External Iliac Artery Thrombosis Research Articles

Early result of minimally invasive cardiac myxoma resection at University Medical Center, Ho Chi Minh City

Objective: The study aimed to evaluate various clinical and paraclinical characteristics, as well as early surgical outcomes of minimally invasive cardiac myxoma resection at University Medical Center HCMC. Subjects and methods: This is a retrospective descriptive case series study involving all patients diagnosed with cardiac myxomas who underwent minimally invasive surgery at University Medical Center HCMC from January 2020 to June 2024. Results: There were 31 patients, consisting of 22 females and 9 males. The mean age was 56,2 ± 10,7 years old (from 37 to 77 years old). The clinical manifestations were diverse: asymptomatic (45,2%), cerebral embolism (6,4%), fatigue (29,0%), dyspnea (35,5%), palpitations (12,9%), and dizziness (12,9%). Echocardiographic results: 90,3% left atrial myxoma, 9,7% right atrial myxoma. The tumor attachment sites: interatrial septum (93,6%), left atrial wall (6,4%). The average tumor size was 36,3 ± 15,1 mm. All tumors were completely resected (100%). Additional surgical procedures: mitral valve repair (3,2%), interatrial septum repair (6,4%). Cardiopulmonary bypass time was 82,4 ± 31,1 minutes (from 49 to 199 minutes), cross - clamp time was 39,2 ± 17,6 minutes (from 18 to 85 minutes), with 3 cases not requiring cardiac arrest. Ventilation time was 13,2 ± 6,3 hours (from 6,7 to 32,4 hours), intensive care unit stay was 52,6 ± 28,1 hours (from 13 to 113,7 hours), postoperative recovery time was 6,9 ± 2,3 days (from 4 to 16 days). Early outcomes: 3 cases of atrial fibrillation with rapid ventricular response, treated medically (9,7%), 1 case of acute kidney injury (3,2%), 4 cases of pleural effusion (12,9%), 3 cases of pneumothorax (9,7%), 1 case of right external iliac artery thrombosis requiring surgical thrombectomy (3,2%), and 2 cases of deep vein thrombosis (6,4%). No surgical site infections, cerebrovascular accidents, or mortality within 30 days post-surgery were reported. Conclusion: Minimally invasive cardiac myxoma resection demonstrates a low complication rate, with no reported tumor recurrence or early postoperative mortality. This technique offers a safe and effective alternative to traditional median sternotomy and may be gradually adopted and implemented in lower - level healthcare facilities.

External iliac artery thrombosis as a result of acetabular fixation through the ilioinguinal approach: a case report

Introduction and importance: Acetabular fractures mostly occur in young people who are involved in high-energy trauma and they are treated by orthopedic trauma surgeons. Patients with acetabular fractures are at high risk for different kinds of complications. We report a case of postoperative thrombosis of the external iliac artery following fixation surgery performed by an ilioinguinal approach while receiving thromboprophylaxis during admission to the hospital. Case presentation: A 57-year-old healthy woman presented with a left both-column acetabular fracture and underwent acetabular fixation through the ilioinguinal approach. The patient was receiving antithrombotic prophylaxis medications in the course of treatment. Clinical discussion: During her convalescence, while at the hospital, she was diagnosed with left external iliac artery thrombosis, needing surgical thrombectomy. These severe and rare complications will lead to uncertainty about a commonly used ilioinguinal approach. Postoperative arterial thrombosis may be rare in patients undergoing acetabular fixation surgery but searching for signs and symptoms of this condition is always necessary. Conclusion: It is possible to prevent severe complications by performing a routine measurement of the distal arterial pressure after similar surgeries.

Long-term outcome of interventional approaches for treatment of coronary artery fistulas: a retrospective cohort study in a great referral center

