Author + information
- Received September 3, 2018
- Accepted September 11, 2018
- Published online December 3, 2018.
- Michinao Tan, MD∗ (, )
- Kazushi Urasawa, MD, PhD,
- Saiin Kohei, MD and
- Shunsuke Kitani, MD
- ↵∗Address for correspondence:
Dr. Michinao Tan, Cardiovascular Center, Tokeidai Memorial Hospital, 2-3 North-1, East 1, Chuo-Ku Sapporo, Hokkaido 060-0031, Japan.
An 85-year-old woman with resting pain in her right foot was referred to our hospital. The index of skin perfusion pressure in the dorsal and plantar regions was 29 and 28 mm Hg, respectively, and duplex echocardiography revealed a chronic total occlusion of both anterior and posterior tibial arteries. On the basis of these findings, the patient was diagnosed with critical limb ischemia corresponding to Rutherford classification 4, and revascularization by endovascular therapy for her right anterior and posterior tibial arteries was planned. Subsequent to successful guidewire crossing, a 2 × 220 mm balloon catheter was introduced to the anterior tibial artery and then inflated. However, because of calcification of the vessel and bone trabecula, expansion of the balloon catheter was difficult to confirm with x-ray fluoroscopy (Figure 1). Following that, a rapid inflation technique, in which the balloon is quickly inflated within several seconds, was applied for improved visualization of the expansion of the balloon catheter using digital subtraction angiography (Figure 2). Following 3 min of balloon angioplasty, a rapid deflation technique was performed with digital subtraction angiography (Figure 3). Both techniques could clearly visualize the expansion of the balloon in real time, and the anterior tibial artery was successfully recanalized. Subsequently, the posterior tibial artery was recanalized as well.
Digital subtraction angiography is used not only for clear visualization of vessels but also for improved visualization of the expansion of a balloon catheter in real time using a rapid inflation and deflation technique.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 3, 2018.
- Accepted September 11, 2018.
- 2018 American College of Cardiology Foundation