Elderly patient with previous fem distal bypass.
Initially presented with a stenosis at proximal anastomosis. This was treated with angioplasty.
Two weeks later represented acutely with thrombosed graft. Due to underlying problems with the graft decision made to attempt to re-canalise the native arteries.
Subintimal angioplasty of native SFA and popliteal arteries done.
Zilver PTX stent placed in the SFA and a Supera stent in the popliteal artery. Single vessel inline flow to posterior tibial artery. Chemical thrombolysis with Alteplase to clear the residual thrombus in the posterior tibial.
Triphasic flow is seen on Doppler three months later.