible and safe to reconstruct the aortic arch with the novel open-branched stent-graft placement.

Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms

BACKGROUND Thoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is greater than the risk of surgical complications. Depending on the cause, size and growth rate of the TAA, treatment may vary from close observation to emergency surgery. Aneurysms of the thoracic aorta can be managed by a number of surgical techniques. Open surgical repair (OSR) of aneurysms involves either partial or total replacement of the aorta, which is dependent on the extent of the diseased segment of the aorta. During OSR, the aneurysm is replaced with a synthetic graft. Hybrid repair (HR) involves a combination of open surgery with endovascular aortic stent graft placement. Hybrid repair requires varying degrees of invasiveness, depending on the number of supra-aortic branches that require debranching. The hybrid technique that combines supra-aortic vascular debranching with stent grafting of the aortic arch has been introduced as a therapeutic alternative. However, the short- and long-term outcomes of HR remain unclear, due to technical difficulties and complications as a result of the angulation of the aortic arch as well as handling of the arch during surgery. OBJECTIVES To assess the effectiveness and safety of HR versus conventional OSR for the treatment of TAAs. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 22 March 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations. SELECTION CRITERIA We considered for inclusion in the review all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing HR to OSR for TAAs. DATA COLLECTION AND ANALYSIS Two review authors independently screened all titles and abstracts obtained from the literature search to identify those that met the inclusion criteria. We retrieved the full text of studies deemed as potentially relevant by at least one review author. The same review authors screened the full-text articles independently for inclusion or exclusion. MAIN RESULTS No RCTs or CCTs met the inclusion criteria for this review. AUTHORS' CONCLUSIONS Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of HR compared to OSR in people with TAAs, and we are unable to provide high-certainty evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs are necessary, addressing the objective of this review.

Endovascular Management of Arterial Injuries Related to Venous Access: A Retrospective Review of 10‑Year Single-Center Experience

Purpose: Retrospective review of the pattern and management techniques of arterial injuries related to central venous access with long-term outcomes. Materials and Methods: Between January 2007 and November 2017, a total of 20 patients (13 females) were included with the mean age of 63 (28–89 years) and mean body mass index of 25.75 (13.3–36.5). Venous access procedures included central venous catheter (CVC) placement, dialysis line insertion, or endovascular venous procedures. The study excluded patients who had arterial injuries related to arterial access, such as postarterial line placement, postangiography, or percutaneous coronary interventions. Results: Iatrogenic arterial injuries occurred after attempted venous access procedures involving the common femoral vein (n = 18) and subclavian vein (n = 2). Injuries were related to CVC placement (n = 5), temporary dialysis catheter (n = 14), and inferior vena cava filter insertion (n = 1). Nine patients had transarterial venous catheter insertion complicated by active bleeding from pseudoaneurysm and arteriovenous fistula. Other injuries included isolated fistula (n = 3), isolated pseudoaneurysm (n = 4), isolated branch injury (n = 2), and intra-arterial insertion (n = 2). Endovascular management included stent–graft placement (n = 14), embolization of bleeding vessel (n = 2), and thrombin injection for pseudoaneurysm (n = 2). Conservative management with manual compression achieved hemostasis in two patients. Technical success was achieved in 100%. One patient required repeat angiography and embolization of bleeding branch vessel following stent–graft placement to control bleeding fistula and pseudoaneurysm. Clinical success was achieved in all patients. Procedure-related complications included puncture site hematoma (n = 1) and partially occlusive thrombus/spasm of deep femoral artery after stent–graft placement. Six patients (33%) died within 20 days after the procedure (3–20 days) due to other comorbidities. Three additional patients (16%) died during the same hospital admission at the time of the procedure (38–114 days). There were no reported complaints related to possible stent–graft stenosis or occlusion at mean follow-up time of 5 years (50 days–8.64 years) in all seven patients who survived after stent–graft placement procedure. Conclusion: Despite technically successful endovascular management of arterial injuries related to venous access in critically ill patients, the mortality rate remains high due to other comorbidities. Allowing for the small sample size, stent–graft placement for arterial injuries in this cohort of patients appears to be an effective option with high long-term patency rate.

A Novel Patient-Specific Human Cardiovascular System Phantom (HCSP) for Reconstructions of Pulsatile Blood Hemodynamic Inside Abdominal Aortic Aneurysm

Background and objectives: Post-operative complications of endovascular aneurysm repair, such as endoleaks, migration, or angular bands in a stent-graft or narrowing and occlusion of a stent-graft lumen are potentially life-threatening and difficult to perceive without constant monitoring. Therefore, our work aimed to propose a new ex-vivo system called Human-Cardiovascular-System-Phantom (HCSP) to simulate pulsatile hemodynamic in the abdominal aortic aneurysm (AAA) before and after stent-graft placement. Materials and Methods: To verify the system twelve AAA-models, before and after medical treatment, were reconstructed based on medical data from AngioCT and US-Doppler. Furthermore, the 3D printed models were installed in the HCSP to reconstruct pulsatile flow and mechanical behavior of the aortic aneurysm wall which was tracked with DC. Clinical data, including results from 2D-Speckle-tracking-technique (2DSTT), were also used to verify wall deformation for heart rate ranging between 60 to 120 min $^{-1}$ , and were confronted with results on wall deformation measured with DC in 3D printed aneurysms. Results: HCSP was able to track and calculate wall deformation with accuracy from 94.4% to 100% compared to 2DSTT. Wall deformation calculated with DC did not statistically vary from 2DSTT values. For instance, wall deformation measured with 2DSTT for anterior position and for 70 min $^{-1}$ was equal to 4.18±0.05 mm, 3.70 ± 0.08 mm and 2.00 ± 0.08 mm for AAA, AAA+thrombus and AAA+stent-graft, respectively. Those values were comparable with those measured with DC. Conclusions: The proposed HCSP allows to successfully follow hemodynamic changes in the AAA-model with thrombus or stent-graft and under different hemodynamic conditions. Thus, our approach may be useful in monitoring the influence of a stent-graft’s spatial configuration on different hemodynamic parameters inside the AAA in the laboratory conditions.

