tipology:letter

numero rivista e pagine: HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2010; 2(3): 229-230
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Coronary angiography and angioplasty in a patient with an iliac artery volvolus

Authors: I. Franzoni1, F. Baratto1, A. Macchi*1, I. Rosa1, F. Buzzetti1, A. Margonato1

Department of Cardiology and Coronary Care Unit, Universitŕ Vita-Salute San Raffaele, Milan, Italy

Corresponding author: * Corresponding author:
Andrea Macchi, MD
Department of Cardiology and Coronary Care Unit
Istituto Scientifico San Raffaele,
Via Olgettina, 60 - 20132 Milan, Italy


E-mail: macchi.andrea@hsr.it

ABSTRACT

A 70-year-old Caucasian male underwent to percutaneous revascularization through arterial iliac “volvolus” by extralong direct stenting using a long 8 french introducer with an optimal angiographic result and clinical outcome.

 

Keywords: coronary angioplasty, iliac artery tortuosity

A 70-year-old Caucasian male with hypertension, hyperlipidemia, permanent atrial fibrillation and recent onset of exercise angina with a positive stress test was admitted to our department to undergo coronary-angiography. He was asymptomatic for claudicatio intermittens, the physical examination revealed only a systolic apical murmur, no other vascular murmure was evident.

 

 

Apparent interruption of right iliac artery (A) and iliac “volvolus” (B).

 

Transthoracic echocardiography showed a normal cardiac systolic function (left ventricular ejection fraction 60%) with moderate mitralic regurgitation.
He undewent coronary catheterization, but the operator felt resistance while introducing the guide wire through the right femoral superficial artery 6 french sheath. Panel A shows the appearance of the guide immediately after insertion.
After injecting contrast medium, a bizarre anatomy of patient’s iliac artery became evident (Panel B). A right iliac artery volvolus was evident, aortic carrefour was shifted to the right, left iliac artery was longer than normal (Panel C).

 

 

Right iliac artery. Post procedural Echo-color-Doppler of right iliac artery

 

Artery diameter was large, flow was preserved. Coronary angiography was performed by a long 8 french introducer (65 cm) that permitted a fine engagement of coronary ostia and showed a critical stenosis of the proximal tract of left anterior descending artery. Using an 8 french sheath, a good back up was achieved and percutaneous revascularization was performed by extralong direct stenting (paclitaxel drug eluting stent 3 x 38 mm), with an optimal angiographic result (TIMI 3 flow) and clinical outcome.
On the next day the patient underwent echo-color-doppler of inferior limbs arteries that showed coiling of the right iliac artery and absence of any vascular complication (Panel D).
At the 12 months follow up, the patient is asymptomatic for angina and claudicatio intermittens.

 

Conflict of interest: No conflict of interest is acknowledged by the authors.