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Lee K, Cho S, Kim H, Joh JH. Incidence and Risk Factors of Iliac Artery Rupture during Aortoiliac Stenting. Vasc Specialist Int 2024; 40:5. [PMID: 38389133 PMCID: PMC10884543 DOI: 10.5758/vsi.230114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
Purpose Aortoiliac occlusive disease (AIOD) is widely prevalent and leads to severe claudication or chronic limb-threatening ischemia. Stent placement for AIOD demonstrated excellent outcomes in terms of long-term patency. However, iliac artery rupture is the most fearful complication during the aortoiliac stenting (AIS). This study aimed to evaluate the incidence and risk factors of iliac artery rupture during AIS. Materials and Methods A retrospective review of consecutive patients with AIOD treated with AIS from 2009 to 2021 was completed. We excluded patients with instent restenosis. All types of stents, including self-expanding stent (SES), balloon-expandable stent (BES), or balloon-expandable covered stent (CS), were used. Angiographic characteristics and procedural outcomes were analyzed. Procedural success was defined as the residual stenosis <30%. Results A total of 242 patients (86.8% male; mean age 68.8±10.0 years) with de novo AIOD were treated with AIS. The procedural success rate was 100%. Rupture occurred in six patients (2.5%) and all ruptures were occurred in the external iliac artery (EIA). Stenting of the EIA and less calcified lesion were risk factors for iliac rupture (P=0.028). All cases of iliac artery rupture were successfully treated with the CSs. Overall primary patency rates were 98.0% and 93.4% at 12 and 36 months, respectively. Primary patency rates of SES, BES, and CS were 87.7%, 88.4%, and 100% at 36 months, respectively. Conclusion The incidence of iliac artery rupture during AIS was 2.5%. Stent placement in the less calcified lesion and EIA was a risk factor for rupture during AIS. Placement of the CS can be the straightforward solution in case of iliac artery rupture during AIS.
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Affiliation(s)
- KwangJin Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sungsin Cho
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyangkyoung Kim
- Department of Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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2
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Awan MU, Omar B, Qureshi G, Awan GM. Successful Treatment of Iatrogenic External Iliac Artery Perforation With Covered Stent: Case Report and Review of the Literature. Cardiol Res 2017; 8:246-253. [PMID: 29118889 PMCID: PMC5667714 DOI: 10.14740/cr596w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022] Open
Abstract
Retroperitoneal hemorrhage from iliac artery injury is a potentially serious complication of vascular interventional procedures leading to hemorrhagic shock and death if not diagnosed early and treated promptly. We report a 70-year-old male admitted to our facility with non-ST-elevation myocardial infarction, whose heart catheterization revealed left anterior descending artery (LAD) with 80% proximal, 95% mid and 100% distal disease. The left circumflex and right coronary arteries were 100% occluded proximally and received collaterals from the LAD. The patient declined coronary artery bypass surgery; therefore, the decision was made to perform high-risk percutaneous coronary intervention (PCI) of the LAD with Impella left ventricular assist device support. Left femoral artery angiogram revealed severely tortuous and calcified aorta, left external iliac and left common iliac arteries, and was accessed with 14-inch Impella sheath. He developed groin pain with mild hypotension thought to be due to sedation, which responded to intravenous fluids and dopamine. He underwent successful rotational atherectomy of the proximal and mid LAD with deployment of drug-eluting stents. Following PCI, he suffered acute profound hypotension necessitating intravenous fluids and vasopressor support with epinephrine. Emergency transthoracic echocardiogram did not reveal any pericardial effusion, and showed normal left ventricle and right ventricle systolic function. The Impella device was removed and selective left common iliac angiogram from the right femoral access revealed a vascular injury site with shift of the bladder to the right indicative of retroperitoneal hematoma. A digital subtraction angiogram revealed extravasation of blood at the vascular injury site. An 8.0 × 59 mm iCAST covered stent was deployed to the left external iliac artery with successful sealing of the perforation. The Impella device site was closed with two Perclose devices. The patient required 4 units of packed red blood cell transfusion. His hospital course was complicated by transient acute kidney injury, with return of his renal function to baseline at discharge 10 days later. This case underscores the importance of prompt recognition and treatment of vascular complications associated with interventional procedures, and highlights some of the risk predictors of such complications, which should be anticipated and planned for prior to intervention.
