In Reply to: Case 997_01 -- Treatment of a right-sided peri-catheter thrombus during treatment of an occluded left common iliac artery posted by Editor on September 16, 1997 at 10:59:59:
1. Nothing in the history indicates that the left iliac occlusion was acute or subacute. Why use thrombolytics? Was there a hope to normalize the artery with thrombolytics? Any time an intraarterial catheter or sheath are inserted, time may work against you. In this case, addition of urokinase prolonged the procedure and increased the risk for pericatheter thrombosis.
2. Heparin rarely causes a hypercoagulable state (thrombocytopenia). Were the platelets checked?
3. Chosing the left common femoral approach for access and recanalization again prolonged the procedure.
4. I would have tried to recanalize the lesion from the right side and reconstructed it with Wallstents (like Scott). If things go smoothly it should be a relatively short procedure. We do not routinely give heparin for iliac angioplasty/stenting. We do put the patient on aspirin after the procedure.