upon identification of the patient is kept supine on the operating table. Standard sterile preparation done after sedation with a 3 mg Versed. Local anesthesia given with 1% lidocaine. As described above patient had a right femoropopliteal bypass graft with proximal anastomosis to the right common femoral artery and distal anastomosis to the distal part of the right popliteal artery in the infra genicular position. This was a 8 mm entering Gore-Tex graft. I accessed the Gore-Tex graft below the knee with an ultrasound using the SonoSite. Ultrasound has shown a occluded femoropopliteal bypass graft. I accessed that with a micropuncture needle and changed to 7 French sheath, I did a diagnostic arteriogram which showed an occluded femoropopliteal bypass graft. At this point systemic anticoagulation was given with IV heparin and maintain ACT more than 200 throughout the case. And changed to Inari InThrill sheath. The I advanced a Inari InThrill catheter across the occluded femoropopliteal bypass graft into the iliac artery. And I did a percutaneous mechanical thrombectomy using the Inari catheter. After multiple passes I could see a backflow into the sheath. At this point I accessed the femoral popliteal bypass graft right at the groin with the sheath facing towards the knee. I accessed that with a micropuncture needle then changed that to 4 French sheath followed by 7 French sheath using ultrasound. Then I managed to pass a 035 Glidewire under trailblazer catheter through the distal anastomosis below the knee and managed to advance into the anterior tibial artery which is a single-vessel run-off to the right foot. After that I predilated the distal anastomosis. Still have a lot of resistance. At this point I introduced a Volcano Pioneer IVUS probe and did a IVUS evaluation of the entire graft across the anastomosis. That showed wire is in the lumen of the femoral-popliteal bypass graft. And also advanced into the anterior tibial artery lumen. After the confirmation that the wire is in the intraluminal the distal part of the right anterior tibial arter a predilated the distal anastomsis witha 5 mm balloon. Then I successfully deployed a 6 x 120 mm EV-3 year old flex self expanding stent from the ostium of the right anterior tibial artery in the femoropopliteal bypass graft. Then I postdilated with a 6 mm balloon. After that the Inari access sheath entry into the graft was close by 8 x 50 mm Gore Tex Viabahn covered stent graft. The angiogram has shown
a completely reopened entire femoral-popliteal bypass graft with a good run off into the right anterior tibial artery. I noted some filing defects in the mid segment of the femoral-popliteal graft. At this point I deployed a 8 x120 mm EV 3 year flex self expanding stent into the mid part of the femoropoliteal bypass graft. A completion angiogram at the end shown excellent result with a completely reopened femoropopliteal bypass graft. There is no evidence of any bleeding at the Inari catheter sheath entry site. And there is excellent distal flow into the right anterior tibial artery. I could also see some flow going down to the posterior tibial artery as well.
a completely reopened entire femoral-popliteal bypass graft with a good run off into the right anterior tibial artery. I noted some filing defects in the mid segment of the femoral-popliteal graft. At this point I deployed a 8 x120 mm EV 3 year flex self expanding stent into the mid part of the femoropoliteal bypass graft. A completion angiogram at the end shown excellent result with a completely reopened femoropopliteal bypass graft. There is no evidence of any bleeding at the Inari catheter sheath entry site. And there is excellent distal flow into the right anterior tibial artery. I could also see some flow going down to the posterior tibial artery as well.