講演情報
[SY24-3]Aneurysmal dilatation after paclitaxiel device
滝村 英幸 (南東北グループ医療法人財団健貢会 総合東京病院)
Aneurysmal dilatation following paclitaxel-coated balloon (DCB) angioplasty has been reported; however, aneurysmal rupture is rare. We report the case of an 80-year-old man with hypertension, diabetes, and dyslipidemia who presented with intermittent claudication due to a left popliteal artery occlusion. Initial endovascular therapy (EVT) using a 5.0 × 150 mm DCB showed temporary improvement, but reocclusion occurred after 4 months. Repeat EVT with additional DCBs was performed; however, symptoms recurred within 1 month. A 7.0 × 40 mm drug-eluting stent was implanted in the proximal superficial femoral artery, followed by DCB dilation of the distal segment. Optical frequency domain imaging showed no aneurysm. Claudication improved, but knee pain developed after 4 months. CT revealed aneurysmal rupture of the popliteal artery, prompting stent graft implantation. Follow-up showed patency, but posterior tibial artery occlusion occurred without symptoms. One month later, tibiofibular trunk aneurysm rupture caused recurrent knee pain. EVT with stent grafts in the anterior tibial artery and tibiofibular trunk led to symptom resolution. This case highlights the clinical challenges associated with rare aneurysmal rupture following treatment with paclitaxel-coated devices. It suggests the need to reconsider the frequency of paclitaxel device use.