Successful selective thrombolysis for limb-threatening ischemia due to bilateral lower extremity emboli after open aortic aneurysm repair.
Severe lower extremity emboli with occlusion of all 3 lower limb arteries bilaterally occurred after an elective open abdominal aortic aneurysm (AAA) repair. Selective thrombolysis with alteplase and repeated percutaneous transluminal angioplasty (PTA) along the occlusions on both side anterior and posterior tibial arteries was performed without complications. Angiography the following day showed continuous filling of the anterior tibial artery down to the dorsalis pedis artery and interrupted, but improved, flow in the medial plantar artery through collaterals. The patient recovered well. At 1 month follow-up, the right foot was unremarkable, whereas the patient experienced slight residual numbness in the medial and distal plantar aspect of his left foot where the great toe/brachial index were lowered to 0.46.
Acosta
S
S
Vascular Center, Malmö University Hospital, Malmö, Sweden. stefan.acosta@telia.com
Lagerström
B
B
Varga
Z
Z
Ravn
H
H
Flarup
S
S
D000800:Angioplasty, Balloon; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D004617:Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator