Abstract
BackgroundThe use of drug-coated balloons (DCBs) with anti-proliferative agents in treating femoropopliteal lesions was approved in Japan in 2017. A better limb salvage rate or amputation-free rate of DCBs relative to plain old balloon angioplasty (POBA) has been reported; however, there is little evidence of the direct effect on intimal hyperplasia (IH).Case presentationA 70-year-old man with chronic limb-threatening ischemia and foot gangrene had undergone bypass surgery from the left common femoral artery to the dorsalis pedis artery 2 years earlier. We evaluated the bypass graft using ultrasonography and found stenosis around the proximal anastomotic site, presumably due to IH. POBA was performed every 3 months due to the repeated re-stenosis of the lesion. Since using the DCB, no restenosis has been detected to date (10 months).ConclusionDCB might be an effective tool for treating re-stenosis due to IH or vein grafts that do not respond to POBA.
Highlights
Despite the remarkable advances in endovascular therapy, autogenous vein graft for peripheral arterial bypass remains the first choice for long occlusions or below-knee lesions due to its excellent patency [1, 2]
drug-coated balloon (DCB) might be an effective tool for treating re-stenosis due to intimal hyperplasia (IH) or vein grafts that do not respond to plain old balloon angioplasty (POBA)
We report the case of a patient with chronic limb-threatening ischemia (CLTI) who underwent distal bypass, in which DCB was used in the treatment of repeated stenosis around the anastomotic site, Matsuura et al Surgical Case Reports (2019) 5:204 presumably due to IH, and demonstrated the effect of the DCB
Summary
Despite the remarkable advances in endovascular therapy, autogenous vein graft for peripheral arterial bypass remains the first choice for long occlusions or below-knee lesions due to its excellent patency [1, 2]. During DUS surveillance, we initially found severe stenosis around the femoral artery, anastomotic site, and vein bypass graft, where the PSV was increased to 564 cm/s, and planned re-intervention (Fig. 1b). His medical history included multiple coronary risk factors, including hypertension, diabetes mellitus, and associated nephropathy requiring hemodialysis, unstable angina, left thalamic hemorrhage, and ex-smoker status. In the final treatment using POBA after another 67 days, we used a 2.5 × 40-mm SABER PTA dilatation catheter and a 3.0 × 100-mm Rapidstream balloon catheter. The third and fourth POBA procedures were performed on the stenosis with PSVs of 299 and 358 cm/s because the bypass pulsation was found to be weakened remarkably. After the procedure using DCB was performed 10 months earlier, no remarkable graft stenosis has been noted till date. (Fig. 2)
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