Occlusion Of External Iliac Artery Research Articles

Alternative Solution for Bilateral Common Iliac Aneurysm in a Patient With Left External Iliac Artery Occlusion

8 Joynt KE, Blumenthal DM, Orav E, Resnic FS, Jha AK. Association of public reporting for percutaneous coronary intervention with utilization and outcomes among medicare beneficiaries with acute myocardial infarction. JAMA 2012;308:1460e8. 9 Chaturvedi S, Bruno A, Feasby T, Holloway R, Benavente O, Cohen SN, et al. Carotid endarterectomydan evidence-based review: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 2005;65:794e801. 10 Kresowik TF, Bratzler DW, Kresowik RA, Hendel ME, Grund SL, Brown KR, et al. Multistate improvement in process and outCan Patients Select the Best Hospital

Contralateral approach to iliac artery recanalization with kissing nitinol stents present in the aortic bifurcation

A 69-year-old man, who had earlier undergone reconstruction of the aortic bifurcation with kissing nitinol stents, presented with occlusion of the left external iliac artery. The occlusion was successfully and safely recanalized using contralateral femoral approach with passage of interventional hardware through the struts of the stents in the aortic bifurcation. Presence of contemporary flexible nitinol stents with open-cell design in the aortic bifurcation is not a contraindication to the use of the contralateral femoral approach.

The Antegrade Approach Using Transbrachial Access Improves Technical Success Rate of Endovascular Recanalization of TASC C-D Aortoiliac Occlusion in Case of Failed Femoral Access

Technical success rates of endovascular recanalizations for Trans-Atlantic Inter-Society Consensus (TASC) C-D chronic occlusions are highly variable and depend on the characteristics and sites of the lesions as well as on the operator experience. We hypothesized that an antegrade approach via transbrachial access could improve the technical success rate of endovascular treatment of TASC C-D occlusions in case of failed femoral access. From January 2010 to December 2012, all patients with symptomatic chronic TASC C-D aortoiliac occlusion were treated with an endovascular-first approach. Recanalization was first attempted using a femoral access. In case of failure, an antegrade approach using a transbrachial access was performed. Patient characteristics, anatomic details, procedural data, and immediate outcomes were prospectively recorded. During the study period, 73 patients (99 arteries) were included. Twenty-seven (37%) patients had TASC C occlusions including 11 bilateral common iliac artery occlusions and 16 external iliac artery (EIA) occlusions involving the common femoral or the internal iliac arteries. Forty-six (63%) patients had TASC D occlusions including 10 aortoiliac occlusions, 31 unilateral occlusions of both common and EIAs, and 5 bilateral EIA occlusions. Technical success with femoral access has been obtained in 53 arteries. An antegrade approach via transbrachial access allowed technical success in the other arteries, except in 7 arteries. Overall technical success rate was 93%, and 2 complications were related to the brachial accesses including 1 thrombosis and 1 pseudoaneurysm both requiring a reintervention. Brachial access for TASC C-D aortoiliac chronic occlusion improves the technical success rate without the need for reentry devices.

The effect of demographic factors and lesion severity on iliac stent patency

The aim of our study was to perform a large multivariate analysis to identify demographic, anatomic, or procedural factors that affect iliac artery stent primary patency (PP). Patients receiving iliac stents from 2007 to 2013 were retrospectively reviewed. Univariate analysis assessed cohort characteristics and their effect on PP. Variables considered significant (P < .05) were brought forward in the multivariate analysis. A total of 213 patients underwent primary iliac artery stenting, and 307 limbs were analyzed. The average age was 66 years (range, 38-93 years), 54% were male, and 55% were Caucasian. Indications for procedure were claudication in 68%, rest pain in 20%, and tissue loss in 12%. All TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II classifications were included: 51% TASC II A, 25% TASC II B, 13% TASC II C, and 11% TASC II D. The treated anatomic locations were 27% isolated external iliac artery (EIA), 56% isolated common iliac artery, and 17% combined common iliac artery and EIA. Multivariate analysis found three factors were correlated with decreased PP: non-Caucasian race (hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.08-3.13; P = .025), younger age (HR, 1.04; 95% CI, 1.01-1.08; P = .006), and presence of EIA occlusion (HR, 2.02; 95% CI, 1.05-3.89; P = .036). Overall, Kaplan-Meier analysis at 1 and 3 years revealed a PP of 86% and 53%, assisted PP of 98% and 89%, and secondary patency of 99% of 98%. Kaplan-Meier analysis showed PP at 1 year for was 91% Caucasian patients vs 77% for non-Caucasian (P = .001). PP was 75% in patients aged <60 years, 86% in patients aged 60-70 years, and 96% in patients aged >70 years, with a significant difference between all groups (P < .001). PP was significantly different for those with and without EIA occlusion (P = .002), with 1-year PP of 71% and 88%, respectively. In our experience with a large number of iliac interventions, younger age, non-Caucasian race, and EIA occlusion were strong predictors for loss of PP.

