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Mehrpooya M, Ghasemi M, Ebrahimi P, Taheri H, Soltani P. Iatrogenic combined common iliac and lateral sacral artery perforation during coronary angiography: A case report and review of literature. Clin Case Rep 2024; 12:e8903. [PMID: 38770412 PMCID: PMC11103556 DOI: 10.1002/ccr3.8903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
Key Clinical Message Arterial rupture is one of the rare but known and devastating complications of the angiogram, which can ultimately lead to loss of limb and life. Therefore, it is recommended that this complication be included in the consent form and that the operator and the logistics team be prepared for this scenario. Moreover, categorizing the patients based on risk factors to be more cautious during the procedure for high-risk patients can be considered a reasonable strategy. Abstract One of the rare but lethal complications of femoral artery catheterization for coronary angiography is arterial rupture, which can cause a range of negligible to massive retroperitoneal hemorrhage. This case presents a woman with unstable angina who underwent coronary catheterization. After arterial sheath placement, extravasation of blood from the right common iliac and lateral sacral arteries was seen, a diagnosis that has been reported rarely before. The bleeding was controlled with balloon inflation in the lateral sacral artery and a stent graft implantation in the right common iliac artery. The patient remained asymptomatic during the procedure and the short- and long-term follow-up. Interventional cardiologists and radiologists who access the femoral artery for any procedure should be aware of this possible event. Sometimes, this situation manifests with nonspecific symptoms such as weakness, lethargy, and pallor. Moreover, more logistical preparation and training are needed to overcome these unexpected conditions.
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Affiliation(s)
- Maryam Mehrpooya
- Department of Cardiology, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
| | - Massoud Ghasemi
- Department of Interventional CardiologyResearch Center of Endovascular Intervention, Imam Khomeini Hospital ComplexTehranIran
| | - Pouya Ebrahimi
- Tehran Heart CenterResearch and Development Center, Tehran University of Medical SciencesTehranIran
| | - Homa Taheri
- Cardiology DepartmentCedars‐Sinai HospitalCaliforniaUSA
| | - Parnian Soltani
- Tehran Heart CenterResearch and Development Center, Tehran University of Medical SciencesTehranIran
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Lee K, Cho S, Kim H, Joh JH. Incidence and Risk Factors of Iliac Artery Rupture during Aortoiliac Stenting. Vasc Specialist Int 2024; 40:5. [PMID: 38389133 PMCID: PMC10884543 DOI: 10.5758/vsi.230114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
Purpose Aortoiliac occlusive disease (AIOD) is widely prevalent and leads to severe claudication or chronic limb-threatening ischemia. Stent placement for AIOD demonstrated excellent outcomes in terms of long-term patency. However, iliac artery rupture is the most fearful complication during the aortoiliac stenting (AIS). This study aimed to evaluate the incidence and risk factors of iliac artery rupture during AIS. Materials and Methods A retrospective review of consecutive patients with AIOD treated with AIS from 2009 to 2021 was completed. We excluded patients with instent restenosis. All types of stents, including self-expanding stent (SES), balloon-expandable stent (BES), or balloon-expandable covered stent (CS), were used. Angiographic characteristics and procedural outcomes were analyzed. Procedural success was defined as the residual stenosis <30%. Results A total of 242 patients (86.8% male; mean age 68.8±10.0 years) with de novo AIOD were treated with AIS. The procedural success rate was 100%. Rupture occurred in six patients (2.5%) and all ruptures were occurred in the external iliac artery (EIA). Stenting of the EIA and less calcified lesion were risk factors for iliac rupture (P=0.028). All cases of iliac artery rupture were successfully treated with the CSs. Overall primary patency rates were 98.0% and 93.4% at 12 and 36 months, respectively. Primary patency rates of SES, BES, and CS were 87.7%, 88.4%, and 100% at 36 months, respectively. Conclusion The incidence of iliac artery rupture during AIS was 2.5%. Stent placement in the less calcified lesion and EIA was a risk factor for rupture during AIS. Placement of the CS can be the straightforward solution in case of iliac artery rupture during AIS.
