Imaging is the major determinant in the assessment of disease activity in Takayasu's arteritis.

OBJECTIVES: There are no valid follow-up parameters in the assessment of disease activity in Takayasu's arteritis (TAK). We investigated the impact of vascular imaging in the assessment of disease activity. METHODS: Patients with TAK who fulfilled the ACR criteria were included. Physician global assessment (PGA), the criteria defined by Kerr et al. and the Indian Takayasu Clinical Activity Score (ITAS2010) were evaluated. Patients were followed up since 3-6 months B-mode/Doppler ultrasonography (US) and 6-12 monthly magnetic resonance imaging/angiography (MRI/MRA). Active disease according to vascular imaging (Rad-Active) was defined based on the presence of any of the 3 parameters: (1) new vessel involvement by any imaging technique; (2) an increase in vessel wall thickness on US compared to previous one; (3) the presence of mural contrast enhancement/oedema on MRI/ MRA. The agreement of Rad-Active with other disease activity indexes was studied. Furthermore, ITAS-A-Rad index was developed by combining the vascular imaging with ITAS-A. RESULTS: A total of 410 visits in 52 patients were evaluated. The agreement was found to be 76% (κ: 0.52) between Rad-Active and PGA; 83% (κ: 0.57) between Rad-Active and Kerr's criteria. Both the agreements of ITAS2010 and acute phase reactants with PGA (69%, κ:0.38 and 60%, κ:0.22, respectively) and also Kerr's criteria (78%, κ:0.49 and 42%, κ:0.05, respectively) were lower compared to those of Rad-Active. Mean ITAS-A-Rad scores were higher in visits with active disease according to PGA and Kerr's criteria. CONCLUSIONS: The results of this study suggest that the vascular imaging should be included in the assessment of disease activity in TAK.

Long-Term Follow-Up of Endovascular Repair in the Management of Arterial Stenosis Caused by Takayasu's Arteritis.

BACKGROUND: This retrospective study evaluated the long-term results of endovascular repair in the management of arterial stenosis caused by Takayasu's arteritis (TA). METHODS: Sixty-seven endovascular procedures (percutaneous transluminal balloon angioplasty or stenting) were performed for 49 arterial lesions in 35 patients. Endovascular treatment was performed when the disease was inactive. The patients were pretreated with immunosuppressive drugs and were followed every 3-6 months to monitor disease activity and medical treatment. Doppler ultrasonography and magnetic resonance angiography were performed every 6 months. Kaplan-Meier method with the log-rank test was used to analyze the survival of renal artery procedures because the number of lesions in other territories was not sufficient for statistical analysis. The mean follow-up duration after the endovascular procedure was 83 months (range: 12-144 months). RESULTS: Twenty-two (33%) endovascular interventions resulted in restenosis or occlusion. Reinterventions resulted in primary assisted patency in 45 (92%) lesions with restenosis. Only 4 (8%) of the 49 arterial lesions were occluded at the time of the final evaluation. The overall patency rate for the renal artery stents was 93.7% (15/16) after 8 years of follow-up. In the Kaplan-Meier survival analyses of the renal artery lesions, the 1- and 8-year restenosis-free survival rates of renal arterial interventions were 74% and 57%, respectively, (P = 0.281). CONCLUSIONS: In this study, endovascular treatment with adequate immunosuppressive medication resulted in long-term patency with one- or multi-stage reinterventions in 92% of stenotic arterial lesions caused by TA.

Bilateral orbital pseudotumor in a patient with Takayasu arteritis: a case report and review of the literature.

Inflammatory orbital pseudotumor is often associated with rheumatologic disorders. It has been reported commonly with ANCA-associated vasculitides, especially granulomatosis with polyangiitis (Wegener's granulomatosis). There are also a few cases of large vessel vasculitis such as giant cell arteritis and Behcet's disease. Here, we report a patient with undiagnosed Takayasu arteritis presenting with proptosis and diplopia, with later diagnosis of an inflammatory pseudotumor of the orbit. In this case, we believe extensive involvement of blood vessels, including bilateral pulmonary artery stenosis, and elevated inflammatory markers that show disease activity may be related to pseudotumor formation in Takayasu arteritis. Since this is an unusual and unreported presentation of the disease, better estimation of a causal relationship may be possible in the future with further information. In conclusion, although uncommon, this case highlights that orbital pseudotumor may be an important finding in Takayasu arteritis. For early diagnosis, better treatment, and good prognosis, it should be considered in patients presenting with ocular symptoms similar to the other vasculitides.

