Peripheral Artery Stent Dehiscence: Percutaneous Management

Abstract

An elderly male presented with left abdominal swelling of 1-week duration and inability to move the left lower limb. He had undergone bilateral common iliac and left external iliac artery stenting with self-expandable stents for aortoiliac occlusive disease 1 month back. Clinical examination revealed tender abdominal nonpulsatile mass with systolic bruit. Ultrasonography suggested retroperitoneal hematoma. His hemoglobin was 7 g%. Echocardiogram showed ejection fraction of 40%. Computed tomography angiogram revealed large 10 × 10 retroperitoneal hematoma with possibility of continued bleeding from the left external iliac artery. He was taken up for urgent catheterization after consultation with the vascular surgeons who deemed him high risk for surgery in view of left ventricular dysfunction. Abdominal aortogram showed diffuse extravasation of contrast from the junction of left common iliac artery and external iliac artery into the retroperitoneal space. Sustained balloon occlusion of the vessel across the extravasated portion was done, still the leak persisted. Two covered stents were deployed in the external iliac artery overlapping each other, percutaneously resulting in complete closure of leak with good distal runoff. His symptoms improved considerably the next day with a decrease in abdominal swelling and he was able to move his left lower limb. Ultrasound of the abdomen showed regression of the retroperitoneal hematoma and no suspicion of leak. Computed tomography angiogram done 10 days and 2 months later showed regression of retroperitoneal hematoma and no extravasation with good peripheral runoff.

Keywords: covered stent; endovascular; hematoma; leak; retroperitoneal.