Korosoglou G, Eisele T, Raupp D, Eisenbach C, Giusca S. Successful recanalization of long femoro-crural occlusive disease after failed bypass surgery. World J Cardiol 2017; 9(12): 842-847 [PMID: 29317991 DOI: 10.4330/wjc.v9.i12.842]
Corresponding Author of This Article
Grigorios Korosoglou, Professor, Cardiology and Vascular Medicine, GRN Academic Teaching Hospital, Roentgenstrasse 1, Weinheim 69469, Germany. grigorios.korosoglou@grn.de
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Dec 26, 2017; 9(12): 842-847 Published online Dec 26, 2017. doi: 10.4330/wjc.v9.i12.842
Successful recanalization of long femoro-crural occlusive disease after failed bypass surgery
Grigorios Korosoglou, Tom Eisele, Dorothea Raupp, Christoph Eisenbach, Sorin Giusca
Grigorios Korosoglou, Tom Eisele, Sorin Giusca, Cardiology and Vascular Medicine, GRN Academic Teaching Hospital, Weinheim 69469, Germany
Dorothea Raupp, Christoph Eisenbach, Diabetology and Gastroenterology, GRN Academic Teaching Hospital, Weinheim 69469, Germany
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at University Hospital Heidelberg, Heidelberg, Germany.
Informed consent statement: The patients involved in this study gave their written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Grigorios Korosoglou, Professor, Cardiology and Vascular Medicine, GRN Academic Teaching Hospital, Roentgenstrasse 1, Weinheim 69469, Germany. grigorios.korosoglou@grn.de
Telephone: +49-6201-892142 Fax: +49-6201-892507
Received: September 10, 2017 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
ARTICLE HIGHLIGHTS
Case characteristics
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).
Clinical diagnosis
PAD with CLI (Rutherford Class 5).
Differential diagnosis
Venous ulcer, neuropathic diabetic ulcer.
Laboratory diagnosis
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.
Imaging diagnosis
PAD was diagnosed by duplex sonography and magnetic resonance angiography (MRA) and was confirmed by digital subtraction angiography (DSA).
Pathological diagnosis
PAD with CLI (Rutherford Class 5).
Treatment
Endovascular strategy using percutaneous balloon angioplasty and without stent placement.
Related reports
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.
Term explanation
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.
Experiences and lessons
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.
