Painful Thigh Hematoma Following Intravascular Lithotripsy for Severe Calcified Superficial Femoral Artery Lesion
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LETTER TO THE EDITOR
ARTERIAL INTERVENTIONS
Painful Thigh Hematoma Following Intravascular Lithotripsy for Severe Calcified Superficial Femoral Artery Lesion Federico Faccenna1 • Pasqualino Sirignano1 Francesco Speziale1
•
Wassim Mansour2
•
Received: 31 August 2020 / Accepted: 19 September 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
To the editor, Endovascular procedures are generally preferred over surgical interventions to treat patient with intermittent claudication due to superficial femoral artery (SFA) or popliteal disease [1], although results are still debated and controversial mainly for the early acute failure related to inadequate vessel preparation of severe calcification [2–4]. Intravascular lithotripsy (IVL) has been proposed as a promising, safe and effective tool to treat significantly calcified lesions [5]. Nevertheless, new technique could be associated with new, unreported complications that must be known by physicians and patients. We would like to report the case of a 66-year-old man admitted to our Vascular and Endovascular Surgery Unit for severe right limb claudication. Preoperative duplex
ultrasound scan (DUS) and computed tomographic angiography (CTA) showed a severely diseased SFA with diffused calcification extending for 11 cm and a subocclusive stenosis on its middle portion, with patent popliteal artery. An endovascular procedure was planned, via percutaneous contralateral access. After systemic heparinization, SFA lesion (Fig. 1A) was intraluminal crossed using an 0.035’’ hydrophilic standard J guidewire. Following 0.014’’ guidewire exchange, a 6 9 60 mm Peripheral IVL System balloon catheter (Shockwave Medical Inc, Fremont, CA – USA) was advanced in place (Fig. 1B) and inflated subnominally at 4ATM and then 30 pulses were delivered. Following lithotripsy, the IVL balloon will be nominally inflated at 6ATM to match the reference vessel diameter, and 30 additional pulses were delivered. The
& Pasqualino Sirignano [email protected] 1
Vascular and Endovascular Surgery Division, Department of Surgery ‘‘Paride Stefanini’’, ‘‘Sapienza’’ University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy
2
Vascular Surgery Unit, Department of Surgery ‘‘P. Valdoni’’, Policlinico ‘‘Umberto I’’, ‘‘Sapienza’’ University of Rome, Rome, Italy
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F. Faccenna et al.: Painful Thigh Hematoma Following Intravascular Lithotripsy…
Fig. 1 Intraprocedural images showing basal angiography (A), IVL device intraluminary placed (B), and C completion angiography after IVL treatment
Fig. 2 Thigh hematoma one week after procedure (A) and after one month (B)
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entire procedure was repeated three times in different SFA segments, followed by two 6x120mm drug-coated balloons (Freeway; Eurocor, Bonn, Germany) inflation. Completion angiography showed the good immediate result, in the absence of significant ([ 30%) residual stenosis and/or flow limiting
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