Duplex ultrasonography findings are not related to menstrual cycle phases in women with early symptoms of lower extremity chronic venous disease.

PURPOSE: To investigate if duplex ultrasonography findings change according to the menstrual cycle phases in women with early symptoms of lower extremity chronic venous disease. METHODS: Thirty women (60 extremities) aged 18-50 years with regular menstrual cycles who presented with complaints of telangiectasia and/or trunk varices with accompanying leg pain were evaluated prospectively by duplex ultrasonography at three different times of a single menstrual cycle. Previous DVT or menstrual irregularities were exclusion criteria. All exams were performed by the same radiologist, under the same conditions. Reflux was provoked in the deep veins, great saphenous vein (GSV), and small saphenous vein (SSV) using the Valsalva maneuver. Reflux times in each vein and average diameters of the GSV and SSV were recorded. RESULTS: Reflux times showed no significant differences in any of the vein segments and the diameters of GSV and SSV were similar in the different menstrual phases (p > 0.05). Reflux was not predominant at any specific phase, and its presence was independent of menstrual phase. CONCLUSIONS: Reflux was not specific to a particular phase of menstrual cycle in women with early symptoms of chronic venous disease.

An Aortoenteric Fistula Arising after Endovascular Management of a Mycotic Abdominal Aortic Aneurysm Complicated with a Psoas Abscess.

Mycotic aortic aneurysms account for 1-3% of all aortic aneurysms. The management of this disease is controversial. Since open surgical repair is associated with high morbidity and mortality rates, endovascular aneurysm repair is an alternative treatment method with promising early and midterm outcomes, although its long-term durability is unknown. Secondary aortoenteric fistulas may occur iatrogenically after either aortic reconstructive surgery or endovascular repair. As the number of aneurysms managed with endovascular aneurysm repair has substantially increased, cases of aortoenteric fistulas referred for endovascular repair are augmented. We report the case of an aortoduodenal fistula manifested with duodenal perforation after staged endovascular and surgical treatment of a mycotic aortic aneurysm.

Endovascular Stent-Graft Treatment of Giant Celiac Artery Pseudoaneurysm.

BACKGROUND: Visceral artery aneurysms (VAAs) comprise an uncommon but life-threatening vascular disease. When rupture is the first clinical presentation, mortality rate reaches 70%. Increased use of cross-sectional imaging has led to a greater rate of diagnosis (40-80%) of asymptomatic VAAs. In the past, surgery was the treatment of choice for VAAs carrying high risk of mortality and morbidity. CASE REPORT: A 22-year-old man, who had undergone gastric, pancreatic and aortic surgery 2.5 years earlier, presented with progressive abdominal pain. Multidetector computed tomography scan revealed an 8-cm celiac pseudoaneurysm. We report a giant celiac pseudoaneurysm treated with stent-graft implantation. CONCLUSIONS: Endovascular treatment of VAA is a safe and effective method alternative to surgery.

Markers of endothelial damage and repair in Takayasu arteritis: are they associated with disease activity?

The current clinical and laboratory parameters of Takayasu arteritis (TA) are insufficient for proper assessment of disease activity. The aims of this study were to investigate the markers of endothelial injury and repair, including circulating endothelial cell (CEC), circulating endothelial progenitor cell (CEPC) and vascular endothelial growth factor (VEGF), and evaluate their associations with disease activity in patients with TA. Thirty-two patients with TA and 30 healthy age- and sex-matched controls were included in this study. Disease activity was assessed in TA patients using various tools, including Kerr's criteria, the Indian Takayasu's Arteritis Scoring (ITAS2010) and physician's global assessment (PGA). CECs and CEPCs were measured by flow cytometry, and VEGF was measured using an enzyme-linked immunosorbent assay. The CEC level was found to be higher in TA patients than in the healthy controls (HC) (p < 0.001). There was no significant difference in CEC level between the active and inactive patients, but its level was slightly correlated with C-reactive protein (CRP) level. CEPC and VEGF levels in TA patients with active disease were higher than those in the inactive patients and HC. CEPC and VEGF levels were positively correlated with ITAS-CRP and PGA scores. This study shows increased level of CEC in patients with TA. It also suggests that the CEPC and VEGF levels may be correlated with disease activity.

Vascular Complications After Liver Transplantation.

