Maria Antonella Ruffino

A 36 y.o. female with a right brachial-cephalic upper arm direct hemodialysis access presented with symptoms of central venous hypertension due to severe stenosis at the transition between the right brachiocephalic vein and the SCV. After PTV of the lesion, due to residual stenosis, a balloon-expandable covered stent (BeGraft Peripheral, Bentley) was deployed restoring the lumen. The CT-angiography performed 19 months later confirmed the patency of the stent-graft.

Surgical thrombectomy is considered the first line strategy for the treatment of acute iliac axis and femoro-popliteal thrombosis, but in some cases it can be inconclusive and lead to controlateral and/or distal embolization and dissection.
This is a case report describing the endovascular options for the treatment of aorto-iliac obstructive disease complicated by popliteal artery thrombosis after failure of surgical trans-femoral iliac thrombectomy in a patient with acute limb ischemia.