Tsujimoto Masanaga, Haraguchi Takuya, Kashima Yoshifumi, Sato Katsuhiko, Fujita Tsutomu
Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
J Cardiol Cases. 2024 Sep 12;30(6):185-188. doi: 10.1016/j.jccase.2024.08.006. eCollection 2024 Dec.
Persistent sciatic artery (PSA) is a rare congenital anomaly that may involve aneurysmal formations. During endovascular treatment for PSA aneurysm (PSAA) occlusion, guidewire crossing can be challenging due to complex anatomy. We report successful endovascular intervention for PSAA occlusion using the "direct tip injection in occlusive lesions (DIOL)" fashion, in which hydraulic pressure with contrast facilitates guidewire crossing by visualizing the vessel course and expanding the microchannel and vessel lumen. An 80-year-old woman presented with severe intermittent left calf claudication due to PSA occlusion with PSAA. Endovascular treatment was attempted for the occlusion; however, bidirectional wiring in the PSAA was unsuccessful. Therefore, bidirectional DIOL was applied; antegrade-DIOL visualized and enlarged the subintimal plane of the proximal PSAA, while retrograde-DIOL showed intramedial lumen enlargement in the middle and distal PSAA. Consequently, bidirectional guidewires were successfully advanced into the expanded lumen, achieving guidewire externalization. After balloon angioplasty, a self-expandable stent and three stent-grafts were implanted throughout the PSA occlusion, with stent-grafts overlapping around the hip joint to overcome chronic external compression. The final angiogram revealed sufficient blood flow, and the symptoms improved. A 2-year follow-up computed tomography angiography indicated no restenosis. Thus, the DIOL fashion facilitates guidewire crossing in complex occlusions.
This case report highlights the successful guidewire crossing for the treatment of a persistent sciatic artery aneurysm (PSAA) occlusion, which can be challenging. The "direct tip injection in occlusive lesions" fashion, using hydraulic pressure with a contrast medium to facilitate guidewire crossing with visualization of the vessel course and expansion of the lesion lumen, is a valuable and safe method for guidewire crossing in PSAA occlusion.
持续性坐骨动脉（PSA）是一种罕见的先天性异常，可能伴有动脉瘤形成。在对PSA动脉瘤（PSAA）进行血管内治疗闭塞时，由于解剖结构复杂，导丝通过可能具有挑战性。我们报告了使用“闭塞病变直接尖端注射（DIOL）”方式成功进行PSAA闭塞的血管内介入治疗，其中造影剂产生的液压通过显示血管走行和扩大微通道及血管腔来促进导丝通过。一名80岁女性因PSA闭塞合并PSAA出现严重的左小腿间歇性跛行。尝试对闭塞进行血管内治疗；然而，在PSAA中双向布线未成功。因此，应用了双向DIOL；顺行DIOL显示并扩大了近端PSAA的内膜下平面，而逆行DIOL显示中、远端PSAA的内侧腔内扩大。结果，双向导丝成功推进到扩大的腔内，实现了导丝引出。球囊血管成形术后，在整个PSA闭塞处植入了一个自膨胀支架和三个覆膜支架，覆膜支架在髋关节周围重叠以克服慢性外部压迫。最终血管造影显示血流充足，症状改善。2年的随访计算机断层血管造影显示无再狭窄。因此，DIOL方式有助于在复杂闭塞中通过导丝。
本病例报告强调了成功通过导丝治疗持续性坐骨动脉瘤（PSAA）闭塞，这可能具有挑战性。“闭塞病变直接尖端注射”方式，利用造影剂产生的液压通过显示血管走行和扩大病变腔来促进导丝通过，是PSAA闭塞中通过导丝的一种有价值且安全的方法。
