Acute iliac stent thrombosis - an unusual complication following use of the Lloyd-Davies position.

Introduction left-sided claudication and left foot paraesthesia. Clinical examination revealed that all left lower limb Over recent years endovascular stenting for iliac artery pulses were absent but there was no sensori-motor deocclusive disease has become a well accepted treatficit, muscle tenderness or swelling. Urgent angioment, with good long-term patency. As many patients graphy confirmed thrombosis of the left CIA stent (Fig. with stents are elderly, it is not uncommon for them 1A). Regionally directed thrombolysis (rt-PA) was comto require other surgical procedures. We present the menced, but after 17 h check angiography showed no case of a 62-year-old who developed acute thrombosis clot dissolution. He therefore underwent emergency of his common iliac artery (CIA) stent following transthrombectomy in the angiography suite, under general urethral resection of a bladder tumour (TURBT) peranaesthesia. Following surgical cut-down to the left formed in the Lloyd-Davies position. This is previously common femoral artery, the occluded CIA stent was unreported in the literature. traversed with a combination of a 0.035′′ straight guidewire (1′′ tip, Cook, U.K.) and a Cobra catheter (Cordis, U.K.). The guidewire was exchanged for a 0.014′′ wire Case Report and the catheter removed. Following arteriotomy, balloon thrombectomy was performed using a fogarty A 62-year-old man was admitted to another hospital embolectomy catheter (Fogarty Thru-Lumen Emfor TURBT. He was a known arteriopath and had bolectomy Catheter, Baxter, CA, U.S.A.). Completion undergone deployment of a left CIA nitinol stent angiography showed a widely patent stent with ex(Memotherm, Angiomed, Bard, U.K.) for intermittent cellent run-off (Fig. 1B). Following this angioplasty was claudication. This had been performed two years preperformed with an 8 mm angioplasty balloon (Smash, viously and serial duplex surveillance showed no eviBoston Scientific) to ensure that no restenosis had been dence of restenosis. TURBT was performed under missed but the balloon inflated fully without any regeneral anaesthetic in the Lloyd-Davies position. The sistance. The patient was discharged after 5 days and procedure lasted 15 min, without intra-operative hyporemains well 6 months later without incident. tension. In recovery the patient complained of left leg pain and paraesthesia and this was treated with analgesics. Despite failing to resolve completely, the pain Discussion was assumed to be musculo–skeletel and the patient was discharged the following day. Endovascular stents are at risk of fracture when subject After 3 weeks he presented to us with short distance to ‘‘unusual’’ compressive or flexion forces and this has been documented in the carotid, subclavian and femoro–popliteal arteries. Common iliac stents lie at ∗ Please address all correspondence to: D. J. A. Scott, Department of the level of the pelvic brim and should not be subject Vascular Surgery and Vascular Interventional Radiology, St. James’s University Teaching Hospital, Beckett Street, Leeds LS9 7TF, U.K. to such forces. Despite this iliac stent thrombosis may