VS04 - Hybrid Leg Revascularization: Remote Endarterectomy & Deep Vein Bypass to Posterior Tibial Artery

Friday, June 17, 2022

10:51 AM – 11:01 AM EDT

Presenting Author only(s)

LK

Lee Kirksey, MD, MBA

Professor and Vice Chairman
The Cleveland Clinic
Cleveland, Ohio

Video

Submitting Author only(s)

HD

Hassan Dehaini

Postdoctoral Research Fellow
The Cleveland Clinic
Cleveland, Ohio

Co-Author(s)

Ahmed A. Sorour, MD

Cleveland Clinic
SHAKER HEIGHTS, Ohio
FC

Francis J. Caputo, MD

Associate Professor and Program Director
The Cleveland Clinic
Cleveland, Ohio
Christopher J. Smolock, MD

Quality Improvement Officer and Staff Vascular Surgeon
Cleveland Clinic Foundation
Cleveland, Ohio

Senior Author(s)

SL

Sean P. Lyden, MD

Professor and Chairman
The Cleveland Clinic
Cleveland, Ohio

Summary: Early endovascular intervention for intermittent claudication is a common practice and is associated with progression to chronic limb-threatening ischemia and elevated amputation risk. When failure for this common approach ultimately occurs, the result is a complex arterial occlusive pattern. Coupled with absent autologous vein conduit, the risk of amputation for this patient profile is high. Remote endarterectomy with endovascular stent explant is a reliable technique to treat chronic total occlusion of the superficial femoral artery (SFA) and restore inflow. In this educational video, we describe a patient who had previously undergone multiple vascular procedures, including SFA stenting and failed, prosthetic and vein bypass. Revascularization was achieved by using a hybrid technique: remote endarterectomy with SFA stents extraction, followed by autologous spliced vein (femoral and cephalic veins) bypass from distal SFA to distal posterior tibial artery. This hybrid intervention represents a novel technique for addressing complex arterial occlusive anatomy in re-operative patients with limb threat.