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Affiliation(s)
- Muhammad Umer Awan
- Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA
| | - Bassam Omar
- Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA
| | - Ghazanfar Qureshi
- Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA
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3
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Delayed Rupture of the External Iliac Artery after Balloon Angioplasty and Stent Placement. J Vasc Interv Radiol 2008; 19:460-2. [DOI: 10.1016/j.jvir.2007.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 11/16/2007] [Accepted: 11/17/2007] [Indexed: 11/18/2022] Open
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4
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Yeo KK, Rogers JH, Laird JR. Use of stent grafts and coils in vessel rupture and perforation. J Interv Cardiol 2008; 21:86-99. [PMID: 18254790 DOI: 10.1111/j.1540-8183.2007.00302.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Vessel rupture and perforation are important complications of percutaneous treatment of coronary and peripheral arterial disease. These complications can result in abrupt vessel closure, distal organ injury, bleeding into the surrounding tissue, and death. Prompt management of such complications is therefore critically important. This paper reviews the management of vessel rupture and perforation, including the use of different types of covered stents (balloon-expandable and self-expanding), as well as the various types of embolization coils. Particular focus will be placed on percutaneous coronary artery and peripheral arterial interventions.
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Affiliation(s)
- Khung Keong Yeo
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA
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5
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Hovis CL, Zeni PT. Percutaneous Thrombin Injection of a Pulmonary Artery Pseudoaneurysm Refractory to Coil Embolization. J Vasc Interv Radiol 2006; 17:1943-6. [PMID: 17185690 DOI: 10.1097/01.rvi.0000250985.07237.fb] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 57-year-old white man with a hypermetabolic right upper-lobe mass underwent treatment with wedge resection. During the immediate postoperative period, a right middle-lobe pulmonary artery pseudoaneurysm developed. After unsuccessful transcatheter coil embolization, fluoroscopically and sonographically guided percutaneous thrombin injection was performed, with complete thrombosis of the pseudoaneurysm.
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Affiliation(s)
- Christopher L Hovis
- Memphis Interventional Radiology Clinic, 6019 Walnut Grove Road, Memphis, Tennessee 38120, USA.
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6
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Abreu AR, Campos MA, Krieger BP. Pulmonary artery rupture induced by a pulmonary artery catheter: a case report and review of the literature. J Intensive Care Med 2004; 19:291-6. [PMID: 15358948 DOI: 10.1177/0885066604265255] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Placement and use of pulmonary artery catheters (PACs) carry potential risks. The authors describe a case of a patient who developed massive hemoptysis after placement of a PAC that caused a rupture of the pulmonary artery with pseudoaneurysm formation. Treatment was successfully achieved with transcatheter coil embolization. Pulmonary artery rupture and pseudoaneurysm formation are among the most serious complications of PAC use because of the associated risk of mortality. Patients with this complication may be asymptomatic or may present with variable amounts of hemoptysis immediately or days after using a PAC. The gold standard diagnostic test is pulmonary angiography, and the treatment of choice for most patients is transcatheter embolization. Physicians and other health care personnel handling these catheters should be familiar with the specific PAC balloon's inflation limits to avoid complications that may injure the patient.
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Affiliation(s)
- Alexandre R Abreu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
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7
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Pentecost MJ, Criqui MH, Dorros G, Goldstone J, Johnston KW, Martin EC, Ring EJ, Spies JB. Guidelines for Peripheral Percutaneous Transluminal Angioplasty of the Abdominal Aorta and Lower Extremity Vessels. J Vasc Interv Radiol 2003; 14:S495-515. [PMID: 14514865 DOI: 10.1016/s1051-0443(07)61267-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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8
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Allaire E, Melliere D, Poussier B, Kobeiter H, Desgranges P, Becquemin JP. Iliac artery rupture during balloon dilatation: what treatment? Ann Vasc Surg 2003; 17:306-14. [PMID: 12712371 DOI: 10.1007/s10016-001-0404-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Intraoperative and postoperative arterial ruptures associated with 657 iliac artery balloon dilatation procedures in our department from 1981 to 2000 were prospectively collected and retrospectively analyzed. Our results showed that failure to exercise basic safety principles and the presence of heavily calcified plaque are the major predictors of iliac artery rupture during balloon dilatation. If rupture is contained, surveillance alone is unreliable. Optimal treatment requires temporary hemostasis by balloon tamponade followed by placement of a covered stent to occlude the opening.
