Rammos Christos, Radecke Tobias, Lortz Julia, Steinmetz Martin, Rassaf Tienush
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany.
SAGE Open Med Case Rep. 2019 Jan 11;7:2050313X18823445. doi: 10.1177/2050313X18823445. eCollection 2019.
In patients with intermittent claudication and long chronic total occlusions of the superficial femoral artery, a primary surgical bypass or stenting is recommended. However, due to the invasive nature, high complication rates and patient-related comorbidities, surgery is currently not the preferred method and full lesion stenting for long chronic total occlusions has the obvious consequences of permanent metallic implants. We report a case of a patient with a long chronic total occlusion of the superficial femoral artery with intermittent claudication. Endorsing an endovascular-first strategy, he was treated via an antegrade and retrograde approach with a complete recanalization and a stentless treatment with rotational atherectomy and drug-coated balloons. We believe this is a feasible endovascular strategy for the treatment of long chronic total occlusions of the superficial femoral artery for patients refusing open surgery. Further investigations are needed to evaluate long-term clinical outcomes of these novel techniques.
对于患有间歇性跛行且股浅动脉存在长期慢性完全闭塞的患者，建议进行一期外科搭桥或支架置入术。然而，由于手术具有侵入性、并发症发生率高以及患者相关的合并症，目前手术并非首选方法，而对于长期慢性完全闭塞病变进行全程支架置入会有永久性金属植入物的明显后果。我们报告一例患有股浅动脉长期慢性完全闭塞并伴有间歇性跛行的患者。支持血管内优先策略，该患者通过顺行和逆行途径接受治疗，实现了完全再通，并采用了旋磨术和药物涂层球囊进行无支架治疗。我们认为，对于拒绝接受开放手术的患者，这是一种治疗股浅动脉长期慢性完全闭塞的可行血管内策略。需要进一步研究来评估这些新技术的长期临床结果。