Delayed Gastrointestinal Bleeding in a Case of Failed Graft Pancreatic and Kidney Transplant: Presidential Poster

Introduction: Arterioenteric fistulae and pseudoaneuryms, although rare, are potentially lifethreatening complications of simultaneous kidney and pancreatic transplants (SPAK). We describe a case of a 53-year-old white man, a recipient of SPAK transplant in 2003, who presented to the emergency department with near syncope following 2 episodes of maroon-colored stools. The kidney and pancreas grafts failed, and he was being treated with insulin and hemodialysis, respectively. The transplanted kidney was resected in 2009, following an infection. A screening colonoscopy done in 2010 was unremarkable. Upon presentation, he was resuscitated with intravenous fluids and multiple blood transfusions for hypovolemic shock from acute blood loss. (Hemoglobin had decreased from 11 gm/dL 1 month ago to 6.9 gm/dL on admission.) Abdominal exam was unremarkable. Gastric lavage revealed bilious fluid, but no blood. Rectal exam revealed maroon stool. An emergent CT angiography showed a 12 mm x 20 mm pseudoaneurysm arising from the right external iliac artery. An emergent stent-assisted coil embolization was performed by interventional radiology; hemostasis and hemodynamic stability were achieved. Three days after the index embolization, he had further episodes of hematochezia,warranting an emergent pelvic angiogram, which demonstrated continued patency of the pseudoaneurysm. Occlusion of the right external iliac artery with a covered stent was subsequently performed. A colonoscopy on day 4 revealed only a few scattered sigmoid diverticula and ulcerated mucosa of the ileocecal valve without active bleeding. An elective exploratory laparotomy revealed the site of the fistula. The renal graft remnant was found to be anastamosed to the iliac artery. Bowel was dissected from the underlying graft, and a 5-cm resection of the bowel was performed. The patient had no further episodes of bleeding and was stable at the time of discharge. Arterial pseudoanerysms and areterio-enteric fistuale are known complications of SPAK transplants. Most of these occur early in the post-operative period. Fistulae are seen in the setting of pancreatic graft failure. This can occur because of anatomic apposition of the arterial and enteric anastomoses or a result of proteolytic enzymes released from the pancreatic graft. Lower gastrointestinal bleeding in patients with failed SPAK transplants should raise a high suspicion for arterioenteric fistulae, and early diagnosis with angiography can be life-saving. Multimodality treatment with percutaneous stenting, coil embolization, and operative correction usually achieve satisfactory results.

Use of iliac branch devices for endovascular repair of aneurysmal distal seal zones after EVAR.

To assess the feasibility and midterm outcomes of iliac branch devices (IBD) for the treatment of aneurysmal distal seal zones after endovascular aneurysm repair (EVAR). Between January 2005 and January 2014, 188 patients with aortic aneurysms involving the iliac bifurcation underwent IBD implantation; of these, 18 consecutive patients (17 men; mean age 70±10 years) were treated for aneurysmal degeneration of 22 distal seal zones (mean 36±6-mm diameter) after EVAR. The main outcome measure was technical success. Further outcomes were primary and assisted primary patency of the internal iliac branch, types Ib/III endoleaks, reintervention, and all-cause mortality. The technical success rate was 100%. The primary patency rate was 100% over a median follow-up of 15 months (interquartile range 4-25). None of the patients developed type Ib or III endoleak. During surveillance, two device-related reinterventions were performed (thrombectomy of an occluded external iliac artery and angioplasty with stenting of a stenotic common iliac artery). One patient died due to metastatic prostate cancer. Iliac side branch endografting showed excellent feasibility and encouraging midterm outcomes for the challenging endovascular repair of aneurysmal distal seal zones post EVAR.

