Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass Gregory A. Magee, MD, MSc, Anastasia Plotkin,

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Presentation transcript:

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass Gregory A. Magee, MD, MSc, Anastasia Plotkin, MD, Jeniann A. Yi, MD, MS, Kathryn E. Bowser, MD, David P. Kuwayama, MD, MPA Journal of Vascular Surgery Cases and Innovative Techniques Volume 4, Issue 1, Pages 58-62 (March 2018) DOI: 10.1016/j.jvscit.2017.12.003 Copyright © 2018 The Authors Terms and Conditions

Fig 1 Initial (left) lower extremity arteriogram (before bypass). Initial arteriography demonstrated normal arterial flow through the superficial femoral, popliteal, proximal anterior tibial, posterior tibial (PT), and peroneal arteries with cessation of flow through all three tibial arteries at the level of the bullet track at the ankle. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 58-62DOI: (10.1016/j.jvscit.2017.12.003) Copyright © 2018 The Authors Terms and Conditions

Fig 2 Completion arteriography after posterior tibial (PT)-pedal bypass. After PT-pedal bypass with reversed saphenous vein graft, completion arteriography demonstrated a patent bypass graft with no anastomotic stenosis, graft kinking, or stenosis. However, there was sluggish flow in the graft and a string-of-beads appearance just before the proximal anastomosis, potentially consistent with clamp-related spasm. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 58-62DOI: (10.1016/j.jvscit.2017.12.003) Copyright © 2018 The Authors Terms and Conditions

Fig 3 Arteriogram 6 hours after bypass. Six hours postoperatively, there was no graft pulse and no distal arterial signals, prompting concern for graft failure. However, arteriography demonstrated a patent bypass with no anastomotic stenosis with sluggish flow due to worsening diffuse vasospasm involving all three tibial arteries. PT, Posterior tibial. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 58-62DOI: (10.1016/j.jvscit.2017.12.003) Copyright © 2018 The Authors Terms and Conditions

Fig 4 Arteriography 6 hours after bypass following bolus vasodilator administration. Repeated arteriography after bolus vasodilator infusion with nicardipine, verapamil, and nitroglycerin demonstrated substantial improvement in the vasospasm with brisk flow through the bypass. PT, Posterior tibial. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 58-62DOI: (10.1016/j.jvscit.2017.12.003) Copyright © 2018 The Authors Terms and Conditions