title: Hybrid revascularization for critical limb ischemia triggered by multiple organ dysfunction due to acute pneumonia; urgent catheter intervention followed by low-density-lipoprotein apheresis and elective peripheral bypass surgery.
abstract: A 66-year-old man was referred for treatment of critical limb ischemia arising with multiple organ dysfunction due to acute pneumonia. Angiographic examinations demonstrated total obstruction of the bilateral external iliac arteries and the bilateral superficial femoral arteries with collateral circulation to the distal vessels. Urgent percutaneous transluminal angioplasty dissolved the obstruction of the left external iliac artery, and subsequent low-density-lipoprotein apheresis ameliorated his progressive ischemia in the lower extremities. Femoro-femoral and bilateral femoro-popliteal bypasses were performed 31 days after the endovascular intervention, which achieved successful limb salvage with the relief of ischemic symptoms related to arteriosclerotic obliterans.
authors.affiliation: Division of Cardiovascular Surgery, Osaka Mishima Emergency Critical Care Center, Takatsuki, Osaka, Japan ; Department of Cardiovascular Surgery, Ishinkai Yao General Hospital, Yao, Osaka, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Cardiovascular Surgery, Ishinkai Yao General Hospital, Yao, Osaka, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Mizuguchi
authors.affiliation: Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Osaka, Japan.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Takayama
keywords: arteriosclerotic obliterans; critical limb ischemia; low-density lipoprotein apheresis