Advanced treatment of acute femoropopliteal bypass graft occlusion with Fogarty catheter guidance

Abstract

Purpose

The guiding role of the Fogarty catheter was investigated among patients suffering from limb ischemia due to acute femoropopliteal bypass graft occlusion.

Methods

A total of 27 patients with a history of femoropopliteal bypass operation who was admitted with acute limb ischemia were enrolled in this retrospective study. In cases in which the Fogarty catheter could not be passed through the popliteal anastomosis, the popliteal region was explored and a new bypass or patch plasty was performed for the distal anastomosis. The cases in which the blood circulation was observed in the graft, but in which the Fogarty catheter balloon was stuck in the native vessels on the proximal and distal side of the graft and the balloon could be withdrawn by deflation, were referred to conventional angiography. The stenosis observed in native vessels was managed by endovascular stent grafting and/or balloon dilatation.

Findings

Graft patency was achieved in all patients. In 11 patients, conventional angiography was implemented following embolectomy. In these patients, all the occlusions found as significant on angiography were removed by percutaneous transluminal angioplasty.

Conclusion

Effective use of Fogarty catheter is safe in acute femoropopliteal bypass graft occlusions and in particular, in the planning of further treatment following thrombectomy.

Keywords

Atherosclerosis acute ischemia of extremities thrombosis

Get full access to this article

View all access options for this article.

References

Voorhees

Jr Jaretzki

Blakemore

. The use of tubes constructed from vinyon ‘N’ cloth in bridging arterial defects. Ann Surg 1952; 135: 332–332.

Vohra

Thomson

Carr

. Comparison of different vascular prostheses and matrices in relation to endothelial seeding. Br J Surg 1991; 78: 417–420.

Tiwari

Salacinski

Seifalian

. New prostheses for use in bypass grafts with special emphasis on polyurethanes. Cardiovasc Surg 2002; 10: 191–197.

Scharn

Daamen

van Kuppevelt

. Biological mechanisms influencing prosthetic bypass graft patency: possible targets for modern graft design. Eur J Vasc Endovasc Surg 2012; 43: 66–72.

Libby

Tanaka

. The molecular bases of restenosis. Prog Cardiovasc Dis 1997; 40: 97–106.

O’ Brien

Simard

. Pathogenesis of Neointima formation following vascular injury. Cardiovasc Hematol Disord Drug Targets 2011; 11: 30–39.

Morrison

. Catheter-directed thrombolysis for acute limb ischemia. Semin Intervent Radiol 2006; 23: 258–269.

Jackson

Belott

Dickason

. The consequences of a failed femoropopliteal bypass grafting: comparison of saphenous vein and PTFE grafts. J Vasc Surg 2000; 32: 498–505.

Berkan

Aksoy

Önen

. Akut arter oklüzyonları. Damar Cer Derg 1998; 2: 69–72.

10.

Yucel

Dumoulin

Waltman

. MR angiography of lower-extremity arterial disease: preliminary experience. J Magn Reson Imaging 1992; 2: 303–309.

11.

Reid

Heriberto

RPM

Menzoian

. Contrast enhanced moving-table MR angiography: prospective comparison to catheter arteriography for treatment planning in peripheral arterial occlusive disease. J Vasc Interv Radiol 2001; 12: 45–53.

12.

Jackson

Johnson

Williford

. The effect of anticoagulation therapy and graft selection on the ischemic consequences of femoropopliteal bypass graft occlusion: results from a multicenter randomized clinical trial. J Vasc Surg 2002; 35: 292–298.

13.

Tilanus

Obertop

Van Urk

. Predictive factors for thrombosis of PTFE femoropopliteal bypass grafts and the management of this complication. Neth J Surg 1988; 40: 37–40.

14.

Wissgott

Kamusella

Richter

. Treatment of acute femoropopliteal bypass graft occlusion: comparison of mechanical rotational thrombectomy with ultrasound-enhanced lysis. Rofo 2008; 180: 547–552.

15.

Abraham-Igwe

Siddiqui

Geddes

. A retrospective study examining thrombolysis for occluded femoro-popliteal grafts – is it worthwhile? Int J Surg 2011; 9: 632–635.

16.

Ouriel

Gray

Clair

. Complications associated with the use of urokinase and recombinant tissue plasminogen activator for catheter-directed peripheral arterial and venous thrombolysis. J Vasc Interv Radiol 2000; 11: 295–298.

17.

Sugimoto

Hofmann

Razavi

. The safety, efficacy, and pharmacoeconomics of low-dose alteplase compared with urokinase for catheter-directed thrombolysis of arterial and venous occlusions. J Vasc Surg 2003; 37: 512–517.