Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Case Report

Volume 8, Number 5, October 2017, pages 246-253

Successful Treatment of Iatrogenic External Iliac Artery Perforation With Covered Stent: Case Report and Review of the Literature

Figures

Figure 1.
Figure 1. Figure 1. Left heart cathetrization RAO view showing (a) severe proximal and mid LAD disease pre PCI, Impella support device is seen in the LV, and a temporary transvenous pacemaker wire in the RV. (b) Post atherectomy and stent placement in the proximal and mid LAD.
Figure 2.
Figure 2. Figure 2. Peripheral angiogram of the left iliac artery showing (a) site of vascular injury and shift of the bladder to the right indicative of compression from the rapidly accumulating retroperitoneal hemaoma; (b) after endovascular repair of the left iliac perforation using a covered stent.
Figure 3.
Figure 3. DSA of the left iliac artery showing (a) extravasation of blood into the retroperitoneal space at the site of vascular perforation; (b) resolution of the bleeding following the deployment of a covered stent.
Figure 4.
Figure 4. CT of the abdomen without contrast in transverse (a) and coronal (b) planes showing site of the covered stent surrounded by retroperitoneal hemorrhage along the plane of left external iliac artery.
Figure 5.
Figure 5. Vascular interdisciplinary team (VIT) approach to help mitigate the risk of iatrogenic vascular complications during planned interventional procedures. OR: operating room; MAP: mean arterial pressure.

Tables

Table 1. Predictors of Iatrogenic Vascular Complications Reported in the Literature, Divided in Potentially Modifiable Versus Non-Modifiable Factors
 
Potentially modifiableNon-modifiabe
High femoral artery punctureDiffuse vascular calcifications
Larger sheath sizeIncreased vascular tortuousity
Excessive guidewire manipulationHigh grade iliac stenosis
Manual inflation (pressure and time)Female gender
Oversized balloonOlder age
Procedure timeLow body surface area (BSA)
Anticoagulation or thrombolyticsChronic kidney disease (CKD)
Hypertension during procedureDiabetes mellitus (DM)
Patient agitation and movementPrior stroke
Long-term steroid therapyConnective tissue disease (e.g. Ehlers Danlos)

 

Table 2. Procedures Reported in the Literature to Treat Iatrogenic Vascular Complications
 
Classical vascular surgery
Covered stent/ stent graft (iCAST)
Vascular plug (Amplatzer)
Percutaneous suture delivery (Perclose)
Endovascular coil embolization (Interlock & IDC)
Collagen plug (Angio-Seal)
Localized thrombin injection (Thrombin JMI)
Coagulated thrombus injection
Prolonged balloon tamponade
Prolonged external compression