Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia

Abstract

The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA) in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft.

Superficial Femoral Artery Rupture “Bailed Out” Using Novel Design of Supera Stent

“…Although Supera stents are conventionally made for the treatment of atherosclerotic peripheral arteries, its use is not restricted to it. The stent has previously been utilized for the successful treatment of PA aneurysms as described by Tessarek 10 and iatrogenic perforation as mentioned by Eisele et al 11 The control of iatrogenic rupture involved the use of overlapping insertion of two stents; however, the unique design and longitudinal flexibility offered by a single Supera stent can be used to control a focal arterial rupture. We used this property of Supera's dynamic architecture by closely arranging the struts of the stent at the focal ruptured site for controlling bleeding from SFA, thus successfully averting the use of overlapping stent and possibly reducing the chances of restenosis.…”

Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries

“…Particularly in vessels smaller than 3 mm in diameter, perforation may occur due to complete filling of the vessel by the catheter, which may eventually suck the vessel wall into the side windows of the catheter head. Although such complications can in most cases be treated by prolonged balloon inflation or by stent placement without requiring surgical action[ 16 , 20 ], the use of the 6F Rotarex ® S system is not currently generally recommended for crural arteries in the current literature[ 21 ]. In this regard, the use of the Rotarex ® S has been reported only in a relatively small number of patients with ALI involving below the knee vessels ( n = 4 in the study of Stanek et al[ 18 ]).…”