Endovascular treatment for unilateral chronic total occlusions of the iliac artery categorized as TASC II type D lesions

To compare the results of endovascular treatment for unilateral iliac occlusion in types B and D, and confirm its validity for type D. Between 2000 and 2011, 108 patients underwent endovascular treatment for unilateral iliac occlusion. 77 were categorized as type B for occlusion of common iliac artery (CIA) or external iliac artery (EIA) and 31 were categorized as type D for occlusion of both CIA and EIA. The initial success rates, procedure time, penetration time, amount of contrast media used, complication rates, and cumulative primary patency rates were determined and compared between these groups. Between type D and B groups, the initial success rates were 87.1 % (type D) and 89.6 % (type B) (p = 0.9316). The procedure time was 137.0 ± 55.5 and 97.2 ± 47.2 min (p < 0.05). The penetration time was 49.1 ± 40.6 and 31.6 ± 30.1 min (p < 0.05). The amount of contrast agent used was 193.9 ± 103.1 and 156.5 ± 85.0 ml (p = 0.0722). The complication rates were 6.5 and 3.9 % (p = 0.8491). The cumulative primary patency rates, at 1, 3, and 5 years were 91, 85, and 85 % and 100, 96, and 93 %. Endovascular treatment can be indicated for unilateral occlusion of both CIA and EIA categorized as type D.

Technical tips and procedural steps in endovascular aortic aneurysm repair with concomitant recanalization of iliac artery occlusions

PurposeThe goal of this paper is to describe our technical strategy and procedural steps for endovascular aneurysm repair (EVAR) when performed with concomitant recanalization of the iliac artery occlusion.Materials and methodsThree octogenarians having abdominal aortic aneurysm (AAA)/common iliac artery aneurysms (CIAA) with unilateral external iliac artery (EIA) occlusion underwent EVAR with recanalization of the occluded iliac arteries. Crossing the iliac artery occlusions was attempted in a retrograde approach using a 0.035 inch-hydrophilic guidewire. After passage of a guidewire, predilation was performed using 6mm balloon. Then a 12-Fr sheath was advanced via the occluded EIA for contralateral iliac limb delivery. Internal iliac artery embolization was subsequently performed as needed. A self-expanding stent was then placed in the occluded EIA after EVAR.ResultsRecanalization of the EIA occlusion, followed by stentgraft delivery through the occlusion and EVAR, was successfully performed in all three patients. Penetration of the occluded EIA was successfully achieved only by retrograde approach in two patients, and by bidirectional approach in the other patient. No perioperative complication or death occurred. Postoperative CT showed no type I or III endoleaks in the aneurysms and patent iliac arteries in all patients.ConclusionsTotal endovascular repairs were successfully performed for three patients with AAA and concomitant unilateral EIA occlusions. The proposed steps described in this report might reduce the complication rate and enhance the technical success rate associated with this procedure.

Subintimal angioplasty with a true reentry device for treatment of chronic total occlusion of the arteries of the lower extremity

To report the efficacy and safety of the Outback(®) LTD(®) Re-Entry Catheter in reentering the distal true lumen during percutaneous intentional extraluminal revascularization (PIER). Reentry catheters are used to treat chronic, total arterial occlusions of the lower extremities when standard methods of recanalization have failed. Success and complication rates of these catheters in the real world are uncertain and variable. A retrospective review of our peripheral catheterization database from January 2004 to September 2009 was undertaken to identify consecutive cases of peripheral chronic total occlusions (CTOs) requiring the use of the Outback reentry catheter. Patient demographics, indication for the procedure, location and extent of occlusion, procedural success, and complications were studied. A total of 51 patients were identified. Of the 51, 28 (54.9%) patients presented with nonhealing ulcer and 22 (43.1%) had lifestyle-limiting claudication. One patient presented with acute limb ischemia. There were 6 (11.8%) patients with common iliac artery occlusion, 2 (3.9%) with external iliac artery occlusion, 1 (1.9%) with common femoral artery occlusion, 35 (68.6%) with superficial femoral artery occlusion, 6 (11.8%) with popliteal artery occlusion, and 1 (1.9%) with tibioperoneal artery occlusion. Median lesion length was 230 mm. Procedural success was achieved in 49 patients (96.1%). There was 1 (1.9%) periprocedural complication. Use of Outback(®) LTD(®) Re-Entry Catheter is a safe and valuable option for PIER/subintimal angioplasty and recanalization in patients with symptomatic lower-extremity CTOs. However, long-term patency remains unknown.

Impotence due to External Iliac Steal Syndrome: Treatment with Percutaneous Transluminal Angioplasty and Stent Placement

We report a case of erectile dysfunction caused by external iliac artery occlusion, associated with pelvic steal syndrome; bilateral internal iliac arteries were patent. The patient stated that he had experienced erectile dysfunction at similar times along with claudication, but he did not mention it before angiography. He expressed that the erectile dysfunction did not last long and that he felt completely okay after the interventional procedure, in addition to his claudication. Successful treatment of the occlusion, by percutaneous transluminal angioplasty and stent implantation, helped resolve erectile dysfunction completely and treat the steal syndrome.

