Endovascular Stenting for Critical Limb Ischemia Patient with Superficial Femoral Artery Occlusive Disease: A Case Report

Cholid Tri Tjahjono,Ryan Ramadhan,Djanggan Sargowo,Novi Kurnianingsih

doi:10.21776/ub.hsj.2020.001.01.7

Cholid Tri Tjahjono, Ryan Ramadhan + Show 2 more

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https://doi.org/10.21776/ub.hsj.2020.001.01.7

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Abstract

BACKGROUND: Critical limb ischemia (CLI) is a terminal stage of peripheral arterial disease (PAD), in the absence of intervention, may lead to lower extremity amputation or death. In cases where medical management is not effective or severe cases of PAD, endovascular and surgical interventions are indicated. 2 Endovascular interventions become a first-line approach of CLI management and have advanced considerably within the past decade. 1,3 CASE DESCRIPTION: A 73-year old female with complain of left leg pain, accompanied with necrotic wound since 6 months ago. Duplex ultrasound showed no-flow from proximal to distal left superficial femoral artery (SFA). From CT-Angiography showed total occlusion from proximal left SFA to proximal poplitea artery about 7,2cm with collateral vessels. She was diagnosed with CLI left inferior extremity Fontaine IV Rutherford III. Angiography inferior extrimities was performed with total occlusion from proximal to distal left SFA with collateral vessels run to distal. We deployed a self-expanding stent with size 6mmx100mmx120cm at proximal-mid SFA. The patient showed improvement and was discharged after 5-days observation DISCUSSION: Patients with CLI have high risk of limb-loss without revascularization and high short term risk of cardiovascular events. Endovascular revascularization of femoro-popliteal occlusive offers lower initial risks than open surgery, with grade IIB-recommendation for lesion less than 25cm. Clinical success of endovascular stenting on CLI usually synonymous to limb salvage CONCLUSION:Favorable results can be achieved with endovascular stenting approach in patients with CLI, where close follow-up treatment afterwards can save limb loss.

Highlights

The patient showed clinically improvement and discharged on the day 5 observation Conclusion: Favorable result could be achieved by endovascular stenting approach in patients with Critical limb ischemia (CLI), where close follow-up treatment afterward could save limb loss
CT-angiography was performed with result suggested a total occlusion of left superficial femoral artery (SFA) 1/3 of distal to the proximal side of popliteal artery 7.2cm in length with surrounding collaterals
It has been reported case of a hypertensive smoker 73 years-old female presenting with clinically Fontaine IV Rutherfords 5 caused by a total occlusion of SFA

Summary

Case Presentation

Peripheral arterial disease (PAD) is defined as a process of atherosclerosis that occurs in arteries from the distal arteries to aortic bifurcation with or without symptoms.[1]. The patient was performed arteriography of the left inferior extremity that showed stenosis 60% in external Iliac artery, multiple stenosis with maximal stenosis 70% in the CFA, total occlusion from proximal to distal SFA, 80% stenosis in the PFA. CT-angiography was performed with result suggested a total occlusion of left SFA 1/3 of distal to the proximal side of popliteal artery 7.2cm in length with surrounding collaterals. A 6mm x 100mm x 120cm self expanding stent was deployed from proximal to mid left SFA resulting in TIMI flow 2 to the distal part (Figure 3). DUS examination showed the blood flow in the left inferior limb filling the left superficial femoral artery through a stent that reached to the left popliteal artery. The patient went home with dual antiplatelet and oral anticoagulant for a certain period until the flow evaluation was performed

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