Emergency endovascular management of the common femoral artery rupture due to radiotherapy for scrotal carcinoma

Abstract

We describe the case of a 72-year-old man with massive hemorrhage and shock resulting from rupture of the left common femoral artery as a complication of radiotherapy in the groin for cancer of the scrotum. This complication is extremely rare, presents dramatically, and is usually fatal. The patient was successfully treated with a stent graft deployment in order to achieve immediate hemostasis maintaining blood flow to the leg. Open surgery is not ideal in those cases especially when there is extensive tumor involvement of the groin causing altered anatomy and increasing the risk of re-bleeding.

Keywords: Stents; angiography; primary neoplasms; radiation effects; scrotum; vascular.

Fig. 1.

(a) Urgent angiogram through contralateral access showing ruptured left CFA with large extravasation of contrast medium despite manual pressure. (b) After 10 mm balloon inflation in the left external iliac artery, an angiogram via the inner lumen of the balloon catheter highlights the feasibility to treat the erosion by placing a stent-graft. (c) Completion angiogram after deployment and post-dilatation of the stent-graft (arrow) showing maintained flow and no sign of leak. (d) Infected necrotic left groin cavity caused by radiotherapy after 2 weeks from the endovascular procedure.