Successful Selective Thrombolysis for Limb-Threatening Ischemia due to Bilateral Lower Extremity Emboli After Open Aortic Aneurysm Repair

Abstract

Severe lower extremity emboli with occlusion of all 3 lower limb arteries bilaterally occurred after an elective open abdominal aortic aneurysm (AAA) repair. Selective thrombolysis with alteplase and repeated percutaneous transluminal angioplasty (PTA) along the occlusions on both side anterior and posterior tibial arteries was performed without complications. Angiography the following day showed continuous filling of the anterior tibial artery down to the dorsalis pedis artery and interrupted, but improved, flow in the medial plantar artery through collaterals. The patient recovered well. At 1 month follow-up, the right foot was unremarkable, whereas the patient experienced slight residual numbness in the medial and distal plantar aspect of his left foot where the great toe/brachial index were lowered to 0.46.

Get full access to this article

View all access options for this article.

References

Cable D. , Cherry K. Systemic thrombolytic therapy after recent abdominal aortic aneurysm repair: an absolute contraindication ? Mayo Clin proc. 2003;78(1):99-102.

Kuhan G. , Raptis S. ‘Trash foot’ following operations involving the abdominal aorta . Aust N Z J Surg. 1997;67(1):21-24.

Mahmood A. , Hardy R. , Garnham A. , et al. Microtibial embolectomy. Eur J Vasc Endovasc Surg. 2003;25(1):35-39.

Gargiulo N. , Veith F. , Lipsitz E. , Suggs W. , Privrat A. , Ohki T. Perimalleolar and pedal thromboembolectomy and bypasses to treat distal embolization during aortoiliac aneurysm repairs. J Vasc Surg. 2008;48(1):43-46.