title: Extensive ischemic ulcers due to limb occlusion after endovascular aneurysm repair: a case report.
abstract: BACKGROUND
  Limb occlusion after endovascular aneurysm repair (EVAR) is a well-known complication. However, extensive ischemic ulcers due to limb occlusion are extremely rare.
  
  
  METHODS
  We report a rare case of extensive ischemic ulcers that developed seven months after EVAR in an 85-year-old Japanese man. He had been taking appropriate anticoagulant therapy because of paroxysmal atrial fibrillation. Angiography showed a left limb occlusion and superficial femoral artery (SFA) chronic total occlusion (CTO), and intravascular ultrasound showed limb kinking. Endovascular therapy (EVT) was performed, and stent placement was used to cover a large amount of thrombi and correct the limb kinking, leading to complete recovery of left limb blood flow. After additional EVT was performed for the SFA CTO, outflow improved and the ulcers healed completely.
  
  
  RESULTS
  It seemed that the combination of poor inflow and poor outflow led to limb thrombosis.
  
  
  CONCLUSIONS
  Here, we describe an extremely rare case of extensive ischemic ulcers due to limb occlusion after EVAR. Patients should undergo careful follow-up after EVAR to monitor blood flow to the lower extremities. Additionally, the early detection and correction of limb kinking and poor outflow are essential to prevent the development of ischemic ulcers.
authors.affiliation: Department of Internal Medicine, Kyotambacho Hospital, 28 Wadaooshita, Kyotambacho, Funai, Kyoto 622-0311 Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Kadoya
authors.affiliation: Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Tsuneaki
authors.initials: T
authors.lastname: Kenzaka
authors.affiliation: Department of Cardiology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Naito
keywords: Case reports; Complications; Endovascular procedures