Hybrid approach to lower extremity revascularization

The patient presented with disabling claudication. Arteriography demonstrated an external iliac artery occlusion and common femoral artery occlusion. The iliac artery occlusion was crossed from a contralateral groin access, and the wire was parked at the level of the diseased common femoral artery (arrow; A) and the wire retrieved with exposure of the common femoral artery. After common femoral endarterectomy, a sheath was placed over the wire (B). Patch closure was then completed with the wire/sheath coming out at the side of the patch with the two ends of the sutures cinched tight. Subsequently, the external iliac artery was stented. After completion arteriography, the sheath was removed and the patch suture tied off.