Endoscopy Biopsy Forceps as Tool for Iliac Covered Stent Removal

Endoscopy biopsy forceps is mostly used in the gastrointestinal tract but here it was used to remove a covered iliac self-expandable stent. A 57-year old male previously treated with bilateral iliac covered stenting and double barrel technique on the right iliac side was admitted for acute ischaemia of the right lower limb. Computed tomography showed thrombosis of covered stents on the right side [aorta/common iliac Viabahn 8 × 100 mm; external iliac artery (EIA) Viabahn 7 × 50 mm; internal iliac artery (IIA) 6 × 50 mm; W.L. Gore Medical, Flagstaff, AZ]. A left percutaneous femoral approach and surgical exposure of the right femoral arteries was performed. After distal clamping, an arteriotomy of the common femoral artery allowed the insertion of a large introducer sheath (Flexor 20F; Cook Medical, Bloomington, IN) via a stiff 0.035" guidewire after recanalization of the thrombosed iliac axis. Via this sheath a coaxial endoscopy biopsy forceps (reusable Fenestrated Rat Tooth Alligator Jaw, working length 230cm; Olympus, Center Valley, PA) was inserted to catch the distal edge of the covered self-expandable stent previously deployed in the EIA ([Fig.]), allowing removal of that covered stent. Next, a balloon was inserted and inflated on the left side, and an over-the-wire thrombectomy using a Fogarty 5F arterial embolectomy catheter (Edwards Lifesciences, Irvine, CA). was performed. A larger covered stent (Viabahn 8 × 100 mm) was used to reline the iliac axis. The ostium of IIA was occluded. In conclusion, endoscopy biopsy forceps could be used in “ultima ratio” as a vascular tool for removing covered self-expandable stents via a surgical femoral approach.