Complications

The complications associated with stent placement are the same as those frequently seen with diagnostic angiography and PTA procedures. Most often they are related to arterial access. A groin hematoma is most common but continued retro-peritoneal hemorrhage can also occur. Patient complaints of significant back pain following a PTA or stent procedure should be evaluated carefully and a CT scan should be considered to rule out hemorrhage.

Acute tubular necrosis can sometimes occur, as the amount of contrast used during complicated stent procedures can be very high. To prevent this, patients should be well hydrated before and after the procedure.

Stenting of aortoiliac occlusive lesions is not easy, although the literature supports an expectation of a high degree of initial technical success. Major complications, requiring significant departure from the treatment plan, occur in approximately 6% of cases with less than 2% requiring surgical intervention.8 Mortality of aortoiliac stent placement is < 0.5%.8 However when complications are recorded strictly, based on "intent to treat" the complication rate can approach 20% even in the hands of experienced operators.9 This complication rate is derived from the fact that many times a lesion that is intended to be treated with a single stent or angioplasty requires placement of additional stents due to extensive intimal dissection, an unsatisfactory pressure gradient or unsatisfactory positioning of the original stent. Acute thrombosis or embolization rarely occur but can frequently be treated successfully with throm-bolytic therapy. These additional maneuvers can salvage the procedure most of the time.

The incidence of intraprocedural complications is increased if patients have pedal gangrene, if more than one stent is deployed, if the patient is female or if there is poor runoff (i.e., occluded superficial femoral artery). This increased complication rate in these situations may be due to an association of more severe and diffuse disease, or in the case of female patients, generally smaller arteries. This translates to the likelihood of more access problems, difficult guidewire passage with an increased risk of intimal dissection. Likewise with the placement of additional stents there are more maneuvers required and therefore more risk for complications.

Other rare but potentially disastrous complications include loss of the stent prior to satisfactory deployment, stent infection and arterial rupture. If a balloon expandable stent slides off its balloon before it has been inflated it can be recaptured. If it is still over the wire a smaller sized balloon catheter can in some instances be reinserted and the stent can be repositioned or deployed in another segment of the iliac artery. A wire snare can be used to grasp the loose stent and possibly remove it. Stent

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