75 year old male, prior right leg bypass graft from the common femoral artery to the anterior tibial artery. Bypass graft failed due to poor outflow in the anterior tibial artery. During thrombolysis the patient had a large retroperitoneal bleed. Treatment was stopped and the patient was told there were no other options. The patient came with rest pain at night, digital ulcerations, and 15 foot claudication. An initial attempt using a traditional approach to recanalization of the superficial femoral and poplieteal arteries failed. A second attempt at revascularization using the femoral and popliteal veins as a route to create a percutaneous bypass graft from the common femoral artery to the popliteal artery was successful.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
Review of the clinical findings and their usefulness in identifying patients with peripheral arterial disease
Endovascular repair of an anastomic stenosis of a aortobifemoral bypass graft using JetStream atherectomy