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CASE20191101_006
| ENDOVASCULAR - Peripheral Vascular Disease and Intervention | |
| A Successful Bail-Out Case from Acute Limb Ischemia Which Recurred with a Short Interval | |
| Kenshi Ono1, Tetsuya Nomura1 | |
| Kyoto Chubu Medical center, Japan1, | |
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[Clinical Information]
- Patient initials or identifier number:
Y.S
-Relevant clinical history and physical exam:
An 86-year-old man who had a medical history of paroxysmal atrial fibrillation without anticoagulant therapy complained of paresthesia and paralysis in his left lower thigh with a sudden onset. His blood pressure was 116/77mmHg, and pulse was 116/min with an irregular rhythm. The left popliteal artery was not palpable in contrast to the well pulsation of the common femoral artery on the same side. Cyanosis of the left leg was not observed.
-Relevant test results prior to catheterization:
Serum creatinine phosphokinase and lactate dehydrogenase measured 408U/L and 430U/L respectively, but the data showed no significant increase than his usual degrees. An electrocardiogram demonstrated atrial fibrillation and complete left bundle branch block. Contrast enhanced computed tomography showed total occlusion in the left distal superficial femoral artery (SFA) in addition to a shaggy aorta and a severe stenosis in the left external iliac artery (EIA).
- Relevant catheterization findings:
An angiography via the left radial artery showed severe stenosis in the left tortuous EIA and total occlusion in the left distal SFA.
 Iliac artery Pre.mpg SFA ALI Pre.mpg |
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[Interventional Management]
- Procedural step:
In the first session, we targeted the SFA occlusive lesion via ipsilateral approach, and successfully revascularized it with a thrombus aspiration and a balloon dilation. Upstream revascularization in the left EIA stenosis was scheduled, but four days after the initial session, acute limb ischemia recurred with subtotal occlusion in the left EIA and total occlusion in the left SFA. Then, we first recanalized the subtotal EIA lesion using two bare nitinol stents via bidirectional approach. Next, we performed reverse catheterization technique of the SFA, and succeeded in revascularization using a stent graft.
First session final.mpg Left EIA occlusion second session.mpg EIA recanalization.mpg- Case Summary:
One of the essential causes of recurrent occlusion in the SFA in a short interval was thought to be due to unperformed upstream revascularization. Therefore, we have to fully examine the strategies in endovascular treatment for those cases of multi-vessel involvement.
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