[MO-26] Presentation Awards
An acute total occlusion of the right iliac artery induced by Exoseal
An 82 years old male with bilateral intermittent claudication who had a history of dialysis for more than 20 years was admitted to our hospital. The right SFA was occluded from the ostium, and a severe stenosis were shown in his bilateral common iliac artery and the left SFA. In addition, severe calcified stenotic lesions were shown in his bilateral common femoral artery (CFA).
To treat the bilateral common iliac artery stenosis by EVT, bilateral femoral artery approach was selected. We confirmed a successful EVT by deploying self-expandable nitinol stents. After the EVT, Exoseal, a hemostatic device, was used to the right femoral artery.Although after 10 minutes later of the Exoseal plug injection, the bleeding did not stopped.
Two days later, the patient had a complaint of severe right foot pain. The right femoral artery was pulseless, and his right leg was cold and pale. The computed tomography showed the occlusion of the right iliac artery. The emergency angiography showed that the total occlusion was started from the ostium of the right common iliac artery. Hybrid revascularization for the acute total occlusion of the right iliac artery and CFA endarterectomy were performed. During the CFA endarterectomy, Exoseal plug was removed from the common femoral artery. It was apparent that the ALI was induced because the CFA with a severe calcified stenosis was occluded by the Exoseal plug.
In conclusion, we experienced a case of ALI which was induced by the injection of the Exoseal plug into the CFA. The case gave us a chance to rethink the adaptation of Exoseal in cases with severe CFA calcification and the complications that might be caused.
To treat the bilateral common iliac artery stenosis by EVT, bilateral femoral artery approach was selected. We confirmed a successful EVT by deploying self-expandable nitinol stents. After the EVT, Exoseal, a hemostatic device, was used to the right femoral artery.Although after 10 minutes later of the Exoseal plug injection, the bleeding did not stopped.
Two days later, the patient had a complaint of severe right foot pain. The right femoral artery was pulseless, and his right leg was cold and pale. The computed tomography showed the occlusion of the right iliac artery. The emergency angiography showed that the total occlusion was started from the ostium of the right common iliac artery. Hybrid revascularization for the acute total occlusion of the right iliac artery and CFA endarterectomy were performed. During the CFA endarterectomy, Exoseal plug was removed from the common femoral artery. It was apparent that the ALI was induced because the CFA with a severe calcified stenosis was occluded by the Exoseal plug.
In conclusion, we experienced a case of ALI which was induced by the injection of the Exoseal plug into the CFA. The case gave us a chance to rethink the adaptation of Exoseal in cases with severe CFA calcification and the complications that might be caused.