BackgroundDespite the spontaneous regression of many cases of coronary artery fistulas (CAFs), symptomatic patients or cases with severe shunting may require therapeutic interventions. In the present study, we aimed to assess the outcome of treatment of CAFs using interventional approaches.MethodsThis retrospective cohort study was performed on 29 patients with CAFs that were referred to our tertiary center between 2009 and 2019. Baseline characteristics were collected by reviewing the hospital files, and the patients were followed up to assess long-term outcomes with a mean follow-up of 3.3 years.ResultsOverall, in 29 patients in our cohort study, 82.9% suffered from isolated CAFs and in the remaining cases, concurrent congenital abnormalities did exist. For treatment, coils (Cook, Pfm, Ev3) were used in 79.3%, ADO II(AGA) in 18.3%, vascular plug (AGA) in 3.4%, and a combination of coil/ vascular plug/amplatzer in 3.4%. Postoperative complications were reported in 4 patients as external iliac artery thrombosis, transient PSVT, ST-T wave changes and mild pericardial effusion that were all managed successfully with no adverse sequels. No coronary artery injury, device dislocation, dissection, ischemia or coronary dilatation occurred, and there was no death. As larger fistulas were treated by a retrograde approach through the right side of the heart, there was significant correlation between residual shunts and the mode of closure approach; the majority of the residual shunts occurred in patients in the retrograde approach group.ConclusionsTrans-catheter approach for treating CAFs leads to appropriate long-term outcome with minimal potential side effects.

SJLA_2024_A16: Unusual Complications of Open Preperitoneal Tension-Free Inguinal Hernia Repair

Background: The purpose of this study is to report two patients referred to our hospital after developing unusual complications attributed to prior open preperitoneal tension-free inguinal hernia repair. Methods: Case # 1 A 75-year-old male developed a left proximal thigh abscess requiring incision and drainage 5 years after open prosthetic, preperitoneal inguinal hernia repair with single-layer mesh. A pelvic computed tomography (CT) scan demonstrated an abscess in the left inguinal preperitoneal space as well as diverticulosis but no diverticulitis. A colonoscopy was negative for any additional findings. The patient underwent groin exploration, debridement of the inguinal canal and sinus tract, and mesh resection followed by JP drain placement. The inguinal defect was repaired utilizing the should ice technique. Intraoperative cultures revealed penicillin-resistant Staphylococcus aureus. The drain was removed on postoperative day nine, and his recovery remains uneventful without hernia recurrence or infectious complications at 11-month follow-up. Case # 2 An 82-year-old man developed progressive left lower extremity edema and disabling claudication 1 month after open prosthetic inguinal hernia repair with a bilayer disc mesh. Venous duplex imaging revealed compression of the left common femoral and external iliac veins. A CT angiogram demonstrated left external iliac and common femoral artery thrombosis and a 5.2 cm fluid collection consistent with hematoma. An inferior vena cava filter was placed. The common femoral artery was controlled after initial exploration revealed a common femoral artery pseudoaneurysm. The mesh was densely adherent to the external iliac vein and was thus not resected. The common femoral artery pseudoaneurysm was repaired and the profunda femoris artery over sewn. An external iliac to superficial femoral artery 8 mm Polytetrafluoroethylene bypass graft was placed. The patient was discharged on systemic anticoagulation without claudication on postoperative day thirteen. Results: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Discussion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Conclusion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available.

Acute Arterial Iliac-Femoral Thrombosis During Doble Lumbar Approach for Degenerative Spondylolisthesis

Vascular complications during anterior lumbar approach are well known, however arterial thrombosis is extremely rare. We report a case of an acute left external iliac artery and common femoral artery thrombosis during a doble lumbar approach. The diagnosis was made in the immediate postoperative period and a iliofemoral thromboendarterectomy was performed by a cardiovascular surgeon. The patient developed a left leg compartment syndrome due to a reperfusion injury which was treated in the same surgical stage through a wide fasciotomy.

Thirty-day Results from the ZEPHYR Registry: Outcomes of EVAR Using the Zenith Alpha™ Abdominal Endovascular Graft for the Treatment of AAA in 347 Patients

