Irretrievable wire wrap and catheter entrapment: Novel failure mode of endobypass device

A 75-year-old man with a history of severe ischemic cardiomyopathy, coronary artery disease status post coronary artery bypass graft, stroke, atrial fibrillation, chronic kidney disease, and recent right metatarsophalangeal amputation was admitted for an ischemic nonhealing wound. Angiography demonstrated right superior femoral artery occlusion with above-knee reconstitution. Percutaneous transmural arterial bypass using the Detour device (Endologix, LLC) was complicated by severe wire wrap and irretrievable catheter entrapment, necessitating open extraction and procedure abortion. Despite technical failure, the wound had healed at follow-up. This case highlights device-specific challenges and divergence between technical and clinical success.