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Patient 1
THE FOLLOWING WAS REPORTED VIA A LITERATURE ARTICLE IN THE ANNALS OF VASCULAR SURGERY JOURNAL, ISSUED 2011; VOLUME 25: 1078-1093. A (B)(6) MAN WITH A MEDICAL HISTORY OF ARTERIAL HYPERTENSION, DYSLIPIDEMIA, TOBACCO ADDICTION, AND CORONARY HEART DISEASE (LEFT VENTRICULAR EJECTION FRACTION AT 58%), AND WHO HAD ALREADY UNDERGONE AN ANGIOPLASTY WITH STENTING OF THE ANTERIOR INTERVENTRICULAR ARTERY (AIVA), WAS ADMITTED. HIS HOME TREATMENT CONSISTED OF A BETA-BLOCKER IN ASSOCIATION WITH A STATIN AND ASPIRIN. THE PT HAD ALREADY BEEN HOSPITALIZED IN A CARDIOLOGY INTENSIVE CARE UNIT FOR AN AURICULAR FLUTTER WITH VENTRICULAR TACHYCARDIA RESULTING IN A FAINTING FIT. A CORONAROGRAPHY WAS PERFORMED ON DAY 15 AS PART OF HIS CARDIOLOGICAL CHECKUP. IT SHOWED A TIGHT AIVA STENOSIS THAT WAS RESTENTED. THE PROCEDURE WAS CARRIED OUT USING A RIGHT INGUINAL APPROACH AND A 6-F INTRODUCER THAT ENDED WITH THE DEPLOYMENT OF A 6-F ANGIO-SEAL). A FEW HOURS AFTER THE PROCEDURE, THE PT PRESENTED WITH A RIGHT LOWER LIMB ISCHEMIA. CLINICAL EXAMINATION REVEALED RIGHT ILIAC ARTERY OBLITERATION. AT THE RIGHT LOWER LIMB, THE SYSTOLIC BLOOD PRESSURE INDEX (SPI) WAS 0.4. AN EMERGENT ARTERIOGRAPHY SHOWED A TIGHT STENOSIS OF THE ILIAC ARTERY ALONG WITH SUPERFICIAL FEMORAL ARTERY OBLITERATION AT ITS ORIGIN WITH A REINJECTION OF THE ABOVE-THE-KNEE POPLITEAL ARTERY AND OF THE TIBIAL ARTERIES. ON THE LEFT SIDE, THE PT WAS ASYMPTOMATIC, DESPITE MANY ATHEROMATOUS LESIONS. THE PT WAS INITIALLY MEDICALLY TREATED WITH HEPARIN AND VASODILATOR DRUGS, WHICH REDUCED THE ISCHEMIC SYNDROME. HOWEVER, 10 DAYS LATER, HE HAD TO BE OPERATED ON FOR A TIGHT INTERMITTENT CLAUDICATION OF THE RIGHT LOWER LIMB. THROUGH A RIGHT INGUINAL APPROACH, THE ANGIO-SEAL WAS WITHDRAWN FROM THE SUPERFICIAL FEMORAL ARTERY AND BALLOON ANGIOPLASTY OF THE RIGHT EXTERNAL ILIAC STENOSIS WAS PERFORMED. THE FEMORAL TRIPOD WAS RECONSTRUCTED WITH CLOSURE ON A PROSTHETIC PATCH. (B)(4).