To report technical and clinical 30-day results following treatment with the Zenith Alpha™ abdominal stent graft from the ZEnith alPHa for aneurYsm Repair Registry (ZEPHYR). Multicenter, nonrandomized, single arm, core laboratory-controlled, prospective registry collecting data on the Zenith Alpha Abdominal Endovascular Graft being used in subjects with abdominal aortic aneurysms (AAA) from sites in Germany, Belgium, and The Netherlands between December 2016 and December 2019. Inclusion criteria were non-ruptured AAAs with a maximum diameter ≥50 mm or enlargement >5 mm over 6 months with an AAA neck length ≥10 mm (site reported). Primary outcome measure was treatment success at 30 days. Treatment success was defined as a combined endpoint consisting of technical and clinical success. Technical success was defined as successful stent graft delivery and deployment as well as successful removal of the delivery system. Clinical success at 30 days was defined as freedom from type I and III endoleak, aneurysm rupture, conversion to open surgery and stent graft occlusion. Three hundred forty-seven subjects were included from 14 sites with a median age of 73.0 years (IQR 68.0-79.0). Thirty-four patients were female (9.8%). The median AAA diameter was 58.3 mm (IQR 55.0-63.5). The median proximal neck diameter was 23.6 mm (IQR 22.0-25.2) with a median proximal neck length of 24.4 mm (IQR 15.0-34.8) and a median infrarenal neck angulation of 24.5° (IQR 15.0-35.0). The right and left common iliac diameter were 16.1 mm (IQR 14.1-19.4) and 16.2 mm (IQR 14.1-19.1), respectively. The treatment success rate at 30 days was 94.8% (N=329). Technical success was achieved in 333 patients (96.0%). The clinical success rate at 30 days was 98.8% (N=343). Three patients had limb occlusions at 30 day follow up (0.9%). One patient had a type Ib endoleak (0.3%). Seventy percent of vascular access approaches were percutaneous. The reintervention rate was 1.7% (N=6) within 30 days. Indications for reinterventions were a false aneurysm at puncture site (N=1), limb complications (N=2), stentgraft-associated renal artery occlusions (N=2), and an external iliac artery thrombosis (N=1). Endovascular aneurysm repair using the Zenith Alpha Abdominal Endovascular Graft is effective in the short term. Long term results will be reported in the future.

External Iliac Artery Injury and Thrombosis during Laparoscopic Gynecologic Surgery

Although vascular injury during laparoscopic surgery is rare, it is occasionally reported. Previously, several physicians have reported cases of compartment syndrome resulting from a thrombus during gynecologic surgery. However, few reports describe thrombosis occurring in artery vessels as a result of applying angiopressure. Herein, we report the case of a 53-year-old woman with endometrioid carcinoma and a vascular injury that resulted in thrombus formation; this is the first such case to be reported. The complication was successfully treated by means of direct anastomosis following partial resection of the injured iliac artery. This is the first report of a case in which applying angiopressure for a vascular injury during laparoscopic pelvic lymphadenectomy led to an intra-arterial thrombus which was found and treated without sequelae.

Comparative study of modified Stoppa approach and ilioinguinal approach for pelviacetabular fractures

<p class="abstract"><strong>Background:</strong> The present study was done to study advantages and disadvantages of modified Stoppa approach (MSA) and ilioinguinal approach (IIA) for surgery of pelviacetabular fractures involving anterior column, anterior wall, quadrilateral plate with protrusion and complex fractures, pelvic ring fractures with pubic diastasis or sacroiliac joint disruptions which needs to be stabilized anteriorly.</p><p class="abstract"><strong>Methods:</strong> Study was conducted in Department of Orthopaedics, Government Medical College and Hospital, Aurangabad on patients with pelviacetabular fractures during June 2018 to March 2020. In our study of 25 patients, they were divided into group A containing 13 patients operated using MSA and group B containing 12 patients operated using IIA. Follow up period was 12-18 months (mean=15) and 12-16 months (mean=14) for group A and B, respectively. Patients assessed using modified Merle d’Aubigné score and Matta’s score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean modified Merle d’Aubigné score was 16 and 14 for group A and B, respectively (p value=0.89). Mean blood loss and operative time were less in MSA. Superficial infection was found in one patient each of group A and B whereas one patient developed deep infection in group B. One patient each of both group had hip pain suggestive of early arthrosis. In group B, two patients developed meralgia paresthetica. One patient developed external iliac artery thrombosis and inguinal hernia in group B. one patient from group A developed incisional hernia.</p><p class="abstract"><strong>Conclusions:</strong> MSA was better and simpler than IIA with due adequate training and practice to achieve direct access for pelviacetabular fracture reduction and also it requires less operative time, less blood loss and better postoperative outcome.</p><p> </p>

The Role of Endovascular Stents in an Experimental Model of Traumatic Arterial Occlusion – the Temporary Endo-Shunt

