Cardiovasc lntervent Radiol (1991) 14:302-306 Case Reports CardioUascular and Intervenfional Radiology 9Springer-Verlag New York Inc. 1991 Iatrogenic Arterial Dissection: Treatment by Percutaneous Transluminal Angioplasty Timothy P. Murphy, j Gary S. Dorfman, I Michelle Segall, ~ and Wilfred I. Carney Jr. ~- Departments of IDiagnostic Imagingand '-Surgery, Rhode Island Hospital, Providence, Rhode Island, USA Abstract. Iatrogenic arterial dissection may require intervention, depending on the severity of resulting stenosis and the degree of symptoms. We present 5 cases of iatrogenic arterial dissection: I with dissec- tion of the lower abdominal aorta, common iliac artery, and external iliac artery, and 3 with external iliac artery dissections, all managed with percutane- ous transfemoral transluminal angioplasty; and 1 with dissection of the superior mesenteric artery with angioplasty performed by the translumbar ap- proach. Four of the 5 patients had no additional therapy; 1 patient eventually underwent surgery for an asymptomatic residual pseudoaneurysm seen on abdominal computed tomography. Angiographic fol- low-up in 2 patients demonstrated persistent im- provement in stenosis, 1 at 2 weeks after angi- oplasty, and the other, 6 weeks following angioplasty. None of the 5 patients required further therapy for recurrence of symptoms on clinical fol- low-up obtained up to I year after angioplasty. Though the incidence of recurrent arterial stenosis following angioplasti~ for dissection may be greater than that incurred after intravascular stent place- ment or surgery, angioplasty may be effective, and has the advantage of being less expensive than both of these treatment modalities, and more widely available and applicable than intravascular stents. Key words: Arteries, injuries, transluminal angi- oplasty The diagnosis of arterial dissection is definitively made angiographically when opacification of true Address reprint requests to." Gary S. Dorfman, M.D., Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA and false lumens is present. Iatrogenic arterial dis- section can occur as a result of invasive procedures such as diagnostic angiography, angioplasty [1], or theoretically secondary to any intraarterial device, such as those used for blood pressure monitoring, blood sampling, or intraaortic balloon counterpulsa- tion. Arterial dissection may occur during angiogra- phy due to subintimal passage of a guidewire or catheter. Intimal clefts are often seen following angi- oplasty and are to be expected considering the mech- anism of this therapy [2]. Treatment for clinically significant arterial dissection has traditionally been surgical or by bypass or endarterectomy [3]. Use of atherectomy, and more recently intravascular stents, for treatment of arterial dissection has been described [4, 5]. Confidence in treatment of dissec- tions will be increased with the use of intravascular stent placement relative to angioplasty alone, but angioplasty has the advantage of being less expen- sive and widely available. We present 5 cases of iatrogenic arterial dissection resulting in significant stenosis of the arterial lumen, all of which were treated successfully by percutaneous angioplasty. Case Reports (Table 1) Case I A 62-year-old female with a history of coron.ary artery disease presented with claudication of her right lower extremity which resulted in significantlimitation of her daily activities. She became symptomatic 5 months after undergoing cardiac catheterization and coronary angioplastyvia a right transfemoral approach. Phys- ical exam at the time of admission revealed absent right popliteal and distal pulses and an ankle-brachial index (ABI) of 0.67. Angiographyvia the left commonfemoral artery demonstrated a distal aortic dissection extending into the right common lilac artery, resulting in significant stenosis at the level of the origin of the external lilac artery (Fig. IA). An angioplasty balloon 8 mm in diameter and 3 cm long was then introduced crossover into the