Complex Iliofemoral lesion recanalization complicated by arteriovenous fistula, partial thrombosis of DFA and small intramuscular hematoma

• Indication: Restpain for over 2 Month (Fontaine's stage III) Target lesion (s): external iliac artery stenosis (PSV 550 cm/s) and comlete CTO SFA
• Approach: crossover femoral
• Description of procedure: recanalization of the AIE and SFA. Angioplasty DCB of the SFA. DFA manual thrombus aspiration. Stent placement in the AIE and proximal SFA
• Devices used: 6-F45-cm crossover sheath (Destination, Terumo), Rubicon™ Support Catheter 0.018" (Boston Scientific), Guidewire 0.018" (Terumo Advantage), Balloon - Dilatation Catheter 5x100mm Sterling™ 0.018” (Boston Scientific), Stent Innova 5mm x 120mm (Boston Scientific), Stent Innova 6mm x 80mm (Boston Scientific), Ranger DCB 4x100mm (Boston Scientific), BigLumen 5F Aspiration Catheter (Optimed), Angio-Seal vascular closure device. Medical therapy: 3000U Heparin during the procedure, DAP (Clopidogrel and ASS), Simvastatin after the procedure
• Follow up: patency of recanalized segment testing by doppler- ultrasound

Take Home Message

1. Extravasation is a possible complication after the recanalization and balloon-angioplasty even if we don't see it in the angiography.
2. Thrombolysis after the CTO recanalisation can cause heavy bleeding.
3. Sonography of the recanalized segment before the thrombolysis can reduce the risk of complications.