Retrograde stent-graft angioplasty of superficial femoral artery occlusion in a claudicant.

Endovascular therapy has become an accepted mode of therapy for lifestyle-limiting claudication, especially if the disease is confined to the superficial femoral artery (SFA). The standard approach to these lesions is from the contralateral femoral artery and crossing over the aortic bifurcation. In patients who have an aortobifemoral bypass (AFB), this technique is usually not feasible secondary to the angles of the graft. The authors report on their approach to a 60-year-old man with lifestyle-limiting claudication and SFA disease, and an AFB in place. They performed a retrograde approach to the SFA via a small above-knee popliteal artery exposure. They used the recently approved (in the United States) heparin-bonded VIABAHN for the revascularization via this approach, which would have allowed them to proceed to an open bypass procedure if they were unsuccessful in the same setting.