Presenter: Masanaga Tsujimoto

Affiliation: Sapporo Cardio Vascular Clinic, Japan

Abstract

This article describes an 80-year-old female with persistent sciatic artery aneurysm (PSAA) occlusion treated by “Direct tip Injection in Occlusive Lesions (DIOL)” technique and VIABAHN® stent-grafts. Two-year follow-up confirmed stent patency and aneurysm shrinkage, offering a novel approach for complex PSAA.

Introduction

PSAA occlusion poses challenges due to organized thrombus. The DIOL technique enhances visualization of microchannels, facilitating safe wire crossing.

Case Study

The patient presented with left limb claudication (Rutherford 3). 

Prior EVT failed. Imaging revealed a 21×19mm PSAA. 

Intervention included:

Bidirectional DIOL: Contrast injection via microcatheter revealed subintimal/intramedial pathways.

Stent-Graft Deployment: VIABAHN® stents (5×100mm, 6×200mm, 6×250mm) were overlapped to exclude the aneurysm.

At 2-year follow-up, the aneurysm reduced to 17×16mm with preserved stent integrity.

Conclusions

1.DIOL enables safe recanalization of occluded PSAA.

2.Overlapping stent-grafts resist mechanical stress and ensure durability.

3.Technique customization is essential for challenging anatomies.