No abstract

We present a case of failed popliteal artery aneurysm repair using a Viabahn stent graft (W. L. Gore & Associates, Flagstaff, Ariz) due to laminated thrombus formation. A 75-year-old man presented with a symptomatic popliteal artery aneurysm. He was treated with a Viabahn stent graft. On follow-up, the patient complained of lower extremity claudication, and duplex ultrasound examination showed a focal intrastent stenosis. A computed tomography scan showed a significant stenosis within the stent graft, at the level of the knee joint creases. The patient underwent superficial femoral artery to distal popliteal surgery. This case report aims to expand on the mechanism of stent graft failure in popliteal aneurysms.

Results: Clinical case 2 describes a 48-year-old woman with a history of Takayasus arteritis, prior proximal descending thoracic aorta to infrarenal abdominal aortic bypass and bypass to the left renal artery for mid-aortic syndrome, and atrophic right kidney presented with severe hypertension, fluid overload, and hyperkalemia, and a creatinine of 5.8 mg/dL requiring urgent dialysis. She was anuric and dialysis dependent. Magnetic resonance angiography revealed occlusion of the left renal artery bypass which originated from the aortic bypass graft and collateral filling of the left kidney with differential areas of perfusion (Fig 2). She underwent redo aortic graft to left renal artery bypass 18 days after her initial presentation. Upon discharge, she was no longer dialysis dependent and her creatinine has normalized.Conclusions: Two patients presenting with dialysis dependent acute renal failure underwent delayed renal artery revascularization, greater than 14 days from their presentation. Complete renal recovery with return to baseline renal function was observed in these patients. In select patients, delayed renal artery revascularization (>48 hours of warm ischemic time) is controversial, but can be associated with complete renal recovery and freedom from dialysis.

Objective: In-stent stenosis is a frequent complication of superficial femoral artery (SFA) endovascular intervention and can lead to stent occlusion or symptom recurrence. Arterial duplex ultrasound stent imaging (ADSI) can be used in the surveillance for recurrent stenosis; however, its uniform application is controversial. In this study, we aimed to determine, in patients undergoing SFA stent implantation (SI), whether surveillance with ADSI yielded a better outcome than in those with only anklebrachial index (ABI) follow-up.Methods: We performed a retrospective analysis of all patients undergoing SFA SI for occlusive disease at a tertiary care referral center between 2009 and 2016. The patients were divided into those with ADSI (ADSI group) and those with ABI follow-up only (ABI group). Life-table analysis comparing stent patency, major adverse limb event (MALE), limb salvage, and mortality between groups was performed.Results: There were 248 patients with SFA SI included, 160 in the ADSI group and 88 in the ABI group. Groups were homogeneous regarding clinical indication (claudication/critical limb ischemia, ADSI 39%/61% vs ABI 38%/62%; P ¼ .982) and TransAtlantic Inter-Society Consensus classification (A/B/C/D for ADSI 17%/45%/16%/22% and ABI 21%/43%/16%/20%; P ¼ .874). Primary patency (PP) was similar between groups at 12, 36, and 56 months (ADSI, 65%/43%/32%; ABI, 69%/34%/34%; P ¼ .770), whereas ADSI patients showed an improved assisted PP (84%/68%/54%) vs ABI (76%/38%/38%; P ¼ .008) and secondary patency (Fig 1). There was a greater freedom from MALE in the ADSI group (91%/76%/64%) vs the ABI group (79%/46%/46%; P < .001) at 12, 36, and 56 months of followup. ADSI patients were more likely to undergo an endovascular procedure as their initial post-SFA SI intervention (P ¼ .001), whereas ABI patients were more likely to undergo an amputation (P < .001; Fig 2).Conclusions: In SFA SI, patients with ADSI follow-up demonstrate an advantage in assisted PP and secondary patency and are more likely to undergo an endovascular reintervention. These factors likely effected a decrease in MALE, indicating the benefit of a more universal adoption of post-SFA SI follow-up ADSI.