Diffuse arterial narrowing as a result of intimal proliferation: A delayed complication of embolectomy with the Fogarty balloon catheter Charles R. Bowles,

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Presentation transcript:

Diffuse arterial narrowing as a result of intimal proliferation: A delayed complication of embolectomy with the Fogarty balloon catheter Charles R. Bowles, M.D., Cornelius Olcott, M.D., Robert L. Pakter, M.D., Charles Lombard, M.D., John Thomas Mehigan, M.D., Joseph F. Walter, M.D. Journal of Vascular Surgery Volume 7, Issue 4, Pages 487-494 (April 1988) DOI: 10.1016/0741-5214(88)90336-9 Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Case 1. Right anterior oblique pelvic arteriogram shows severely narrowed left common femoral artery (lower arrow) which had undergone balloon embolectomy. Note arteriotomy site in the external iliac artery (upper arrow). Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Case 1. Postoperative left leg arteriogram shows normal superficial femoral and popliteal arteries. Tibioperoneal trunk is occluded (arrow), with reconstitution of the distal posterior tibial artery from anterior tibial collaterals (obscured by the fibular cortex). Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Case 1. Left leg arteriogram done 3 months after Fig. 2 shows diffuse reduction in caliber of the superficial femoral, popliteal, and anterior tibial arteries (arrows), all of which had balloon passage. Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Case 2. Left anterior oblique pelvic arteriogram shows narrowed right external iliac artery (arrow) that had undergone balloon catheter embolectomy. Catheter obturates tight stenosis of the left external iliac artery (asterisk). Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Case 2. Bilateral runoff arteriogram demonstrates severely narrowed distal left superficial femoral artery (arrow), which had been shown to be normal on an earlier arteriogram. (Unfortunately, films of the proximal superficial femoral arteries have been lost.) Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Case 3. Bilateral runoff arteriogram in November 1981 shows mild diffuse disease in the superficial femoral arteries. Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Case 3. Bilateral runoff arteriogram in January 1982 shows development of long stenosis of the left superficial femoral artery at balloon catheter embolectomy site (arrows). This artery subsequently occluded. The right superficial artery remains unchanged. Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Case 3. Section of superficial femoral artery demonstrates concentric narrowing of lumen by intimal hyperplasia without atheromatous change. (Hematoxylineosin stain; original magnification ×20.) Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 Case 3. High-power view of intimal hyperplasia shows smooth muscle cells in edematous myxoid stroma without foamy histiocytes or cholesterol clefts. (Hematoxylin-eosin stain; original magnification ×200.) Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 10 Case 4. Bilateral runoff arteriogram shows severe, diffuse narrowing of the right superficial femoral and popliteal arteries (arrows) 2 months after balloon catheter embolectomy. The preoperative arteriogram is not available but was reported to show widely patent superficial femoral and popliteal arteries. Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 11 Case 5. Runoff arteriogram before catheter embolectomy demonstrates superficial femoral and popliteal arteries of normal caliber. Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 12 Case 5. Four months after catheter embolectomy of the right leg, the right superficial femoral, popliteal, and anterior tibial arteries are diffusely narrowed (arrows), and the tibioperoneal trunk is occluded (asterisk). Journal of Vascular Surgery 1988 7, 487-494DOI: (10.1016/0741-5214(88)90336-9) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions