When the bifurcation fights back

A 75-year-old woman with hypertension and dyslipidaemia presented with critical left limb ischaemia and severe left-sided claudication.

She had previously undergone left iliac artery stenting, followed by early in-stent thrombosis requiring repeat stenting.

A preoperative CT scan revealed recurrent thrombosis of the left iliac artery in the setting of an atheromatous aortic bifurcation.

With several possible strategies available, the anatomy and previous treatment history made the next step far from straightforward.

Hortense Chalret du Rieu

You must be logged in or create an account to see all the content

I have my account

Not registered yet? Create your account and get free access to:

Access slide presentations from PVI
Watch session videos and cases
Discuss cases with your peers
Register for and view PVI
Read a selection of articles
And more…

Create my account

Part I - Case presentation

Medical history

A 75-year-old woman with a history of hypertension and dyslipidaemia, but no known coronary or renal disease, and no history of smoking.

Her medical history also included hypothyroidism and rhizomelic pseudopolyarthritis.

In December 2025, she underwent left iliac artery stenting via a humeral approach at another centre. Within a few weeks, the treated segment thrombosed, requiring repeat iliac stenting.

She subsequently presented with critical left limb ischaemia and severe left-sided claudication.

Pre-operative CT scan

In-stent thrombosis of the left iliac artery