Substent Anchor Technique for Recanalisation of a Full Metal Jacket Femoropopliteal In-Stent Occlusion

Abstract

PurposeTo report the endovascular treatment of a full metal jacket (FMJ) femoropopliteal chronic total occlusion (CTO) using a new ancillary retrograde technique.Case reportAn 80 year old woman with type 2 diabetes presented to the Diabetic Foot Clinic with critical limb ischaemia with tissue loss in the right leg. Her comorbidities included coronary artery disease, morbid obesity, hypertension, dyslipidaemia, and active smoking habit. The patient had been treated at another hospital by femoropopliteal FMJ stenting six years before this presentation. The duplex ultrasound showed a full length in-stent re-occlusion. An antegrade recanalisation was attempted via contralateral femoral access, but was unsuccessful. An ultrasound guided retrograde puncture of the popliteal artery in the P2 segment was performed very close to the distal occluded stent. A 0.018 guidewire was pushed in the substent plane, functioning as an anchor to achieve a stable system. The FMJ was then retrogradely recanalised with a second guidewire. The procedure was completed by antegrade angioplasty with drug coated balloons.ConclusionThe substent anchor technique can help to achieve stability even if close to the occluded stents, and spares the distal landing zone for surgical revascularisation if the endovascular approach fails. This technique could be useful in retrograde treatment of long in-stent CTO.

A case report of valve-sparing aortic root replacement in a patient with full metal jacket aorta

“…As a result, the vasculature after TEVAR became different from native, so that more caution In our case, previous open surgery for aortic dissection and multiple stent graft procedures led to an unusual situation so-called full metal jacket aorta. The expression of "full metal jacket aorta" is a term coined concerning the entirely stented coronary or peripheral artery by catheter intervention (12)(13)(14).…”

The safety and efficacy of different endovascular treatments for in-stent restenosis of the femoropopliteal artery: A network meta-analysis

“…Debulking with atherectomy devices, and especially ELA, plays a vital role in the treatment of femoropopliteal ISR. 43,44 Most of the existing studies involved a 1-year follow-up and did not include stent type. Debulking technologies (ELA or DA) combined with DCB in the treatment of femoropopliteal ISR require more exploration in complex lesions, longer follow-up results, and different stent types.…”

Substent Anchor Technique for Recanalisation of a Full Metal Jacket Femoropopliteal Occlusion: An Unconventional Road to Rome

“…In the current issue of European Journal of Vascular and Endovascular Surgery Short Reports Testi et al. present an unconventional way to recanalise a chronic total occlusion (CTO) of a previously full metal jacket (FMJ) stented femoropopliteal arterial segment 1 . With the rapid expanding endovascular armamentarium the number of complex atherosclerotic lesions will increase significantly and patients, such as those presented in the case of Testi et al.…”