Barat Sorin, Casian Dumitru
Division of Vascular and Endovascular Surgery, Republican Clinical Hospital, 29 Nicolae Testemitanu Str., Chisinau, Moldova.
Department of General Surgery Nr.3, Vascular Surgery Clinic, Nicolae Testemitanu State University of Medicine and Pharmacy, 165 Stefan cel Mare si Sfant Bd., Chisinau, Moldova.
Case Rep Vasc Med. 2021 Jun 21;2021:5546194. doi: 10.1155/2021/5546194. eCollection 2021.
We report our initial experience in off-label use of the double-layer micromesh (DLM) Roadsaver® stent for the hybrid treatment of a fusiform popliteal artery aneurism complicated by distal embolization and chronic limb threatening ischemia in a COVID-19-positive young male. A 36-year-old male patient was admitted with chronic limb threatening ischemia of the left lower limb. The duplex ultrasound and computer tomography angiography (CTA) demonstrated a fusiform popliteal artery aneurism with a maximal diameter of 14 mm and distal occlusion of peroneal and both tibial arteries. Urgent hybrid intervention was performed, starting with an open thrombectomy from the distal posterior tibial artery via a retromalleolar access followed by percutaneous deployment of the DLM Roadsaver® stent (Terumo, Tokyo, Japan) for the exclusion of the popliteal artery aneurism. The flow diverting effect was observed immediately with contrast stagnation in the asymmetrical part of the aneurism sac (grade C2 of the O'Kelly-Marotta flow diversion scale). The procedure was uneventful, with the regaining of an adequate foot perfusion and palpable pulse at the posterior tibial artery. On the 2 postoperative day, the patient was diagnosed with a symptomatic form of COVID-19 infection and transferred to a dedicated facility. At a one-month follow-up, the patient had no symptoms of limb ischemia and CTA showed complete thrombosis of the aneurism sac, absence of endoleaks, and patency of the treated arterial segment. This case demonstrates the possibility of off-label use of the DLM Roadsaver® stent for hybrid treatment of popliteal artery aneurism complicated by distal embolization and critical limb ischemia.
我们报告了使用双层微网（DLM）Roadsaver®支架对一名COVID-19检测呈阳性的年轻男性梭形腘动脉瘤合并远端栓塞和慢性肢体威胁性缺血进行杂交治疗的初步经验。一名36岁男性患者因左下肢慢性肢体威胁性缺血入院。双功超声和计算机断层血管造影（CTA）显示一个最大直径为14毫米的梭形腘动脉瘤，腓动脉和双侧胫动脉远端闭塞。进行了紧急杂交干预，首先通过后踝入路从胫后动脉远端进行开放性血栓切除术，然后经皮植入DLM Roadsaver®支架（日本东京泰尔茂公司）以排除腘动脉瘤。立即观察到分流效果，瘤囊不对称部分造影剂停滞（O'Kelly-Marotta分流分级C2级）。手术过程顺利，足部灌注恢复正常，胫后动脉可触及搏动。术后第2天，患者被诊断为有症状的COVID-19感染，并被转至专门机构。在1个月的随访中，患者无肢体缺血症状，CTA显示瘤囊完全血栓形成，无内漏，治疗的动脉段通畅。该病例证明了DLM Roadsaver®支架用于杂交治疗合并远端栓塞和严重肢体缺血的腘动脉瘤的非标签使用可能性。