Imaging Findings after Stent-graft Placement in the Aorta

Imaging Findings after Stent-graft Placement in the Aorta

Salvage Procedure Using a Chimney Endograft for Early Cerebral Ischaemia after Hybrid Aortic Arch Repair of a Primary Aorto-bronchial Fistula.

IntroductionHybrid aortic arch repair for the treatment of aorto-bronchial fistulas has been suggested as a safe alternative to open repair. However, surgical morbidity and mortality are still significant and re-intervention is sometimes inevitable.ReportSuccessful rescue by a hybrid approach is reported in a 76 year old woman who was transferred from another centre with recurrent episodes of left hemiplegia shortly after debranching of the supra-aortic vessels and thoracic aortic stent grafting for an aorto-bronchial fistula associated with a true aneurysm at the level of origin of the left subclavian artery. Investigation revealed partial coverage of the ostium of the brachiocephalic artery and Type Ib and II endoleaks. In the first stage a chimney graft was put into the brachiocephalic trunk, and in the second stage the left subclavian artery was plugged and the thoracic stent graft was extended distally. Completion angiography showed restoration of the supra-aortic blood flow and no residual endoleaks. After 1 year follow up the patient was doing well with no recurrent neurological events and no signs of infection.DiscussionProcedure related problems should be suspected first when early post-operative complications occur after a hybrid aortic arch repair. The chimney graft technique is a valuable option for unintentional covering of a critical supra-aortic branch. Nevertheless, the importance of precise positioning during initial thoracic stent graft placement should be emphasised.

Ruptured abdominal aortic aneurysm after endovascular repair

Introduction. An aneurysm is a localized, permanent dilation of an arterial blood vessel with a diameter greater than 50% of the usual diameter for that aortic segment. It is treated with endovascular stent graft placement or open surgery. Endovascular stent grafting of the abdominal aorta has become popular as an elective treatment. but one of the complications is increased aneurysm diameter that may lead to rupture. Case Series. This case series reviews open reconstructive surgery of ruptured abdominal aortic aneurysms in three patients treated with endovascular repair. The diameter of the aneurysm increased due to endoleak or stent graft migration, leading to rupture. Due to the inability to extract the stent graft in two patients, the graft was transversely cut at the proximal part, where upper anastomosis was created using a Dacron graft prosthesis. Conclusion. Regular annual controls for the rest of patients lives are of great importance in order to avoid fatal complications after endovascular aneurysm repair. One of the methods after the abdominal aortic rupture after endovascular stent graft treatment that significantly shortens the duration of the surgery and gives a more stable upper anastomosis, is transverse stent graft cut in the proximal part. Complete prevention remains a challenge because a rupture may occur even if the abnormalities are not evident. The ultimate goal is to increase the survival rate after the ruptured abdominal aortic aneurysm.

Endolymphatic Thoracic Duct Stent-Graft Reconstruction for Chylothorax: Approach, Technical Success, Safety, and Short-term Outcomes

To report approach, technical success, safety, and short-term outcomes of thoracic duct stent-graft reconstruction for the treatment of chylothorax. Two patients, 1 (50%) male and 1 (50%) female, with mean age of 38years (range: 16-59years) underwent endolymphatic thoracic duct stent-graft reconstruction between September 2016 and July 2017. Patients had radiographic left-sided chylothoraces (n=2) from idiopathic causes (n=1) and heart transplantation (n=1). In both (100%) patients, antegrade lymphatic access was used to opacify the thoracic duct after which retrograde access was used for thoracic duct stent-graft placement. Pelvic lymphangiography technical success, antegrade cisterna chyli cannulation technical success, thoracic duct opacification technical success, retrograde thoracic duct access technical success, thoracic duct stent-graft reconstruction technical success, ethiodized oil volume, contrast volume, estimated blood loss, procedure time, fluoroscopy time, radiation dose, clinical success, complications, deaths, and follow-up were recorded. Pelvic lymphangiography, antegrade cisterna chyli cannulation, thoracic duct opacification, retrograde thoracic duct access, and thoracic duct stent-graft reconstruction were technicallysuccessful in both (100%) patients. Mean ethiodized oil volume was 8mL (range: 5-10mL). Mean contrast volume was 13mL (range: 5-20mL). Mean estimated blood loss was 13mL (range: 10-15mL). Mean fluoroscopy time was 50.4min (range: 31.2-69.7min). Mean dose area product and reference air kerma were 954.4 μGmy2 (range: 701-1,208 μGmy2) and 83.5mGy (range: 59-108mGy), respectively. Chylothorax resolved in both (100%) patients. There were no minor or major complications directly related to the procedure. Thoracic duct stent-graft reconstruction may be a technically successful and safe alternative to thoracic duct embolization, disruption, and surgical ligation for the treatment of chylothorax. Additional studies are warranted.

Femoro-Supragenicular Popliteal Bypass with a Bridging Stent Graft in a Diffusely Diseased Distal Target Popliteal Artery: Alternative to Below-Knee Popliteal Polytetrafluoroethylene Bypass.

BackgroundLesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease.MethodsBetween April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral–above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications.ResultsAll procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months), and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55) significantly increased to 0.8 (range, 0.5 to 1.0) at 12 months (p<0.01). The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks.ConclusionIn AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK) bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.