Salvage of Critical Limb Ischemia with the “Trellis Reserve” of Subintimal Superficial Femoral-Popliteal Artery Occlusion: A New Modality in Managing Critical Limb Ischemia

Abstract

Subintimal angioplasty is a safe, effective, but nondurable procedure in treating long superficial femoral artery occlusions in patients with severe lower limb ischemia. The authors report a case of acute thrombosis that presented 16 weeks after subintimal angioplasty. The “Trellis” percutaneous thrombolytic infusion system permitted a controlled site-specific infusion of recombinant tissue-type plasminogen activator (rtPA). The unique design of the “Trellis” allowed complete aspiration of thrombus and avoiding regional and systemic thrombolytic side effects. The “Trellis” system is effective in percutaneous management of thrombotic lesions; however, intimal dissection may need to be addressed.