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Successful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in the Popliteal Artery

Patient: Male, 73-year-old Final Diagnosis: Subacute lower limb ischemia Symptoms: Coldness • pallor • numbness • rest pain of the right toes Medication: — Clinical Procedure: Percutaneous Fogarty thrombectomy Specialty: Cardiac Surgery • Cardiology OBJECTIVE: Unusual setting of medical care BACKGRO...

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Autores principales: Yanagiuchi, Takashi, Kato, Taku, Hanabusa, Katsuyuki, Ushimaru, Shunpei, Yokoi, Hirokazu, Zen, Kan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9251805/
https://www.ncbi.nlm.nih.gov/pubmed/35763450
http://dx.doi.org/10.12659/AJCR.936377
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author Yanagiuchi, Takashi
Kato, Taku
Hanabusa, Katsuyuki
Ushimaru, Shunpei
Yokoi, Hirokazu
Zen, Kan
author_facet Yanagiuchi, Takashi
Kato, Taku
Hanabusa, Katsuyuki
Ushimaru, Shunpei
Yokoi, Hirokazu
Zen, Kan
author_sort Yanagiuchi, Takashi
collection PubMed
description Patient: Male, 73-year-old Final Diagnosis: Subacute lower limb ischemia Symptoms: Coldness • pallor • numbness • rest pain of the right toes Medication: — Clinical Procedure: Percutaneous Fogarty thrombectomy Specialty: Cardiac Surgery • Cardiology OBJECTIVE: Unusual setting of medical care BACKGROUND: Subacute lower limb ischemia occurs more than 14 days and less than 3 months from symptom onset. Although endovascular procedures are the preferred treatment choice for a viable and not immediately threatened limb in patients with acute lower limb ischemia (<14 days), percutaneous catheter-directed thrombolysis, percutaneous mechanical thrombectomy, or percutaneous thromboaspiration are not recommended, and no treatment strategy has yet been established for nonacute lower limb ischemia (>14 days). A percutaneous Fogarty thrombectomy, an endovascular thrombus removal procedure with the use of a large-caliber sheath and a Fogarty balloon catheter, has recently been reported as a less invasive alternative to open surgery in patients with acute lower limb ischemia. In this report, we use this technique for a case of subacute lower limb ischemia caused by a resistant thrombus. CASE REPORT: A 73-year-old man with a diagnosis of essential thrombocythemia presented with symptoms of right lower limb ischemia, which started about a month before. The diagnosis was subacute lower limb ischemia due to a resistant thrombus in the popliteal artery. First, we attempted percutaneous thromboaspiration and prolonged dilation with a large-caliber balloon catheter, but there were still severe residual stenoses with delayed blood flow. Although vascular scaffold implantation might have achieved complete revascularization, we avoided it because of a high probability of stent fracture in the popliteal artery. Thus, we performed a subsequent percutaneous Fogarty thrombectomy immediately after the conventional endovascular recanalization failed, achieving complete revascularization and next-day discharge without any complications. CONCLUSIONS: A percutaneous Fogarty thrombectomy could be a new treatment option for subacute lower limb ischemia due to a resistant thrombus, which can be performed immediately after failure of the conventional endovascular recanalization.
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spelling pubmed-92518052022-07-21 Successful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in the Popliteal Artery Yanagiuchi, Takashi Kato, Taku Hanabusa, Katsuyuki Ushimaru, Shunpei Yokoi, Hirokazu Zen, Kan Am J Case Rep Articles Patient: Male, 73-year-old Final Diagnosis: Subacute lower limb ischemia Symptoms: Coldness • pallor • numbness • rest pain of the right toes Medication: — Clinical Procedure: Percutaneous Fogarty thrombectomy Specialty: Cardiac Surgery • Cardiology OBJECTIVE: Unusual setting of medical care BACKGROUND: Subacute lower limb ischemia occurs more than 14 days and less than 3 months from symptom onset. Although endovascular procedures are the preferred treatment choice for a viable and not immediately threatened limb in patients with acute lower limb ischemia (<14 days), percutaneous catheter-directed thrombolysis, percutaneous mechanical thrombectomy, or percutaneous thromboaspiration are not recommended, and no treatment strategy has yet been established for nonacute lower limb ischemia (>14 days). A percutaneous Fogarty thrombectomy, an endovascular thrombus removal procedure with the use of a large-caliber sheath and a Fogarty balloon catheter, has recently been reported as a less invasive alternative to open surgery in patients with acute lower limb ischemia. In this report, we use this technique for a case of subacute lower limb ischemia caused by a resistant thrombus. CASE REPORT: A 73-year-old man with a diagnosis of essential thrombocythemia presented with symptoms of right lower limb ischemia, which started about a month before. The diagnosis was subacute lower limb ischemia due to a resistant thrombus in the popliteal artery. First, we attempted percutaneous thromboaspiration and prolonged dilation with a large-caliber balloon catheter, but there were still severe residual stenoses with delayed blood flow. Although vascular scaffold implantation might have achieved complete revascularization, we avoided it because of a high probability of stent fracture in the popliteal artery. Thus, we performed a subsequent percutaneous Fogarty thrombectomy immediately after the conventional endovascular recanalization failed, achieving complete revascularization and next-day discharge without any complications. CONCLUSIONS: A percutaneous Fogarty thrombectomy could be a new treatment option for subacute lower limb ischemia due to a resistant thrombus, which can be performed immediately after failure of the conventional endovascular recanalization. International Scientific Literature, Inc. 2022-06-28 /pmc/articles/PMC9251805/ /pubmed/35763450 http://dx.doi.org/10.12659/AJCR.936377 Text en © Am J Case Rep, 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Yanagiuchi, Takashi
Kato, Taku
Hanabusa, Katsuyuki
Ushimaru, Shunpei
Yokoi, Hirokazu
Zen, Kan
Successful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in the Popliteal Artery
title Successful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in the Popliteal Artery
title_full Successful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in the Popliteal Artery
title_fullStr Successful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in the Popliteal Artery
title_full_unstemmed Successful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in the Popliteal Artery
title_short Successful Percutaneous Fogarty Thrombectomy for Subacute Lower Limb Ischemia Due to Resistant Thrombus in the Popliteal Artery
title_sort successful percutaneous fogarty thrombectomy for subacute lower limb ischemia due to resistant thrombus in the popliteal artery
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9251805/
https://www.ncbi.nlm.nih.gov/pubmed/35763450
http://dx.doi.org/10.12659/AJCR.936377
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