Percutaneous deep venous arterialization at femoropopliteal segment for unhealed amputated stump ulcer after below the knee amputation.
Percutaneous deep venous arterialization at femoropopliteal segment for unhealed amputated stump ulcer after below the knee amputation.
复制标题
股腘段经皮深静脉动脉化治疗膝下截肢后未愈合的截肢溃疡。
DOI：
10.1002/ccd.29693
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Kichikawa K
中科院分区：
文献类型：
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作者：
Ichihashi S;Tamura Y;Maeda S;Kichikawa K
据报道，经皮深静脉动脉化（pDVA）治疗慢性肢体缺血患者的疗效。迄今为止，该手术仅限于膝关节以下/踝关节以下闭塞性疾病。本报告描述了在股腘动脉节段进行的pDVA，用于膝下截肢后出现残端并发症的患者。患者为一名70岁男性，6年前有右侧股浅动脉（SFA）血管内治疗和膝下截肢病史。他在截肢残端有一个未愈合的溃疡3年。计算机断层扫描血管造影显示右侧SFA闭塞，腘动脉狭窄。由于没有流出血管，认为血运重建不可行。为了改善溃疡处的灌注，在远端SFA水平进行pDVA，使用覆膜支架桥接SFA和股静脉。最终的血管造影片显示了血运重建的SFA与腘静脉连接，血流活跃。pDVA后，残端溃疡改善，6个月后覆膜支架保持通畅。SFA水平的pDVA在技术上是可行的，并且可能是膝下截肢术后残端并发症的有用方法。
Efficacy of percutaneous deep venous arterialization (pDVA) has been reported for patients with no‐option chronic limb threatening ischemia. To date, the procedure has been limited for below the knee/below the ankle occlusive disease. The present report describes the pDVA performed at a femoropopliteal segment for a patient with a stump complication after below the knee amputation. The patient was a 70‐year‐old male who had a history of endovascular treatment in the right superficial femoral artery (SFA) and below knee amputation 6 years before. He had an unhealed ulcer at the amputated stump for 3 years. Computed tomography angiography demonstrated occluded right SFA, with a stenotic popliteal artery. Revascularization was considered unfeasible due to the absence of run off vessels. In order to improve the perfusion at the ulcer, pDVA was performed at the distal SFA level, bridging SFA and femoral vein using stent grafts. The final angiogram demonstrated the revascularized SFA connecting to popliteal vein with a brisk flow. After pDVA, the stump ulcer improved and the stent grafts were kept patent after 6 months of the procedure. pDVA at the SFA level was technically feasible and could be a useful approach for stump complication after below knee amputation.