Misuraca Leonardo, Buonpane Angela, Trimarchi Giancarlo, Picchi Andrea, Filippi Federico, Biancofiore Antonio, Limbruno Ugo, Rizza Antonio
Department of Interventional Cardiology, Misericordia Hospital, Azienda USL (Unità Sanitaria Locale) Toscana Sud Est, Grosseto, ITA.
Department of Cardiology, Foundation University Polyclinic Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ITA.
Cureus. 2024 Aug 14;16(8):e66874. doi: 10.7759/cureus.66874. eCollection 2024 Aug.
Aortoiliac occlusive disease (AIOD) is a specific form of peripheral artery disease (PAD) that affects the infrarenal aorta and iliac arteries. Patients with PAD commonly suffer from intermittent claudication (IC), a condition characterized by cramping pain during or after exercise that is relieved by rest. The first-line therapy for IC involves medical management, foot care, and structured exercise programs while revascularization therapy, which can be endovascular, surgical, or a combination of both, is generally reserved for patients with claudication who do not respond adequately to initial therapies. We present the clinical case of a 58-year-old female with hypertension, dyslipidemia, and a smoking habit who was referred to our hospital (Misericordia Hospital, Grosseto, Italy) due to bilateral IC of the buttocks and thighs. Computed tomography (CT) angiography revealed a 90% tight stenosis of the infrarenal abdominal aorta just above the iliac bifurcation with diffuse calcifications. After a careful evaluation of the patient's condition and anatomical characteristics of the atherosclerotic disease, the vascular team decided to perform covered endovascular reconstruction of aortic bifurcation (CERAB) with previous intravascular lithotripsy (IVL) with shockwave balloon using intravascular ultrasound (IVUS) as guidance, because of severe aortic luminal calcifications. We performed successful CERAB, and the patient was discharged in good clinical condition on the fifth day of hospitalization with an indication to follow optimal medical therapy. At the one-month clinical follow-up, the patient reported the disappearance of claudication with marked improvement in quality of life. This first described case of IVUS-guided IVL-facilitated CERAB demonstrates the efficacy and safety of IVL in calcific aortic disease and shows the usefulness of IVUS as guidance in peripheral calcium debulking procedures.
主髂动脉闭塞性疾病（AIOD）是外周动脉疾病（PAD）的一种特殊形式，累及肾下腹主动脉和髂动脉。PAD患者常患有间歇性跛行（IC），其特征是运动期间或运动后出现痉挛性疼痛，休息后缓解。IC的一线治疗包括药物治疗、足部护理和结构化运动计划，而血运重建治疗（可采用血管内治疗、手术治疗或两者结合）通常适用于对初始治疗反应不佳的跛行患者。我们报告了一例58岁女性患者的临床病例，该患者患有高血压、血脂异常且有吸烟习惯，因双侧臀部和大腿间歇性跛行被转诊至我院（意大利格罗塞托米塞里科迪亚医院）。计算机断层扫描（CT）血管造影显示，髂总动脉分叉上方的肾下腹主动脉有90%的严重狭窄，并伴有弥漫性钙化。在仔细评估患者病情和动脉粥样硬化疾病的解剖特征后，由于严重的主动脉管腔钙化，血管团队决定在血管内超声（IVUS）引导下，使用冲击波球囊先行血管内碎石术（IVL），然后进行主动脉分叉覆膜血管内重建术（CERAB）。我们成功实施了CERAB，患者在住院第五天临床状况良好出院，并被建议遵循最佳药物治疗方案。在1个月的临床随访中，患者报告跛行消失，生活质量显著改善。这例首次报道的IVUS引导下IVL辅助CERAB病例证明了IVL在钙化性主动脉疾病中的有效性和安全性，并显示了IVUS在周围血管钙化减容手术中的指导作用。
