Author + information
- Received February 13, 2017
- Accepted February 23, 2017
- Published online May 17, 2017.
- aBrookwood Baptist Health System, Birmingham, Alabama
- bCardiology Associates, PC, Birmingham, Alabama
- ↵∗Address for correspondence:
Dr. William C. Black, 817 Princeton Avenue SW, POB 2, Suite 106, Birmingham, Alabama 35211.
A 60-year-old African-American woman with a history of dilated cardiomyopathy and permanent atrial fibrillation presented to the emergency department with acute onset of bilateral lower extremity pain and partial paralysis. History was notable for recent implantable cardioverter-defibrillator generator replacement 1 week prior requiring brief discontinuation of rivaroxaban. Physical examination revealed nonpalpable femoral pulses and cyanotic feet. The arterial duplex was unable to identify a pulse at the common femoral level. Computed tomography revealed total occlusion of the infrarenal abdominal aorta extending into the common iliac arteries (Figure 1). Transesophageal echocardiography confirmed a large thrombus in the left atrial appendage. The patient was treated with systemic heparin. After consultation with vascular surgery, it was believed that neither thrombolytic infusion nor thrombectomy would be useful in this case and would likely lead to further distal embolization. The decision was made to proceed with covered stent placement, as stent-assisted recanalization has been demonstrated to have a high success rate as a bailout procedure for the management of acute limb ischemia (1). Two (8 × 100 mm) covered stents (Gore VIABAHN, Gore Medical, Flagstaff, Arizona) were placed in the abdominal aorta, extending down into the left and right common iliac arteries (Figure 2A). The stents were deployed simultaneously and then post-dilated with 8-mm balloons. Final arteriography was performed, revealing a widely patent distal abdominal aorta with excellent runoff and no evidence of distal embolization (Figure 2B). This case demonstrates an excellent result of an aortic reconstruction technique with covered stents in a patient with acute thrombotic occlusion.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 13, 2017.
- Accepted February 23, 2017.
- 2017 American College of Cardiology Foundation