Antegrade dissection of external iliac artery after failed attempt of common femoral artery chronic total occlusion angioplasty

Abstract

Introduction. Endovascular treatment of chronic total occlusion (CTO) represents a true challenge even for experienced interventional radiologists. We are presenting a case of hidden antegrade dissection of external iliac artery (EIA) after failed attempt to recanalize CTO of common femoral artery (CFA). Case outline. Fifty-two-year-old male patient was admitted for multidetector computed tomography angiography. Left common iliac artery (CIA) stenting was performed followed by ?crossover? attempt of recanalization of right CFA CTO that failed. The next day, left femoral superficial artery angioplasty was performed and after one month, angioplasty of the left popliteal and bellow knee arteries. A month later the patient was readmitted for surgical reconstruction of the CFA. After desobstruction, excellent inflow was obtained and Dacron graft inserted. A few hours postoperatively, Fogarty catheter thrombectomy was performed. The next morning pulsations were weakened again and CT angiography showed antegrade dissection of the EIA. Stenting of the EIA was performed with two stents and favourable outcome. After detailed analysis of CT, hidden thrombosed antegrade dissection of EIA was noted in lateral view, that was not seen in posterior/anterior view and was presented as fibrous plaque with mural thrombosis. Dissection occurred after failed attempt of CFA recanalization and was clinically silent until flow was established triggering opening of the false lumen and release of thrombotic masses. Conclusion. In patients with failed angioplasty of chronic total occlusion of CFA and CT characteristics of fibrous plaque proximal of the site of attempted angioplasty, thrombosed antegrade dissection should be thought of.