Endovascular treatment of an occluded axillofemoral bypass graft.
Unsuspected subclavian or axillary disease may cause failure of axillofemoral bypass grafts. A 52-year-old woman who underwent left axillofemoral bypass grafting 5 years ago presented with 24 h of left foot pain. Routine duplex ultrasonography 2 months previously demonstrated velocities throughout the graft > 80 cm/s. Emergent angiography revealed thrombotic occlusion of the axillofemoral bypass graft. Both rheolytic thrombectomy and pulse spray thrombolysis using tissue plasminogen activator were used to restore graft patency. Arterial pressure waveform and pressure remained damped throughout the graft; a 50 mmHg gradient was found from the descending thoracic aorta to the mid-left subclavian artery. Angiography revealed a 70% diameter stenosis at the origin of the left subclavian artery. Following balloon angioplasty and stent placement, the pressure gradient was eliminated. In conclusion, careful evaluation of arterial inflow to bypass grafts is critical for ensuring long-term graft patency.
Slovut
David P
DP
Department of Cardiology, St Mary's/Duluth Clinic Heart Center, Duluth, Minnesota, USA. david.slovut@mssm.edu
Bacharach
J Michael
JM
D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D001366:Axillary Artery / Q000601:surgery; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D015607:Stents; D013348:Subclavian Artery / Q000473:pathology; D017131:Thrombectomy; D014654:Vascular Patency; D014656:Vascular Surgical Procedures