Using Rivaroxaban as Thrombolytic Treatment for a Patient of Pedal Arch Arterial Thrombosis with Suboptimal Result of Endovascular Therapy

Abstract

A 77-year-old male with subacute right foot ischemia was treated with endovascular therapy to relieve total thrombosis of the pedal arch extending from the dorsalis pedis of the anterior tibial artery into the posterior tibial artery, plantar segment. Because the procedure was only partially successful, rivaroxaban was used for thrombolytic treatment resulting in improvement of the patient's ischemic pain and avoidance of gangrenous progression and surgical amputation. This is the first report describing successful recanalization of pedal arch arterial thrombosis using rivaroxaban in a patient after suboptimal results of endovascular therapy.

Keywords: Arterial thrombosis; Endovascular therapy; Rivaroxaban.

Figures

Figure 1

Baseline angiography shows patent right anterior tibial (AT) and posterior tibial (PT) arteries (A-C), but total occlusion (red arrows) within the pedal arch of the right foot extending from the dorsalis pedis (DP) of the AT artery into the PT plantar segment, shown from different angle views on lateral (D) and anteroposterior views (E).

Figure 2

After balloon angioplasty using a 2.0 × 80 mm Bantam balloon (A-B), angiography reveals blood flow through the entire pedal arch between the anterior and posterior tibial arteries (C). After 3 months of rivaroxaban treatment, follow-up angiography (D) shows recanalization of the previously thrombotic metatarsal arteries (red arrows) (C).