Author + information
- Kentaro Yamashita1,
- Takumi Inoue1,
- Taro Kamada1,
- Shun Yokota1,
- Masamichi Iwasaki1 and
- Takatoshi Hayashi1
Patient initials or identifier number
Relevant clinical history and physical exam
A 46 year-old man suffered from intermittent claudication in his left leg one year and 9 months ago. One year ago, he was diagnosed as blue toe syndrome at his left 1st toe due to thrombus embolism from occluded left external iliac artery. Since then, he had been treated optimal medical therapy for peripheral artery disease. As his intermittent claudication symptom worsened gradually, we underwent endovascular therapy for chronic total occlusion at left external iliac artery.
Relevant test results prior to catheterization
Relevant catheterization findings
To attempt antegrade approach first, a 6Fr sheath was inserted into the left brachial artery and located proximally from the chronic total occlusive lesion, which was passed easily by a 0.014-inch guide wire. Intravascular ultrasound images at the chronic total occlusive lesion demonstrated massive plaque burden without any calcification. Immediately after pre-dilatation by a 6.0 mm balloon, the angiogram showed that most of the plaque burden moved forward to a common femoral artery. Despite aspiration of a lot of clots, severe stenosis of an external iliac artery and total occlusion of common femoral artery still remained. With indwelling distal protection device at the superficial femoral artery, we dilated the balloon at external iliac artery-common femoral artery and implanted a self-expanded stent at the external iliac artery. Unfortunately, the thrombus moved forward to mid superficial femoral artery and was aspirated again and again. Finally, the thrombus was flown to a distal popliteal artery and completely obstructed the blood flow to his left toes, resulted in ischemic rest pain and paleness. Repeated aspiration of the thrombi recovered the blood flow to an anterior tibial artery and his symptom was disappeared.
We experienced and bailed out a complication of distal embolism during endovascular therapy for thrombotic aorto-iliac occlusive disease, resulted in acute arterial occlusion. We have to take care of distal embolism potentially led to acute arterial occlusion when we perform endovascular therapy for suspected thrombotic aorto-iliac occlusive disease.