Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

Mehta, Vimal; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay

doi:10.1007/s00270-015-1125-0

Cited by 3 publications

(4 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As we did not have a covered stent on the shelf, we fashioned a covered stent using easily available materials. This has been reported previously [ 9 ] and we have used self-made stents at our institute in cases of aortic coarctation during coarctoplasty with excellent long-term outcomes (unpublished data). Anticipated problems in the use of these self-made stents include 1) the presence of thrombogenic balloon material and 2) the unknown response of the underlying vessel with the potential to cause vascular calcification, atherosclerosis or aneurysms.…”

Section: Discussionsupporting

confidence: 67%

Management of Iatrogenic External Iliac Artery Perforation With a Self-Made Covered Stent

Marimuthu¹,

Rao²,

Jadhav³

et al. 2022

Cureus

View full text Add to dashboard Cite

Retroperitoneal hemorrhage (RPH) following transfemoral arterial access is a dreaded complication needing immediate management. A 70-year-old female with inferior wall myocardial infarction developed hemodynamic instability following transfemoral percutaneous coronary intervention. The evaluation revealed an RPH due to an iatrogenic guidewire-related perforation of the external iliac artery. This was successfully managed with the deployment of a custom, a self-made covered stent. In this report, we describe our method of creating and deploying this self-made stent and discuss potential issues compared to commercially available covered stent systems.

show abstract

Section: Discussionsupporting

confidence: 67%

Management of Iatrogenic External Iliac Artery Perforation With a Self-Made Covered Stent

Marimuthu¹,

Rao²,

Jadhav³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…Trehan et al [ 23 ] used a longer stent-graft on a shorter balloon to emergently treat an iatrogenic iliac artery rupture. Mehta et al [ 24 ] successfully treated a massive bleed from a guidewire perforation of an external iliac artery with hand-made stent-graft placement. Arat and colleagues [ 25 ] reported successful treatment of a femoral bleeding site with two covered self-expanding coronary stent-grafts.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

Retroperitoneal hemorrhage from iliac artery injury is a potentially serious complication of vascular interventional procedures leading to hemorrhagic shock and death if not diagnosed early and treated promptly. We report a 70-year-old male admitted to our facility with non-ST-elevation myocardial infarction, whose heart catheterization revealed left anterior descending artery (LAD) with 80% proximal, 95% mid and 100% distal disease. The left circumflex and right coronary arteries were 100% occluded proximally and received collaterals from the LAD. The patient declined coronary artery bypass surgery; therefore, the decision was made to perform high-risk percutaneous coronary intervention (PCI) of the LAD with Impella left ventricular assist device support. Left femoral artery angiogram revealed severely tortuous and calcified aorta, left external iliac and left common iliac arteries, and was accessed with 14-inch Impella sheath. He developed groin pain with mild hypotension thought to be due to sedation, which responded to intravenous fluids and dopamine. He underwent successful rotational atherectomy of the proximal and mid LAD with deployment of drug-eluting stents. Following PCI, he suffered acute profound hypotension necessitating intravenous fluids and vasopressor support with epinephrine. Emergency transthoracic echocardiogram did not reveal any pericardial effusion, and showed normal left ventricle and right ventricle systolic function. The Impella device was removed and selective left common iliac angiogram from the right femoral access revealed a vascular injury site with shift of the bladder to the right indicative of retroperitoneal hematoma. A digital subtraction angiogram revealed extravasation of blood at the vascular injury site. An 8.0 × 59 mm iCAST covered stent was deployed to the left external iliac artery with successful sealing of the perforation. The Impella device site was closed with two Perclose devices. The patient required 4 units of packed red blood cell transfusion. His hospital course was complicated by transient acute kidney injury, with return of his renal function to baseline at discharge 10 days later. This case underscores the importance of prompt recognition and treatment of vascular complications associated with interventional procedures, and highlights some of the risk predictors of such complications, which should be anticipated and planned for prior to intervention.

show abstract

“…During the transportation, especially with unstable patient in severe condition, the information to the admitting center (ATMIST scheme) should be sent ( Table 3) [5].…”

Section: Prehospital Care In Patients With Vascular Injury 21 On-sitmentioning

confidence: 99%

“…A perforation or tear of the arterial wall not in the access site is the second very frequent complication of the endovascular procedure. The typical location of the perforation is iliac arteries, when during the approach to the target lesion (coronary arteries, carotid arteries, abdominal aorta) a hydrophilic guidewire perforates the vessel typically in the location of arteriosclerotic plaque [5,39]. If the guidewire perforation is noticed quickly, usually it has no consequences besides small extravasation which may require a low-pressure balloon inflation to seal the leak.…”

Section: Iatrogenic Vascular Injurymentioning

confidence: 99%

Vascular Trauma

Szaniewski¹,

Byrczek²,

Sikora³

2019

Emergency Medicine and Trauma

View full text Add to dashboard Cite

Trauma is a leading cause of death and disability in young adults in developed countries with the high impact on future patient quality of life and productivity. The traumatic injury of the vessels is one of the most dangerous types of injury, requiring a fast and reliable diagnosis and, in vast majority of cases, immediate surgical treatment. In this chapter, the authors describe various types of vascular injuries according to injury types and locations. The prehospital care algorithms in patients with vascular trauma are proposed with the emphasis on bleeding control techniques and transportation technique to the nearest hospital. In the next subsection, the various peripheral vascular injuries of specific body areas are described. The truncal vessel trauma is discussed in the next subsection, focusing on fast diagnosis and decision on surgery. In the last subsection, a problem of iatrogenic vascular injury is described due to a rapid increase of minimally invasive techniques in which a vascular injury, as a complication of therapy, may occur.

show abstract

Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

Cited by 3 publications

References 8 publications

Management of Iatrogenic External Iliac Artery Perforation With a Self-Made Covered Stent

Management of Iatrogenic External Iliac Artery Perforation With a Self-Made Covered Stent

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

Vascular Trauma

Contact Info

Product

Resources

About