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Iatrogenic arterial dissection: treatment by percutaneous transluminal angioplasty
T P Murphy1, G S Dorfman, M Segall
1Department of Diagnostic Imaging, Rhode Island Hospital, Providence 02903.
Insights
Percutaneous transluminal angioplasty effectively treated iatrogenic arterial dissections in 5 patients. This less expensive, widely applicable procedure showed sustained symptom improvement up to one year.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Iatrogenic arterial dissection can necessitate intervention based on stenosis severity and symptoms.
- Management options include angioplasty, stent placement, and surgery.
Observation:
- Five cases of iatrogenic arterial dissection were managed with percutaneous transluminal angioplasty.
- Dissections involved the aorta, common iliac, external iliac, and superior mesenteric arteries.
- Angioplasty approaches included transfemoral and translumbar.
Findings:
- Four patients required no additional therapy post-angioplasty.
- One patient underwent surgery for an asymptomatic pseudoaneurysm.
- Angiographic follow-up showed persistent stenosis improvement in two patients.
- No recurrence of symptoms was noted up to one year post-procedure.
Implications:
- Percutaneous transluminal angioplasty is an effective, less expensive, and widely applicable treatment for iatrogenic arterial dissection.
- While recurrence of stenosis may be higher than with stents or surgery, angioplasty offers significant advantages.
- This approach provides a valuable alternative for managing arterial dissections, especially in resource-limited settings.
Abstract:
Iatrogenic arterial dissection may require intervention, depending on the severity of resulting stenosis and the degree of symptoms. We present 5 cases of iatrogenic arterial dissection: 1 with dissection of the lower abdominal aorta, common iliac artery, and external iliac artery, and 3 with external iliac artery dissections, all managed with percutaneous transfemoral transluminal angioplasty; and 1 with dissection of the superior mesenteric artery with angioplasty performed by the translumbar approach. Four of the 5 patients had no additional therapy; 1 patient eventually underwent surgery for an asymptomatic residual pseudoaneurysm seen on abdominal computed tomography. Angiographic follow-up in 2 patients demonstrated persistent improvement in stenosis, 1 at 2 weeks after angioplasty, and the other, 6 weeks following angioplasty. None of the 5 patients required further therapy for recurrence of symptoms on clinical follow-up obtained up to 1 year after angioplasty. Though the incidence of recurrent arterial stenosis following angioplasty for dissection may be greater than that incurred after intravascular stent placement or surgery, angioplasty may be effective, and has the advantage of being less expensive than both of these treatment modalities, and more widely available and applicable than intravascular stents.