Peripheral Arterial Disease Masquerading as Low Back Pain

A 49-yr old man was referred by primary care for evaluation of low back pain. The patient reported chronic mild axial lumbar region pain with a more recent onset of left gluteal/hip and thigh region pain, with the latter being more bothersome. This newer pain was described as a “fatigue” sensation that only occurred after walking for approximately 15 mins and promptly resolved with rest. He denied any radiation of this pain to the distal lower limb or any lower limb neurologic symptoms. His medical history was significant for hypercholesterolemia, hypertension, and a 70–pack year smoking history. Lumbar examination was benign, with no tenderness and full pain-free range of motion. Lower limb neurologic examination result was normal as well. Vascular examination was notable for an absent left pedal pulse and reproduction of the patient’s typical left gluteal/hip region symptoms after ambulating 10 mins. Lumbar radiographs demonstrated degenerative disc changes at L4–5 and L5–S1. The patient was referred for Ankle-Brachial Index measurements. Results revealed moderately severe left peripheral arterial disease (Ankle-Brachial Index: left, 0.62; right, 0.91). Vascular surgery was consulted and a computed tomography angiogram (Fig. 1) demonstrated occlusion of the entire left external iliac artery. One month later, the patient underwent left ileofemoral bypass, which resulted in the complete resolution of his left gluteal/hip region claudication symptoms. Follow-up Ankle-Brachial Index measurement 3 days after surgery showed marked improvement (left, 1.02; right, 1.10).FIGURE 1: Computed tomography angiogram demonstrating a long segment occlusion of the left external iliac artery.Low back pain remains one of the most common reasons for physician visits in the United States.1 A single specific etiologic diagnosis is infrequently identified in most low back pain patients.2 Although the differential for low back pain is quite broad, physicians must remain cognizant of less common but treatable causes of regional low back pain. This case highlights the importance of paying close attention to the salient aspects of a patient’s history. In this patient with multiple cardiovascular risk factors, the recent onset of new proximal limb symptoms was exacerbated by exertion and was alleviated with rest, and an absent lower limb pulse on examination all pointed to vascular claudication as the etiology for his pain. Peripheral arterial disease typically presents with posterior distal leg pain. However, this patient’s symptoms were more consistent with proximal vessel peripheral arterial disease, and this suspicion was confirmed with the Ankle-Brachial Index measurement and computed tomography angiogram. Complete and successful resolution of his symptoms with a vascular bypass procedure further confirmed this diagnosis.

Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair

Concurrent iliac occlusion and abdominal aortic aneurysm is rare. Traditionally, the endovascular approach to these patients has consisted of aortouniiliac devices combined with femoral-femoral bypass. With improved facility of endovascular techniques, standard bifurcated endografts represent an alternative option in these patients. This study examined outcomes of patients undergoing iliac recanalization and traditional bifurcated endovascular aneurysm repair in the face of access vessel occlusion. Outcomes of patients at three academic tertiary referral centers who underwent attempted iliac recanalization of chronic iliac occlusions and concurrent endovascular aneurysm repair of an infrarenal aortic aneurysm were retrospectively reviewed. Patients with acute iliac thrombosis and those with severely stenotic (but patent) iliac vessels were excluded. During a 6-year period, 15 occluded iliac arteries were treated in 14 patients (13 men). Mean age was 67.8 years (range, 52-80 years). Primary indication for intervention was disabling claudication in four patients, size of abdominal aortic aneurysm in nine, and symptomatic aneurysm in one. Seven patients presented with a unilateral common iliac artery (CIA) occlusion, four with a unilateral external iliac artery (EIA) occlusion, three with a unilateral combined CIA and EIA occlusion, and one with bilateral CIA occlusions. Stents had been placed previously in two of the occluded CIAs and in one of the occluded EIAs. Average length of the occluded segment was 7.5 cm (range, 2-17 cm). The occluded CIAs and EIAs had mean diameters of 8.6 and 5.7 mm, respectively. Successful recanalization was achieved in 14 of the 15 vessels (93.3%). One EIA ruptured during recanalization but was easily controlled with a covered stent. A re-entry device was used in two cases. Overall, 13 bifurcated devices were successfully implanted. Bilateral iliac occlusions in one patient were recanalized. One Talent (Medtronic, Santa Rosa, Calif), eight Excluder (W. L. Gore and Associates, Flagstaff, Ariz), and four Zenith (Cook Medical, Bloomington, Ind) devices were used. Mean length of stay was 2.3 days (range, 1-6 days). No major perioperative complications or deaths occurred. During a mean follow-up of 28.2 months (range, 1-86 months), there was 100% primary patency of successfully recanalized iliac arteries. Aneurysm sac size decreased from a mean of 5.1 cm (range, 3.1-7.6 cm) preoperatively to 4.4 cm (range, 2.8-7.1 cm) at follow-up. No aneurysms grew or ruptured. Three type II endoleaks occurred, one of which required coiling at 15 months. Two late deaths occurred: one at 36 months secondary to complications from a coronary artery bypass graft/mitral valve replacement and one at 34 months from a myocardial infarction. The use of bifurcated endovascular devices after recanalization of an occluded iliac system is technically feasible and durable at midterm follow-up. This technique re-establishes aortoiliac inflow to both lower extremities, obviates the need for extra-anatomic bypass, and may preserve hypogastric perfusion in some patients.

