A Case of Vasculitis Due to Distal Particulate Embolization After Use of Drug-Coated Balloon
A Case of Vasculitis Due to Distal Particulate Embolization After Use of Drug-Coated Balloon
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药物涂层球囊远端颗粒栓塞致血管炎一例
DOI：
10.1016/j.jcin.2022.05.030
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Kawasaki Daizo
中科院分区：
文献类型：
--
作者：
Nakamura Ryoko;Torii Sho;Kato Tsukasa;Kawasaki Daizo
一名89岁女性，因慢性肢体威胁缺血接受过血管内治疗（EVT）和双侧股腘动脉旁路手术，右大脚趾出现难治性溃疡（Rutherford class 5）。血管造影显示腘动脉和膝下动脉闭塞（图1A）。我们使用紫杉醇包被球囊（PCB; Bard Lutonix）对右腘动脉进行EVT，对膝下动脉进行平囊血管成形术（图1B），然后在右大脚趾指间关节处截肢。右基底指骨在EVT后4个月也因变色和脚趾疼痛加重而被切除。截肢脚趾的病理分析显示，异物颗粒栓塞导致小动脉局灶性血管炎（图1C和1D）。偏光显微镜显示中度炎症，提示PCB的一种赋形剂引起了血管炎（图1E）。虽然有其他几条动脉血栓闭塞，但炎症是局部的，大多数动脉是
An 89-year-old woman with a history of endovascular treatment (EVT) and bilateral femoropopliteal bypass for chronic limbthreatening ischemia developed a refractory ulcer on the right big toe (Rutherford class 5). Angiography revealed occlusion of the popliteal and below-the-knee arteries (Figure 1A). We performed EVT with a paclitaxel-coated balloon (PCB; Bard Lutonix) for right popliteal artery and plain balloon angioplasty for below-the-knee arteries (Figure 1B), followed by amputation at the interphalangeal joint of the right big toe. The right basal phalanx was also amputated 4 months after EVT because of discoloration and worsening toe pain.Pathologic analysis of the amputated toe demonstrated focal vasculitis in a small artery due to particulate embolization of a foreign body (Figures 1C and 1D). Polarized light microscopy showed moderate inflammation, suggesting that an excipient of the PCB caused vasculitis (Figure 1E). Although there was thrombotic occlusion of several other arteries, inflammation was localized, and most arteries were