Yamada Takehiro, Kawasaki Daizo
Division of Cardiology, Morinomiya Hospital, Osaka, Japan.
J Cardiol Cases. 2020 Jul 4;22(4):163-165. doi: 10.1016/j.jccase.2020.05.020. eCollection 2020 Oct.
A 77-year-old male was admitted to our hospital for severe intermittent claudication of both legs. He was diagnosed with aorto-iliac occlusions and a right femoro-popliteal artery occlusion with a diseased common femoral artery by a computed tomography angiography of the lower limb. We planned endovascular therapy for these multi-level occlusive lesions. The aorto-iliac lesion of the left side was antegradely recanalized via the left brachial artery. That of the right side was recanalized retrogradely by a direct occlusive vessel puncture (DOVP) with a dedicated 20 G needle and the Hi-Torque Command 18 ST. After stenting, his symptoms were completely relieved without revascularization of right femoro-popliteal artery, and he was discharged without any complications. The DOVP may also be used as an alternative option when there is not an appropriate approach site. < The appropriate selection of the access site for peripheral artery occlusive disease (PAOD) is one of the most important factors to obtain a successful guidewire recanalization. We occasionally encounter multi-level PAOD without an appropriate access site. The direct occluded vessel puncture should be considered as an alternative option.>.
一名77岁男性因双腿严重间歇性跛行入住我院。通过下肢计算机断层血管造影，他被诊断为腹主动脉-髂动脉闭塞以及右侧股-腘动脉闭塞伴股总动脉病变。我们计划对这些多节段闭塞性病变进行血管内治疗。左侧腹主动脉-髂动脉病变经左肱动脉顺行再通。右侧病变通过使用专用的20G穿刺针和Hi-Torque Command 18 ST进行直接闭塞血管穿刺（DOVP）逆行再通。支架置入后，他的症状完全缓解，右侧股-腘动脉未进行血管重建，且他无任何并发症出院。当没有合适的入路部位时，DOVP也可作为一种替代选择。< 为外周动脉闭塞性疾病（PAOD）选择合适的入路部位是成功进行导丝再通的最重要因素之一。我们偶尔会遇到没有合适入路部位的多节段PAOD。直接闭塞血管穿刺应被视为一种替代选择。>
