Department of Radiology, Nara Medical University, Kashihara, Japan.
Department of Cardiovascular Surgery, Nara Prefecture Seiwa Medical Center, Ikomagun, Japan.
Catheter Cardiovasc Interv. 2021 Jul 1;98(1):E124-E126. doi: 10.1002/ccd.29693. Epub 2021 Apr 6.
Efficacy of percutaneous deep venous arterialization (pDVA) has been reported for patients with no-option chronic limb threatening ischemia. To date, the procedure has been limited for below the knee/below the ankle occlusive disease. The present report describes the pDVA performed at a femoropopliteal segment for a patient with a stump complication after below the knee amputation. The patient was a 70-year-old male who had a history of endovascular treatment in the right superficial femoral artery (SFA) and below knee amputation 6 years before. He had an unhealed ulcer at the amputated stump for 3 years. Computed tomography angiography demonstrated occluded right SFA, with a stenotic popliteal artery. Revascularization was considered unfeasible due to the absence of run off vessels. In order to improve the perfusion at the ulcer, pDVA was performed at the distal SFA level, bridging SFA and femoral vein using stent grafts. The final angiogram demonstrated the revascularized SFA connecting to popliteal vein with a brisk flow. After pDVA, the stump ulcer improved and the stent grafts were kept patent after 6 months of the procedure. pDVA at the SFA level was technically feasible and could be a useful approach for stump complication after below knee amputation.
经皮深静脉动脉化（pDVA）已被报道可用于治疗无选择的慢性肢体威胁性缺血患者。迄今为止，该手术仅限于膝下/踝下闭塞性疾病。本报告描述了在股腘段进行的 pDVA，患者为膝下截肢后残端并发症。患者为 70 岁男性，6 年前曾在右股浅动脉（SFA）行血管内治疗和膝下截肢。他的截肢残端有一处溃疡，3 年来未愈合。计算机断层血管造影显示右 SFA 闭塞，伴腘动脉狭窄。由于缺乏流出血管，再血管化被认为不可行。为了改善溃疡的灌注，在 SFA 远端水平进行了 pDVA，使用支架移植物桥接 SFA 和股静脉。最终的血管造影显示再血管化的 SFA 与腘静脉连接，血流迅速。pDVA 后，残端溃疡改善，支架移植物在术后 6 个月仍保持通畅。SFA 水平的 pDVA 在技术上是可行的，对于膝下截肢后的残端并发症是一种有用的方法。