Background.We aimed to evaluate patency following the deployment of a bare-metal (BMS) or covered stent (CS) across a traumatic occlusive arterial lesion and to estimate the feasibility of urgent stent placement for temporary endovascular shunting.
 Methods. Fifteen sheep (25-45 kg) underwent laparoscopic creation of a left external iliac artery (EIA) thrombosis by means of repeated clamping. Animals were then randomized into one of three groups: no-treatment (control group), a BMS group or CS group. Animals were followed up for 30 days with no anticoagulants or anti-platelet drugs administered postoperatively. Doppler ultrasound, computed tomography angiography (CTA), and digital subtraction angiography (DSA) were used to evaluate EIA patency.
 Results.Stent implantation resulted in the restoration of in-line flow through the EIA in all cases. The peak systolic velocity (PSV) in the injured limb increased from 10 (0–16) to 31 (28–37) cm/sec in the BMS group (p<0.0001) and from 15 (7–18) to 24 (21–29) cm/sec in the CS group (p=0.043) immediately after stent deployment (both p=0.001 compared to the control group). There was no difference in the PSV between the groups at post-injury day 3, and thereafter. Day-14 CTA and day-30 DSA demonstrated only one patent stent in each study group.
 Conclusions.Stent (BMS or CS) implantation restores arterial patency of a traumatic occlusive lesion for a period of less than three days in our ovine model. While acute recanalization of the injury with stent implantation may be used for temporary endovascular shunting, long-term patency remains a problem.

Delayed Presentation of Traumatic Acute Limb Ischemia

Acute limb ischemia is defined as sudden cessation of limb perfusion that threatens the viability of the limb. Although uncommon, acute limb ischemia can present with severe symptoms. We present the case of a 23-year-old male who was admitted for treatment of abdominal gunshot injury. Laparotomy revealed multiple transections of the small bowel with a non-expanding zone 2 retroperitoneal hematoma. Following resection of the damaged bowel, 12 hours postoperatively, the patient complained of right lower limb numbness. Examination revealed absent right femoral, popliteal, dorsalis pedis and posterior tibial pulses, with a capillary refill time (CRT) of 3 seconds. Computed tomography arteriogram (CTA) showed right external iliac artery thrombosis, with reconstitution of flow in the distal external iliac artery. Repeat laparotomy showed a peri-arterial hematoma of the right external iliac artery distal to the common iliac bifurcation. We removed a 3 cm thrombus from the right external iliac artery and performed an interposition graft. Following surgery, all the lower limb pulses were palpable and the patient was discharged in good condition on postoperative day 6. Delayed presentation of acute limb ischemia is possible in the setting of trauma, and should be kept in mind, as timely intervention is important for limb salvage with good outcome.

TOI 9. A Rare Case of Bilateral External Iliac Artery Thrombosis due to Endofibrosis in a 33-Year-Old Female Triathlete

TOI 9. A Rare Case of Bilateral External Iliac Artery Thrombosis due to Endofibrosis in a 33-Year-Old Female Triathlete

External iliac artery thrombosis after hypogastric artery ligation and pelvic packing for placenta previa percreta

Placenta previa percreta is a serious pregnancy condition that may cause massive bleeding. Life-threatening hemorrhage is commonly managed via cesarean hysterectomy or vascular ligations in order to preserve fertility. We present a case of bilateral external iliac artery thrombosis after pelvic compression and uterine devascularization due to placenta previa percreta. The patient had cesarean section due to ultrasonography and magnetic resonance imaging-diagnosed placenta previa percreta, and stated that she preferred a conservative approach rather than hysterectomy in a case of massive bleeding. Spontaneous hemorrhage was recognized during the operation. Pelvic compression and bilateral uterine and internal iliac artery ligations were performed. The left external iliac artery was accidentally held and bonded as the left internal iliac artery, which was turned loose within a minute after distinguishing the vessels. Emergency angiography that was applied because of patient’s leg pain showed bilateral external iliac artery thrombosis. Angioplasty was performed by a cardiologist for bilateral occlusions. Placenta invasion abnormalities may be managed by pelvic compression or vascular ligations, which have their own serious complications that the surgeon must manage immediately.

