Recently, older patients with advanced atherosclerotic disease contract acute limb ischemia. For these patients, metallic stents were inserted to the aorto-iliac stenotic lesions after thrombectomy with Fogarty catheter. Thirteen patients (16 limbs) were included. There were 5 acute (within 1 day after onset), 4 subacute (between 2 days and 4 weeks after onset), and 4 chronic (more than 4 weeks after onset) cases. Five aortobiiliac occlusions, 7 uni-iliac occlusions, and 1 ilio-femoral occlusion were found by contrast enhancement computed tomography. Operative thrombectomy was performed under the guidance of digital cinefluoroscopy, and followed by intraoperative angiography. Remnant stenotic lesions were treated by balloon angioplasty and stent placement. No remarkable complication was indicated. It is important to be accustomed to both open and fluoroscopically guided techniques to treat acute arterial occlusion in an optimum fashion.
A 52-year-old man had a sudden onset of stomach ache and back pain. Computed tomography (CT) scan showed a dissociation of the celiac artery and the superior mesenteric artery (SMA). The dissection of the SMA was Type III of the Sakamoto classification. We started conservative treatment, but the stomach ache persisted. There were mild expansion of ulcer-like projection (ULP) and the stenosis of the SMA distal side in CT scan of the tenth day. We conducted covered-stent placement without being able to deny the intestinal ischemia. The stent performed probe patency, and ULP was thrombosed, and stenosis of the SMA was improved by the CT scan of the third month after treatment.