Endovascular Treatment of External Iliac Artery Injuries After Hip Arthroplasty

Bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure

Background

We report an exceedingly rare case of bilateral external iliac artery pseudoaneurysms causing urinary obstruction and acute renal failure.

Case presentation

A young man presented with acute severe bilateral testicular pain radiating to the back. Clinical and radiological workup showed bilateral external iliac artery pseudoaneurysms, which caused bilateral ureterohydronephrosis due to urinary obstruction with subsequent renal failure. Management included immediate bilateral external iliac artery endovascular repair and bilateral ureterolysis using a retroperitoneal approach, with resolution of the obstruction and successful endovascular treatment of both pseudoaneurysms. The only identifiable risk factor for cardiovascular disease was cocaine addiction.

Conclusions

This case highlights an unusual and severe clinical presentation of bilateral EIA pseudoaneurysms causing bilateral ureterohydronephrosis and subsequent renal failure. Awareness of this condition may help avoid misdiagnosis and delayed management, which is of utmost importance for a favorable outcome.

Emergency stent-graft implantation for iatrogenic peripheral arterial rupture

PURPOSE

We evaluated the experience with and efficacy of stent-grafting for iatrogenic peripheral arterial ruptures.

MATERIALS AND METHODS

From 2005 to 2009 we performed stent-grafting on four male patients (age 38-67 years) with iatrogenic peripheral arterial ruptures. In patient 1, grointissue necrosis followed a subcutaneous injection and led to femoral arterial rupture. Pseudoaneurysms ruptured in patients 2 and 3 who were undergoing femoral arteriotomy. Patient 1 experienced a ruptured carotid artery during neck surgery. Shock occurred in three of the four patients. Four patients underwent self-expanding stent-grafting (8 mm×60 mm or 8 mm×80 mm) under local anaesthesia.

RESULTS

Haemorrhages were controlled in all patients. No procedure-related complications occurred. Patient 1 died of lung metastases 13 months after stent-grafting. Follow-up examinations showed that the stent-graft remained patent in patients 1, 2 and 4, whereas stent occlusion occurred after 15 months in patient 3; in this case, a pseudoaneurysm proximal to the stent was identified, and although repeat stent-grafting successfully stopped the bleeding, the patient died of multiple organ failure 1 week later.

CONCLUSIONS

Emergency stent-grafting is a technically feasible and therapeutically effective modality for treating high-risk patients who experience iatrogenic peripheral arterial ruptures. The efficient treatment of hypotension and early endovascular intervention will improve the prognosis.

Endovascular Treatment of Iliac Artery Aneurysms

Endovascular treatment is now an alternative to surgery for the treatment of iliac artery aneurysms (IAAs). A variety of minimally invasive therapeutic options are available (eg, coil embolization, stent-graft placement), and choosing an appropriate option is essential for achieving excellent long-term results and reducing potential complications. Preprocedural imaging with multi-detector row computed tomography or magnetic resonance imaging is necessary for evaluating patient eligibility and planning the interventional procedure. An imaging classification system for IAAs that is based on anatomic features and endovascular treatment options has been developed and may help determine therapeutic strategies for affected patients. Early experience indicates that endovascular treatment is safe and effective in treating IAAs, and it is expected that various devices that will make endovascular treatment easier to perform will soon become commercially available. However, large, long-term follow-up studies will be needed to determine whether this approach is a practical alternative to open surgery.