Arterial Interventions: Other

Percutaneous Creation of an Extraluminal Arterial Bypass Graft Using a Commercially Available Self-Expanding Stent Graft: Comparison to Surgical Arterial Bypass Graft in a Swine Model

Monday, March 22, 2021

10:10 AM – 10:19 AM ET

Presenting Author(s)

Diego A. Hipolito Canario, BS

Medical Student

Author/Co-author(s)

Charles Y. Kim, MD

Chief of Interventional Radiology
FG

Francisco Grippi Figueredo, MD

Resident Physician
FP

Federico Parodi, MD

Associate Professor
MK

Melina Kibbe, MD

Professor
Jessie K. Stewart, MD

Assistant Professor

Purpose: Peripheral arterial disease (PAD) of the lower extremities is a prevalent disease that can result in claudication, rest pain, ulceration, gangrene, and loss of limb. Not all patients are candidates for surgical bypass grafting. In severe cases, endovascular recanalization of total occlusions of the femoropopliteal arteries may not be possible, and even when successful, severe arterial calcifications can significantly limit patency rates. The objective of this study was to compare the short term patency of a percutaneous endovascular technique for arterial bypass versus the standard of care, a surgically created bypass using PTFE, in a swine model.

Materials and Methods: The experimental study was performed on 7 domestic swine. For each animal, a percutaneous extra-anatomic arterial bypass of the left common carotid artery was created using sonographic and fluoroscopic guidance. The percutaneous arterial bypass was created using a Viabahn stent graft without a surgical anastomosis. A surgical arterial bypass using GORTEX PTFE was performed on the right carotid artery for each animal. The grafts were monitored weekly with color doppler to evaluate for patency of the grafts. Angiography and animal sacrifice was performed after 4 weeks. The animals were treated with aspirin and clopidogrel throughout the study period.

Results: Both the percutaneous and surgical arterial bypass grafts were successfully created in 6/7 animals. One animal was euthanized after stent graft maldeployment during the procedure. The remaining 6 animals maintained patent grafts over the 4 week study period. No major adverse events occurred following the procedures.

Conclusion: This study found that short-term patency of a percutaneously created arterial bypass graft utilizing a commercially available stent graft had a similar short term patency rate compared to surgical arterial bypass grafting. This novel, minimally invasive procedure could eventually become an acceptable alternative to the standard of care, especially in patients who are considered poor surgical candidates.

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