Aurora St Lukes Medical Center

Presentation Notes

Presented at the CARVE Endovascular Conference. February 14, 2024; Park City, UT.


Background: More than 200 million people worldwide in 2010 were affected by peripheral arterial disease (PAD). Open surgical bypass procedures are typically considered the definitive treatment for symptomatic PAD, favoring autogenous vein grafts over prosthetic graft. Novel techniques for when the more classic surgical approach to PAD fail continue to progress, particularly when considering at-risk populations such as the elderly and the medically compromised patients who present with PAD.

Clinical Case: 68 years-old male presents with severe peripheral arterial disease, chronic nonhealing wounds within the left foot and chronic clinical left lower extremity ischemia. History of occluded left femoral popliteal bypass graft, occluded left native SFA status post multiple prior attempts at endovascular revascularization. A vascular sheath was established with the contralateral common femoral artery (CFA). Lower extremity angiogram demonstrates a patent profunda femoral artery. The native SFA and bypass graft remain occluded. The popliteal artery is reconstituted at the bifurcation with the anterior tibial artery (ATA). ATA and peroneal are patent. Posterior tibial artery is chronically occluded. US guided 21-gauge needle was advanced through the anterolateral wall of the common femoral artery, out the posterior lateral wall of the CFA and into the left common femoral vein. A snare was advanced via this access into the popliteal vein to the level of the patent popliteal artery. A sheath was then placed in the distal ATA and an angioplasty balloon advanced retrograde to the level of the snare. 21-gauge needle was used in gunsight technique in conjunction with the angioplasty balloon and snare to establish bodyfloss. Viabahn stent graft was deployed such that a venous intraluminal arterial conduit was created with proximal aperture within the patent CFA and distal aperture within the patent popliteal arterial segment. This successful femoropopliteal endoluminal arterial bypass led to resolution of the patient’s rest pain and healing of the left foot wounds with current 2-year patency.

Conclusions: This case demonstrates successful salvage revascularization in a setting of severe chronic critical limb ischemia. This is concordant with published results within the DETOUR clinical trial. Forward looking this technique may become a complimentary revascularization technique for patients with severe chronic limb threatening ischemia and open or endoluminal repair was not feasible and/or had failed.


Fowkes FG, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382:1329-1340.

AbuRahma AF. When are endovascular and open bypass treatments preferred for femoropopliteal occlusive disease? Ann Vasc Dis. 2018;11:25-40.


Oral/Podium Presentation




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