Sutureless endovascular bypass technique in long femoropopliteal occlusions

This letter details an experience with a novel technique, similar to the one described by Sarradon et al.1Sarradon P. Ozdemir B.A. Becquemin J.P. Technique and early results of percutaneous femoropopliteal bypass with stent graft.J Vasc Surg Cases Innov Tech. 2023; 9101317PubMed Google Scholar and published as a pioneering work in Brazil by Beck et al. in 2020.2Beck R.T. Bohatch Júnior M.S. Dantas M.H. Vidal da Silva A.F. Perli Pinto C. IN-OUT-IN: The use of a new Sutureless Endovascular Bypasses Technique as an Alternative to treat High-risk Surgical Patients with Extensive Femoropopliteal Lesion.J Vasc Med Surg. 2020; 8: 1-3Google Scholar In 2017, Beck et al. performed a sutureless femoropopliteal bypass using a percutaneous approach and a subcutaneous route using Viabahn. The patient, a 60-year-old with multiple comorbidities, presented prolonged occlusion of the superficial femoral artery (SFA) with a trophic lesion (Rutherford V). A minimally invasive 'In-Out-In' technique was performed, which yielded excellent surgical results, maintained patency in the 6-month follow-up, and wholly healed the lesion. The technical steps are very similar between the studies, with some device variations. Notably, the use of a urological clamp introduced subcutaneously at the puncture site in the work of Sarradon et al.2Beck R.T. Bohatch Júnior M.S. Dantas M.H. Vidal da Silva A.F. Perli Pinto C. IN-OUT-IN: The use of a new Sutureless Endovascular Bypasses Technique as an Alternative to treat High-risk Surgical Patients with Extensive Femoropopliteal Lesion.J Vasc Med Surg. 2020; 8: 1-3Google Scholar Sutureless telescoping anastomosis, which was initially described as VORTEC (Viabahn Open Rebranching Technique) in 2008 by Lachat et al.3Lachat M. Mayer D. Criado F.J. Pfammatter T. Rancic Z. Genoni M. Veith F.J. New technique to facilitate renal revascularization with use of telescoping self-expanding stent grafts: VORTEC.Vascular. 2008; 16: 69-72Crossref PubMed Scopus (76) Google Scholar In this study, the authors performed hybrid revascularization of the renal arteries, based on renal arterial puncture.3Lachat M. Mayer D. Criado F.J. Pfammatter T. Rancic Z. Genoni M. Veith F.J. New technique to facilitate renal revascularization with use of telescoping self-expanding stent grafts: VORTEC.Vascular. 2008; 16: 69-72Crossref PubMed Scopus (76) Google Scholar In 2010, Donas et al. reported successful clinical outcomes using a VORTEC technique for debranching supra-aortic vessels, allowing for safe and fast-track revascularizations without strokes.4Donas K.P. Rancic Z. Lachat M. Pfammatter T. Frauenfelder T. Veith F.J. Mayer D. Novel sutureless telescoping anastomosis revascularization technique of supra-aortic vessels to simplify combined open endovascular procedures in the treatment of aortic arch pathologies.J Vasc Surg. 2010; 51: 836-841Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar The technique is a significant advancement in treating thoracoabdominal and pararenal aortic aneurysms by hybrid procedure revascularization.5Donas K.P. Lachat M. Rancic Z. Oberkofler C. Pfammatter T. Guber I. Veith F.J. Mayer D. Early and midterm outcome of a novel technique to simplify the hybrid procedures in the treatment of thoracoabdominal and pararenal aortic aneurysms.J Vasc Surg. 2009; 50: 1280-1284Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar The transition of the technique to the femoropopliteal territory began with Greenberg et al. in 2011. The VORTEC technique is utilized for distal anastomosis of a prosthetic femoropopliteal bypass to the above-knee popliteal artery.6Greenberg G. Szendro G. Mayzler O. Ginzburg V. Leytzin A. Use of ViaBahn open revascularisation technique for above-knee femoro-popliteal anastomosis: a technical note.Eur J Vasc Endovasc Surg. 2011; 42: 202-205Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Percutaneous treatment began with publications in 20197Touma J. Senemaud J. Jaziri A. Cochennec F. Desgranges P. Percutaneous Trans-venous Femoropopliteal Bypass in Long Occlusions of the Superficial Femoral Artery.Cardiovasc Intervent Radiol. 2019; 42: 1800-1805Crossref PubMed Scopus (1) Google Scholar and 20208Krievins D.K. Halena G. Scheinert D. et al.One-year results from the DETOUR I trial of the PQ Bypass DETOUR System for percutaneous femoropopliteal bypass.J Vasc Surg. 2020; 72 (1648-58.e2)Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, with percutaneous transvenous access with the trajectory of the stents within the superficial femoral vein.8Krievins D.K. Halena G. Scheinert D. et al.One-year results from the DETOUR I trial of the PQ Bypass DETOUR System for percutaneous femoropopliteal bypass.J Vasc Surg. 2020; 72 (1648-58.e2)Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Di Primio et al.7Touma J. Senemaud J. Jaziri A. Cochennec F. Desgranges P. Percutaneous Trans-venous Femoropopliteal Bypass in Long Occlusions of the Superficial Femoral Artery.Cardiovasc Intervent Radiol. 2019; 42: 1800-1805Crossref PubMed Scopus (1) Google Scholar reported a technique in which the route was extravascular in the perivascular tissue. The main differences were the proximal type of the stent located in the deep femoral artery rather than in the origin of the SFA. Beck et al. complement Di Primo and Sarredon's case series, highlighting the improvement and reproducibility of the 'In-Out-In' technique. This technique, with low morbidity and acceptable patency, is a viable alternative for high-risk patients with long occlusions and without autologous grafts. 9Di Primio M. Angelopoulos G. Lazareth I. Lin F. Petit A. Priollet P. Sapoval M. Emmerich J. Yannoutsos A. Endovascular Extra-Anatomic Femoro-Popliteal Bypass for Limb Salvage in Chronic Critical Limb Ischemia.Cardiovasc Intervent Radiol. 2019; 42: 1279-1292Crossref PubMed Scopus (4) Google Scholar; 9..