{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:44:56Z","timestamp":1787021096817,"version":"build-2736575974"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,10]],"date-time":"2021-07-10T00:00:00Z","timestamp":1625875200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,10]],"date-time":"2021-07-10T00:00:00Z","timestamp":1625875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CVIR Endovasc"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Abdominal aortic aneurysms (AAA) which present with a hostile access are not uncommon. When an arterial occlusion continuously involves from the iliac to the femoropopliteal artery, endovascular aneurysm repair (EVAR) can become complex, necessitating an adjunctive surgical procedure. The present report outlines a successful EVAR which was conducted without any adjunctive surgical procedure for an AAA complicated by extensive access vessel occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>The patient, an 82-year-old male, had a fusiform 50\u2009mm infrarenal AAA. He had a history of above knee amputation of the right leg due to a gangrene from Buerger\u2019s Disease. Despite the continuous occlusions of the right external iliac artery (EIA), common femoral artery (CFA), and superficial femoral and profunda femoris artery, limb ischemia was not observed in his right leg. Since revascularization of the occluded right iliac and femoral arteries was deemed to be too complex technically and no ischemic symptoms were observed, EVAR was performed using the occluded access only for the delivery of the stent graft without restoring the flow. Firstly, the occluded right CFA was punctured under ultrasound guidance. Next, a 0.014\u2009in. guidewire and a microcatheter were successfully navigated to the subintimal space of the right common iliac artery (CIA), these were then exchanged with a reentry device. The reentry device allowed the advancement of a guidewire into the true lumen of the right CIA. Then, a 12Fr sheath for delivery of a contralateral limb was advanced via the occluded right access to aorta, and a 16 Fr sheath for delivery of a main body graft was advanced via a patent left iliac artery. A standard EVAR procedure was subsequently performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EVAR was successfully performed for an AAA complicated with an arterial occlusion from the EIA to the SFA using direct puncture of the occluded CFA. This technique could be an effective measure for cases with a hostile access involving the CFA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42155-021-00247-1","type":"journal-article","created":{"date-parts":[[2021,7,10]],"date-time":"2021-07-10T02:03:16Z","timestamp":1625882596000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Direct puncture of an occluded common femoral artery as a new approach for endovascular aortic aneurysm repair"],"prefix":"10.1186","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1809-4079","authenticated-orcid":false,"given":"Shigeo","family":"Ichihashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsunehisa","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bolstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keitarou","family":"Koshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,10]]},"reference":[{"issue":"1","key":"247_CR1","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1177\/152660280401100104","volume":"11","author":"FR Arko","year":"2004","unstructured":"Arko FR, Filis KA, Seidel SA, Gonzalez J, Lengle SJ, Webb R, Rhee J, Zarins CK (2004) How many patients with infrarenal aneurysms are candidates for endovascular repair? The Northern California experience. J Endovasc Ther 11(1):33\u201340. https:\/\/doi.org\/10.1177\/152660280401100104","journal-title":"J Endovasc Ther"},{"key":"247_CR2","doi-asserted-by":"publisher","unstructured":"Giannopoulos S, Malgor RD, Sobreira ML et al (2021) Iliac conduits for endovascular treatment of aortic pathologies: a systematic review and meta-analysis. J Endovasc Ther. 2021;15266028211007468. https:\/\/doi.org\/10.1177\/15266028211007468.","DOI":"10.1177\/15266028211007468"},{"issue":"1","key":"247_CR3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s42155-020-00116-3","volume":"3","author":"S Ichihashi","year":"2020","unstructured":"Ichihashi S, Nagatomi S, Iwakoshi S, Inagaki M, Bolstad F, Kichikawa K (2020) Balloon-oriented puncture for creating an access for endovascular aortic aneurysm repair in a case of iliac and femoral artery occlusion. CVIR Endovasc 3(1):25. https:\/\/doi.org\/10.1186\/s42155-020-00116-3","journal-title":"CVIR Endovasc"},{"issue":"4","key":"247_CR4","doi-asserted-by":"publisher","first-page":"349","DOI":"10.5551\/jat.57083","volume":"28","author":"D Kawasaki","year":"2021","unstructured":"Kawasaki D, Yamada T, Fukunaga M (2021) Feasibility and safety of the direct occluded vessel puncture technique as a new access site for complex peripheral artery occlusive disease. J Atheroscler Thromb 28(4):349\u2013355. https:\/\/doi.org\/10.5551\/jat.57083","journal-title":"J Atheroscler Thromb"},{"issue":"1","key":"247_CR5","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.jvs.2018.08.191","volume":"70","author":"Y Takeuchi","year":"2019","unstructured":"Takeuchi Y, Morikage N, Mizoguchi T, Nagase T, Samura M, Ueda K, Suehiro K, Hamano K (2019) Using bifurcated endoprosthesis after iliac artery recanalization for concomitant abdominal aortic aneurysm and chronic total occlusions of access routes. J Vasc Surg 70(1):117\u2013122. https:\/\/doi.org\/10.1016\/j.jvs.2018.08.191","journal-title":"J Vasc Surg"},{"issue":"1","key":"247_CR6","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1186\/2193-1801-2-605","volume":"2","author":"JS Uchiyamada","year":"2013","unstructured":"Uchiyamada JS, Ichihashi S, Iwakoshi S, Itoh H, Tabayashi N, Kichikawa K (2013) Technical tips and procedural steps in endovascular aortic aneurysm repair with concomitant recanalization of iliac artery occlusions. Springerplus. 2(1):605. https:\/\/doi.org\/10.1186\/2193-1801-2-605","journal-title":"Springerplus."},{"issue":"6","key":"247_CR7","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1016\/j.jvs.2012.05.089","volume":"56","author":"R Vallabhaneni","year":"2012","unstructured":"Vallabhaneni R, Sorial EE, Jordan WD Jr, Minion DJ, Farber MA (2012) Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair. J Vasc Surg 56(6):1549\u20131554. https:\/\/doi.org\/10.1016\/j.jvs.2012.05.089","journal-title":"J Vasc Surg"}],"container-title":["CVIR Endovascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-021-00247-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-021-00247-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-021-00247-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,10]],"date-time":"2021-07-10T02:03:47Z","timestamp":1625882627000},"score":1,"resource":{"primary":{"URL":"https:\/\/CVIRendovasc.springeropen.com\/articles\/10.1186\/s42155-021-00247-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,10]]},"references-count":7,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["247"],"URL":"https:\/\/doi.org\/10.1186\/s42155-021-00247-1","relation":{},"ISSN":["2520-8934"],"issn-type":[{"value":"2520-8934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,10]]},"assertion":[{"value":"27 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Approved by trust review committee.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"58"}}