Shimada Takenobu, Goto Tsuyoshi, Kubo Shunsuke, Habara Seiji, Tanaka Hiroyuki, Kadota Kazushige
Department of Cardiology, Kurashiki Central Hospital.
Int Heart J. 2018 May 30;59(3):660-663. doi: 10.1536/ihj.17-216. Epub 2018 May 6.
A 69-year-old man on maintenance dialysis underwent endovascular therapy for a refractory wound due to critical limb ischemia in the popliteal and below-knee arteries. Because of bulky calcified nodules projecting into the popliteal artery, conventional balloon angioplasty alone did not seem to provide a sufficient lumen area, and we ablated the calcified nodules by using myocardial biopsy forceps for lesion preparation. Under roadmap guidance, we repeated ablation 39 times to carefully tear off the bulky calcified nodules, and subsequently performed balloon angioplasty in the popliteal artery. Neither flow-limiting dissection nor perforation occurred, and a sufficient lumen area was obtained. After treatment of the popliteal artery, conventional endovascular therapy was performed in the below-knee arteries. One month later, the wound was fully epithelialized. We report a case of critical limb ischemia with calcified nodules projecting into the popliteal artery, in which the use of myocardial biopsy forceps led to good results.
一名接受维持性透析的69岁男性因腘动脉及膝下动脉严重肢体缺血导致难治性伤口而接受血管内治疗。由于有巨大的钙化结节突入腘动脉，单纯传统球囊血管成形术似乎无法提供足够的管腔面积，因此我们使用心肌活检钳对病变进行预处理以消融钙化结节。在路图引导下，我们重复消融39次以小心地撕下巨大的钙化结节，随后在腘动脉进行球囊血管成形术。既未发生限流性夹层也未发生穿孔，并且获得了足够的管腔面积。在腘动脉治疗后，对膝下动脉进行了传统血管内治疗。1个月后，伤口完全上皮化。我们报告了1例伴有突入腘动脉钙化结节的严重肢体缺血病例，其中使用心肌活检钳取得了良好效果。
