Successful management of iliac artery perforation during peripheral angioplasty: a case report.

Background: Peripheral artery disease is commonly managed with percutaneous balloon angioplasty, now the standard for replacing open surgical methods. Although generally effective, this procedure can lead to complications, including the rare but potentially fatal vessel perforation. Prompt identification and intervention are crucial to avoid severe outcomes. This case report presents a rare instance of iliac artery perforation during angioplasty, successfully managed with a covered stent. Case summary: A 58-year-old male with poorly controlled type 2 diabetes mellitus presented with a non-healing ulcer and claudication in the left lower limb. Computed tomography (CT) angiography revealed complete occlusion of the left external iliac artery and significant stenosis of the right external iliac artery. During peripheral angioplasty, vessel perforation occurred after post-stenting balloon dilation, causing haemodynamic instability. Immediate management included balloon tamponade and deployment of a covered stent to seal the perforation. The patient's condition stabilized, and he was discharged with medications, including antiplatelets, anticoagulants, and statins. A follow-up CT angiography one month later showed a patent stent with good distal blood flow, and the patient remained clinically well. Discussion: Iliac artery perforation, though rare, is a severe complication of peripheral angioplasty demanding prompt and effective intervention to avert mortality and morbidity. This case demonstrates successful management using a covered stent, emphasizing the necessity of meticulous pre-procedural planning and intraoperative vigilance. The report also highlights the value of intravascular imaging and advanced techniques for vascular bed preparation in minimizing the risk of such complications during angioplasty.