OBJECTIVES: Vascular complications after liver transplant can be lethal. High levels of suspicion and aggressive use of diagnostic tools may help with early diagnosis and treatment. Here, we share our experiences regarding this topic. MATERIALS AND METHODS: Adult and pediatric patients who had liver transplant between February 1997 and June 2018 in our clinic were included in the study. Patients were grouped according to age (pediatric patients were those under 18 years old), male versus female, indication for transplant, type of liver transplant, type of vascular complication, treatment, and survival aftertreatment.We analyzed the statistical incidence of vascular complications according to age, male versus female, and type of liver transplant. RESULTS: Our analyses included 607 liver transplant procedures, including 7 retransplants, with 349 (57.4%) from living donors and 258 (42.6%) from deceased donors. Of total patients, 539 were adults (89.8%) and 61 were children (10.2%). Vascular complications occurred in 25 patients (4.1%), with hepatic artery complications seen in 13 patients (2.1%) (10 adults [1.8%] and 3 children [4.9%]), portal vein complications seen in 9 patients (1.5%) (6 adults [1.1%] and 3 children [4.9%]), and hepatic vein complications seen in 3 patients (0.5%) (2 adults [0.36%] and 1 child [1.6%]). Rate of vascular complications was statistically higher in pediatric patients (11.4% vs 3.3%; P = .007) and higher but not statistically in recipients of livers from living donors (5.2% vs 2.7%; P = .19). Twelve patients (48.8%) were treated with endovascular approach, and 11 (0.44%)required surgicaltreatment. Two patients underwent immediate retransplant due to hepatic artery thrombosis. CONCLUSIONS: Because vascular complications are the most severe complications afterlivertransplant,there must be close follow-up of vascular anastomoses, particularly early postoperatively, with radiologic methods. In cases of vascular complications, emergent treatment, including endovascular interventions, surgery, and retransplant, must be performed.

Unusual case of severe late-onset cytomegalovirus-induced hemorrhagic cystitis and ureteritis in a renal transplant patient.

Cytomegalovirus (CMV) infection is common in solid organ transplant recipients and accounts for the majority of graft compromise. Major risk factors include primary exposure to CMV infection at the time of transplantation and the use of antilymphocyte agents such as OKT3 (the monoclonal antibody muromonab-CD3) and antithymocyte globulin. It most often develops during the first 6 months after transplantation. Although current prophylactic strategies and antiviral agents have led to decreased occurrence of CMV disease in early posttransplant period, the incidence of late-onset CMV disease ranges from 2% to 7% even in the patients receiving prophylaxis with oral ganciclovir. The most common presentation of CMV disease in transplant patients is CMV pneumonitis followed by gastrointestinal disease. Hemorrhagic cystitis is a common complication following hematopoietic stem cell transplantation. The condition is usually due to cyclophosphamide-based myeloablative regimens and infectious agents. Even in these settings, CMV-induced cases occur only sporadically. Ureteritis and hemorrhagic cystitis due to CMV infection after kidney transplantation is reported very rarely on a case basis in the literature so far. We report here a case of late-onset CMV-induced hemorrhagic cystitis and ureteritis presenting with painful macroscopic hematuria and ureteral obstruction after 4 years of renal transplantation. The diagnosis is pathologically confirmed by the demonstration of immunohistochemical staining specific for CMV in a resected ureteral section. We draw attention to this very particular presentation of CMV hemorrhagic cystitis with ureteral obstruction in order to emphasize atypical presentation of tissue-invasive CMV disease far beyond the timetable for posttransplant CMV infection.

The role of volumetric and textural analysis of pretreatment 18F-fluorodeoxyglucose PET/computerized tomography images in predicting complete response to transarterial radioembolization in hepatocellular cancer.

