{"title":"The ViaHole technique: a novel approach for recanalizing major side branch occluded by Viabahn stent-graft.","authors":"Takuya Haraguchi, Masanaga Tsujimoto, Ryo Otake, Yoshifumi Kashima, Katsuhiko Sato, Tsutomu Fujita","doi":"10.1186/s42155-023-00385-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>In managing arterial rupture, stent-graft implantation may cause limb ischemia by crossing a major branch for hemostasis. The ViaHole technique could circumvent a major branch occlusion.</p><p><strong>Materials and methods: </strong>The process involved advancing retrograde devices into an occluded major branch by the stent-graft implantation to reach the outer surface of the stent-graft, puncturing the stent-graft with a 20-gauge needle to touch the retrograde device, manipulating the guidewire through the needle hole and externalizing it, advancing the microcatheter into the proximal lumen, catching the microcatheter using an antegrade 4-Fr catheter, inserting an antegrade guidewire into the retrograde microcatheter to cross the stent-graft hole, dilating the lesion and stent-graft hole using a 3.0-mm balloon, and ensuring hemostasis at the puncture site.</p><p><strong>Results: </strong>A 72-year-old male with a history of stent-grafted treatment for right popliteal aneurysm presented with acute limb ischemia (ALI). The occlusion spanned distal superficial femoral artery to the below-the-knee arteries. Hemostasis was achieved after an unintentional rupture of the proximal posterior tibial artery during surgical thrombectomy by implanting endoluminal stent-grafts instead of surgical bypass due to no distal anastomosis site. However, recurrent ALI occurred three months later. Surgical bypass was again deemed unfeasible due to no run-off. Unsuccessful recanalization attempts of the bilateral tibial arteries led us to perform the ViaHole technique to recanalize the peroneal artery occlusion. Finally. successful revascularization was achieved, and 1-year patency was confirmed.</p><p><strong>Conclusions: </strong>The ViaHole technique may be valuable for revascularizing a major side branch occluded by stent-graft implantation.</p>","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10349792/pdf/","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CVIR Endovascular","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s42155-023-00385-8","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 1
Abstract
Introduction: In managing arterial rupture, stent-graft implantation may cause limb ischemia by crossing a major branch for hemostasis. The ViaHole technique could circumvent a major branch occlusion.
Materials and methods: The process involved advancing retrograde devices into an occluded major branch by the stent-graft implantation to reach the outer surface of the stent-graft, puncturing the stent-graft with a 20-gauge needle to touch the retrograde device, manipulating the guidewire through the needle hole and externalizing it, advancing the microcatheter into the proximal lumen, catching the microcatheter using an antegrade 4-Fr catheter, inserting an antegrade guidewire into the retrograde microcatheter to cross the stent-graft hole, dilating the lesion and stent-graft hole using a 3.0-mm balloon, and ensuring hemostasis at the puncture site.
Results: A 72-year-old male with a history of stent-grafted treatment for right popliteal aneurysm presented with acute limb ischemia (ALI). The occlusion spanned distal superficial femoral artery to the below-the-knee arteries. Hemostasis was achieved after an unintentional rupture of the proximal posterior tibial artery during surgical thrombectomy by implanting endoluminal stent-grafts instead of surgical bypass due to no distal anastomosis site. However, recurrent ALI occurred three months later. Surgical bypass was again deemed unfeasible due to no run-off. Unsuccessful recanalization attempts of the bilateral tibial arteries led us to perform the ViaHole technique to recanalize the peroneal artery occlusion. Finally. successful revascularization was achieved, and 1-year patency was confirmed.
Conclusions: The ViaHole technique may be valuable for revascularizing a major side branch occluded by stent-graft implantation.