Avanços nos materiais e no tratamento endovascular de oclusões arteriais crônicas totais: um relato de caso

As oclusões arteriais crônicas totais com forte componente cálcico são ainda nos dias atuais, um fator muitas vezes limitante para o tratamento endovascular devido à dificuldade em transpor estas lesões com fios-guia e cateteres habitualmente utilizados. Revisamos a literatura e descrevemos um caso de tratamento endovascular de uma oclusão total de artéria ilíaca externa, onde o uso de novos materiais desenvolvidos especificamente para o tratamento deste tipo de lesão foi determinante para o sucesso do caso.

A Unique Technique for Intentional Occlusion of an Abdominal Aortic Aneurysm

We report the case of a 78-year-old man with severe chronic obstructive pulmonary disease, aortoiliac occlusive disease, and a 7-cm infrarenal abdominal aortic aneurysm (AAA). He also had a 5-cm right common iliac artery (CIA) aneurysm (CIAA) with right external iliac artery occlusion (Fig 1). The patient had undergone axillobifemoral bypass graft placement 10 years prior for disabling claudication. We describe the use of an infrarenal aortouniiliac graft and subsequent intentional graft occlusion as an endovascular solution. Under locoregional anesthesia, percutaneous access for periprocedural imaging was obtained via the right brachial artery. A left retroperitoneal incision allowed access to the left CIA. The right internal iliac artery and CIAA were coil embolized. A Renu aortoiliac graft (Cook Medical, Bloomington, Ind) was deployed via the left CIA. The endograft was intentionally occluded with a Cook Zip occluder, and two Amplatzer plugs (AGA Medical, Plymouth, Minn). The left CIA was surgically ligated distal to the endograft, excluding both aneurysms. The left hypogastric artery maintained retrograde perfusion via the previously placed axillobifemoral graft (Fig 2). The patient tolerated the procedure and remains asymptomatic 6 months after surgery, with demonstrated occlusion of the infrarenal aorta, the AAA, and CIAA, and no enlargement of either aneurysm sac. The axilobifemoral bypass remains patent (Fig 3). We have described a unique case of intentional endovascular aortic occlusion for the treatment of an AAA in the setting of severe aortoiliac disease and a previous axillobifemoral bypass graft. This technique may be useful in select high-risk AAA patients with similar anatomic circumstances.

Endovascular repair of abdominal aortic aneurysm with pelvic transplant kidney with antegrade deployment of iliac limb

A 63-year-old woman presented with a symptomatic aneurysm and a pelvic transplant kidney on the side of an external iliac artery occlusion. A commercially available bifurcated endograft was introduced through the common iliac artery contralateral to the kidney. The external iliac artery occlusion required antegrade delivery of an iliac limb through the contralateral endograft gate and cannulation of the common iliac artery to allow for deployment proximal to the transplant kidney artery. This technique was successful and remains so six months postoperatively. Endovascular repair of aneurysms proximal to pelvic transplant kidneys remains the preferred method of repair. However, inadequate access vessels may require antegrade delivery of endograft components which is facilitated by advances in endograft design.

