Pasveer Erik, van Eps Randolph G S, Wever Jan J, van Overhagen Hans, van Dijk Lukas C, Veger Hugo T C
Department of Vascular Surgery, HagaZiekenhuis, The Hague, The Netherlands.
Department of Interventional Radiology, HagaZiekenhuis, The Hague, The Netherlands.
Ann Vasc Surg. 2019 Jul;58:374-376. doi: 10.1016/j.avsg.2018.12.066. Epub 2019 Feb 13.
Bilateral limb occlusion after aortobifemoral (ABF) prosthesis occurs in 1-3% patients. Multiple remedial choices are known in literature to manage a bilateral occluded ABF such as "redo" ABF bypass, axillobifemoral bypass, endovascular recanalization of the native aortoiliac system, and thrombectomy. We present a patient with an occluded ABF bypass since 2001. A new minimal invasive treatment strategy was performed by traversing the occluded limbs with aortic re-entry using stiff Terumo wires. To make way for safe passing of the stents, kissing balloon angioplasty was performed of the entire ABF bypass. Kissing Viabahn (W. L. Gore & Associates, Flagstaff, AZ) balloon-expandable stents were placed in the proximal part of the ABF bypass and extended with a Viabahn self-expandable stent (standard Viabahn). This option should be added to the known multiple remedial choices in case of bilateral limb occlusion of an ABF.
主动脉双股动脉（ABF）人工血管置换术后双侧肢体闭塞在1%至3%的患者中出现。文献中已知有多种补救选择来处理双侧闭塞的ABF，如再次进行ABF搭桥、腋股动脉搭桥、对原生主动脉髂动脉系统进行血管腔内再通以及血栓切除术。我们报告一例自2001年起ABF搭桥闭塞的患者。采用硬的泰尔茂导丝通过闭塞肢体并重新进入主动脉，实施了一种新的微创治疗策略。为使支架安全通过，对整个ABF搭桥进行了球囊对吻血管成形术。在ABF搭桥近端置入了球囊扩张式的对吻Viabahn（WL戈尔公司，亚利桑那州弗拉格斯塔夫）支架，并用一个Viabahn自膨式支架（标准Viabahn）进行延伸。对于ABF双侧肢体闭塞的情况，这种选择应添加到已知的多种补救选择中。
