1 Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy.
J Endovasc Ther. 2019 Feb;26(1):128-132. doi: 10.1177/1526602818815699. Epub 2018 Nov 30.
To report an alternative approach for rescue of an occluded aortofemoral bypass using the Gore Excluder Iliac Branch Endoprosthesis (IBE).
A 52-year-old man presented with acute right limb ischemia because of displaced and occluded iliac stents and was treated with aortofemoral bypass. On the third postoperative day, there was early bypass failure due to distal embolization from aortic thrombus. After fluoroscopy-guided balloon thrombectomy of the bypass, an endovascular bailout strategy was used. The Gore Excluder IBE was deployed below the renal arteries (with the external iliac limb opening in the surgical prosthesis and the gate opening within the aortic lumen). After antegrade catheterization of the gate, a Gore Viabahn endoprosthesis was inserted as the bridging endograft and deployed so that it landed just above the preimplanted aortoiliac kissing stents without overlapping them. Completion angiography showed technical success without complications; results were sustained at 1-year follow-up.
The Gore Excluder IBE may represent a versatile solution for the rescue of complex cases when open surgery would be associated with a considerable risk. This off-label application of a well-recognized endovascular device is safe and feasible and may prove useful as a valuable alternative in properly selected patients.
报告一种使用戈尔 Excluder 髂支内支架移植物（IBE）抢救闭塞的主动脉-股动脉旁路的替代方法。
一名 52 岁男性因髂支架移位和闭塞导致急性右肢缺血，接受了主动脉-股动脉旁路手术。术后第 3 天，由于主动脉血栓导致远端栓塞，出现早期旁路失败。在透视引导下对旁路进行球囊血栓切除术，采用血管内紧急救援策略。将戈尔 Excluder IBE 部署在肾动脉以下（髂外支开口位于外科假体中，门开口位于主动脉管腔中）。在门的顺行导管插入后，插入 Gore Viabahn 覆膜支架作为桥接覆膜支架，并将其放置在预先植入的主动脉-髂动脉吻合并置支架上方，不重叠。完成血管造影显示技术成功，无并发症；在 1 年随访时结果持续。
当开放手术风险较大时，戈尔 Excluder IBE 可能是抢救复杂病例的一种多功能解决方案。这种经过充分验证的血管内设备的超适应证应用是安全可行的，并且可能在适当选择的患者中作为一种有价值的替代方法而有用。
