Successful Endovascular Revascularization of Aortoiliac Occlusive Disease With Favorable Outcome for Refractory Heart Failure After Axillary‐Bifemoral Bypass Surgery: A Case Report

Endovascular therapy for occlusive lesion might reduce cardiac afterload and improve cardiac function potentially, but there is limited evidence regarding its effects on heart failure, particularly in patients with poorly controlled symptoms. One month earlier, this 80‐year‐old woman with paroxysmal atrial fibrillation had undergone left axillo‐bifemoral bypass for acute aortoiliac occlusion and was transferred to a rehabilitation hospital. After that, she was returned to our hospital after developing palpitations, dyspnea, and hypoxia during post‐operative rehabilitation. Laboratory tests showed anemia, mild renal dysfunction, and markedly elevated B type natriuretic peptide. Chest radiography demonstrated bilateral pulmonary congestion. She was diagnosed to acute heart failure, and treatment with intravenous furosemide at a dose of 40 mg/day and oral amiodarone at a dose of 100 mg/day was initiated. Because sinus rhythm could not be maintained despite medical therapy and pulmonary vein isolation, atrioventricular node radiofrequency catheter ablation and cardiac resynchronization therapy pacemaker implantation were performed on hospital Day 12. However, exertional oxygen desaturation persisted, BNP remained elevated, and rehabilitation was limited by bilateral intermittent claudication. On hospital Day 22, endovascular therapy for aortoiliac occlusive disease was performed. Subsequently, additional endovascular therapy was undertaken for chronic total occlusion of the left superficial femoral artery. She was able to ambulate 20 m with support without any intermittent claudication (ankle‐brachial index increased from 0.67 to 0.91 on the right and from 0.81 to 0.98 on the left). Oxygen demand also gradually decreased (from 1 L/min to room air), and B type natriuretic peptide levels declined. Both systolic and diastolic blood pressure improved, and the patient was transferred back to the rehabilitation hospital on hospital Day 54 (32 days after endovascular therapy) without recurrence of heart failure symptoms. This case highlights two clinically relevant points. First, endovascular therapy for aortoiliac occlusive disease led to improvement in heart failure status. Second, B type natriuretic peptide levels showed a clear improvement following endovascular therapy.