Iatrogenic Arterial Perforation During Endovascular Interventions

Rizk, T.; Patel, Darren; Dimitri, Nahu G; Mansour, Khaled; Ramakrishnan, Vijay

doi:10.7759/cureus.10018

Cited by 9 publications

(14 citation statements)

References 17 publications

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“…Due to the retroperitoneal location of the external iliac artery, its complications can prove to be potentially serious and may lead to hemorrhagic shock or death if they are not identified and managed rapidly (Rizk et al, 2020). Therefore, we suggest locating this vessel using external landmarks like PS and ASIS.…”

Section: Discussionmentioning

confidence: 99%

Revisiting the surgical anatomy of the triangle of doom and the triangle of pain

Gupta

Kumari

et al. 2022

Clinical Anatomy

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Better understanding of the surgical anatomy of the triangle of doom and the triangle of pain with fixed bony landmarks like the anterior superior iliac spine (ASIS) and the pubic symphysis (PS) can help in defining a safe location for trocar placement during laparoscopic surgeries and minimize neurovascular complications. Ten cadavers were dissected bilaterally to explore the surgical anatomy of both the triangles. ASIS and PS were evaluated in relation to the deep inguinal ring, external iliac artery, femoral nerve, and inferior epigastric artery. The deep inguinal ring was located at a depth of ~3 cm, about 4.9 ± 0.56 cm along the y-axis and 6.2 ± 0.94 cm along the x-axis, from the ASIS. The external iliac artery was located ~4.33 ± 0.6 cm along the y-axis and 7.29 ± 0.76 along the x-axis from the ASIS. The inferior epigastric artery was at ~4.31 ± 0.38 cm from the midline at the level of ASIS. This knowledge can help in the surface localization of both the triangles and prevent injury to the various neurovascular structures in relation to these triangles. In the current study, cranial to the ASIS lying at a distance of >5 cm from the midline was observed to be a safe zone for accessory trocar placement. The umbilical port has been observed to be safe for trocar placement. The mean angle between ductus deferens and testicular vessels was observed to be 43.5 ± 4.79 , which could help in determining their relative locations during various surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Revisiting the surgical anatomy of the triangle of doom and the triangle of pain

Gupta

Kumari

et al. 2022

Clinical Anatomy

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“…11,12 However, there is general agreement that conservative management may be reserved for stable patients with retroperitoneal hematomas due to complications of arterial femoral access while in the other cases of aorto-iliac lesions interventional treatment represent the treatment of choice; open surgery, is rarely recommended nowadays. [11][12][13] Therefore, starting from the above reported considerations, we believe that in cases of incidental finding of post-EVAR periaortic hematoma, graft relining or, alternatively, in selected cases, open conversion is mandatory. A conservative approach can be considered reasonable only in patients unfit for reoperation.…”

Section: Discussionmentioning

confidence: 99%

Early periaortic hematoma development after EVAR in the presence of severely calcified and modestly conical-shaped aortic neck: A potential trigger for sudden aneurysm progression toward rupture

2020

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Objective The aim of this report is to present a singular case of early post-endovascular aneurysm repair abdominal aortic aneurysm rupture and discuss the possible etiopathogenic mechanism promoting the sudden aneurysm progression toward rupture. Methods/Results: An 84-year-old man was submitted to endovascular aneurysm repair via second-generation endograft (Cordis-Incraft Stent-graft) during which, the left occluded common iliac artery was recanalized via balloon-expandable covered-stent-graft (Atrium-Advanta-V12). The aneurysm presented a severely calcified and modestly conical-shaped aortic-neck. The post-operative course was complicated by a broncho pneumonic infiltrate and a CT scan performed two weeks postoperatively accidentally revealed a relatively small hematoma surrounding the aortic wall. No active bleeding, endoleak, or aneurysm increase in diameter was documented. Nevertheless, the patient remained closely monitored. Three days later, he suffered from abdominal aortic aneurysm rupture. A CT scan revealed an arterial wall tear at the neck level. Intra-operatively the reanalyzed common iliac artery was intact and a good endograft-sealing was confirmed. Following this event, small lumbar arteries suture saccotomy was performed. The patient eventually died of multiorgan failure one month later. Conclusions The apparently “self-limiting” post-endovascular aneurysm repair CT-scan finding of periaortic hematoma may have represented a potential trigger for abdominal aortic aneurysm rupture. The possibility of developing undetected aortic lesions during endovascular aneurysm repair, specifically in the presence of potentially “at risk” anatomical conditions, should always be considered.

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“…32 Straight tips and stiff wires also increase the risk of vessel injury. 33 When crossing an occlusion, the vessel perforation can be recognized by the deviation of the guidewire from the expected course of the artery. Early detection is necessary because further passage of the catheter or angioplasty balloon can increase the size of the perforation.…”

Section: Guidewire and Catheter-induced Injurymentioning

confidence: 99%

Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review

Kumar

Valakkada

Ayyappan

et al. 2022

Journal of Clinical Interventional Radiology ISVIR

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Endovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.

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Iatrogenic Arterial Perforation During Endovascular Interventions

Cited by 9 publications

References 17 publications

Revisiting the surgical anatomy of the triangle of doom and the triangle of pain

Revisiting the surgical anatomy of the triangle of doom and the triangle of pain

Early periaortic hematoma development after EVAR in the presence of severely calcified and modestly conical-shaped aortic neck: A potential trigger for sudden aneurysm progression toward rupture

Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review

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