PTA後の血管解離の治療に血管内エコーが有用であった1例

The Utility of Intravenous Ultrasound for Percutalleous Transluminal Angioplasty: A case report

　症例は68歳男性．1983年より狭心症の治療で通院，1992年2月頃より歩行時右大腿部に鈍痛を覚え精査，加療のため入院．大動脈造影で右外腸骨動脈に30 mmHgの圧較差を伴う90％狭窄を認め8mmのバルーンでPTAを施行した．PTA後の血管内エコー像ではplaque ruptureと解離像を認めた．以後，経過は順調であったが，1993年2月頃より再び同様の下肢痛が出現し血管造影にて狭窄および線状解離像が観察され，血管内エコーにて血管径を計測し，左から8mm，右から6mmのバルーンで同時に拡張し，真腔の開大と解離腔の縮小を得た．以上，造影にて解離を伴った複雑な狭窄に対し血管内エコーは拡張病態の評価および加療に有用であると考えられた．

The patient was a 68-year old man, who had been treated for angina pectoris since 1983. In February 1992,he began to experience on walking, a dull pain in his right thigh, and he was admitted to out hospital to receive further treatment.

Aortography revealed 90% stenosis of the right exter-nal iliac artery with a pressure gradient of 30 mmHg. Subsequently, PTA was performed with an 8 mm bal-loon catheter. An IVUS taken after the procedure showed plaque rupture and dissection of the vessel. The patient initially improved following PTA. IIowever, in February, 1993, he began to experience a similar pain in his lower extremities. Stenosis and linear dissection were observed by angiography. IVUS before PTA was employed to evaluate dissection and measure the vessel diameter, and an 8 mm balloon catheter (from the left) and a 6 mm balloon catheter (from the right) were used simultaneously to expand the stenosis. This resulted in widening of the true lumen and narrowing of the dissec-tion lumen. This case seems to indicate that echocar-diography can be useful in the evaluation and treatment of severe vascular occlusion involving complex stenosis with dissection.