J Korean Soc Radiol.  2010 Dec;63(6):505-508.

Warfarin-induced Primary Dissection of Lower Peripheral Arteries: A Case Report

• Lee JA
• You HC
• Han YM
• Kwak HS

Abstract

Primary dissection of a peripheral artery without involvement of the aorta is a rare entity. Warfarin is currently used as the standard oral anticoagulant in a variety of clinical settings. We report here on a case of focal dissection of the common iliac artery and the superficial femoral artery following prophylactic treatment with warfarin for a prosthetic heart valve. The patient's laboratory results showed a high international normalized ratio and prolongation of the activated partial thromboplastin time. Angiography showed a dissection of the left common iliac artery and the right superficial femoral artery. His symptoms immediately disappeared after deploying stents to the arterial dissections.

MeSH Terms

Angiography
Aorta
Arteries
Femoral Artery
Heart Valves
Iliac Artery
International Normalized Ratio
Partial Thromboplastin Time
Stents
Warfarin
Warfarin

Figure

• 

  Fig. 1 A 48-year-old man with focal dissections of the left common iliac artery and right superficial femoral artery. A. The contrast-enhanced CT scan of the pelvis shows an intimal flap in the left common iliac artery (arrow). B. The pelvic angiogram shows dissection of the left common iliac artery with an intimal flap (arrow). C. Six-month later, the right lower arterial angiography showed a short-segmental dissection of the right superficial femoral artery (arrow). The patient's symptoms immediately disappeared after stent deployment.

Reference

1. Barker SG, Burnand KG. Retrograde iliac artery dissection in Marfan's syndrome. A case report. J Cardiovasc Surg (Torino). 1989; 30:953–995.

2. Cook PS, Erdoes LS, Selzer PM, Rivera FJ, Palmaz JC. Dissection of the external iliac artery in highly trained athletes. J Vasc Surg. 1995; 22:173–177.

3. Rahmani O, Gallagher JJ. Spontaneous superficial femoral artery dissection with distal embolization. Ann Vasc Surg. 2002; 16:358–362.

4. Massalha K, Goyen M, Rudofsky G. Stenosis-jet can cause a dissection of the superficial femoral artery. Vasa. 1999; 28:131–133.

5. Fitzmaurice DA, Blann AD, Lip GY. Bleeding risks of antithrombotic therapy. BMJ. 2002; 325:828–831.

6. Bauer KA. Coumarin-induced skin necrosis. Arch Dermatol. 1993; 129:766–768.

7. Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. The European Atrial Fibrillation Trial Study Group. N Engl J Med. 1995; 333:5–10.

8. Torn M, Van Der Meer FJ, Rosendaal FR. Lowering the intensity of oral anticoagulant therapy: effects on the risk of hemorrhage and thromboembolism. Arch Intern Med. 2004; 164:668–673.

9. Blunt DM, Impallomeni MG. Warfarin-associated thoracic aortic dissection in an elderly woman. Age Ageing. 2004; 33:199–201.

10. Lyden SP, Srivastava SD, Waldman DL, Green RM. Common iliac artery dissection after blunt trauma: case report of endovascular repair and literature review. J Trauma. 2001; 50:339–342.