Arterial Rupture Without Balloon Rupture During Percutaneous Transluminal Angioplasty

A 58-year-old man with severe left lower extremity claudication and rest pain underwent percutaneous transluminal angioplasty. A high-pressure balloon was inflated in an area of severe atherosclerotic narrowing. The patient complained of severe pain during inflation and had a vasovagal response. After balloon deflation, angiography displayed extravasation just inferior to the lower edge of the balloon. Immediate inflation of the balloon tamponaded the leak and allowed the patient's transfer to the operating room in stable condition. It is hypothesized that the new high-pressure balloons can overcome resistance in nondistensible arterial walls, causing rupture without balloon rupture.