Re: Arterial Perforation (by Balloon) During Subintimal Angioplasty By Dr Wright and colleagues from Leicester Royal Infirmary, Leicester, United Kingdom published in Eur J Vasc Endovasc Surg 28, 108–110 (2004)

Abstract

I read with interest your recent report of late bleeding associated with subintimal angioplasty as we had a similar experience in a 67-year-old woman with rheumatoid-arthritis who presented with critical limb ischaemia of the left leg. Diagnostic angiography was performed followed by subintimal angioplasty of the occluded left superficial femoral artery (SFA) by subintimal technique. Completion angiography demonstrated a successful outcome of a subintimal angioplasty with full restoration of SFA flow. Medically, the patient was extremely well and she was able to walk within less than 48 h. A Duplex ultrasound scan just before leaving the hospital (3 days after subintimal angioplasty) showed a patent left SFA and popliteal artery and no other abnormality identified. Less than 48 h after discharge, the patient experienced acute left upper thigh pain which gradually became severe associated with sudden drop in blood pressure and gradually the thigh became significantly swollen. She was re-admitted to the hospital where she had four units of blood transfused. An on-table angiogram was performed in theatre to allow for immediate surgical intervention as the left thigh was now tense, red and blistering (Fig. 1, Fig. 2). The angiogram showed an upper left SFA rupture and pseudo-aneurysm. Since she had a good profunda and the SFA was seriously damaged, the artery was ligated. The bleeding stopped and a massive haematoma was evacuated (Fig. 3, Fig. 4).Fig. 2Blistering of skin over tense left thigh haematoma.View Large Image Figure ViewerDownload (PPT)Fig. 3Ligated left SFA at operative decompression.View Large Image Figure ViewerDownload (PPT)Fig. 4Large decompression fasciotomies required.View Large Image Figure ViewerDownload (PPT) She recovered well following the surgical exploration but she required hospital stay for 2 weeks until the wound healed completely. It is planned to review her regarding her claudication symptoms after full recovery. In conclusion, in the light of Dr Wright's experience and our own, we consider that late rupture after subintimal angioplasty is not as uncommon as previously thought.