Push and park: uma opção técnica no tratamento do ateroembolismo agudo dos membros inferiores

Atherothrombosis is a multisystemic disease associated with high morbidity and mortality rates. Management of arteries with guide-wires or catheters may cause mechanical trauma, with consequent detachment of atheromatous material from the vascular wall. An 82-year-old patient, in whom a distal femoropopliteal in situ saphenous vein graft bypass had been performed 10 years before, presented with pain, pallor, hypothermia, loss of sensibility and motor activity on the right lower limb 6 hours after coronary angiography from the femoral artery (Rutherford class 2b). Arteriography demonstrated bypass patency, with multiple irregularities in its distal third, compatible with atheroembolic material, and very poor distal circulation. We indicated lower limb revascularization on an emergency basis, by both conventional and endovascular techniques. Using the "push and park" technique, the atheroembolic obstruction was crossed by guide-wire and the whole affected arterial axis was treated by angioplasty. The patient progressed well, with good distal perfusion, adequate capillary refill, relief of pain and immediate recovery of sensory and motor function.