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Abdominal and left leg CT scan without contrast: A, axial view with the bone setting at the level of the vertebroplasty demonstrates a leakage of acrylic cement in the lumbar artery supply to the aorta (long arrow); B, left lower limb CT reveals the cement embolus in the peroneal artery (P), anterior tibial artery (AT), and posterior tibial artery (PT); C, the thoracolumbar spine CT (sagittal view) shows the cement in the aorta (short arrow).
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Angiogram before contrast medium injection, showing scattered opacity (cement) in the popliteal fossa (A), leg (B), and foot (C) on the left side (white arrows). After the injection of the contrast medium (D), no blood flow was observed from the popliteal fossa distally with an abrupt occlusion of the popliteal artery (black arrows).
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The proximal portions of the popliteal arteries had also acceptable blood flow but thereafter a cement cast existed causing a poor run-off from the popliteal fossa distally (Figure 2).
Re-establishment of the blood flow after successful angioplasty of the anterior tibial and peroneal arteries. While attempting to dilate the totally occluded posterior tibial artery, the tip of the balloon was torn off and its distal part remained at the bifurcation of the tibioperoneal trunk (A). Note the two balloon markers (arrows). The tibioperoneal trunk and proximal part of the anterior tibial artery have been opened (B).
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We were able to dilate the lesions of the anterior tibial artery at its origin, proximal, and mid parts by utilizing a 2.5 mm x 120.0 mm Pacific Xtrime (Invatec, Rocandelle, BS, Italy) balloon, while the distal portions of this artery and the dorsalis pedis artery were repeatedly inflated with a 2.5 mm x 30 mm Sprinter balloon catheter (Medtronic, Inc., Minneapolis, Minnesota) (Figure 3A). Then in an effort to dilate the totally occluded posterior tibial artery at the bifurcation of tibioperoneal trunk, the balloon was attached to the cement lining in the artery wall, and part of its distal fragment remained in this vessel (Figure 3A). The final imaging showed an acceptable blood flow in the anterior tibial artery, and in the tibioperoneal artery (Figure 3B).