Remote Iliac Artery Endarterectomy

Remote endarterectomy of external and common iliac artery occlusions through a single, groin incision under fluoroscopic guidance is a relatively unknown surgical procedure. This prospective single-center cohort study describes this less invasive endovascular technique with the ring strip cutter and its early complications. The results at midterm follow-up are presented. From April 2004 to July 2010, 49 remote endarterectomies of the external or common iliac artery were performed in a retrograde manner from a single, groin incision in 48 patients (30 men, 31 procedures). The median age was 66 years (range, 39-82 years). Indications for operation were severe claudication in 28 (57%), rest pain in 13 (27%), and gangrene in 8 (16%) procedures. Follow-up included clinical evaluation, ankle-brachial index, and duplex scanning at 6 weeks, 3 months, and yearly thereafter. Intraoperative technical success was achieved in 43 procedures (88%). A retroperitoneal incision was necessary in three patients for an additional arteriotomy in the iliac artery and in three others for a bypass procedure. The mean follow-up was 20 months (range 2-77 months). Three-year cumulative primary patency rate by means of life-table analysis was 60.2% ± 12.0% (SE). During follow-up, percutaneous transluminal balloon angioplasty with and without stenting was performed in six and two patients, respectively, resulting in a 3-year primary-assisted patency rate of 85.7% ± 9.56%. Three-year secondary patency was 94.2% ± 5.50%. Remote endarterectomy in external and common iliac arterial occlusive disease is a feasible endovascular procedure with a low complication rate. The midterm primary-assisted patency rate is good.

A Unique Case of Unilateral Lower Extremity Sparing Systemic Peripheral Gangrene

We present here the case of a 70-year-old female who developed a systemic peripheral gangrene in both of her upper extremities (all fingers) and her right foot due to a severe septic shock requiring a systemic vasopressor therapy. Interestingly, the patient's left foot remained spared from gangrenous changes possibly due to a chronic external iliac artery occlusion and thus the lower concentration of vasopressors in that extremity.

Late partial failure of a free ALT flap

Late failure of microsurgical flaps is a rare event and it has been reported as a consequence of compression of the vascular pedicle or late infection. We report a case of late partial failure occurring 3 weeks post-operatively which was shown by vascular imaging to be caused by a previously unidentified complete occlusion of the right external iliac artery. After successful vascular bypass surgery, the suffering flap developed granulation tissue and was skin grafted. In patients carrying multiple risk factors for peripheral vascular disease, the risk of proximal vessel occlusion as a cause of flap failure, should be kept in mind.

Antiphospholipid Syndrome and the Aorta: A Rare Presentation

To the Editor: Antiphospholipid syndrome (APS) is a disorder of coagulation that is usually manifested by arterial or venous thrombosis, or pregnancy-related complications such as miscarriage, stillbirth, preterm delivery, or severe preeclampsia1. The syndrome occurs due to the autoimmune production of antibodies against the cell membrane phospholipid. A 39-year-old woman presented to the emergency department with severe abdominal pain. An abdominal computed tomography (CT) angiogram showed complete occlusion of the distal abdominal aorta from the origin of the left renal artery, common and external iliac artery occlusion, extensive infarcts of kidneys and spleen, and a superior mesenteric artery thrombus (Figures 1 and 2). Figure 1. Abdominal computed tomography coronal slice shows large aortic thrombus extending infrarenally. Figure 2. Axial computed tomography reveals large aortic thrombus and left renal infarcts. She had a history of intermittent left upper-quadrant abdominal pain with radiation to the back with nausea and diapheresis. Her history was significant for hypertension, a remote history of peptic … Address correspondence to Dr. Shroff; E-mail: anjali.shroff{at}gmail.com

Acute Pancreatitis after Percutaneous Mechanical Thrombectomy: Case Report and Review of the Literature

We describe a case of severe acute pancreatitis after percutaneous mechanical thrombectomy (PMT) and review the literature for the occurrence of this complication. A 53-year-old man with a history of bilateral external iliac artery stent placement sought care for acute onset of lifestyle-limiting left claudication. Angiography confirmed left external iliac stent occlusion, and PMT with the AngioJet Xpeedior catheter (Possis Medical, Minneapolis MN) was performed. After PMT of the occluded external iliac artery, a residual in-stent stenosis required the placement of a second iliac stent. The procedure was complicated by severe acute pancreatitis. Other causes of pancreatitis were eliminated during the patient's hospital stay. A literature review revealed nine cases of acute pancreatitis after PMT. Although rare, pancreatitis can be a devastating complication of PMT. The development of pancreatitis seems to be related to the products of extensive hemolysis triggering an inflammatory process. To prevent this complication, we recommend that close attention be paid to the duration and extent of PMT, thereby avoiding extensive hemolysis and subsequent complications.