Therapeutic combination of catheter-directed thrombolysis, rheolytic thrombectomy and percutaneous transluminal angioplasty in acute on chronic limb ischemia: a case report
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Keywords
Acute on Chronic Limb Ischemia, Catheter Directed Thrombolysis, Rheolytic Thrombectomy, Percutaneous Transluminal Angioplasty
Abstract
Background: Acute limb ischemia (ALI) is a sudden decrease in leg perfusion that threatens the viability of the limb with symptom onset within 2 weeks. In peripheral artery disease (PAD) conditions, occlusion of blood vessels can occur due to thrombosis or atherosclerotic plaque embolism, which is called "acute on chronic ischemia". The development of endovascular therapy has made this therapy an important role in restoring leg perfusion. The aim of this study to demonstrate the safety and feasibility of therapeutic combination of catheter-directed thrombolysis, rheolytic thrombectomy and percutaneous transluminal angioplasty in acute on chronic limb ischemia.
Case Description: We report a case of a 51-year-old man, came to the hospital with complaints of pain in the left extremity that persisted at rest or activity and cold in the left extremity which has been felt since 2 weeks ago. A year ago, the patient started to feel pain in the left extremity that persist in activity. Physical examination revealed cold feet and muscle atrophy.
Conclusion: Therapeutic combination of catheter-directed thrombolysis, rheolytic thrombectomy and percutaneous transluminal angioplasty are considered to be safe and feasible to do in acute on chronic limb ischemia.
References
2. Erben Y, Miller SM, Sumpio BJ, Dillon BJ, Lee AI, Blume P, et al. Acute Limb Ischemia in an 8-Year-Old Patient: A Case Report. Ann Vasc Surg. 2018;51:327.e1-327.e8. Available from: https://pubmed.ncbi.nlm.nih.gov/29655809/
3. de Donato G, Pasqui E, Setacci F, Palasciano G, Nigi L, Fondelli C, et al. Acute on chronic limb ischemia: From surgical embolectomy and thrombolysis to endovascular options. Semin Vasc Surg. 2018;31(2–4):66–75. Available from: https://pubmed.ncbi.nlm.nih.gov/30876643/
4. Falluji N, Mukherijee D. Critical and acute limb ischemia: an overview. Vascular. 2012;20:174-7. Available from: https://pubmed.ncbi.nlm.nih.gov/23277633/
5. Signorelli SS, Marino E, Scuto S and Raimondo DD. Pathophysiology of Peripheral Arterial Disease (PAD): A Review on Oxidative Disorders. International Journal of Molecular Sciences. 2020:21:4393. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352779/
6. Gulati A, Garcia L, Acharji S. Epidemiology of chronic critical limb ischemia. Critical limb ischemia. Boston: Springer International Publishing Switzerland. 2017; 9-14. Available from: https://www.semanticscholar.org/paper/Epidemiology-of-Chronic-Critical-Limb-Ischemia-Gulati-Garcia/a6f02b9d24bf392fb0980efd1afaadd821ecb7f5
7. Fowkes GR, Aboyans V, Fowkes FJI, McDermott MM, Sampson UKA, Criqui MG. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol. 2017;14(3):156-70. Available from: https://pubmed.ncbi.nlm.nih.gov/27853158/
8. Laksono GAK, Erwin F and Tahalele PL. Acute Limb Ischemia (Ali): An Overview Of Clinical Diagnosis And Treatment. Journal of Widya Medika Junior. 2020: 2(2): 138 – 150. Available from: https://journal.wima.ac.id
9. Rutherford RB. Clinical staging of acute limb ischemia as the basisfor choice of revascularization method: when and how to intervene. Semin Vasc Surg. 2009; 22:5–9. Available from: https://pubmed.ncbi.nlm.nih.gov/19298929/
10. Obara H, Matsubara K, Kitagawa Y. Acute Limb Ischemia. Ann Vasc Dis. 2018; 11(4): 443–448. Available from: https://pubmed.ncbi.nlm.nih.gov/30636997/
11. de Donato G, Setacci F, Sirignano P, et al. The combination of surgical embolectomy and endovascular techniques may improve outcomes of patients with acute lower limb ischemia. J Vasc Surg 2014; 59: 729-36. Available from: https://pubmed.ncbi.nlm.nih.gov/24342067/
12. Leung DA, Blitz LR, Nelson T, Amin A, Soukas PA5, Nanjundappa A, et al. Rheolytic Pharmacomechanical Thrombectomy for the Management of Acute Limb Ischemia: Results From the PEARL Registry. J Endovasc Ther. 2015;22: 546-57. Available from: https://pubmed.ncbi.nlm.nih.gov/26109628/
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Erina Febriani Widiastari, Departemen Bedah Toraks, Kardiak dan Vaskular, Departemen Bedah, Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia
Departemen Bedah Toraks, Kardiak dan Vaskular, Departemen Bedah, Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia
Gary Pradhana, Departemen Bedah Toraks, Kardiak dan Vaskular, Departemen Bedah, Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia
Departemen Bedah Toraks, Kardiak dan Vaskular, Departemen Bedah, Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia
Marolop Pardede, Departemen Bedah Toraks, Kardiak dan Vaskular, Departemen Bedah, Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia
Departemen Bedah Toraks, Kardiak dan Vaskular, Departemen Bedah, Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia