Both occlusion and pseudoaneurysm are complications of femoropopliteal bypass surgery. Open revision is the gold standard, but it is associated with high morbidity and mortality compared with endovascular treatment. Percutaneous stent-graft repair is a valid option either for recovering the patency of occluded prosthetic femoropopliteal bypass or for excluding anastomotic pseudoaneurysm. In this report, it is presented a case of occlusion concomitant to a pseudoaneurysm of the distal anastomosis in a previous prosthetic femoropopliteal bypass; a simultaneous endovascular treatment of both complications has been performed through self-expanding stent-graft (Viabahn) placement.

Background Recanalization of graft limb occlusion can prove challenging and the use of the GoBack crossing and reentry device may be a suitable option, especially when there is no other way to restore flow with an usual endovascular approach. The GoBack catheter is a novel device designed to enhance pushability, and to enable direction-change inside hard plaques and crossing of tough lesions, even when they involve graft fabric. Case presentation It’s reported a case of a 76-year-old male who presented with claudication, previous placement of an aorto-bi iliac graft by open surgery for a ruptured abdominal aneurysm 10 years ago that, over time, developed severe kinking on the left limb and a fabric occlusion on the right limb. After several unsuccessful attempts to cross the occlusion of the right common iliac artery, the GoBack™ was deployed to create a lumen through graft’s folds. After angioplasty and stenting a satisfactory result was achieved, restoring flowCT-scan at 1 month and duplex ultrasound (DUS) at 3 months confirmed the patency of ilio-femoral axis. Conclusions The advent of this new CTO crossing device has the potential to facilitate recanalization of some of the most challenging occlusions. Facilitating more consistent distal entry and allowing for a decrease in crossing time. Therefore, the GoBack catheter should be considered as a potential complementary tool to treat vascular occlusions via endovascular approaches, especially when classical endovascular techniques fail.