Endovascular treatment of acute limb ischemia due to thrombotic occlusion of the suprainguinal artery

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Kosin Med J. 2016;31(1):56-66

Publication date (electronic) : 2016 February 04

doi : https://doi.org/10.7180/kmj.2016.31.1.56

Byung Woo Kang , Jun Ho Bae ^,, Deuk Young Nah , Jin Wook Chung , Byeong Joo Jo , Jun Gi Park

Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju-si, Gyeongsangbuk-do, Korea

Corresponding Author: Jun Ho Bae, Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, 87, Dongdae-ro, Gyeongju-si, Gyeongsangbuk-do, 38067, Korea Tel: +82-54-770-8587 Fax: +82-54-770-8378 E-mail: junhodr@naver.com

Received 2015 March 25; Revised 2015 August 24; Accepted 2015 September 16.

Abstract

Acute limb ischemia (ALI) is a serious condition requiring prompt intervention due to a sudden decrease in limb perfusion threatening limb viability. Treatment of ALI depends on the clinical status of the affected limb and patient comorbidities. Surgical therapy has been the historical standard of care for restoring limb perfusion; however, percutaneous endovascular intervention has been shown to be a promising treatment option in selected patients of ALI at high surgical risk. We report on a case of a 75-year-old man with ALI caused by thrombotic occlusion of the suprainguinal artery, successfully treated with endovascular therapy including stent insertion and thrombus aspiration and catheter-directed urokinase infusion in view of the clinical findings and imaging studies.

Keywords: Key Words; Endovascular procedures; Ischemia; Lower extremity; Thrombolytic therapy

Fig. 1.

(A) Initial angiography shows total occlusion of the left common iliac artery. (B) After guide wire and glide catheter are passed the left common iliac artery lesion, angiography shows total occlusion of the popliteal artery.

Fig. 2.

After several aspiration thrombectomy with a 5-Fr Heartrail guiding catheter and balloon angioplasty, angiography shows significant luminal stenosis of the left common iliac artery and intraluminal filling defects in the left common and external iliac artery.

Fig. 3.

(A) After aspiration thrombectomy, balloon angioplasty and the stent insertion at the left common iliac artery, angiography shows good flow restoration to the distal part popliteal artery. (B) After aspiration thrombectomy, balloon angioplasty and intrathrombus urokinase injection at anterior and posterior tibial artery, angiography shows good flow restoration to the dorsalis pedis artery (white arrow head).

Fig. 4.

Follow-up angiography after continuous urokinase infusion (50,000 IU/hr) with a multi-sideport infusioncatheter for 12 hours shows good patent anterior tibial artery, posterior tibial artery and peroneal artery and good antegrade flow to foot.

Fig. 5.

Computed tomography angiography 2 months later shows a well expanded stent at the left common iliac artery, good patency of the popliteal artery.

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