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Affiliation(s)
- Eric Allaire
- Service de Chirurgie Vasculaire, Hôpital henri Mondor, Creteil, France
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9
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Poplausky MR, Rozenblit G, Rundback JH, Crea G, Maddineni S, Leonardo R. Swan-Ganz catheter-induced pulmonary artery pseudoaneurysm formation: three case reports and a review of the literature. Chest 2001; 120:2105-11. [PMID: 11742949 DOI: 10.1378/chest.120.6.2105] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The use of Swan-Ganz catheters has increased tremendously since they were first introduced in 1970. Their ability to give vital hemodynamic measurements in critically ill patients makes their use invaluable when providing quality medical care. The formation of pulmonary artery (PA) pseudoaneurysm from a Swan-Ganz catheter-induced perforation of the PA is a rare but potentially fatal complication of Swan-Ganz catheter use. Three case presentations and a review of the literature are presented.
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Affiliation(s)
- M R Poplausky
- Department of Radiology, New York Medical College, Westchester Medical Center, Valhalla, NY 10595, USA.
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10
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Abstract
The uses of the pulmonary artery catheter have been expanded from its original use, helping to assess the cardiac output and left ventricular filling pressure of patients with cardiac disease, to include the management of patients with trauma, septic shock, respiratory failure, and those undergoing high-risk surgeries. Although more than 1 million pulmonary artery catheters are inserted each year in the United States, clear evidence establishing that they improve outcome remains hard to find. This article discusses the complications of invasive hemodynamic monitoring.
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Affiliation(s)
- T D Coulter
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Ohio, USA
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11
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12
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Maclennan AC, Moss J. Re: Rupture of the iliac artery during angioplasty after balloon embolectomy. Cardiovasc Intervent Radiol 1995; 18:205-6. [PMID: 7648602 DOI: 10.1007/bf00204154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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13
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Pentecost MJ, Criqui MH, Dorros G, Goldstone J, Johnston KW, Martin EC, Ring EJ, Spies JB. Guidelines for peripheral percutaneous transluminal angioplasty of the abdominal aorta and lower extremity vessels. A statement for health professionals from a special writing group of the Councils on Cardiovascular Radiology, Arteriosclerosis, Cardio-Thoracic and Vascular Surgery, Clinical Cardiology, and Epidemiology and Prevention, the American Heart Association. Circulation 1994; 89:511-31. [PMID: 8281692 DOI: 10.1161/01.cir.89.1.511] [Citation(s) in RCA: 227] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- M J Pentecost
- Office of Scientific Affairs, American Heart Association, Dallas, TX 75231-4596
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14
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Gupta AK, Ravimandalam K, Rao VR, Joseph S, Unni M, Rao AS, Neelkandhan KS. Total occlusion of iliac arteries: results of balloon angioplasty. Cardiovasc Intervent Radiol 1993; 16:165-77. [PMID: 8334688 DOI: 10.1007/bf02641886] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Fifty-six occluded iliac arteries (mean length 6.1 cm; range 1-17 cm) in 50 patients were treated by percutaneous transluminal angioplasty (PTA) or laser-assisted PTA (bilateral lesions in 6 patients). Twenty-seven patients (54%) were at high risk for surgery. Patients were followed for a maximum period of 72 months (mean 23.12 months; median 20 months). The initial success rate was 78.57% for arteries and 82% for patients. Laser-assisted PTA was attempted in 11 occluded arteries (19.64%) and was successful in 4 arteries (7.14%). Conventional PTA was successful in 71.4% of arteries including all 7 arteries for which laser-assisted PTA failed (76% of patients). PTA was unsuccessful in 12 arteries (21.43%). Urokinase was used before PTA in 1 artery. The effect of PTA was evident clinically by relief of rest pain (66.66%), healing of ulcer (57%), increased claudication distance or no claudication (79%) in limbs, and objectively, by improvement in ankle/arm index (AAI) (an increase of 0.16 to 0.91) and increased exercise tolerance. Continuous improvement in AAI was observed after PTA on follow-up in 9 limbs. One patient died during follow-up. On follow-up, 3 arteries were occluded, 6 showed evidence of stenosis, and 1 showed fusiform dilatation at the PTA site. The long-term results using the life-table method determined a 76% primary patency rate and 81% secondary patency rate for 72 months. The overall patency including failures was 63%. Age of the patients (p = 0.0169) and hypertension (p = 0.0015) significantly affected the long-term patency of the artery but not the initial success. The major complications were arterial rupture in a repeat procedure in 1 artery, axillary artery thrombosis in 1, and distal thromboembolic occlusion during PTA in 4. The long-term patency rates suggest that PTA of totally occluded iliac arteries is a safe and effective procedure and provides a long-term benefit.
