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Case Reports
. 2022 Aug 27;14(8):e28460.
doi: 10.7759/cureus.28460. eCollection 2022 Aug.

Management of Iatrogenic External Iliac Artery Perforation With a Self-Made Covered Stent

Varun Marimuthu  1 , Subramani Khamitkar Shankar Rao  1 , Santosh Jadhav  1 , Mohan H Nayak  1 , Nagamani Alur  1
Affiliations
Case Reports

Management of Iatrogenic External Iliac Artery Perforation With a Self-Made Covered Stent

Varun Marimuthu et al. Cureus. .

Abstract

Retroperitoneal hemorrhage (RPH) following transfemoral arterial access is a dreaded complication needing immediate management. A 70-year-old female with inferior wall myocardial infarction developed hemodynamic instability following transfemoral percutaneous coronary intervention. The evaluation revealed an RPH due to an iatrogenic guidewire-related perforation of the external iliac artery. This was successfully managed with the deployment of a custom, a self-made covered stent. In this report, we describe our method of creating and deploying this self-made stent and discuss potential issues compared to commercially available covered stent systems.

Keywords: complications; covered stent; haemorrhage; iliac artery; retroperitoneal space.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Trans-femoral percutaneous coronary intervention
(A) RCA injection showing a mid-segment 90% lesion. (B) Post PCI. (C) LCA injection showing a mid-segment 80% lesion in the LAD. (D) Post PCI. (E) Radial artery sheath injection showing entry of the sheath into a small branch, precluding completion of the radial intervention. White arrow – a tip of the radial sheath. RCA – Right coronary artery, PCI - Percutaneous coronary intervention, LCA – Left coronary artery, LAD – Left anterior descending artery
Figure 2
Figure 2. Bladder sign showing the contrast-filled bladder pushed to the left, implying a massive right retroperitoneal hemorrhage (arrow)
Figure 3
Figure 3. External iliac artery perforation
(A) Injection in the right CIA from the LFA access shows the site of perforation (black arrow). The leftward shifted bladder can be seen (white arrow). (B) DSA. CIA – Common iliac artery, LFA – Left femoral access, DSA – Digital subtraction angiography
Figure 4
Figure 4. Preparation of covered stent
(A) Removing the balloon material from the balloon using scissors at the distal end of the balloon catheter. (B) Proximally. (C) Using a dilator, the balloon material is removed from the shaft. (D) The balloon material is inserted over the peripheral stent. (E) Absorbable 5-0 sutures are placed proximally and distally to secure the two together. (F) The self-made covered stent.
Figure 5
Figure 5. Deployment of self-made covered stent
(A) The covered stent is deployed. (B) Angiogram after deployment showing no leak.
Figure 6
Figure 6. Post-procedure reconstructed CT angiogram of the lower limbs
(A) Good stent position (white arrow) and no residual leak. (B) Good distal perfusion and patent stent.
See this image and copyright information in PMC

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