Kimura Toshio, Nishibori Yoshiharu, Miki Kojiro, Tanaka Katsunao, Fujita Koichi, Takada Masanori, Maruyama Takao, Ishihara Masaharu
Department of Cardiology, Kawasaki Hospital, Kobe, Japan.
Division of Cardiovascular Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
J Cardiol Cases. 2019 Sep 14;21(1):20-23. doi: 10.1016/j.jccase.2019.09.001. eCollection 2020 Jan.
Endovascular therapy (EVT) has been accepted as a minimally invasive treatment for peripheral artery disease, and its applicability has been widened with the development of techniques and devices. A long, totally occluded lesion in the superficial femoral artery (SFA) is one of the most challenging lesions for EVT due to technical difficulties in wire-crossing. Recently, intentional subintimal recanalization is often considered as an alternative option for long SFA occlusions. Previous studies have shown that subintimal approach achieved superior technical success rate and similar patency rate, compared to conventional intraluminal approach. However, there is limited information about complications of the treatment with subintimal approach. Deep vein thrombosis (DVT) due to direct compression by pseudoaneurysm in the SFA, which subsequently develops pulmonary embolism (PE), is considered as a rare complication of subintimal angioplasty for the occlusive SFA lesion. We herein present a case of a patient who developed pseudoaneurysm formation in the SFA after EVT. Although initial EVT was performed successfully with subintimal approach, DVT and PE were caused by the SFA pseudoaneurysm at sub-acute phase following the initial procedure. The pseudoaneurysm was treated with implantation of a covered stent sealing the entry point, disappearing with no endoleak. < We present a case of the patient who developed pseudoaneurysm formation in the superficial femoral artery (SFA) after endovascular therapy with subintimal approach. At sub-acute phase, deep vein thrombosis and pulmonary embolism were caused by the SFA pseudoaneurysm. The pseudoaneurysm was treated with implantation of a covered stent sealing the entry point. Attention should be paid to pseudoaneurysm following subintimal angioplasty, and a covered stent can be an option as bailout treatment.>.
血管内治疗（EVT）已被公认为是外周动脉疾病的一种微创治疗方法，并且随着技术和设备的发展，其适用性不断扩大。股浅动脉（SFA）的长段完全闭塞病变是血管内治疗最具挑战性的病变之一，因为导丝通过存在技术困难。最近，有意的内膜下再通常被视为长段股浅动脉闭塞的一种替代选择。先前的研究表明，与传统的腔内入路相比，内膜下入路获得了更高的技术成功率和相似的通畅率。然而，关于内膜下入路治疗并发症的信息有限。股浅动脉假性动脉瘤直接压迫导致的深静脉血栓形成（DVT），随后发展为肺栓塞（PE），被认为是内膜下血管成形术治疗股浅动脉闭塞病变的一种罕见并发症。我们在此报告一例患者，其在血管内治疗后股浅动脉出现假性动脉瘤形成。尽管最初采用内膜下入路成功进行了血管内治疗，但在初始手术后的亚急性期，股浅动脉假性动脉瘤导致了深静脉血栓形成和肺栓塞。通过植入覆盖支架封闭入口点治疗假性动脉瘤，其消失且无内漏。<我们报告一例采用内膜下入路进行血管内治疗后股浅动脉出现假性动脉瘤形成的患者。在亚急性期，股浅动脉假性动脉瘤导致了深静脉血栓形成和肺栓塞。通过植入覆盖支架封闭入口点治疗假性动脉瘤。应注意内膜下血管成形术后的假性动脉瘤，覆盖支架可作为一种补救治疗选择。>
