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Original Article
Endovascular treatment of acute limb ischemia due to thrombotic occlusion of the suprainguinal artery
Byung Woo Kang, Jun Ho Bae, Deuk Young Nah, Jin Wook Chung, Byeong Joo Jo, Jun Gi Park
Kosin Medical Journal 2016;31(1):56-66.
DOI: https://doi.org/10.7180/kmj.2016.31.1.56
Published online: February 4, 2016

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: March 25, 2015   • Revised: August 24, 2015   • Accepted: September 16, 2015

Copyright © 2016 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • 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.
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.
kmj-31-56f1.jpg
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.
kmj-31-56f2.jpg
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).
kmj-31-56f3.jpg
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.
kmj-31-56f4.jpg
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.
kmj-31-56f5.jpg
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