Transverse Tibial Cortex Transport in the Treatment of Kawasaki Disease

Abstract

Kawasaki disease is a systemic primary vasculitis of medium-sized vessels, predominantly affecting children, whose diagnosis and management in adulthood remain challenging, particularly in the presence of rare peripheral vascular manifestations. Severe ischemic limb lesions in adult patients with sequelae of the disease have limited therapeutic options, with amputation often being indicated. This study reports the first case described in the literature of the use of Transverse Tibial Cortex Transport (TTT) as a limb-salvage strategy in an adult patient with Kawasaki disease and critical lower limb ischemia. A 38-year-old female patient, with a history of spontaneous resolution of the disease in childhood, evolved with severe chronic ischemia, a trophic lesion with bone exposure, absence of a distal runoff bed, and failure of conventional clinical therapies. Given the impossibility of revascularization and a prior indication for amputation, TTT was performed. A significant clinical improvement in perfusion was observed, evidenced by increased ankle pressure, reduced capillary refill time, progressive wound healing, and recovery of functional ambulation. Follow-up computed tomography angiography demonstrated neovascularization and the development of collateral circulation previously absent. TTT proved to be a viable and effective alternative for limb preservation in this pioneering case of Kawasaki disease, suggesting potential application in other primary vasculitides associated with critical ischemia. Prospective studies are needed to better define its indications, pathophysiological mechanisms, and long-term outcomes.