PMC3542306_01
53-year old man with right sided claudication and erectile dysfunction.. A. Anteroposterior diagnostic pelvic angiography shows right external iliac artery occlusion and hypertrophied right internal iliac artery. Distal abdominal aorta was mildly aneurysmatic (3.6 cm in diameter). B. Left oblique diagnostic angiography shows right external iliac artery occlusion, hypertrophied right internal iliac artery, and collateral flow via dilated obturator (thick arrow) and medial femoral circumflex arteries (thin arrows) to right common femoral artery. C. Right oblique diagnostic angiography shows normal left main, internal, and external iliac arteries. D. After percutaneous transluminal angioplasty and stenting, angiogram shows normal calibration and excellent patency of right external iliac artery. Flow through right internal iliac artery slowed immediately, as a result of decrased volume. Right medial femoral circumflex artery was not seen on angiogram. E. Late phase of post-stent arteriography shows internal iliac artery branches better.
kjr-14-81-g001.jpg
PMC3542306_01_kjr-14-81-g001.jpg
F1
Endovascular treatment of the occlusion was planned as the aneurysmal dilatation of the distal infrarenal aorta was mild (Fig. 1A). Angiograms confirmed fusiform aneurysmatic dilatation of the distal infrarenal abdominal aorta as well as occlusion of the entire length of the right external iliac artery (Fig. 1A). The right internal iliac artery was patent and was considerably dilated, with a high volume flow on the angiogram (Fig. 1B). The dilatation of, and very high flow through, the right internal iliac artery was likely a result of the redirection of blood flow to the right leg (Fig. 1B). The left common and external iliac arteries were normal (Fig. 1C). Angiogram after stent placement showed excellent patency of the occluded external iliac artery (Fig. 1D). There was abrupt decrease of flow velocity in the right internal iliac artery, as if the contrast had been suspended in the artery (Fig. 1D). The late phase of post-stent iliac arteriography shows better internal iliac artery branches (Fig. 1E).