PMC9614243_01
Angiographic images of the patient. (A) Initial angiography of the target lesion (black arrow); (B) predilation of the lesion and post-dilation images; (C) paclitaxel-coated balloon and the no-reflow phenomenon (black arrow); (D) angiographic images after intravascular therapy (black arrow); (E) final images and blood flow revascularization.
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F1
Initial angiography showed that the long occlusion of the femoropopliteal artery (~45 cm) and the outflow below the knee were acceptable (Figure 1A). Then, predilation was performed with a plain balloon (Cordis Savvy Long 2, 3, and 4-220 mm and ev3 Evercross 5-200 mm), and angiography indicated revascularization of target vessels without obvious dissection (Figure 1B). Finally, the target vessels were dilated with a PCB (Acotec 5-200 and 5.5-300 mm, 8 atm, 90 s), and acute occlusion occurred after deflation (Figure 1C). Thereafter, angiography confirmed that the lesion was reopening, but a flow-limiting dissection was detected distal to the femoral artery; thus, a bailout stent (Cordis Smart Control, 6-100 mm) was placed (Figure 1D). Final angiography showed that the dissection had disappeared and that the blood flow had returned to normal (Figure 1E).
The mixed components of drug debris, thrombosis, and plaque. The mixed components include drug debris [(A,B), white arrow], plaque debris [(A), yellow arrow], and thrombosis debris (black arrow).
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F2
Prior to treatment, we vacuumed the blood from the sheath and found mixed paste-like components of drug debris, plaque and thrombosis (Figure 2), and then rapid injection of urokinase (300,000 units), papaverine (60 mg), and heparin saline (250 ml) through the arterial catheters was performed; this strategy was repeated after 15 min.
Dynamic changes in vital signs. (A) Changes in systolic pressure (SBP), diastolic pressure (DBP), and mean arterial pressure (MAP); (B) vasoactive agents used during hypotension: dopamine (DA), norepinephrine (NE), and posterior pituitary hormone (PT); (C) changes in heart rate; and (D) body temperature.
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F3
The patient's systolic blood pressure (SBP) fluctuated between 80 and 95 mmHg following the procedure (Figure 3A). Dopamine (DA, 40-75 ml/l) was administered to maintain the patient's blood pressure in the first week, and then the DA concentration was gradually reduced (Figure 3B). The patient recovered completely after 2 min, and his SBP gradually stabilized at 90 mmHg (Figure 3A). To avoid the side effects of DA, the concentration was reduced at post-procedure day 9, and noradrenaline (NE) was administered (starting concentration: 8 ml/h, Figure 3B). Interestingly, the heart rate and body temperature of the patient remained stable during the entire therapeutic process (Figures 3C,D).