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Atheroembolization: a harmful complication of therapeutic internal iliac artery occlusion
Bettina Marty1, Christophe Perruchoud, Stephan Wicky
1Department of Cardiovascular Surgery, University Hospital of Lausanne, Switzerland.
Insights
Atheroembolization, a rare complication of internal iliac artery (IIA) embolization for aortoiliac aneurysms, can cause severe ischemia. This case highlights severe consequences including gangrene after IIA coil embolization.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Atheroembolic Disease
Background:
- Endovascular treatment of aortoiliac aneurysms often involves internal iliac artery (IIA) coil embolization.
- Established morbidities include buttock claudication and erectile dysfunction, with acceptable rates.
- Atheroembolic complications following IIA embolization have not been previously reported.
Observation:
- A patient developed gangrene of the prepuce and cutaneous necrosis of the ipsilateral buttock and foot post-IIA coil embolization.
- Histopathologic examination of excised tissue revealed multiple atheroemboli.
Findings:
- Atheroembolization is a rare but severe complication of therapeutic IIA occlusion.
- Ischemic sequelae can be exacerbated by the combined event of atheroembolization and main artery occlusion.
Implications:
- This case underscores the potential for severe ischemic complications from atheroembolization after IIA coil embolization.
- Vigilance for atheroembolic events is crucial in endovascular procedures involving arterial embolization.
- Further research may be warranted to elucidate the incidence and management of atheroembolization in this context.
Abstract:
Coil embolization of the internal iliac artery (IIA) for proper endovascular treatment of aortoiliac aneurysms is a procedure with an acceptable morbidity rate consisting of buttock claudication in 12% to 55% and erectile dysfunction in 1% to 13%. Atheroembolic complications in this context are not yet reported. We present a case with gangrene of the prepuce and focal cutaneous necrosis of the ipsilateral buttock and foot after coil embolization of one IIA. Multiple atheroemboli were found with the histopathologic examination of the excised prepuce. Atheroembolization is a rare complication of therapeutic IIA occlusion, and the ischemic sequels can be severe because of the coincidence of atheroembolization and occlusion of the main supplying artery.