A successful case of "temporary endoluminal bypass technique" using a guide extension catheter during thrombolysis for acute limb ischemia in the non-stenting zone. Issue 5 (May 2021) - Yamane, Haruya
Abstract: It is still difficult to treat acute limb ischemia (ALI) in the non-stenting zone such as the popliteal artery. We describe a temporary endoluminal bypass technique for ALI in the non-stenting zone using a guide extension catheter. An 83-year-old female was admitted and diagnosed with ALI in her left leg. The angiogram showed a thrombotic obstruction of the left popliteal artery. Aspiration and dilation by angioplasty could not revascularize. Although Fogarty thrombectomy can be applicable, we avoided it because of its risk of complications and performed a temporary endoluminal bypass technique. After evaluating the occluded lesion by intravascular ultrasound, we delivered a guide extension catheter to fully cover it. Because it played the role of an endoluminal bypass, the blood flow to the distal tibial arteries could be confirmed in the angiogram. A thrombolytic drug was administered intra-arterially for the whole day, and the angiogram showed a reduction of the thrombus on postoperative day (POD) 1. On POD 2, the blood flow was maintained without flow limitation even after removing the catheter. Finally, she was discharged without any complications. This technique might be an alternative in cases of failed conventional treatments for ALI although further investigation needs to be undertaken. <Learning objective: Although endovascular treatment (EVT) has recently been developed, revascularization for acute limb ischemia (ALI) in the non-stenting zone such as popliteal artery has remained the unsolved problem. We report temporary endoluminal bypass technique for ALI in the non-stenting zone using a guide extension catheter. This technique can prevent limb ischemia during thrombolysis. When the conventional EVT procedures fail, it can be an alternative for ALI in the non-stenting zone.>