Successful limb salvage by endovascular treatment for critical limb ischemia subsequent to acute limb ischemia

Acute on Chronic Limb Ischemia Treatment: Case Series

ABSTRACT   BACKGROUND: Acute on chronic limb ischemia is a condition caused by acute disruption in chronic vessel disease. The major cause is peripheral arterial disease or embolism. Treating the acute phase while considering the origin of disease is important to treat acute on chronic limb ischemia. CASE DESCRIPTION: 3 cases were described on this serial case report. The first and second case represent acute on chronic limb ischemia conditions with history of intermittent claudication (IC) and signs of acute limb ischemia (ALI) upon arrival. They were both treated with surgical intervention for ALI. Despite of adequate surgical intervention, both cases showed suboptimal limb recovery. Both patients were referred for further evaluation of chronic vessel disease with angiography. Third case represent chronic limb ischemia as end point of treatment from the first and second case. Patient with worsening IC despite adequate medical and exercise treatment underwent angiography examination. Angiography result found two sites of total occlusion of right common iliac artery and superficial femoral artery. Angioplasty and primary stenting were done on common iliac artery. Drug coated balloon and stenting was also performed on superficial femoral artery. CONCLUSION: Patients with acute on chronic limb ischemia need to be treated during acute phase and the remaining chronic vessel disease. Consideration and care should be taken when managing similar cases for optimal treatment.   KEYWORDS: Acute on chronic limb ischemia, Thrombectomy, Angioplasty, Drug-coated Balloon.