OBJECTIVE: This study evaluates the role of pretreatment 18F-FDG PET/CT in predicting the response to treatment in patients with hepatocellular cancer (HCC) who applied transarterial radioembolization (TARE) via the volumetric and texture features extracted from 18F-FDG PET/CT images. METHODS: Thirty-three patients with HCC who had applied TARE [lobar (LT) or superselective (ST)] after 18F-FDG PET/CT were included in the study. Response to the treatment was evaluated from posttherapy magnetic resonance (MR). Patients were divided into two groups: the responder group (RG) (complete responders) and non-RG (NRG) (including partial response, stabile, and progressive). Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) and texture features were extracted from PET/CT images. The differences among MTV, TLG, and texture features between response groups were analyzed with the Mann-Whitney U test. ROC analysis was performed for features with P < 0.05. Spearman correlation analysis was used, and features with correlation coefficient < 0.8 were evaluated with the logistic regression analysis. RESULTS: Significant differences were detected in TLG, MTV, SHAPE_compacity, GLCM_correlation, GLRLM_GLNU, GLRLM_RLNU, NGLDM_coarseness, NGLDM_busyness, GLZLM_LZHGE, GLZLM_GLNU, and GLZLM_ZLNU between RG and NRG. Multivariate analysis demonstrated that MTV was the only meaningful parameter with an AUC of 0.827 (P = 0.002; 95% CI, 0.688-0.966). The best cutoff value was determined as 74.11 ml with 78.9% sensitivity and 78.6% specificity in discriminating nonresponders. CONCLUSION: In predicting the curative effect of TARE, multivariate analysis results demonstrated that MTV was the only independent predictor, and MTV higher than 74.11 ml were determined the best predictor of nonresponders.

Evaluation of Surgical Outcomes of Type A Intramural Hematoma.

INTRODUCTION: In this study, we aimed to retrospectively evaluate the results of type A intramural hematoma (TA-IMH) cases that underwent ascending aortic surgery. METHODS: One hundred ninety-four patients who underwent aortic surgery between 2010 and 2018 were included in this study. TA-IMH was differentiated according to tomography angiographic images. Demographic data, operation type, hypothermic circulatory arrest times, echocardiographic findings, wall thickness of IMH, complications, and prognosis were retrospectively analyzed. RESULTS: TA-IMH (n=14) or type A aortic dissection (AD) (n=35) data were collected from patients' files and 49 cases were enrolled into the study. Bentall operation was performed in eight patients (type A AD = six [17.1%], TA-IMH = two [14.3%]); 41 patients underwent tubular graft interposition of ascending aorta (AD = 29 [82.9%], TA-IMH = 12 [85.7%]). There was no significant difference in terms of age, gender distribution, aortic dimensions, cardiopulmonary bypass times, hypothermic circulatory arrest times, hospital ward stay, and intensive care unit stay between the two groups. The mortality rate of AD group was 34.4% and of TA-IMH group was 14.3%. There was no significant difference in terms of mortality between the groups. In our study, 45.7% of patients had hypertension and that rate was lower than the one found in the literature. In addition, bicuspid aorta was not observed in both groups. Connective tissue disease was not detected in any group. CONCLUSION: Surgical treatment of aorta is beneficial for TA-IMH. Our aortic surgical indications comply with the European aortic surgical guidelines. Hypertension control should be provided aggressively.

Coexistence of Takayasu arteritis and chronic myeloid leukemia: Coincidental or paraneoplastic phenomenon?

Vasculitis may rarely be seen in the course of myeloproliferative neoplasms (MPN). In vasculitis associated with hematological diseases, mostly small- and medium-vessel involvement is expected, aortitis is very rare. It is not exactly known whether large-vessel vasculitis associated with MPN is a paraneoplastic phenomenon or coincidental. We aimed to present an uncommon case diagnosed with chronic myeloid leukemia and Takayasu arteritis concurrently.

A rare cause of renovascular hypertension: Takayasu arteritis with only renal artery involvement.

Takayasu arteritis is a chronic inflammatory disease that affects mainly the aorta, main branches of aorta, and pulmonary arteries with unknown etiology. Disease affecting solely the renal arteries is rare. We will present a case that had hypertension, hypokalemia, and metabolic alkalosis where the etiology was type 2 Takayasu arteritis, affecting renal arteries.

Drug-Eluting Balloon Angioplasty for Juxta-Anastomotic Stenoses in Distal Radiocephalic Hemodialysis Fistulas: Long-Term Patency Results.

