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Vol 13, No 6 (2018)
Case Reports
Published online: 2019-02-13
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Multi-stage endovascular treatment of iatrogenic, distal, acute lower limb ischaemia in a patient with penetrating aortic ulcer

Dawid Siemieniuk, Piotr Myrcha, Mariusz Kozak, Tomasz Miłek, Piotr Ciostek
DOI: 10.5603/FC.2018.0123
·
Folia Cardiologica 2018;13(6):571-574.

open access

Vol 13, No 6 (2018)
Case Reports
Published online: 2019-02-13

Abstract

Introduction. Acute limb ischaemia (ALI) is a potentially treatable disease of the arteries. ALI can be caused by many factors. A rare cause of ALI is embolisation due to a penetrating aortic ulcer (PAU). The endovascular approach has made progress as an alternative treatment for ALI. However, using only one method of treatment may not be enough to salvage the limb. Case report. We present a case of an iatrogenic, intraoperative embolisation of the lower limb arteries after left external iliac artery (EIA) stenting in a patient with a potential source of embolisation from a PAU. In the treatment process, we performed an elective percutaneous transluminal angioplasty, left EIA stenting, and emergency intra-arterial thrombolysis. The patient was discharged from the clinic in a good condition and without limb ischaemia. After one month, an aortic stent graft was implanted to supply abdominal aortic aneurysm with PAU. Control angiography of computed tomography of the abdominal aorta and lower limb arteries was performed, and a correct stent graft and stent patency in left EIA was demonstrated. Conclusions. Endovascular treatment of acute limb ischaemia may require the use of different techniques to solve the problem, especially in complicated cases. Catheter directed thrombolysis is an effective method of treatment in an iatrogenic, distal embolisation. Stent graft implantation seems to be an effective method of eliminating emboli sourced from the aortic ulcer.

Abstract

Introduction. Acute limb ischaemia (ALI) is a potentially treatable disease of the arteries. ALI can be caused by many factors. A rare cause of ALI is embolisation due to a penetrating aortic ulcer (PAU). The endovascular approach has made progress as an alternative treatment for ALI. However, using only one method of treatment may not be enough to salvage the limb. Case report. We present a case of an iatrogenic, intraoperative embolisation of the lower limb arteries after left external iliac artery (EIA) stenting in a patient with a potential source of embolisation from a PAU. In the treatment process, we performed an elective percutaneous transluminal angioplasty, left EIA stenting, and emergency intra-arterial thrombolysis. The patient was discharged from the clinic in a good condition and without limb ischaemia. After one month, an aortic stent graft was implanted to supply abdominal aortic aneurysm with PAU. Control angiography of computed tomography of the abdominal aorta and lower limb arteries was performed, and a correct stent graft and stent patency in left EIA was demonstrated. Conclusions. Endovascular treatment of acute limb ischaemia may require the use of different techniques to solve the problem, especially in complicated cases. Catheter directed thrombolysis is an effective method of treatment in an iatrogenic, distal embolisation. Stent graft implantation seems to be an effective method of eliminating emboli sourced from the aortic ulcer.
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Keywords

acute limb ischaemia, penetrating aortic ulcer, percutaneous transluminal angioplasty, intra-arterial thrombolysis

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About this article
Title

Multi-stage endovascular treatment of iatrogenic, distal, acute lower limb ischaemia in a patient with penetrating aortic ulcer

Journal

Folia Cardiologica

Issue

Vol 13, No 6 (2018)

Pages

571-574

Published online

2019-02-13

DOI

10.5603/FC.2018.0123

Bibliographic record

Folia Cardiologica 2018;13(6):571-574.

Keywords

acute limb ischaemia
penetrating aortic ulcer
percutaneous transluminal angioplasty
intra-arterial thrombolysis

Authors

Dawid Siemieniuk
Piotr Myrcha
Mariusz Kozak
Tomasz Miłek
Piotr Ciostek

References (10)
  1. Eliason JL, Wainess RM, Proctor MC, et al. A national and single institutional experience in the contemporary treatment of acute lower extremity ischemia. Ann Surg. 2003; 238(3): 382–9; discussion 389.
  2. Ouriel K, Veith FJ. Acute lower limb ischemia: determinants of outcome. Surgery. 1998; 124(2): 336–41; discussion 341.
  3. Gerhard-Herman M, Gornik H, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Vasc Med. 2017; 22(3): NP1–NP43.
  4. Creager MA, Belkin M, Bluth EI, et al. 2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN/SVS Key data elements and definitions for peripheral atherosclerotic vascular disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (Writing Committee to develop Clinical Data Standards for peripheral atherosclerotic vascular disease). J Am Coll Cardiol. 2012; 59(3): 294–357.
  5. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997; 26(3): 517–538.
  6. Batt M, Haudebourg P, Planchard PF, et al. Penetrating atherosclerotic ulcers of the infrarenal aorta: life-threatening lesions. Eur J Vasc Endovasc Surg. 2005; 29(1): 35–42.
  7. Karapolat S, Dag O, Abanoz M, et al. Arterial embolectomy: a retrospective evaluation of 730 cases over 20 years. Surg Today. 2006; 36(5): 416–419.
  8. Comerota AJ, Weaver FA, Hosking JD, et al. Results of a prospective, randomized trial of surgery versus thrombolysis for occluded lower extremity bypass grafts. Am J Surg. 1996; 172(2): 105–112.
  9. Erbel R, Aboyans V, Boileau C, et al. Authors/Task Force members, ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(41): 2873–2926.
  10. Karnabatidis D, Spiliopoulos S, Tsetis D, et al. Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischemia. Cardiovasc Intervent Radiol. 2011; 34(6): 1123–1136.

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