[MO-75] Presentation Awards
Endovascular stenting of radiation-induced external iliac artery stenosis
A 62-year-old female had received radiation therapy for uterine carcinoma 28 years ago. Recently, she developed intermittent claudication of the right leg. Her ankle-brachial index (ABI) was 0.71 and 1.08 for the right and left leg, respectively. CT angiography revealed right external iliac artery (EIA) stenosis with calcification, however less atherosclerotic lesions were shown in the common iliac and femoral artery. We planed endovascular treatment for her right EIA, however, it was very difficult to approach from right femoral artery because her skin of inguinal region was very thick and hard following radiation therapy, so we decided to approach from brachial artery. After a 4-Fr sheath was inserted from the left brachial artery, a 6-Fr Destination was delivered to terminal aorta. An initial angiography showed that the right EIA had focal stenosis with calcification. A 0.035-inch guidewire successfully crossed the lesion and straight catheter passed the lesion. The pressure gradient was 50mmHg. After switching 0.014 wire, intravascular ultrasound (IVUS) showed severe calcification and the diameter of the stenosis site was 2.0mm and healthy lesion was 7.0mm. After 5.0/40mm balloon dilatation, we implanted self-expandable stent (SMART Control 7.0/40mm). IVUS showed that the stent did not dilated sufficiently, we performed post-dilation with non-compliant balloon (SHIDEN HP 6.0/40mm). Pressure gradient decreased to 26 mmHg. After the procedure, her symptom disappeared and ABI increased to 1.02 and 1.11, respectively. In this case, we avoided femoral approach which was suspected to radiation-induced skin injury and successfully implanted self-expandable stent from brachial approach.