PURPOSE: To evaluate long-term primary and secondary patency results of drug-eluting balloon angioplasty for the treatment of juxta-anastomotic stenoses in distal radiocephalic arteriovenous fistulas. MATERIALS AND METHODS: Thirty-eight patients with juxta-anastomotic stenotic distal radiocephalic arteriovenous fistulas who underwent endovascular treatment with drug-eluting balloons between January 2014 and August 2016 in our interventional radiology department were included in this retrospective study. Color Doppler examination for follow-up was performed 15 days, 6 months, 12 months, 18 months, 24 months, 36 months, and 48 months after the procedure. Kaplan-Meier analysis was used to estimate primary and secondary patency rates. RESULTS: Totally, 42 angioplasty with drug-eluting balloons was performed in 38 patients (20 men and 18 women; mean age 66.42 ± 12.01). Technical and clinical success rate was 100% (42/42). The mean follow-up period was 27.71 months ± 12.98 (range, 1-54 months). The estimated primary patency rates at 6 months were 94.7% (95% CI, 80.9%-99.0%), at 12 months were 81.2% (95% CI, 64.6%-91.4%), at 24 months were 60.7% (95% CI, 43.6%-75.7%), and at 48 months were 53.1% (95% CI, 36.5%-69.1%). The estimated secondary patency rates at 6 months were 97.3% (95% CI, 84.5%-99.8%), at 12 months were 86.5% (95% CI, 70.7%-94.8%), at 24 months were 69.0% (95% CI, 51.8%-82.4%), and at 48 months were 61.7% (95% CI, 44.6%-76.5%). CONCLUSION: Drug-eluting balloon angioplasty is a useful, effective technique in dysfunctional radiocephalic fistulas due to juxta-anastomotic stenoses. We demonstrated remarkably high primary patency rates at 6, 12, 24, and 48 months.

Early ultrasonographic markers of atherosclerosis in patients with familial Mediterranean fever.

Systemic inflammation plays an important role in the development of atherosclerosis (AS). The aim of this study was to evaluate the presence of early AS in patients with familial Mediterranean fever (FMF) that is characterized by recurrent inflammatory attacks of serositis. Sixty-one FMF patients (30 Male/31 Female; 31.5 [18-54] years) and 31 healthy controls (16 Male/15 Female; 31 [22-58] years) were studied. All FMF patients were on regular daily colchicine treatment and during attack-free periods. Both the FMF patients and controls with a history of diabetes mellitus (DM), hypertension, and hyperlipidemia were excluded. Body mass index (BMI) was calculated. Serum lipids, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were assessed. Two-hour oral glucose tolerance test was performed to rule out DM and glucose intolerance. To investigate early AS "endothelium-dependent flow-mediated dilatation (FMD%)," "nitroglycerin-induced endothelium-independent peripheral vasodilatation (NTG%)," and intima-media thickness (IMT) of common carotid arteries (CCA) were measured by ultrasonograpy. The median disease duration for FMF patients was 16 (1-45) years. Age, sex, BMI, smoking status, and serum lipids were comparable in patients and controls (p > 0.05). However, ESR and standard CRP were significantly higher in the patients group (p < 0.05). There were no differences in the measurements of right, left, and averaged IMT of CCA between patients and controls ([0.49 vs 0.5], [0.51 vs 0.52] and [0.5 vs 0.51]; p > 0.05, respectively). None of the subjects had carotid artery plaques. FMD% and NTG% were also similar in patients and controls group ([18.2 vs 20.6] and [24.2 vs 22.5]; p > 0.05, respectively). This study suggests that the markers of early AS are not impaired in FMF patients on regular daily colchicine treatment.

Evaluation of Surgical Outcomes of Type A Intramural Hematoma

Abstract Introduction: In this study, we aimed to retrospectively evaluate the results of type A intramural hematoma (TA-IMH) cases that underwent ascending aortic surgery. Methods: One hundred ninety-four patients who underwent aortic surgery between 2010 and 2018 were included in this study. TA-IMH was differentiated according to tomography angiographic images. Demographic data, operation type, hypothermic circulatory arrest times, echocardiographic findings, wall thickness of IMH, complications, and prognosis were retrospectively analyzed. Results: TA-IMH (n=14) or type A aortic dissection (AD) (n=35) data were collected from patients' files and 49 cases were enrolled into the study. Bentall operation was performed in eight patients (type A AD = six [17.1%], TA-IMH = two [14.3%]); 41 patients underwent tubular graft interposition of ascending aorta (AD = 29 [82.9%], TA-IMH = 12 [85.7%]). There was no significant difference in terms of age, gender distribution, aortic dimensions, cardiopulmonary bypass times, hypothermic circulatory arrest times, hospital ward stay, and intensive care unit stay between the two groups. The mortality rate of AD group was 34.4% and of TA-IMH group was 14.3%. There was no significant difference in terms of mortality between the groups. In our study, 45.7% of patients had hypertension and that rate was lower than the one found in the literature. In addition, bicuspid aorta was not observed in both groups. Connective tissue disease was not detected in any group. Conclusion: Surgical treatment of aorta is beneficial for TA-IMH. Our aortic surgical indications comply with the European aortic surgical guidelines. Hypertension control should be provided aggressively.

