Middle aged male with complaints of left lower extremity claudication.
An abdominal aortogram and lower extremity run-off were performed. The image above demonstrates a focal flow-limiting stenosis of the left common iliac artery (arrow).
A slightly obliqued and magnified image better demonstrates the lesion.
The initial angiogram was performed from a right common femoral artery approach. A second puncture was made in the left groin for more direct access to the lesion. The right groin puncture was used to place a "protective" balloon in the right common femoral artery prior to angioplasty and stenting. The balloon on the contralateral side protects the aortic bifurcation from unintended dissection during angioplasty or stenting of lesions in the common iliacs.
With both balloons inflated, the dissection flap created by angioplasty (angioplasty itself creates a controlled dissection) is prevented from propagating in an unintended direction. On the ipsilateral side, a large filling defect is seen in the balloon (arrow) indicating the original lesion.
Even after multilple attempts, the stenosis remains. This probably represents a chunk of intramural calcium, resistant to angioplasty.
The appearance of the lesion is improved with placement of a stent.
Common Iliac Artery Stenosis |
