Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan.
Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Am J Case Rep. 2022 Jun 28;23:e936377. doi: 10.12659/AJCR.936377.
BACKGROUND Subacute lower limb ischemia occurs more than 14 days and less than 3 months from symptom onset. Although endovascular procedures are the preferred treatment choice for a viable and not immediately threatened limb in patients with acute lower limb ischemia (<14 days), percutaneous catheter-directed thrombolysis, percutaneous mechanical thrombectomy, or percutaneous thromboaspiration are not recommended, and no treatment strategy has yet been established for nonacute lower limb ischemia (>14 days). A percutaneous Fogarty thrombectomy, an endovascular thrombus removal procedure with the use of a large-caliber sheath and a Fogarty balloon catheter, has recently been reported as a less invasive alternative to open surgery in patients with acute lower limb ischemia. In this report, we use this technique for a case of subacute lower limb ischemia caused by a resistant thrombus. CASE REPORT A 73-year-old man with a diagnosis of essential thrombocythemia presented with symptoms of right lower limb ischemia, which started about a month before. The diagnosis was subacute lower limb ischemia due to a resistant thrombus in the popliteal artery. First, we attempted percutaneous thromboaspiration and prolonged dilation with a large-caliber balloon catheter, but there were still severe residual stenoses with delayed blood flow. Although vascular scaffold implantation might have achieved complete revascularization, we avoided it because of a high probability of stent fracture in the popliteal artery. Thus, we performed a subsequent percutaneous Fogarty thrombectomy immediately after the conventional endovascular recanalization failed, achieving complete revascularization and next-day discharge without any complications. CONCLUSIONS A percutaneous Fogarty thrombectomy could be a new treatment option for subacute lower limb ischemia due to a resistant thrombus, which can be performed immediately after failure of the conventional endovascular recanalization.
亚急性下肢缺血是指从症状出现到发病 14 天以上但不足 3 个月的时间内发生的下肢缺血。尽管血管内介入治疗是急性下肢缺血（<14 天）患者有活力且不存在即刻威胁肢体的首选治疗选择，但不推荐经皮导管定向溶栓、经皮机械血栓切除术或经皮血栓抽吸术，对于非急性下肢缺血（>14 天）也尚未建立治疗策略。最近有报道称，经皮 Fogarty 血栓切除术（一种使用大口径鞘管和 Fogarty 球囊导管的血管内血栓清除术）是急性下肢缺血患者替代开放手术的一种微创方法。在本报告中，我们使用该技术治疗了一例由顽固血栓引起的亚急性下肢缺血病例。
一名 73 岁男性，诊断为特发性血小板增多症，出现右下肢缺血症状，发病约一个月前。诊断为由腘动脉内顽固血栓引起的亚急性下肢缺血。首先，我们尝试了经皮血栓抽吸术和大口径球囊导管的长时间扩张，但仍存在严重的残余狭窄和血流延迟。虽然血管支架植入术可能实现完全再血管化，但由于在腘动脉中支架断裂的可能性较高，我们避免了该手术。因此，在常规血管内再通失败后，我们立即进行了随后的经皮 Fogarty 血栓切除术，实现了完全再血管化，并于次日出院，无任何并发症。
经皮 Fogarty 血栓切除术可能是一种治疗顽固血栓引起的亚急性下肢缺血的新方法，可在常规血管内再通失败后立即进行。