Hyperhomocysteinemia: a novel risk factor for erectile dysfunction.

Nitric oxide (NO), the key mediator synthesized by different NO synthase isoenzymes, plays an important role in endothelial function. It was recently shown that hyperhomocysteinemia is an important regulator of NO synthase. We investigated the role of homocysteine (Hcys) in erectile dysfunction (ED), which is associated with the defect in NO generation. Thirty-one nondiabetic patients and 33 control cases were evaluated. Patients with diabetes, coronary artery disease, vitamin B(12), or folate deficiency were excluded in the study. The International Index of Erectile Function questionnaire was used to gauge identified erectile quality. Fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, vitamin B(12), folic acid, and Hcys levels of patients were measured. Penile color Dupplex ultrasound was used to detect vascular abnormalities in nondiabetic patients with ED. Patients with ED were older than the control subjects (55.6 +/- 8.4 vs 44.5 +/- 4.7 years, respectively; P < .001). Patients with ED had higher fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol, and Hcys levels. There was a significant negative correlation between mean Hcys level and mean International Index of Erectile Function domain score (P < .001). The penile color Doppler ultrasound findings showed that there was a negative significant correlation between mean Hcys level and the 1st, 5th, and 10th minute's peak-systolic velocity. Logistic regression analysis revealed that age and Hcys levels were the main determinants in ED. Hyperhomocysteinemia, known to be an important risk factor in endothelial dysfunction, seems to be an important determinant in ED. These data suggest that slightly elevated Hcys levels are significantly related with arterial and probably endothelial dysfunction in patients with ED.

Automated measurement of intima-media thickness of carotid arteries in ultrasonography by computer software.

PURPOSE: Intima-media thickness (IMT) has been proposed to be a morphological criterion of atherosclerosis. The purpose of this study was to investigate the interobserver variability of manual and also of computer software measurements of IMT. MATERIALS AND METHODS: High-resolution common carotid artery (CCA) images of 88 patients that have been obtained by a linear broadband L5-12 MHz transducer and archived in PACS were retrospectively evaluated. Two separate investigators, who were unaware of the former results, evaluated the same images by using computer software that had a dedicated tool for automatic measurement of IMT. The results of the investigators were compared. RESULTS: According to the two investigators who have performed manual measurements, mean values of IMT of right CCA were 0.6396 mm and 0.6356 mm; of the left CCA were 0.6662 mm and 0.6575 mm, respectively. The interobserver variability of measurements revealed the mean IMT as 0.6071 mm and 0.6048 mm for the right, 0.6216 mm and 0.6227 mm for the left CCA. Manual measurements of both investigators were found to be higher than the automatic measurements and the differences were statistically significant. Interobserver correlation of manual measurements was between 0.80-0.88 and of the automated measurements was between 0.93-0.98. CONCLUSION: Manual measurements reveal higher values than the automated measurements of IMT. The interobserver correlation of automated measurements is higher than manual measurements. The use of dedicated software may be proposed to reduce the measurement errors.

Advanced treatment of acute femoropopliteal bypass graft occlusion with Fogarty catheter guidance.

PURPOSE: The guiding role of the Fogarty catheter was investigated among patients suffering from limb ischemia due to acute femoropopliteal bypass graft occlusion. METHODS: A total of 27 patients with a history of femoropopliteal bypass operation who was admitted with acute limb ischemia were enrolled in this retrospective study. In cases in which the Fogarty catheter could not be passed through the popliteal anastomosis, the popliteal region was explored and a new bypass or patch plasty was performed for the distal anastomosis. The cases in which the blood circulation was observed in the graft, but in which the Fogarty catheter balloon was stuck in the native vessels on the proximal and distal side of the graft and the balloon could be withdrawn by deflation, were referred to conventional angiography. The stenosis observed in native vessels was managed by endovascular stent grafting and/or balloon dilatation. FINDINGS: Graft patency was achieved in all patients. In 11 patients, conventional angiography was implemented following embolectomy. In these patients, all the occlusions found as significant on angiography were removed by percutaneous transluminal angioplasty. CONCLUSION: Effective use of Fogarty catheter is safe in acute femoropopliteal bypass graft occlusions and in particular, in the planning of further treatment following thrombectomy.