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Affiliation(s)
- KwangJin Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sungsin Cho
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyangkyoung Kim
- Department of Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Hamamoto K, Oyama-Manabe N, Chiba E, Shinmoto H. Successful Closure of External Iliac Artery Perforation with Super-selective Transcatheter Coil Embolization. INTERVENTIONAL RADIOLOGY 2022; 7:75-80. [PMID: 36196381 PMCID: PMC9527105 DOI: 10.22575/interventionalradiology.2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/14/2022] [Indexed: 11/04/2022]
Abstract
We present two cases of external iliac artery perforation occurring after endovascular interventions successfully treated with direct closure using super-selective transcatheter coil embolization. Two patients, one 78-year-old man and one 78-year-old woman, underwent cardiac catheterization via the right femoral approach for coronary artery disease and atrial fibrillation. Following the procedures, both patients suffered severe acute hypotension, and contrast-enhanced computed tomography revealed a massive retroperitoneal hematoma due to perforation of the right external iliac artery. We attempted direct perforation site closure with super-selective transcatheter embolization using microcoils and achieved complete hemostasis in both cases. Our technique could be an alternative treatment option for external iliac artery perforations associated with the endovascular intervention.
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Affiliation(s)
- Kohei Hamamoto
- Department of Radiology, National Defense Medical College
| | | | - Emiko Chiba
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry
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Shi F, Zhang Y, Sun LX, Long S. Life-threatening subclavian artery bleeding following percutaneous coronary intervention with stent implantation: A case report and review of literature. World J Clin Cases 2022; 10:1937-1945. [PMID: 35317135 PMCID: PMC8891778 DOI: 10.12998/wjcc.v10.i6.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/26/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vascular complications of transradial percutaneous coronary intervention (PCI) are rare and usually occur at the access site below the elbow. Life-threatening vascular complications during transradial PCI therapy, such as vessel perforation and dissection in the brachiocephalic, subclavian, internal mammary, and thyrocervical arteries, are rarely reported. Subclavian artery bleeding is a potentially serious complication of vascular interventional procedures leading to tracheal obstruction, hemothorax, respiratory failure, hemorrhagic shock, and death if not diagnosed early and treated promptly.
CASE SUMMARY A male patient with typical angina pectoris underwent coronary angiography and stent implantation. During the procedure, the patient felt pharyngeal pain and tightness, which we mistook for myocardial ischemia. After PCI, swelling in the right neck and supraclavicular area was observed. The patient experienced dyspnea, emergency endotracheal intubation was performed, and then a sudden drop in blood pressure was observed. Ultrasound and contrast-enhanced computed tomography scans demonstrated a cervical hematoma severely compressing the trachea due to subclavian artery bleeding. Brachiocephalic angiography revealed a vascular injury site at the root of the right subclavian artery at the intersection of the right common carotid artery. A covered stent was deployed to the right subclavian artery with successful sealing of the perforation, and a bare stent was implanted in the junction of the right common carotid and brachiocephalic arteries to prevent obstruction of blood flow to the brain.
CONCLUSION Subclavian artery bleeding is a lifethreatening complication of PCI. Early prevention, rapid recognition, and prompt treatment may improve the prognosis.
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Affiliation(s)
- Fei Shi
- Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Ying Zhang
- Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Li-Xian Sun
- Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Sen Long
- Traditional Chinese Medicine, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
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Adiarto S. Displaced urinary bladder: a sign of iliac rupture. Cardiovasc Interv Ther 2020; 37:234-235. [PMID: 33245499 DOI: 10.1007/s12928-020-00736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
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Siddiqui S, Ayzenberg S, Morshed A, Miller A, Malyshev Y. Percutaneous Intervention of Iatrogenic Iliac Artery Vascular Complication. Cureus 2020; 12:e10181. [PMID: 33029461 PMCID: PMC7529497 DOI: 10.7759/cureus.10181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The mortality of patients from a retroperitoneal hematoma remains high if treatment is delayed or inappropriate. Percutaneous endovascular repair of iatrogenic vascular complications is quickly becoming the treatment of choice. Here, we report a case of a 76-year-old female with a non-ST-elevation myocardial infarction, whose cardiac catheterization revealed a 70% distal left main coronary artery (LMCA) stenosis. She underwent successful rotational atherectomy and deployment of drug-eluting stents of the distal LMCA. Following percutaneous coronary intervention, she suffered acute profound hypotension and was found to have a retroperitoneal hematoma. Given the high cardiac risk for vascular surgery due to recent intervention and overall comorbidities, she was immediately taken to the cardiac catheterization laboratory and had a diagnostic angiogram, which revealed a right external iliac artery perforation that was treated with a covered stent. She tolerated the procedure well. This case highlights the importance of early diagnosis of retroperitoneal bleed, the prompt decision to take the patient to the cardiac catheterization laboratory, and potential use of intravascular interventions to ensure a successful outcome.
