Case report
External iliac artery pseudo-stenosis associated with catheterization: report of two cases

Introduction

Spasm of small arteries such as the coronary or radial artery is well described and observed as a usual state in practice. But spasm of large arteries such as the femoral or iliac artery is an unexpected condition. This situation may cause difficulties to access the artery, or may be responsible for unnecessary interventions.

We report two cases of pseudo-stenosis of the external iliac artery related to catheterization.

Case reports

Case 1



A 51-year-old patient with acute anterior myocardial infarction was taken to the catheter laboratory for primary percutaneous coronary intervention. Resistance was sensed at the iliac artery level but crossed successfully with a 0.038 inch guide-wire. Coronary angiography revealed subtotal occlusion of the left anterior descending artery. Peripheral angiography was performed after the successful coronary intervention. High-grade tandem stenoses were seen at the right external iliac artery (Fig. 1 A). The patient was considered for iliac artery stent implantation. But he had no history of claudication or ischemia-related signs and the intervention was cancelled. Control angiography was performed before guidewire advancement at the next session. Just a non-critical lesion and tortuosity were found at the external iliac artery (Fig. 1 B).



Case 2



A 55-year-old man suffering from stable angina pectoris was referred to our hospital for elective coronary angiography. Resistance was sensed at the iliac artery during the crossing of a 0.038 inch guide wire. Coronary angiography revealed only non-critical atherosclerotic disease; but peripheral angiography revealed a significant right external iliac artery stenosis (Fig. 1 C). The patient was considered for iliac stenting at another session. But the patient had neither claudication nor ischemia-related findings. At the next session, after an introducer sheath had been placed, angiography was performed again. But no lesion appeared at the iliac artery (Fig. 1 D).

Discussion

Peripheral arterial interventions are performed more extensively by cardiologists day by day. High success rates have been reported and these results give hope to cardiologists [1, 2]. Sometimes cardiologists diagnose peripheral artery disease during diagnostic or interventional catheterization. Unexpectedly diagnosed significant limb artery lesions, especially in the case of acute coronary syndrome, sometimes make the physician neglect the symptoms of patients associated with peripheral artery disease due to the visually seen “significant lesion”. Catheter-induced vasospasm is a familiar phenomenon for invasive cardiologists. This condition may mimic lesions in coronary and small peripheral arteries [3]. Another condition which causes pseudo-stenosis imaging is called the “accordion effect”. This condition occurs due to wire straightening or a folding effect of wire in the tortuous vessels. This phenomenon is seen especially at the right coronary artery when an extra support guide wire is used [4]. This image may be seen theoretically in all sizes of vessels. But the accordion effect at the large arteries such as the iliac artery has rarely been reported [5-9]. Implementations of diagnostic and interventional peripheral catheterization by cardiologists are becoming widespread. Hence unawareness of these conditions may cause unnecessary peripheral interventions. Considering vasospasm and the accordion effect phenomenon may be helpful in novel, unexplained stenotic situations without any symptom or complaint.

References

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