Arterial Occlusion Caused by Intimal Flap Elevation After Arteriosclerosis Obliterans Stent Implantation: A Case...

Stent-related dissection is a well-recognized complication of endovascular intervention. However, acute arterial occlusion resulting from stent-induced intimal flap displacement at a major bifurcation is rare and carries a high risk of limb-threatening ischemia. We present the case of an 84-year-old female with multilevel lower extremity atherosclerotic disease, complicated by diabetes and hypertension, who presented with bilateral ischemic foot ulcers. During endovascular revascularization, iatrogenic intimal flap prolapse at the tibioperoneal trunk led to acute occlusion of the peroneal artery. Successful restoration of distal flow was achieved through retrograde puncture followed by balloon angioplasty. Final angiography demonstrated optimal distal perfusion with no residual stenosis. This case underscores the necessity of prompt intraoperative identification and the strategic application of salvage techniques to manage complex mechanical complications during distal revascularization.