Korean Circ J.  2008 Jun;38(6):335-338. 10.4070/kcj.2008.38.6.335.

Balloon Embolectomy of a Cylindrical Dissected Plaque That Complicated Performing Superficial Femoral Artery Angioplasty

• Kim JS
• Lee IJ
• Kim SJ
• Jo SH
• Kim HS
• Cho GY
• Choi YJ
• Rhim CY
• Kim KI
• Park HR

• KMID: 2225782
• DOI: http://doi.org/10.4070/kcj.2008.38.6.335

Abstract

We report here on a case of successfully removing a calcified plaque embolus that complicated performing angioplasty. A 67 year-old woman underwent percutaneous transluminal angioplasty for a stenosis of the right superficial femoral artery (SFA). The angiogram showed a marked stenosis at the mid-portion of SFA and diffuse circular calcification along the atheroma rim was seen on the computed tomographic angiography. Although balloon inflation was attempted on the lesion, it was not fully dilated. After repeated balloon inflations, a radiopaque calcified atheroma was detached from the arterial wall and it migrated proximally along with withdrawing the balloon. The embolus was too extensive to be pulled out through the catheter sheath; therefore, a small balloon was inflated at the distal end of the embolic atheroma to anchor it and the embolus was removed with the balloon and the sheath system via an arteriotomized puncture site. A huge cylindrical atheroma that measured 4 cm in length was successfully removed. The final angiography showed a widened target site without any dye leakage.

Keyword

Femoral artery; Angioplasty; Complication; Calcification

MeSH Terms

Angiography
Angioplasty
Balloon Embolectomy
Catheters
Constriction, Pathologic
Embolism
Female
Femoral Artery
Humans
Inflation, Economic
Plaque, Atherosclerotic
Punctures

Figure

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  Fig. 1 The preprocedural femoral angiograms, the computed tomographic angiograms and embolization of the dissected plaque during angioplasty. The femoral angiogram showed a markedly narrowed lesion in the mid-portion of the right superficial femoral artery (A). Radiopaque density corresponding to calcium was seen within the arterial wall at the site of the stenosis on the computed tomographic angiography (B, white arrow). The non-enhanced computed tomography images revealed heavy calcification over an arc of approximately 360 degree, which encircled the arterial lumen (C, white arrow). Fluoroscopy showed a radiopaque density corresponding to calcium within the arterial wall (D, black arrows). It was visible proximal to the initial site after balloon dilatation of the lesion (E). The radiopacity moved more proximally along with the withdrawal of the balloon, suggesting extensive local dissection and embolization of the plaque from the arterial wall (F).

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  Fig. 2 The post-procedural femoral angiogram and the pathologic findings. A fragment of bony hard tubular tissue, measuring 4×0.5×0.5 cm at its greatest dimension, was taken out from the femoral artery by surgical balloon embolectomy (A). After removal of the embolized atherosclerotic plaque, the angiogram demonstrated a fully opened artery without further intervention (B). Microscopic examination revealed reduplication and fragmentation of the internal elastic lamina and thickening of the media with fibrotic degeneration (C: H&E, ×12.5; D: H&E, ×100; E: verhoeff van Gieson, ×100).

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