Gohbara Masaomi, Shigenaga Atsuichiro, Sugano Teruyasu, Ishikawa Toshiyuki, Tamura Kouichi, Kimura Kazuo
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Cardiovasc Interv Ther. 2022 Jul;37(3):538-542. doi: 10.1007/s12928-021-00831-1. Epub 2022 Jan 11.
A 76-year-old female who had a history of endovascular treatment (EVT) for her left superficial femoral artery with endovascular stent grafts [VIABAHN (W. L. Gore & Associates, Inc., DE, USA)] suddenly experienced intermittent claudication of her left leg. Angiography revealed total occlusion of previous stent grafts, and a thrombus aspiration catheter was used after crossing the guidewire. Since retrograde angiography using a thrombus aspiration catheter revealed a large residual thrombus at the distal edge of the previous stent even after several thrombus aspirations, biopsy forceps for intestinal endoscopes [Radial Jaw (Boston Scientific, MA, USA)] were successfully used to remove that thrombus. After balloon inflation under distal protection, angiography revealed a large residual thrombus at her left common femoral artery with a flow limiting of her deep femoral artery. Again, biopsy forceps were successfully used to remove that thrombus. In this case series, we reported a total of 11 cases which underwent EVT using biopsy forceps for intestinal endoscopes [Radial Jaw (Boston Scientific, MA, USA)]. Of the 11 cases, eight underwent EVT using biopsy forceps for thrombus removal, two underwent calcification removal in severely calcified lesions, and one underwent removal of a detached guidewire. There were no major adverse limb events (MALEs) except for one patient who underwent major amputation after EVT. One MALE occurred independently of biopsy forceps use because biopsy forceps were used only to remove the detached wire. Biopsy forceps for intestinal endoscopes were clinically useful and safe for EVT.
一名76岁女性，曾接受过左股浅动脉血管内支架植入术（使用美国特拉华州W. L. Gore & Associates公司生产的VIABAHN血管内支架移植物），突然出现左腿间歇性跛行。血管造影显示先前的支架移植物完全闭塞，在导丝穿过后置入血栓抽吸导管。由于使用血栓抽吸导管进行逆行血管造影显示，即使经过多次血栓抽吸，先前支架远端边缘仍有大量残余血栓，遂成功使用肠道内窥镜活检钳（美国马萨诸塞州波士顿科学公司生产的Radial Jaw活检钳）清除该血栓。在远端保护下进行球囊扩张后，血管造影显示左股总动脉有大量残余血栓，股深动脉血流受限。再次成功使用活检钳清除该血栓。在本病例系列中，我们共报告了11例使用肠道内窥镜活检钳（美国马萨诸塞州波士顿科学公司生产的Radial Jaw活检钳）进行血管内治疗（EVT）的病例。在这11例病例中，8例使用活检钳进行血栓清除的血管内治疗，2例在严重钙化病变中进行钙化清除，1例进行游离导丝清除。除1例患者在血管内治疗后接受了大截肢手术外，未发生主要肢体不良事件（MALE）。1例MALE的发生与活检钳的使用无关，因为活检钳仅用于清除游离导丝。肠道内窥镜活检钳在血管内治疗中临床应用有效且安全。
