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Vol 17, No 2 (2011)
Original papers
Published online: 2011-07-04
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Treatment of iatrogenic iliac artery rupture during endovascular surgery

Witold Woźniak, Robert Krzysztof Mlosek, Piotr Zydlewski, Tomasz Miłek, Piotr Myrcha, Marcin Kowalski, Piotr Ciostek
Acta Angiologica 2011;17(2):150-157.

open access

Vol 17, No 2 (2011)
Original papers
Published online: 2011-07-04

Abstract

Recently a growing number of endovascular operations are associated with an increased number of iatrogenic vascular injuries. The aim of the study is to analyse the treatment of iliac artery damage during angioplasty. Method. In the period 2002–2009, 328 patients underwent endovascular surgery of iliac artery stenosis, 219 men and 109 women aged from 47 to 85 years. Qualified patients displayed IIB, III, and IV stage of ischaemia by Fontaine. The collected information concerned details of the performed procedures, possible complications and ways of solving problems. Results. In 132 cases, endovascular surgery consisted of extension of the iliac artery using a stent, while in 196 no stent was applied. Iatrogenic injury to the iliac artery during the angioplasty occurred in six patients. In four cases, there was damage to the common iliac artery, and in the next two patients to the external iliac artery. In four cases, there was damage to the artery during endovascular expansion, and in two cases after stent implantation. In four cases, the damage to the artery was treated by an endovascular method, in two patients a stent was implanted, in one patient a stent-graft was introduced, and in one case a spillage was sealed using a balloon. Two patients underwent classic surgery due to symptoms of hypovolaemic shock caused by bleeding into the retroperitoneal space; in one case arterial damage was sutured, and in the second patient an aortal-femoral bypass graft was implanted. Of the patients supplied by an intravascular method, in one case, because of the very large retroperitoneal haematoma and the compression symptoms associated with it, surgical drainage was necessary. In the remaining cases, the postoperative course passed without complications. Among the patients who underwent classic surgery there was one case of deep vein thrombosis. All patients achieved satisfactory haemodynamic and clinical effects. There were no deaths. Conclusions. 1. Each instance of iatrogenic iliac artery injury during endovascular surgery requires an individual approach. 2. An attempt to repair damage by an intravascular method is the treatment of choice in haemodynamically stable patients. 3. In cases of large retroperitoneal bleeding, patients require immediate conversion to classical surgery.
Acta Angiol 2011; 17, 2: 150–157

Abstract

Recently a growing number of endovascular operations are associated with an increased number of iatrogenic vascular injuries. The aim of the study is to analyse the treatment of iliac artery damage during angioplasty. Method. In the period 2002–2009, 328 patients underwent endovascular surgery of iliac artery stenosis, 219 men and 109 women aged from 47 to 85 years. Qualified patients displayed IIB, III, and IV stage of ischaemia by Fontaine. The collected information concerned details of the performed procedures, possible complications and ways of solving problems. Results. In 132 cases, endovascular surgery consisted of extension of the iliac artery using a stent, while in 196 no stent was applied. Iatrogenic injury to the iliac artery during the angioplasty occurred in six patients. In four cases, there was damage to the common iliac artery, and in the next two patients to the external iliac artery. In four cases, there was damage to the artery during endovascular expansion, and in two cases after stent implantation. In four cases, the damage to the artery was treated by an endovascular method, in two patients a stent was implanted, in one patient a stent-graft was introduced, and in one case a spillage was sealed using a balloon. Two patients underwent classic surgery due to symptoms of hypovolaemic shock caused by bleeding into the retroperitoneal space; in one case arterial damage was sutured, and in the second patient an aortal-femoral bypass graft was implanted. Of the patients supplied by an intravascular method, in one case, because of the very large retroperitoneal haematoma and the compression symptoms associated with it, surgical drainage was necessary. In the remaining cases, the postoperative course passed without complications. Among the patients who underwent classic surgery there was one case of deep vein thrombosis. All patients achieved satisfactory haemodynamic and clinical effects. There were no deaths. Conclusions. 1. Each instance of iatrogenic iliac artery injury during endovascular surgery requires an individual approach. 2. An attempt to repair damage by an intravascular method is the treatment of choice in haemodynamically stable patients. 3. In cases of large retroperitoneal bleeding, patients require immediate conversion to classical surgery.
Acta Angiol 2011; 17, 2: 150–157
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Keywords

artery rupture; retroperitoneal haematoma; percutaneous angioplasty; angioplasty complications; endovascular treatment

About this article
Title

Treatment of iatrogenic iliac artery rupture during endovascular surgery

Journal

Acta Angiologica

Issue

Vol 17, No 2 (2011)

Pages

150-157

Published online

2011-07-04

Bibliographic record

Acta Angiologica 2011;17(2):150-157.

Keywords

artery rupture
retroperitoneal haematoma
percutaneous angioplasty
angioplasty complications
endovascular treatment

Authors

Witold Woźniak
Robert Krzysztof Mlosek
Piotr Zydlewski
Tomasz Miłek
Piotr Myrcha
Marcin Kowalski
Piotr Ciostek

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