A 56 year old Male smoker presented to us with pain in both lower Limbs on walking . The Pain was worse on the right side . He also gave history of impotence the last 6 months . He is a diabetic and was used to smoking .
On examination the pulses of the right leg could not be felt and that on the left side was feeble. An angiogram was performed by a small puncture in the left thigh . (fig) It showed a compelete block of the right common iliac artery (the main blood vessel of the lower limb) and a narrowing of that of the opposite side.
Till a decade a go this would have required major surgery . Today thanks to interventional radiology based procedures this could be treated by inserting balloons and stents through a 2.5 mm tube (sheath)in the femoral artery (main blood vessel in the thigh)
Under local anesthesia the blood vessel was punctured in the thigh
near the hip and a thin soft wire was inserted through the needle into the femoral artery. The needle was replaced for a sheath and the guide wire carefully navigated beyond the occluded segment. following this balloons catheters were introduced over the wires on both sides and the diseased segments treated by angioplasty finally appropriate stents were deployed on both sides.
The angiogram following the procedure shows excellent results with normal flow in both lower limbs.
The patient was discharged 24 hours later asymptomatic.
Angioplasty and stenting has revolutionized the way we treat peripheral vascular disease today . It is the treatment of choice and has a patency of up to 80% at five years.