Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
Mr. AJ, a 58 years old man complaining of bilateral lower extremity paraesthesia, numbness, coldness and pain. The pain has been present for few months, but he has noticed an increase within the last weeks. He describes it as a sharp pain, especially his left leg. The pain worsens when he walks long distances and subsides within a few minutes after he stops physical activity and rests.
Relevant test results prior to catheterization
Chest X-ray found cardiomegaly.
Echocardiography : Mild mitralregurgitation, and normal other cardiac valves. Left atrial and left ventricle dilatation. Poor systolic left ventricle function (Ejection fraction by teich32%, by biplane 29%), abnormal left ventricle relaxation, and there is large soft thrombus in apex until lateral left ventricle wall. Eccentric left ventricle hypertrophy.CT angiography we found the total occlusion incommon illiac artery that run off in illiac bifurcation and run off in common femoral arteri with the occlusion length along 13.02 cm.
Relevant catheterization findings
From the arteriography examination, we got CTO (Chronic Total Occlusion) in external illac artery until common femoral artery, CTO in popliteal artery and collateral grade III from popliteal arteryto anterior tibial artery. Then, the revascularization was performed.
After Arteriography, then, the revascularization performed. In this patient, the access selected from right common femoral artery with JR 4.0 6F catheter. The catheter was replaced by a IM (internal mammary) 6F catheter in order that the wire could penetrate the lesion more easily. Glide wire Terumo (tips angle) 0.035 “penetrated the lesion through common femoral arteryin the right side, with the nuckling shaped wire tip to avoid penetration into the extralumen. Balloon mustang 5.0 x 100 mm was penetrated towards the left common femoral artery until the common iliac artery and dilatated 10 atm for 30 seconds. The left common femoral artery is punctured retrograde ipsilateral with the guiding wire from the contralateral artery, so the balloon could be delivered and stent could be installed more easily. Balloon Mustang 5.0 x 100 mm through the right CFA is developed at 10 atm for 30 seconds in the femoral artery to the ostial common left ilia cartery. Due to the long lesion, we installed INNOVA 8 x 150 mm (self expandable) stent from the artery to femoral artery with the satisfied result.
In conclusion, a patient Mr. AJ 58 years old complaining of bilateral lower extremity paraesthesia, numbness, coldness and pain has diagnosed with ostial common iliac artery occlusion. Patient with aortoiliac disease need appropriate evaluation and management of this disease. Patient with risk factors of arterial embolism, such as heart failure with dyskinetic of left ventricle and soft thrombus need accurate physical examination, noninvasive and invasive diagnostic evaluation. We report this case to remind physician always consider aortic disorder during differential diagnosis of bilateral lower extremity paraesthesia, numbness, coldness and pain.