Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: An underdiagnosed entity

The common femoral artery (CFA) is the most widely used inflow in all types of surgical revascularization in patients with peripheral artery disease. However, the CFA cannot always be used because of calcification, obstruction, or previous dissection. Here, we report a rare case of selecting the deep circumflex iliac artery (DCIA) as a source of inflow to perform a surgical revascularization in a patient with chronic limb-threatening ischemia. A 62-year-old man was admitted to our hospital due to necrotized third and fifth toes with pain at rest. Computed tomography showed severe stenosis of the CFA, superficial femoral artery, and deep femoral artery, and an entirely stented external iliac artery. The DCIA was identified as the only patent artery. Considering the condition of the other arteries, we selected the DCIA as a source of inflow. Deep circumflex iliac–popliteal bypass was performed with a saphenous vein. The bypass graft was patent 9 months after surgery and limb salvage had been achieved.

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Successful and Unsuccessful Blind Placement of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Catheters Through Damaged Arteries: A Report of Three Cases

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v2i1.43 ◽

2018 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Philip Joseph Wasicek ◽

William A Teeter ◽

Peter Hu ◽

Deborah M Stein ◽

Thomas M Scalea ◽

...

Keyword(s):

Iliac Artery ◽

External Iliac Artery ◽

Common Femoral Artery ◽

Arterial Injury ◽

Balloon Occlusion ◽

Tactile Feedback ◽

Balloon Inflation ◽

Iliac Arteries ◽

Tertiary Center ◽

The Common

Background: Patients who receive REBOA for temporization of exsanguinating hemorrhage may have occult injuries sustained to the iliac arteries or aorta which may pose increased risks in performing REBOA. There is a paucity of literature describing the successful blind placement of wires and/or catheters for REBOA through damaged vasculature. Methods: Patients admitted between February 2013 and July 2017 at a tertiary center who had a successful or unsuccessful blind placement of a REBOA catheter or wire through a damaged iliac artery or aorta were included. Results: Three patients were identified. Two patients had successful placement of the REBOA catheter; one sustained injury to the external iliac artery, and the other sustained injury to the abdominal aorta. Confirmation of catheter placement was obtained before balloon inflation; and the damaged vessels were identified upon immediate operative intervention. One patient had unsuccessful placement of the REBOA catheter during cardiac arrest despite accurate access of the common femoral artery (CFA). Conclusions: Emergent, blind placement of wires and catheters past arterial injuries is possible. Physical exam and/or tactile feedback should alert the surgeon to the possibility of arterial injury and imaging confirmation should precede balloon inflation if at all possible to minimize risk of further vascular injury.

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Imaging Anatomy and Surface Localization of External Control Device-Targeted Arteries for Noncompressible Torso Hemorrhage

Military Medicine ◽

10.1093/milmed/usab050 ◽

2021 ◽

Author(s):

Hua-yu Zhang ◽

Yong Guo ◽

Heng Liu ◽

Hao Tang ◽

Yang Li ◽

...

Keyword(s):

Iliac Artery ◽

External Iliac Artery ◽

Common Femoral Artery ◽

Organ Damage ◽

Control Device ◽

External Control ◽

Vertical Distance ◽

Localization Strategy ◽

Surface Localization ◽

The Common

ABSTRACT Background External hemorrhage control devices (EHCDs) are effective in reducing the death risk of noncompressible torso hemorrhage (NCTH), but the pressurized area is too large to prevent serious organ damage. This study aims to establish the surface localization strategy of EHCDs based on the anatomical features of NCTH-related arteries through CT images to facilitate the optimal design and application of EHCDs. Methods Two hundred patients who underwent abdominal CT were enrolled. Anatomical parameters such as the length of the common iliac artery (CIA), the external iliac artery (EIA), and the common femoral artery were measured; positional relationships among the EHCD-targeted arteries, umbilicus, anterior superior iliac spine (ASIS), and pubic tubercle (PT) were determined. The accuracy of surface localization was verified by the 3D-printed mannequins of 20 real patients. Results Aortic bifurcation (AB) was 7.5 ± 8.6 mm to the left of the umbilicus. The left CIA (left: 46.6 ± 16.0 mm vs. right: 43.3 ± 15.5 mm, P = .038) and the right EIA (left: 102.6 ± 16.3 mm vs. right: 111.5 ± 18.8 mm, P < .001) were longer than their counterparts, respectively. The vertical distance between the CIA terminus and the ipsilateral AB–ASIS line was 19.6 ± 8.2 mm, and the left and right perpendicular intersections were located at the upper one-third and one-fourth of the AB–ASIS line, respectively. The length ratio of EIA–ASIS to ASIS–PT was 0.6:1. The predicted point and its actual subpoint were significantly correlated (P ≤ .002), and the vertical distance between the two points was ≤5.5 mm. Conclusion The arterial localization strategy established via anatomical investigation was consistent with the actual situation. The data are necessary for improving EHCD design, precise hemostasis, and EHCD-related collateral injuries. Trial registration: Ratification no. 2019092. Registered November 4, 2020—retrospectively registered, www.chictr.org.cn.