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Affiliation(s)
| | | | - Ahmad Morshed
- Cardiology, Maimonides Medical Center, Brooklyn, USA
| | | | - Yury Malyshev
- Cardiology, Maimonides Medical Center, Brooklyn, USA
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Rizk T, Patel D, Dimitri NG, Mansour K, Ramakrishnan V. Iatrogenic Arterial Perforation During Endovascular Interventions. Cureus 2020; 12:e10018. [PMID: 32983713 PMCID: PMC7515740 DOI: 10.7759/cureus.10018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The use of minimally invasive endovascular procedures has increased, and as such, the frequency of associated vascular complications has also increased. Regardless of the access site location, rarely, arterial perforation can occur, which can be fatal if not properly managed. Interventionalists should be aware of the risk factors for perforation, commonly perforated vessels, and how different sites of perforation are diagnosed and managed. Rapid recognition and endovascular management reduce the need for open surgical repair, and thus reduce the morbidity and mortality of these complications. This review outlines the presentation, diagnosis, and management of iatrogenic perforations of the subclavian artery, thyrocervical trunk (TT), common carotid artery, superficial femoral artery (SFA), and external iliac artery.
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Armstrong EJ, Soukas PA, Shammas N, Chamberlain J, Pop A, Adams G, de Freitas D, Valle J, Woo E, Bernardo NL. Intravascular Lithotripsy for Treatment of Calcified, Stenotic Iliac Arteries: A Cohort Analysis From the Disrupt PAD III Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1262-1268. [PMID: 32147133 DOI: 10.1016/j.carrev.2020.02.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The presence of calcification in the iliac arteries is associated with decreased procedural success and increased complication risk during endovascular intervention. The objective of this study was to evaluate the safety and efficacy of peripheral intravascular lithotripsy (IVL) during endovascular treatment of iliac arterial peripheral artery disease (PAD). METHODS The Disrupt PAD III Observational Study is a prospective, non-randomized, multi-center single-arm study to assess the 'real-world' safety and effectiveness of the Shockwave Peripheral IVL System for the treatment of de novo calcified lesions in the peripheral arteries, with a goal of treating 1500 patients. This is an analysis of consecutive patients enrolled for treatment of an iliac artery, a specified sub-group, with at least moderate calcification and a minimum length of 20 mm. RESULTS Between December 2017 and July 2019, 118 patients with a total of 200 lesions were enrolled across 20 sites. 101 patients were treated primarily for claudication or critical limb ischemia, while 17 patients were treated to optimize the iliac vasculature for large-bore access. All 118 patients had successful IVL catheter delivery. The average reference vessel diameter was 7.3 mm ± 1.9 mm, with an average diameter stenosis of 83.1% ± 13.4% and an average lesion length of 58.3 mm ± 57.6 mm. Severe calcification was present in 82.0% of overall cases. Stent placement was performed in 72.9% of the overall cases. As expected, the access group received less adjunctive therapies including stents (41.2%, p < 0.001). Angiographic complications were minimal with no flow-limiting dissections and a final mean residual stenosis of 12.0% ± 12.1% with no differences between the groups. CONCLUSIONS Acute results with IVL in calcified iliac lesions suggest that it is a safe and effective option for calcified, stenotic iliac disease. IVL can be used successfully both for treatment of PAD symptoms and to optimize access for large-bore procedures.
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Affiliation(s)
- Ehrin J Armstrong
- University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Peter A Soukas
- The Miriam Hospital/Brown Medical School, Providence, RI, United States of America.
| | - Nicolas Shammas
- Midwest Cardiovascular Research Foundation, Davenport, IA, United States of America
| | - Jack Chamberlain
- Alexian Brothers Medical Center, Elk Grove Village, IL, United States of America
| | - Andrei Pop
- Alexian Brothers Medical Center, Elk Grove Village, IL, United States of America.
| | - George Adams
- UNC Rex Healthcare, Raliegh, NC, United States of America.
| | - Dorian de Freitas
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado School of Medicine, Auorora, CO, United States of America.
| | - Javier Valle
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado School of Medicine, Auorora, CO, United States of America.
| | - Edward Woo
- Medstar Washington Hospital Center, Washington, DC, United States of America.
| | - Nelson L Bernardo
- Medstar Washington Hospital Center, Washington, DC, United States of America
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