Professor Zhou Weimin's Team at The Second Affiliated Hospital of Nanchang University: A Case of Femoral Artery In-Stent Restenosis Treated with DKutting® LL Scoring Balloon

Patient Information

Basic Information:Male, 84 years old.

Chief Complaint:Left lower limb pain for more than 1 month.

History of Present Illness:The patient reported that more than one year ago, without obvious cause, swelling and pain occurred in the left lower limb, which was related to walking, accompanied by numbness in both lower limbs. The left lower limb could not dorsiflex, so he went to the local hospital for treatment. After conservative treatment with drugs such as promoting blood circulation and removing blood stasis, the condition did not improve. In March this year, he was hospitalized in our hospital, and CT and other related examinations were completed. He was diagnosed with "lower extremity arteriosclerosis obliterans" and underwent "left lower extremity arteriography, femoral artery balloon dilatation and stent placement". In the past month, the affected limb has experienced pain again. Today, he came to our hospital for treatment and was admitted to our department with "lower extremity arteriosclerosis obliterans". Since the onset of the disease, the patient's spirit, appetite, and sleep have been fine, and his bowel movements and urination have been normal, with no significant change in body weight.

Past Medical History:Hypertension and diabetes for many years, self-reported blood pressure and blood sugar under control.

Physical Examination:The color of the left lower limb showed no obvious pallor, with scattered slight skin pigmentation visible. The distal phalanx of the fifth toe of the left foot was blackened; no skin ulceration or erythema was observed. The pulsation of the bilateral femoral arteries was visible, basically symmetrical, with normal intensity. The pulsation of the right popliteal artery, dorsalis pedis artery, and posterior tibial artery was palpable. No pulsation was detected in the left lower limb popliteal artery and dorsalis pedis artery. No significant abnormalities were noted in the skin sensation of both lower limbs and feet, and the limb motor function was essentially normal.

Previous interventional treatment

Preoperative Analysis

Surgical Procedure

Preoperative CTA of the First Surgery

Intraoperative DSA during the first surgery

Follow-up

Discharge Status:

• The patient's general condition is acceptable, complaining of discomfort in the lower limbs after walking.Pain relief and significant improvement in limb coldness,No headache, nausea, abdominal pain or other discomfort. Physical examination: no edema in both lower limbs, warm skin temperature, no numbness, palpable pulsation of bilateral femoral arteries, normal movement of both lower limbs, no obvious hematoma, pseudoaneurysm or other abnormalities at the puncture site.

• Long-term oral entericAspirin Tablets(1 tablet [100mg] once daily), in combination with oralRivaroxaban(2.5mg, twice daily), be aware that the side effects of the medication may cause gastric ulcers or gastrointestinal bleeding, consult a gastroenterology department if necessary, and take oral acid-suppressing medication at the same time;

• Long-term oral administration of Simvastatin (one tablet per day, once daily); control triglycerides to less than 1.7 mmol/L, and regularly review blood lipids;

• Oral administration of Sarpogrelate Hydrochloride for at least one month (one tablet per dose, three times daily);

• If you feel unwell, stop taking the medicine promptly. The specific course of medication will depend on the changes in your condition.

Case Summary

Case Characteristics:Long-segment stenosis and occlusion within the superficial femoral artery stent.

Summary:In the treatment of lower limb arterial disease, the vessel preparation phase plays a crucial role. Although plain old balloon angioplasty (POBA) has been a commonly used treatment method, with the innovation of balloon technology,DK Medtech Scoring BalloonStand Out in This Field with Advanced Design. Through its special notch design, it can expand the plaque inside blood vessels in an orderly manner, effectively avoiding the potential damage that the disordered expansion force of traditional balloons might cause to blood vessels. This orderly expansion helps reduce the elastic recoil of plaques or hyperplastic intimal tissue and lowers the risk and severity of flow-limiting dissections.