Published online Dec 26, 2017. doi: 10.4330/wjc.v9.i12.842
Peer-review started: September 13, 2017
First decision: October 23, 2017
Revised: November 1, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: December 26, 2017
Processing time: 100 Days and 6.5 Hours
An 80-year-old female patient with peripheral artery disease (PAD) and long occlusion of the femoro-popliteal artery and below-the-knee arteries after failed bypass surgery, who presented with critical limb ischemia (CLI).
PAD with CLI (Rutherford Class 5).
Venous ulcer, neuropathic diabetic ulcer.
Laboratory markers showed increased inflammation due to the arterial ulcer. In addition, a reduced renal function with an estimated glomerular filtration rate of 36 mL/min per 1.73 m² was noticed.
PAD was diagnosed by duplex sonography and magnetic resonance angiography (MRA) and was confirmed by digital subtraction angiography (DSA).
PAD with CLI (Rutherford Class 5).
Endovascular strategy using percutaneous balloon angioplasty and without stent placement.
The direct stent puncture technique has been used for the recanalization of complex femoro-popliteal occlusive disease in cases were an antegrade recanalization is not successful. The lesion in the patient was more complex, as it did not end in the femoro-popliteal segment, but also involved the proximal and mid part of crural arteries.
CLI is a life-threatening condition due to advanced occlusive PAD, usually accompanied by ischemic rest pain, arterial ulcers and gangrene. If left untreated this condition will in major amputation, sepsis and death.
In patients with complex femoro-popliteal occlusive disease, the direct stent puncture technique may facilitate recanalization of very long occlusive lesions without the need of bypass surgery. An endovascular first approach needs to be considered in such patients, who usually are bad candidates for surgery due to cardiopulmonary disease and other comorbidities.