Abstract
An 83-year-old man was admitted with intermittent claudication (IC) on walking 50 m and lower leg pain at rest. Enhanced computed tomography (CT) showed multifocal peripheral arterial disease (PAD) involving total occlusion of the right common iliac artery and severe stenosis of the left common iliac artery and superficial femoral artery (SFA). He was given a diagnosis of polycythemia vera based on high whole blood cell counts. Hybrid surgical and endovascular therapy (EVT) was scheduled for the multifocal PAD. Under local anesthesia, EVT with a self-expandable shape-memory, alloy-recoverable technology stent was applied to the left-side PAD. However, thrombus formation was observed from the SFA to the popliteal artery. Percutaneous thrombectomy using a vascular catheter was successfully performed. Subsequently, surgical intervention by femoro-femoral crossover bypass using an 8-mm polytetrafluoroethylene Maxiflo prosthetic graft was performed under general anesthesia. Anticoagulant therapy with heparin was immediately performed postoperatively, and then 2 anti-platelet agents and coumadin were prescribed to prevent thrombotic complications postoperatively. The postoperative clinical course was uneventful, and postoperative enhanced CT demonstrated good patency of the stents and prosthesis. His clinical symptoms improved, and his IC had improved up to a distance of 650 m at discharge. Therefore, hybrid intervention for multifocal PAD could be an effective and minimally invasive approach to treat complicated PAD, such as in the present elderly patient with polycythemia vera.
