Endovascular treatment of a critical common iliac artery stenosis using intravascular ultrasound guidance in a patient with a known severe iodine contrast allergy

Abstract

Introduction: The mainstay of endovascular treatment in peripheral arterial disease is digital subtraction angiography with an iodinated contrast. In patients with a known contrast allergy, the current most commonly used alternative is to perform carbon dioxide angiography. Operator experience and availability of carbon dioxide (CO₂) angiography delivery systems are, however, limited. Intravascular ultrasound is now commonly used in combination with fluoroscopy in peripheral venous interventions and in coronary arterial disease and we propose that this also provides a safe and effective alternative option to guide endovascular intervention in patients with a known contrast allergy.

Case report: We present a case describing the use of intravascular ultrasound and fluoroscopy to guide endovascular treatment of a critical left common iliac artery stenosis in a patient with known anaphylaxis to iodinated contrast.

Discussion: Intravascular ultrasound is fast becoming the gold standard treatment option in peripheral venous interventions; however, the use in peripheral arterial disease is limited. We believe this is the first case that reports the use of predominantly intravascular ultrasound in endovascular peripheral arterial intervention with a contrast adjunct.

Conclusion: We have demonstrated that intravascular ultrasound is a safe and effective alternative or adjunct to iodinated contrast for arterial angiography and stenting in the setting of patient contra-indications.

Keywords: Endovascular; IVUS; intravascular; peripheral arterial disease; ultrasound.

Figure 1.

Magnetic resonance angiography demonstrating critical stenosis of the left common iliac artery.

Figure 2.

Intravascular ultrasound images demonstrating the critical common iliac artery stenosis and the normal common iliac artery where luminal diameter can be measured as shown.

Figure 3.

In-stent IVUS imaging at the site of previous stenosis showing successful deployment and stent apposition.

Figure 4.

Post stent deployment digital subtraction angiography using a Gadolinium-based contrast, confirming procedural success and stent patency.