Endovascular treatment of an occluded axillofemoral bypass graft

David P. Slovut, J. Michael Bacharach

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Unsuspected subclavian or axillary disease may cause failure of axillofemoral bypass grafts. A 52-year-old woman who underwent left axillofemoral bypass grafting 5 years ago presented with 24 h of left foot pain. Routine duplex ultrasonography 2 months previously demonstrated velocities throughout the graft >80 cm/s. Emergent angiography revealed thrombotic occlusion of the axillofemoral bypass graft. Both rheolytic thrombectomy and pulse spray thrombolysis using tissue plasminogen activator were used to restore graft patency. Arterial pressure waveform and pressure remained damped throughout the graft; a 50 mmHg gradient was found from the descending thoracic aorta to the mid-left subclavian artery. Angiography revealed a 70% diameter stenosis at the origin of the left subclavian artery. Following balloon angioplasty and stent placement, the pressure gradient was eliminated. In conclusion, careful evaluation of arterial inflow to bypass grafts is critical for ensuring long-term graft patency.

Original languageEnglish (US)
Pages (from-to)33-36
Number of pages4
JournalVascular Medicine
Volume10
Issue number1
DOIs
StatePublished - May 26 2005

Keywords

  • Axillofemoral bypass graft
  • Extra-anatomic bypass graft
  • Stent
  • Subclavian artery stenosis
  • Thrombectomy
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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