Balloon-Expandable Covered Stent to Superficial Femoral Artery

J INVASIVE CARDIOL 2023;35(8):E75-E83

Key words: superficial femoral artery, chronic total occlusion, balloon-expandable covered stent

A 57-year-old woman with critical limb-threatening ischemia (CLTI) of the left lower leg underwent endovascular therapy (Figure 1A). She had undergone a femoropopliteal (F-P) bypass for treatment of chronic total occlusion (CTO) of the superficial femoral artery (SFA) four years prior. However, its occlusion occurred. Thus, a self-expandable stent was placed at the F-P bypass anastomosis three years previously. Nevertheless, the F-P bypass occluded, and CLTI recurred. Therefore, distal bypass (common femoral artery [CFA] – anterior tibial artery [ATA]) was performed one year prior (Figure 1B).

However, occlusion recurred three months previously. Lower-limb arteriography revealed an occluded native SFA, F-P bypass, and distal bypass (Figure 1C, Video). Using the distal puncture technique, we crossed the wire to the dorsalis pedis artery (DPA). We dilated the CTO of the SFA at the F-P bypass anastomosis jailed by the stent. However, we could not achieve sufficient dilation because the wire passed through the stent strut (Figure 1D, E, Video). Notably, the lesion could not be expanded without destroying the stent strut. Therefore, we used a balloon-expandable covered stent (VBX, Gore-Tex) (Figure 1F, Video). Sufficient dilation was observed (Figure 1G). Subsequently, we placed self-expandable stents in the proximal and middle SFA (Video). Additionally, the ATA was dilated using a noncompliant balloon (Video). Finally, we obtained sufficient blood flow to the DPA (Figure 1H, Video). In such cases, no other alternatives exist for sufficient expansion of the CTO of the SFA at the F-P bypass anastomosis. While placement of balloon-expandable covered stents in the SFA has not been adapted, it can be effective for sufficient dilation and limb salvage.

Affiliations and Disclosures

From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan.

Disclosure: The authors report no financial relationships or conflicts of interest regarding the content herein. The study was published with the written consent of the patient. Ethics approval for this single-case analysis was waived by the Ethics Committee of Tokushima Red Cross Hospital.

Manuscript accepted January 23, 2023.

Address for correspondence: Hiroto Tamura, Department of Cardiology, Tokushima Red Cross Hospital, 103 Irinokuchi, Komatsushima-cho, Komatsushima, Tokushima 773-8502, Japan, Email: hiroto.tamura2118@gmail.com.