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Relevant clinical history and physical exam
A 38 year-old woman had ulceration of Rutherford class 5 in right lower limb. Angiography revealed severe stenosis of the left common iliacartery (CIA) and total occlusion of the right CIA and patency of the abdominal aorta. Although at that time we recommended bypass surgery she strongly rejected the operation. However, after 3 months of performing angiography, she felt severe pain in right lower limb due to critical limb ischemia (CLI) and accepted the operation recommended.
Relevant test results prior to catheterization
The computed tomography angiography showed total occlusion of the abdominal aorta. In addition, skin perfusion pressure (SPP) showed both pressure of plantar and dorsalis pedis arteries were under 20 mmHg. Furthermore, echocardiography revealed occlusion of the terminal aorta, right CIA to external iliac artery (EIA), and left CIA.
Relevant catheterization findings
The angiography after 3 months of first one, showed newly occlusion of the terminal aorta, and similarly the right CIAto popliteal artery, and the left CIA. In addition, the right lumber artery fed into blow-knee arteries through common femoral artery and deep femoral artery and the left lumber artery fed into the distal of left EIA.
Destination (TERUMO, Tokyo, Japan) 6Fr-90 cm guide sheath inserted from the left brachial artery to the abdominal aorta. Using Radifocus (Terumo,Tokyo, Japan) 1.5 mm J stiff and Gridecath (TERUMO, Tokyo, Japan), we got the wire through the right common femoral artery (CFA). In the same way, Radifocus angle (TERUMO, Tokyo, Japan) 0.035-inch wire was pull through the left CFA.After ballooning with Metacross (TERUMO, Tokyo, Japan) 4 mm x 200 mm at the right CIA and EIA, and Metacross (TERUMO, Tokyo, Japan) 5 mm x 200 mm at left CIA and EIA. We implanted Epic (Boston Scientific, Natick, MA, US) 10 mm x 100mm and S.M.A.R.T Control(Cordis,Fremont, CA, US) 8 mm x 120 mm at lesions from the abdominal aorta to the right EIA with overlap, and Epic 10 mm x 100 mm. An S.M.A.R.T Control 8 mm x 60 mm at lesions from the abdominal aorta to the leftEIA. Finally, we performed kissing balloon technique (KBT) using Metacross 6 mm x 200 mm at the abdominal aorta to the right CIA and Metacross 7 mm x 150 mm at the abdominal aorta to the left CIA. In addition, Omnilink (Abbott Vascular,Santa Clara, CA, US) 8 mm x 39 mm implanted at the ostium of left CIA, which isthe proximal site of the stent implanting previously, because new stenosis in the stent at the left CIA occurred in consequence of implanting the stent at the right CIA. Final angiography showed no stenosis in the both iliac arteries.
A 38 years-old woman suffered from CLI in right lower limb, which is ulceration of Rutherford class 5. Angiography revealed severe stenosis of the left CIA and total occlusion of the right CIA and patency of the abdominal aorta. Although at that time we recommended bypass surgery, she strongly rejected the operation.However, after 3 months of performing angiography, we confirmed occlusion of the abdominal aorta by angiography. We reported a case with rapidly the terminal aorta occluded.