Acute on Chronic Limb Ischemia Treatment: Case Series
DOI:
https://doi.org/10.3889/oamjms.2022.8028Keywords:
Acute on chronic limb ischemia, Thrombectomy, Angioplasty, Drug-coated balloonAbstract
ABSTRACT
BACKGROUND: Acute on chronic limb ischemia is a condition caused by acute disruption in chronic vessel disease. The major cause is peripheral arterial disease or embolism. Treating the acute phase while considering the origin of disease is important to treat acute on chronic limb ischemia.
CASE DESCRIPTION: 3 cases were described on this serial case report. The first and second case represent acute on chronic limb ischemia conditions with history of intermittent claudication (IC) and signs of acute limb ischemia (ALI) upon arrival. They were both treated with surgical intervention for ALI. Despite of adequate surgical intervention, both cases showed suboptimal limb recovery. Both patients were referred for further evaluation of chronic vessel disease with angiography. Third case represent chronic limb ischemia as end point of treatment from the first and second case. Patient with worsening IC despite adequate medical and exercise treatment underwent angiography examination. Angiography result found two sites of total occlusion of right common iliac artery and superficial femoral artery. Angioplasty and primary stenting were done on common iliac artery. Drug coated balloon and stenting was also performed on superficial femoral artery.
CONCLUSION: Patients with acute on chronic limb ischemia need to be treated during acute phase and the remaining chronic vessel disease. Consideration and care should be taken when managing similar cases for optimal treatment.
KEYWORDS: Acute on chronic limb ischemia, Thrombectomy, Angioplasty, Drug-coated Balloon.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Waton S, Johal A, Heikkila K, Cromwell D. National Vascular Registry Report 2017. London: The Royal College of Surgeons of England; 2017. Available from: https://www.annualreports.com/HostedData/AnnualReportArchive/W/TSX_WJA_2017.pdf. [Last accessed on 2021 Oct 01].
Fowkes FG, Aboyans V, Fowkes FJ, McDermott MM, Sampson UK, Criqui MH. Peripheral artery disease: Epidemiology and global perspectives. Nat Rev Cardiol. 2017;14(3):156-70. http://doi.org/10.1038/nrcardio.2016.179 PMid:27853158 DOI: https://doi.org/10.1038/nrcardio.2016.179
Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(1):5-67. http://doi.org/10.1016/j.jvs.2006.12.037 PMid:17223489 DOI: https://doi.org/10.1016/j.jvs.2006.12.037
Nickinson A, Bown MJ. Acute and chronic limb ischaemia. Surg (United Kingdom). 2019;37(2):93-101. https://doi.org/10.1016/j.mpsur.2018.12.007 DOI: https://doi.org/10.1016/j.mpsur.2018.12.007
O’Connell JB, Quiñones-Baldrich WJ. Proper evaluation and management of acute embolic versus thrombotic limb ischemia. Semin Vasc Surg. 2009;22(1):10-6. http://doi.org/10.1053/j.semvascsurg.2008.12.004 PMid:19298930 DOI: https://doi.org/10.1053/j.semvascsurg.2008.12.004
Kwolek CJ, Fahad S. Acute ischemia: Treatment. In: Sidawy AN, Perler BA, editors. Rutherfor’s Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019. p. 1326.
Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: Executive summary: A report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circulation. 2017;135(12):686-725. http://doi.org/10.1161/CIR.0000000000000501 PMid:28320815 DOI: https://doi.org/10.1161/CIR.0000000000000501
Olinic DM, Stanek A, Tătaru DA, Homorodean C, Olinic M. Acute limb ischemia: An update on diagnosis and management. J Clin Med. 2019;8(8):1215. http://doi.org/10.3390/jcm8081215 PMid:31416204 DOI: https://doi.org/10.3390/jcm8081215
Nomura T, Tasaka S, Ono K, Sakaue Y, Wada N, Keira N, et al. Successful limb salvage by endovascular treatment for critical limb ischemia subsequent to acute limb ischemia. Oxford Med Case Reports. 2019;2019(10):439-42. http://doi.org/10.1093/omcr/omz103 PMid:31772742 DOI: https://doi.org/10.1093/omcr/omz103
Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69(6):3S-125.e40. http://doi.org/10.1016/j.jvs.2019.02.016 PMid:31159978 DOI: https://doi.org/10.4103/ijves.ijves_50_19
Thukkani AK, Kinlay S. Endovascular intervention for peripheral artery disease. Circ Res. 2015;116(9):1599-613. http://doi.org/10.1161/CIRCRESAHA.116.303503 PMid:25908731 DOI: https://doi.org/10.1161/CIRCRESAHA.116.303503
Saltzman AJ, Stone GW, Claessen BE, Narula A, Leon-Reyes S, Weisz G, et al. Long-term impact of chronic kidney disease in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: The HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. JACC Cardiovasc Interv. 2011;4(9):1011-9. http://doi.org/10.1016/j.jcin.2011.06.012 PMid:21939942 DOI: https://doi.org/10.1016/j.jcin.2011.06.012
Bekken JA, Jongsma H, de Vries JP, Fioole B. Self-expanding stents and aortoiliac occlusive disease: A review of the literature. Med Devices Evid Res. 2014;7(1):99-105. http://doi.org/10.2147/MDER.S60594 PMid:24833925 DOI: https://doi.org/10.2147/MDER.S60594
Khan MS, Zou F, Khan AR, Moustafa A, Schmid CH, Baig M, et al. Meta-analysis comparing endovascular treatment modalities for femoropopliteal peripheral artery disease. Am J Cardiol. 2020;128:181-8. https://doi.org/10.1016/j.amjcard.2020.05.015 PMid:32650917 DOI: https://doi.org/10.1016/j.amjcard.2020.05.015
Liistro F, Grotti S, Porto I, Angioli P, Ricci L, Ducci K, et al. Drug-eluting balloon in peripheral intervention for the superficial femoral artery: The DEBATE-SFA randomized trial (Drug eluting balloon in peripheral intervention for the superficial femoral artery). JACC Cardiovasc Interv. 2013;6(12):1295-302. http://doi.org/10.1016/j.jcin.2013.07.010 PMid:24239203 DOI: https://doi.org/10.1016/j.jcin.2013.07.010
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2022 Renaldi Prasetio, I Komang Adhi Parama Harta (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0