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Early results of external iliac artery stenting combined with common femoral artery endarterectomy

Journal of Vascular Surgery ◽

10.1067/mva.2002.124374 ◽

2002 ◽

Vol 35 (6) ◽

pp. 1107-1113 ◽

Cited By ~ 96

Author(s):

Peter R. Nelson ◽

Richard J. Powell ◽

Marc L. Schermerhorn ◽

Mark F. Fillinger ◽

Robert M. Zwolak ◽

...

Keyword(s):

Femoral Artery ◽

Iliac Artery ◽

External Iliac Artery ◽

Common Femoral Artery ◽

Early Results

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Case 16.11

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0410 ◽

2014 ◽

pp. 779-780

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Femoral Artery ◽

Iliac Artery ◽

External Iliac Artery ◽

Common Femoral Artery ◽

Severe Stenosis ◽

Iliac Arteries ◽

History Of ◽

The Right ◽

Multiple Episodes

22-year-old man with a history of multiple episodes of bleeding, bruising, and hematomas Coronal VR image from 3D CE MRA of the abdomen and pelvis (Figure 16.11.1) reveals lobulated aneurysms of both external iliac arteries and the right common femoral artery. Note the severe stenosis of the left external iliac artery distal to the aneurysm....

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Early Detection of Post-Endarterectomy Complication by Point-of-Care Ultrasound

Reports ◽

10.3390/reports4030021 ◽

2021 ◽

Vol 4 (3) ◽

pp. 21

Author(s):

Bo-Ku Chen ◽

Po-Wei Chiu ◽

Chih-Hao Lin

Keyword(s):

Femoral Artery ◽

Point Of Care ◽

Postoperative Bleeding ◽

External Iliac Artery ◽

Common Femoral Artery ◽

Atheromatous Plaque ◽

Point Of Care Ultrasound ◽

Related Complication ◽

Contrast Extravasation ◽

The Right

Endarterectomy is an effective intervention to remove the atheromatous plaque in the inner lining of the artery, aiming to revascularize the occluded/stenosed vessel in patients with peripheral arterial occlusive disease (PAOD). The most common wound-related complication is postoperative bleeding, followed by infection, hematoma, and seroma. However, hematoma complications with air surrounded have rarely been reported in clinical cases. Case presentation: A 90-year-old female patient visited our emergency department because of a rapidly growing hematoma with pulsatile bleeding over her right groin area. She had received bilateral percutaneous transluminal angioplasty with endarterectomy for PAOD one month prior. A point-of-care ultrasound revealed a large hypoechoic mass, with a dirty shadow on the right groin area. Computed tomography angiography showed a hematoma over her right femoral region, with free air surrounding the right femoral artery. Angiography revealed an irregular shaped lesion on the right femoral artery without contrast extravasation. The patient was diagnosed with right-femoral post-endarterectomy infection with infected hematoma, with the inclusion of air. She underwent urgent excision and repair of the right femoral artery infectious lesion, debridement of the infectious hematoma and stenting of the right external iliac artery, common femoral artery and superficial femoral artery.

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Healing of femoral artery dissection after drug-coated balloon angioplasty: A case report with intravascular ultrasonography and angioscopy images

SAGE Open Medical Case Reports ◽

10.1177/2050313x19834159 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1983415

Author(s):

Taketsugu Tsuchiya ◽

Minako Oda ◽

Takaaki Takamura ◽

Katsuhide Kitagawa ◽

Koji Kajinami ◽

...

Keyword(s):

Femoral Artery ◽

Balloon Angioplasty ◽

Iliac Artery ◽

Superficial Femoral Artery ◽

External Iliac Artery ◽

Artery Dissection ◽

Intravascular Ultrasonography ◽

Stent Deployment ◽

Atherosclerotic Stenosis ◽

Drug Coated Balloon

Early 80s male with intermitted claudication underwent endovascular therapy for atherosclerotic stenosis at left external iliac artery and middle of superficial femoral artery. Patient also had chronic atrial fibrillation, diabetes mellitus, and hypertension. After stent deployment for external iliac artery lesion, a short superficial femoral artery lesion was performed with angioplasty using drug-coated balloon. The drug-coated balloon angioplasty resulted in 50% residual stenosis with linear dissection; however, provisional stenting was not performed as decent ante-grade blood flow allowed 10 extra minutes. Medication involved ongoing use of aspirin 100 mg and rivaroxaban 15 mg. Angiography post 3 months from index procedure showed external iliac artery and superficial femoral artery patency and healing of intimal dissection at superficial femoral artery lesion was estimated by intravascular ultrasonography. In angioscopy findings, red thrombus was seen in dissection cavity.

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