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Title: Acute Iliac Artery Rupture: Endovascular Treatment

Abstract

The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results.

Authors:
; ; ; ; ; ;  [1]
  1. University of Athens, Radiology Department, Areteion Hospital (Greece)
Publication Date:
OSTI Identifier:
21091032
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 30; Journal Issue: 2; Other Information: DOI: 10.1007/s00270-005-0357-9; Copyright (c) 2007 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ACCIDENTS; CORONARIES; GRAFTS; PATIENTS; RUPTURES

Citation Formats

Chatziioannou, A., Mourikis, D., Katsimilis, J., Skiadas, V., E-mail: bill_skiadas@yahoo.gr, Koutoulidis, V., Katsenis, K., and Vlahos, L. Acute Iliac Artery Rupture: Endovascular Treatment. United States: N. p., 2007. Web. doi:10.1007/S00270-005-0357-9.
Chatziioannou, A., Mourikis, D., Katsimilis, J., Skiadas, V., E-mail: bill_skiadas@yahoo.gr, Koutoulidis, V., Katsenis, K., & Vlahos, L. Acute Iliac Artery Rupture: Endovascular Treatment. United States. doi:10.1007/S00270-005-0357-9.
Chatziioannou, A., Mourikis, D., Katsimilis, J., Skiadas, V., E-mail: bill_skiadas@yahoo.gr, Koutoulidis, V., Katsenis, K., and Vlahos, L. Sun . "Acute Iliac Artery Rupture: Endovascular Treatment". United States. doi:10.1007/S00270-005-0357-9.
@article{osti_21091032,
title = {Acute Iliac Artery Rupture: Endovascular Treatment},
author = {Chatziioannou, A. and Mourikis, D. and Katsimilis, J. and Skiadas, V., E-mail: bill_skiadas@yahoo.gr and Koutoulidis, V. and Katsenis, K. and Vlahos, L.},
abstractNote = {The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results.},
doi = {10.1007/S00270-005-0357-9},
journal = {Cardiovascular and Interventional Radiology},
number = 2,
volume = 30,
place = {United States},
year = {Sun Apr 15 00:00:00 EDT 2007},
month = {Sun Apr 15 00:00:00 EDT 2007}
}
  • Purpose: To evaluate the clinical and radiological long-term results of recanalization of chronic occluded iliac arteries with balloon angioplasty and stent placement.Methods: Sixty-nine occluded iliac arteries (mean length 8.1 cm; range 4-16 cm) in 67 patients were treated by percutaneous transluminal angioplasty and stent placement. Evaluations included clinical assesment according to Fontaine stages, Doppler examinations with ankle-brachial index (ABI) and bilateral lower extremity arteriograms. Wallstent and Cragg vascular stents were inserted for iliac artery recanalization under local anesthesia. Follow-up lasted 1-83 months (mean 29.5 months).Results: Technical success rate was 97.1% (67 of 69). The mean ABI increased from 0.46 tomore » 0.85 within 30 days after treatment and was 0.83 at the most recent follow-up. Mean hospitalization time was 2 days and major complications included arterial thrombosis (3%), arterial rupture (3%) and distal embolization (1%). During follow-up 6% stenosis and 9% thrombosis of the stents were observed. Clinical improvement occurred in 92% of patients. Primary and secondary patency rates were 75% and 95%, respectively.Conclusion: The long-term patency rates and clinical benefits suggest that percutaneous endovascular revascularization with metallic stents is a safe and effective treatment for patients with chronic iliac artery occlusion.« less
  • Endovascular therapy is the treatment of choice for type A and the preferred treatment for type B lesions. In selective patients, this type of treatment can be applied in type C and even type D lesions. Ipsilateral femoral, contralateral femoral, and brachial approach and both the intraluminal and subintimal space can be used for successful recanalization. The application of stents has improved the immediate hemodynamic and probably long-term clinical results of iliac percutaneous transluminal angioplasty. However, the superiority of primary or direct stenting over selective stenting has not been proven yet. The choice of stent type depends on lesion morphologymore » and location but otherwise there is insufficient evidence to support the use of a particular stent design. There is insufficient evidence to justify routine use of covered stents. All patients should receive antiaggregant therapy following endovascular recanalization of iliac arteries. There is no consensus regarding prophylaxis with antibiotics in iliac recanalization procedures.« less
  • In patients with peripheral arterial disease not much is known about the relationship between the localization of the pain and the localization of arterial occlusions in the iliac arteries. Occlusions high in the iliac arteries are assumed to be able to induce pain in the buttocks and upper leg as well as pain in the calves. Several case reports show that the symptoms of arteriosclerotic lesions in the internal iliac artery are often atypical and not easy to diagnose. In this report, 3 patients with internal iliac artery occlusions who were treated with percutaneous transluminal angioplasty (PTA) are described. Onemore » patient had isolated pain in the buttock region. In the other 2 patients the initial pain was focused on the buttock region with extension to the calves during exercise. After PTA, 2 patients were free of symptoms, while in the other patient the symptoms improved but did not disappear. Future research should clarify the relation between certain arterial occlusions and the location of the pain.« less
  • Ruptured aneurysms of the internal iliac artery (IIA) are rare and challenging to treat surgically. Due to their anatomic location they are difficult to operate on and perioperative morbidity is high. An endovascular approach can be helpful. We recently treated a patient with a ruptured IIA aneurysm in the interventional radiology suite with embolization of the side-branch of the IIA and placement of a covered stent in the ipsilateral common and external iliac arteries. A suitable stent-graft was not available initially and had to be brought in from elsewhere. An angioplasty balloon was temporarily placed across the ostium of themore » IIA to obtain hemostasis. Two hours later, the procedure was finished by placing the stent-graft.« less
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