Unrecognized Rupture of Angioplasty Balloon: A Hidden Underlying Reason for the Delayed Occlusion of the Graft

Abstract

Rupture of angioplasty balloons is a recognized complication of percutaneous transluminal angioplasty (PTA), occurring in approximately 5-10% of cases. If a rupture occurs, balloon fragments may embolize or cause thrombotic artery occlusion. Immediate recognition of a damaged balloon allows for prompt surgical or endovascular removal, depending on the patient’s condition and the location of the balloon inside the vessel. However, unrecognized balloon rupture with delayed symptoms is rare. We present a case of acute lower limb ischemia in a patient with a prior aortobifemoral reconstruction. Several years after an aortobifemoral bypass due to a failing right limb graft, endovascular graft treatment was performed. Eight years later, the patient required surgical treatment for acute ischemia, during which a piece of cup-shaped remnants from a ruptured balloon was found, with a confirmed circumferential balloon tear. Successful surgical extraction restored adequate inflow. The literature reports successful percutaneous retrieval of balloon fragments using techniques such as endoscopic biopsy forceps, grasping forceps, and subintimal angioplasty, but in our case, neither the rupture nor the balloon remnants were identified during the PTA procedure or on angiography eight years later. The retained fragment ultimately caused acute ischemia and limb graft occlusion, necessitating surgical intervention.

Keywords

• acute ischemia
• balloon rupture
• percutaneous transluminal angioplasty
• surgical retrieval