Case of the Week - Patient Summary 4068Peer Reviewed and Certified -
Hemodynamic significant stenosis of right common iliac artery with stenosis within left iliac stent | Case of the Week - Patient Summary 4068 Peer Reviewed and Certified - | |
| Demographics: 57 y.o. F | |
| History & Chief complaint: | |
| History of previous left common iliac artery stent placement, now with lower extremity claudication | |
| Physical exam and Laboratory: | |
| weak distal pulses | |
| Summary of Findings: | |
| Pre interventional contrast injection revealed a left common iliac stent with 80% stenosis and the right common iliac artery with 50% stenosis. Normal flow and diameter were obtained after dual stent placement with "kissing balloons" technique. | |
| Differential Diagnosis: | |
| Atherosclerotic disease with hemodynamic significant stenosis | |
| Diagnosis: | |
| Hemodynamic significant stenosis of right common iliac artery with stenosis within left iliac stent | |
| Treatment and Followup: | |
| Bilateral stent placement in common iliac arteries with kissing balloon technique | |
| Most iliac artery stenoses are amenable to balloon angioplasty. Hemodynamically significant focal, uncalcified stenoses <5cm long and eccentric or calcified stenoses<3 cm long are clear indications for angioplasty. The results of iliac artery stent placement are somewhat better than for balloon angioplasty alone. If a stent is placed up to the aortic bifurcation, it is prudent to at least keep a guidewire across the contralateral iliac artery in the unlikely event that this vessel becomes dissected or ocluded during stent deployment. Bilateral aortic bifurcation disease is managed with "kissing stents". Complications occur in about 10% of cases and include puncture site injuries, acute stent thrombosis, distal embolization stent dislodgment, pseudoaneurysm formation, and vessel rupture. | |
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