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Affiliation(s)
- A K Gupta
- Department of Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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15
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Kim D, Porter DH, Siegel JB, Shapiro ME, Strom TB, Glotzer DJ. Use of a reperfusion catheter after angioplasty dissection for salvage of ischemic renal allograft: case report. Cardiovasc Intervent Radiol 1991; 14:179-82. [PMID: 1831690 DOI: 10.1007/bf02577725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Percutaneous transluminal angioplasty was performed on a right common iliac artery stenosis presumed to be causing renovascular hypertension in a patient with a renal allograft anastomosis to the right external iliac artery. This was complicated by an obstructive dissection resulting in acute threatening renal allograft ischemia. Renal blood flow was restored by means of a transluminal reperfusion catheter until corrective surgery could be performed. This case is reported because such catheters can be acutely helpful to the interventionalist, and they have not been described in the radiology literature.
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Affiliation(s)
- D Kim
- Department of Radiology, Beth Israel Hospital, Boston, Massachusetts 02215
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16
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Larson LO, Crider BA. An unusual manifestation of pulmonary artery perforation during pulmonary artery catheter insertion. ACTA ACUST UNITED AC 1988; 2:816-20. [PMID: 17171894 DOI: 10.1016/0888-6296(88)90108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- L O Larson
- Department of Anesthesiology, University of Michigan Hospitals, Ann Arbor 48109-0718, USA
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17
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Hartmann G, Steib A, Ludes B, Ravanello J. [Perforation of the pulmonary artery following Swan-Ganz catheterization]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1988; 7:486-93. [PMID: 3066241 DOI: 10.1016/s0750-7658(88)80087-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pulmonary arterial rupture due to the use of a Swan-Ganz catheter is a rare accident, with an estimated 2% incidence rate. It is fatal in almost 50% of cases. Predisposing factors are age greater than 60 years, pulmonary arterial hypertension and anticoagulant treatment. In patients older than 60 years, changes in the arterial wall increase the risk of rupture; pulmonary hypertension leads to too distal a movement of the catheter, and a concomitant treatment with anticoagulant drugs increases the amount of blood lost. Handling errors when setting up the catheter are often the cause of these accidents, especially a balloon too blown up and a catheter pushed too far. A subsequent movement of the catheter can be a cause of rupture during cardiac surgery. Haemoptysis is the major symptom of this accident, being found in 90% of cases. It can however be of minor importance; if it is ignored, this can lead to a secondary overwhelming haemorrhage. The haemorrhage can be life-threatening because of the cardiovascular collapse and acute respiratory failure by asphyxia. The treatment can only be carried out in intensive care. It will depend on the severity of the accident. It can go from an expectant wait after partial or total removal of the catheter, to an emergency thoracotomy for vascular suture, segmentectomy or even lobectomy. Intermediate measures include turning the patient onto the healthy side, injecting adrenaline or a clot of the patient's blood by the distal end of the catheter, placing a Fogarty catheter in the affected bronchus, or tracheal intubation with a double-lumen catheter and using mechanical ventilation with PEEP.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Hartmann
- Service d'Anesthésie et de Réanimation Chirurgicale, Hôpital de Hautepierre, Strasbourg
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18
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Murphy TP, Cronan JJ, Paolella LP, Dorfman GS, Francis WW. Arterial rupture without balloon rupture during percutaneous transluminal angioplasty. J Vasc Surg 1987. [DOI: 10.1016/0741-5214(87)90315-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Joseph N, Levy E, Lipman S. Angioplasty-related iliac artery rupture: treatment by temporary balloon occlusion. Cardiovasc Intervent Radiol 1987; 10:276-9. [PMID: 2960452 DOI: 10.1007/bf02578009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A case of nonsurgical treatment of common iliac artery rupture secondary to percutaneous transluminal angioplasty is reported.
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Affiliation(s)
- N Joseph
- Department of Radiology, West Penn Hospital, Pittsburgh, PA 15224
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