Natural History of Iatrogenic Pediatric Femoral Artery Injury

Iatrogenic femoral artery trauma complicates the course of critically ill neonates and children. Complications from persistent arterial occlusion may include claudication and limb length discrepancies. Data supporting risk factors for such and need for revascularization are lacking. Review of a prospectively maintained database at a tertiary institution of iatrogenic pediatric femoral artery injuries incurred between 2013 and 2014 was performed. Additional injuries were identified by review of pediatric arterial duplex performed between 2008 and 2013. Demographics, risk factors, and outcomes were queried. Data analysis utilized Fischer's exact t-test and logistic regression. Seventy-six patients were identified of which 68 presented with acute limb ischemia (ALI) and 8 with chronic iliofemoral arterial occlusion resulting in claudication (n=6) or limb length discrepancy (n=2). Mean weight at injury was 6.3kg; mean age at injury was 49weeks (50% aged <3months). Mean follow-up was 14months (out to 11years). Six patients required surgery for ALI, and 6 required delayed operation for limb length discrepancy (n=4) or for persistent external iliac artery (EIA) occlusion. Mean age at delayed revascularization was 6years (range: 2-13 years). Vasopressor use, mechanism/location of injury, and concomitant venous thrombosis were not significantly correlated with need for operation; trends suggested that cardiac catheterization and EIA thrombosis may correlate with chronic disease. Increased age at injury was associated with need for operation. Although a majority of children with ALI may be successfully treated medically, 9% will require operation for ALI and 16% ultimately required revascularization during follow-up. Persistent iliofemoral arterial thrombosis is a likely risk factor for limb length discrepancy with growth; identifying risk factors for this and improved methods for surveillance requires ongoing investigation.

An unusual case of external iliac artery thrombosis after renal transplant surgery

The rates of renal transplant for end stage renal disease are increasing worldwide. Vascular complications due to arterial thrombosis is seen only in less that 1% cases. We describe a case of 36 year old male who underwent a live-related renal transplant, whose post-operative period was complicated by juxta-anastomotic distal external iliac artery thrombosis. He was managed by thrombectomy and improved with complete recovery. Attention should be paid to anastomotic technique and prevention of formation of intimal flap. In case of arterial thrombosis, graft salvage can be attempted depending on the clinical scenario.

Surgical Complications of Live Related Renal Transplantation

AbstractIntroduction:Renal transplantation is the treatment of choice for patients with end stage renal disease. It offers marked improvement in the quality of life of patients who undergo this form of treatment. Surgical complications are important in the sense that they can lead to loss of allograft and in severe cases loss of patient life. The aim of this study is to determine the frequency of surgical complications after renal trans-plantation in our population.Materials and Methods:We retrospectively reviewed the surgical complications in 350 patients who had live related renal transplantation performed at Postgraduate Medical Institute, Shaikh Zayed hospital Lahore from January 2007 to December 2013.Results:Among 57 (16.1%) surgical complications 18 (5.1%) had urological complications. Urinary fistulae, ureteral stenosis, ureteral stricture and hematuria occurred in 9 (2.5%), 4 (1.14%), 4 (1.14%) and 1 (0.28%) patients respectively. Vascular complications occurred in 5 (1.42%) patients in total. 2 (0.57%) patients had renal artery thrombosis and 1 (0.28%) patient had renal vein thrombosis. 2 (0.57%) patients had thrombosis of external iliac artery. Lymphocele occur-red in17 (4.8%) of patients and wound infection developed in 19 (5.4%) patients.Conclusion:Surgical complications after kidney transplantation may be reduced or minimized if basic surgical principles of transplantation are followed. We conclude that kidney transplantation is a safe procedure with fewer surgical complications. The most important thing is the early diagnosis and prompt treatment of the complications in order to save the graft and the patient.Keywords:Transplantation, Complications, Live related.

Clinical Profile of Surgical Diseases with Emergence of New Problems in HIV+ Individuals.

North Karnataka is one of the regions with the high prevalence of HIV+ individuals. Bijapur is a district in North Karnataka with high prevalence as per fact sheets of NACO of March 2012. Better awareness, access to health care, and antiretroviral therapy have improved survival and increase in number of people living with HIV/AIDS (PLHA). Improved survival has increased their attendance to hospitals with variety of surgical problems, some known and some less known. The percentage of HIV+ individuals was 1.64% among all admissions. Of these individuals, 13.65% (272) had surgical problems. Abscesses were the commonest. Abscesses at uncommon sites also were encountered. Anorectal pathologies, tuberculosis, lymphadenopathy, appendicitis, etc. commonly seen in HIV+ individuals were seen. Drug-induced pancreatitis due to anti retroviral therapy was one of the common problems encountered. Uncommon conditions like ureteric calculi, external iliac artery thrombosis, diaphragmatic eventration, and few more were observed. Even though literature on AIDS/HIV is abundant, there is less information on surgical conditions encountered more so from this part of the subcontinent. Hence, it was decided to report the profile of the conditions encountered.

