EURORAD ESR

Case 8826

An unusual complication during iliac recanalisation

Author(s)
Pozzi Mucelli F, Medeot A, Giarraputo L, Pizzolato R, Cova M

Struttura Complessa di Radiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy
 
Patient
female, 71 year(s)
 
 
  • Figure 1
    First angiography and 24 hours check
     

    Preliminary angiography shows complete occlusion of the right common and external iliac artery (three occluded stents are visible in the right common iliac artery).

     

    Check angiography after 24 hours of local fibrinolytic therapy: no improvement is detected. Note the guidewire has crossed the occlusion intraluminally.

     
     
     
  • Figure 2
    PTA with unexpected complication
     

    Check angiogram after PTA (injecting from the sheath) mainly focused on the external iliac artery shows good reopening of the vessel.

     

    Check angiogram injecting from the distal aorta: the right iliac artery is patent, however, there is a problem. Can you see it? The solution is in the next figure.

     

    The cranial stent (inserted 18 months before) moves freely in the distal aorta. What to do?

     
     
     
  • Figure 3
    Stent repositioning
     

    With a guidewire and a preshaped 4F diagnostic catheter the ´free´ stent was engaged.

     

    We did 2 different oblique views to chech the correct position of the guidewire, which confirmed the right position.

     

    An 8 mm PTA balloon was advanced and inflated inside the stent and this was pulled back in the original position.

     

    In order to fasten the stent another stent of the same size was deployed between the first and the second stent.

     

    Final angiogram shows complete resolution of the problem.

     
     
     
Preliminary angiography shows complete occlusion of the right common and external iliac artery (three occluded stents are visible in the right common iliac artery).
 
Check angiography after 24 hours of local fibrinolytic therapy: no improvement is detected. Note the guidewire has crossed the occlusion intraluminally.
 
Check angiogram after PTA (injecting from the sheath) mainly focused on the external iliac artery shows good reopening of the vessel.
 
Check angiogram injecting from the distal aorta: the right iliac artery is patent, however, there is a problem. Can you see it? The solution is in the next figure.
 
The cranial stent (inserted 18 months before) moves freely in the distal aorta. What to do?
 
With a guidewire and a preshaped 4F diagnostic catheter the ´free´ stent was engaged.
 
We did 2 different oblique views to chech the correct position of the guidewire, which confirmed the right position.
 
An 8 mm PTA balloon was advanced and inflated inside the stent and this was pulled back in the original position.
 
In order to fasten the stent another stent of the same size was deployed between the first and the second stent.
 
Final angiogram shows complete resolution of the problem.
 
 
 
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