Unusual cause of acute limb ischemia – stent fracture

Authors: J. C. M. Lubanda
Published in: Kardiol Rev Int Med 2010, 12(4): 179-180
Category: Angiological Symposium


We report a case of an 81 year old man who was treated for recurrent acute limb ischemia of the right leg. The patient had a prosthetic femoropopliteal bypass inserted 25 years ago. This reconstruction was replaced with a new prosthetic bypass 10 years later. The patient was readmitted for acute limb ischemia in May 2006. Because of several comorbidities at that time, surgery was not possible and endovascular treatment was undertaken with rheolytic thrombectomy and angioplasty with bailout stenting of the distal anastomosis of the femoropopliteal bypass. Two years after this intervention, the patient presented with acute limb ischemia due to reocclusion of the femoropopliteal bypass. He was then treated with catheter directed local thrombolysis and a stent fracture was found in the distal anastomosis of the bypass. This was the primary cause of the reocclusion of the bypass. According to current practice, stent implantation in prosthetic femoropopliteal bypasses should be avoided, if possible, and a surgery is the strategy of choice. Bailout stenting in this specific location should be reserved for such cases when the surgery is not feasible and limb salvage is required.

acute limb ischemia – stent fracture – femoropopliteal bypass


1. Chochola M, Linhart A. Epidemiology of ischemic diseases of the lower extremities. Čas Lék čes 2006; 145: 368–370.

2. Chochola M, Pytlík R, Kobylka P et al. Autologous intra-arterial infusion of bone marrow mononuclear cells in patients with critical leg ischemia. Int Angiol 2008; 27: 281–290.

3. Norgren L, Hiatt WR, Dormandy JA et al. TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33 (Suppl. 1): S1–S75.

4. Campbell WB, Ridler BM, Szymanska TH. Current management of acute leg ischaemia: results of an audit by the Vascular Surgical Society of Great Britain and Ireland. Br J Surg 1998; 85: 1498–1503.

5. Berridge DC, Kessel D, Robertson I. Surgery versus thrombolysis for acute limb ischaemia: initial management. Cochrane Database Syst Rev 2002: CD002784(1).

6. Ouriel K, Veith FJ, Sasahara AA. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med 1998; 338: 1105–1111.

7. Korn P, Khilnani NM, Fellers JC et al. Thrombolysis for native arterial occlusions of the lower extremities: clinical outcome and cost. J Vasc Surg 2001; 33: 1148e–1157e.

8. Klein AJ, Chen SJ, Messenger JC et al. Quantitative assessment of the conformational change in the femoropopliteal artery with leg movement. Catheter Cardiovasc Interv 2009; 74: 787–798.

9. Lewitton S, Babaev A. Superficial femoral artery stent fracture that led to perforation, hematoma and deep venous thrombosis. J Invasive Cardiol 2008; 20: 479–481.

10. Arena FJ. Arterial kink and damage in normal segments of the superficial femoral and popliteal arteries abutting nitinol stents – a common cause of late occlusion and restenosis? A single-center experience. J Invasive Cardiol 2005; 17: 482–486.

Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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