Author + information
- Received April 13, 2015
- Revision received May 11, 2015
- Accepted May 23, 2015
- Published online October 1, 2015.
- Masahiro Yamamoto, MD∗,
- Osami Kawarada, MD, PhD∗∗ (, )
- Shingo Sakamoto, MD∗,
- Koichiro Harada, MD, PhD∗,
- Teruo Noguchi, MD, PhD∗,
- Satoshi Yasuda, MD, PhD∗ and
- Hisao Ogawa, MD, PhD∗,†
- ∗Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- †Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- ↵∗Reprint requests and correspondence:
Dr. Osami Kawarada, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
Subacute lower limb ischemia is defined as occurring more than 14 days and less than 3 months from symptom onset (1). Despite tremendous advancements in the treatment of vascular disease, no treatment strategy has been established for subacute lower limb ischemia. A 67-year-old man with a history of intermittent claudication in the left lower limb experienced a sudden worsening of claudication and pain at rest 3 weeks previously. The patient was referred to our vascular team for diagnosis and treatment. Although blood tests revealed no abnormalities, his ankle pressure was not detectable due to severe ischemia. Enhanced computed tomography revealed total occlusion due to an organized thrombus from the left popliteal artery to the infrapopliteal trifurcation. Based on these findings, he was diagnosed with subacute lower limb ischemia. Using a cut-down approach, a 4-French sheath was placed in the left common femoral artery for confirmatory angiography (Figure 1A). We successfully crossed the occlusion with a 0.014-inch guidewire and performed balloon angioplasty with a 2.0 × 40-mm2 balloon to macerate the organized thrombus (Figures 1B and 1C). After removal of the sheath, we attempted fluoroscopy-guided thrombectomy with a 4-French Fogarty catheter to eliminate the underlying thrombus (Figure 1D). Final angiography demonstrated excellent revascularization (Figure 1E). Of particular note, a significant thrombus more than 15 cm in length was removed (Figure 2). His symptoms resolved immediately after the procedure, and his ankle brachial index increased to 0.8.
Hybrid therapy consisting of balloon maceration and Fogarty thrombectomy might be an additional therapeutic option for subacute lower limb ischemia with organized thrombus.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 13, 2015.
- Revision received May 11, 2015.
- Accepted May 23, 2015.
- American College of Cardiology Foundation