Korosoglou Grigorios, Eisele Tom, Raupp Dorothea, Eisenbach Christoph, Giusca Sorin
Cardiology and Vascular Medicine, GRN Academic Teaching Hospital, Weinheim 69469, Germany.
Diabetology and Gastroenterology, GRN Academic Teaching Hospital, Weinheim 69469, Germany.
World J Cardiol. 2017 Dec 26;9(12):842-847. doi: 10.4330/wjc.v9.i12.842.
Patients with critical limb ischemia necessitate immediate intervention to restore blood flow to the affected limb. Endovascular procedures are currently preferred for these patients. We describe the case of an 80-year-old female patient who presented to our department with ischemic rest pain and ulceration of the left limb. The patient had history of left femoral popliteal bypass surgery, femoral thromboendarterectomy and patch angioplasty of the same limb 2 years ago. Doppler sonography and magnetic resonance angiography revealed an occlusion of the left superficial femoral artery (SFA) and popliteal artery and of all three infra-popliteal arteries. Due to severe comorbidities, the patient was scheduled for a digital subtraction angiography. An antegrade approach was first attempted, however the occlusion could not be passed. After revision of the angiography acquisition, a stent was identified at the level of the mid SFA, which was subsequently directly punctured, facilitating the retrograde crossing of the occlusion. Thereafter, balloon angioplasty was performed in the SFA, popliteal artery and posterior tibial artery. The result was considered suboptimal, but due to the large amount of contrast agent used, a second angiography was planned in 4 wk. In the second session, drug coated balloons were used to optimize treatment of the SFA, combined with recanalization of the left fibular artery, to optimize outflow. The post-procedural course was uneventful. Ischemic pain resolved completely after the procedure and at 8 wk of follow-up and the foot ulceration completely healed.
严重肢体缺血患者需要立即进行干预以恢复患肢的血流。目前，血管内介入手术是这类患者的首选治疗方法。我们描述了一名80岁女性患者的病例，该患者因左下肢缺血性静息痛和溃疡前来我院就诊。患者2年前曾接受左股腘动脉搭桥手术、股动脉血栓内膜切除术及同肢体的补片血管成形术。多普勒超声和磁共振血管造影显示左股浅动脉（SFA）、腘动脉以及所有三支腘下动脉均闭塞。由于存在严重的合并症，该患者计划接受数字减影血管造影检查。首先尝试顺行入路，但闭塞部位无法通过。在重新评估血管造影图像后，发现在SFA中段水平有一枚支架，随后直接对其进行穿刺，从而实现了闭塞部位的逆行通过。此后，对SFA、腘动脉和胫后动脉进行了球囊血管成形术。结果被认为不太理想，但由于使用了大量造影剂，计划在4周后进行第二次血管造影。在第二次手术中，使用药物涂层球囊对SFA进行优化治疗，并对左腓动脉进行再通以优化流出道。术后过程顺利。术后缺血性疼痛完全缓解，随访8周时足部溃疡完全愈合。
