Author + information
- Received July 24, 2015
- Accepted July 31, 2015
- Published online December 28, 2015.
- Yoshiya Yamamoto, MD,
- Osami Kawarada, MD, PhD,
- Shingo Sakamoto, MD,
- Koichiro Harada, MD, PhD,
- Teruo Noguchi, MD, PhD,
- Hisao Ogawa, MD, PhD and
- Satoshi Yasuda, MD, PhD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Satoshi Yasuda, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan.
Given the marked increase in the number of patients with atrial fibrillation (AF) (1), more than 80% of acute limb ischemia (ALI) cases are now due to cardiac embolism associated with AF (2). Fogarty thrombectomy is the gold standard treatment of ALI.
An 87-year-old man with a chronic AF who underwent Fogarty thrombectomy for ALI due to cardiac embolism in his right leg 1 year earlier was hospitalized in our department for the treatment of right calf claudication (Figures 1A and 1B). His ankle-brachial index (ABI) was 0.69 on the right. Enhanced computed tomography (CT) revealed a severe focal stenosis in the right superficial femoral artery that had been patent at the ALI onset of 1 year ago (Figure 1C). Angiographic findings were consistent with CT findings (Figure 2A). Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) demonstrated intraluminal narrowing due to significant intimal hyperplasia with a multiple-channel appearance (Figures 2B to 2G). The lesion was successfully dilated with balloon angioplasty. The patient’s ABI increased to 0.94 and calf claudication resolved with no recurrence of symptoms during 6 months of follow-up.
These imaging findings support a previous experimental animal study reporting that Fogarty balloon injury could increase intimal hyperplasia (3), which enhances our awareness of the mechanism of recurrent occlusive lesions after Fogarty thrombectomy. Intimal hyperplasia was also enhanced by thrombus, the recanalization of which was associated with a multiple-channel appearance on IVUS, as reported in previous studies (4). An increasing awareness of the potential for peripheral artery disease after Fogarty thrombectomy may be important in the management of patients with a history of ALI.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 24, 2015.
- Accepted July 31, 2015.
- American College of Cardiology Foundation
- ↵Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 7 May 2015 [E-pub ahead of print].
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