Subintimal Angioplasty of Lengthy Femorotibial Total Occlusion in Buerger's Disease

Purpose To report successful subintimal angioplasty of a lengthy femorotibial occlusion in a patient with Buerger's disease, with wound healing and limb salvage. Case Report A 38-year-old female heavy smoker was referred to our hospital for treatment of extensive infectious tissue loss, with se...

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Bibliographic Details
Published in:	Journal of endovascular therapy Vol. 20; no. 4; pp. 578 - 581
Main Authors:	Kawarada, Osami, Ayabe, Shinobu, Yotsukura, Hiroko, Nakaya, Takako, Kanayama, Junji, Harada, Koichiro, Ishihara, Masaharu, Yasuda, Satoshi, Ogawa, Hisao
Format:	Journal Article
Language:	English
Published:	Los Angeles, CA SAGE Publications 01-08-2013 Allen Press Inc
Subjects:	Adult Amputation Angioplasty - methods Arterial Occlusive Diseases - etiology Arterial Occlusive Diseases - surgery Autoimmune diseases Disease Female Femoral Artery - surgery Foot diseases Hospitals Humans Ischemia Medical imaging Pain Patients Thromboangiitis Obliterans - complications Tunica Intima Veins & arteries Wound healing catheter-based treatment thromboangiitis obliterans femoropopliteal segment tibial arteries chronic total occlusion subintimal angioplasty Buerger's disease
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Summary:	Purpose To report successful subintimal angioplasty of a lengthy femorotibial occlusion in a patient with Buerger's disease, with wound healing and limb salvage. Case Report A 38-year-old female heavy smoker was referred to our hospital for treatment of extensive infectious tissue loss, with severe foot pain 1 month after early failure of a distal bypass graft. Angiography revealed total occlusion in the femoropopliteal and infrapopliteal arteries. Endovascular recanalization was attempted in order to establish “straight-line flow” to the foot on the verge of limb loss. The subintimal angioplasty technique with a 0.014-inch hydrophilic guidewire facilitated successful crossing of the occlusive femoropopliteal and posterior tibial arteries. The lesions were serially dilated (standard and cutting balloons). Angiography demonstrated antegrade flow to the foot without flow-limiting dissection, and the serious pain dramatically disappeared. Complete wound healing was observed 5 months after initial revascularization with the assistance of repeat angioplasty for restenosis. Conclusion Contemporary endovascular therapy using the subintimal angioplasty technique could represent a viable option for Buerger's disease.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1526-6028 1545-1550
DOI:	10.1583/12-4139.1