Temporary prophylactic intravascular balloon occlusion of the common iliac arteries before cesarean hysterectomy for controlling operative blood loss in abnormal placentation

ObjectivesThe purpose of this study was to investigate the efficacy and safety of temporary prophylactic intravascular balloon occlusion of the common iliac arteries (CIA) before planned cesarean hysterectomy for controlling operative blood loss in abnormal placentation. Materials and methodsA retrospective study of 13 pregnant women at risk for placenta accreta identified using sequential obstetric ultrasonography and magnetic resonance imaging from January 2007 to December 2009 was performed. Temporary prophylactic intravascular balloon catheterization of the bilateral CIA before cesarean hysterectomy was performed by interventional radiologists. The maximum duration of occlusion time of CIA must not exceed 60 minutes. The primary outcome for this study included estimated blood loss and secondary outcomes included the development of thromboembolism, disseminated intravascular coagulation and surgical complications. ResultsAmong these13 patients, the mean age of the patients was 32.8 ± 0.7 years (range 29–37 years). The mean gestational age at cesarean hysterectomy was 32.2 ± 0.9 weeks (range 28–36 weeks), and the mean intraoperative blood loss was 1902.3 ± 578.8 mL (range 500–8000 mL). Operative bleeding was controlled by conservative treatment without additional surgery in two cases. Importantly, two patients (15.8%) had severe complications possibly related to the interventional procedure. One patient was noted to have a popliteal artery thrombosis. A second patient had an external iliac artery thrombosis with 80–90% occlusion. Both patients required antithrombotic treatment without sequelae. ConclusionWith limited experience in this small series, we observed a statistically significant reduction in operative blood loss after the use of temporary prophylactic balloon occlusion of the CIA technique compared with historical controls of similar demographic characteristics previously published (1902.3 ± 578.8 mL, range 500–8000 mL vs. 4445.7 ± 996.48 mL, range 1040–15,000 mL, p = 0.0402). Additionally, two patients had arterial thrombosis. These preliminary findings are based on a small number of patients, and therefore further investigation is needed to determine the effectiveness and safety of this new technique.

Endovascular Management of Iliac Arterial Injury in Blunt Pelvic Trauma

Iliac arterial injury in blunt pelvic trauma is rare, associated with fracture pelvis, massive retroperitoneal bleeding from the presacral, prevesical and venous plexuses, which is self-limiting but carries high mortality rate if it is allowed to re-expand after it was sealed. Most of the vascular injuries range from intimal injury with intimal flap formation to complete transection and total or partial occlusion by thrombus formation. Advances in endovascular therapy significantly change management of such vascular injuries and serves as a damage control helping the recovery from acute systemic injury and delay open surgical intervention. External fixation and endovascular management have increased in frequency and become the preferred method of intervention as it is safe with low complication rate. These are two case reports of two young males suffered blunt pelvic trauma, with huge retroperitoneal bleeding; left external iliac artery thrombosis managed with balloon mounted covered stent.

Thrombosis of external iliac artery due to endofibrosis

Thrombosis of external iliac artery due to endofibrosis

External Iliac Vein Thrombosis in an Athletic Cyclist With a History of External Iliac Artery Endofibrosis and Thrombosis

External iliac artery endofibrosis describes an intimal subendothelial fibrosis leading to wall thickening and stenosis that has been described in high-performance athletes. There are anatomical, mechanical, and probably metabolic factors that may contribute to this pathology. Ankle-brachial index (ABI) measurement with exercise testing, duplex ultrasound, computed tomography (CT) or magnetic resonance (MR) angiogram, and ultimately arteriography help to make the diagnosis. Management can be conservative, but most cases require surgical intervention. External iliac vein stenosis and thrombosis in cyclists has rarely been described in the literature. We report a case of extensive left lower limb deep venous thrombosis (DVT) including the external iliac vein diagnosed in a 57-year-old athletic cyclist with a history of external iliac artery thrombosis.