Guide wire perforation leading to fatal perirenal hemorrhage from transcortical collaterals after renal artery stent placement.

After successful renal artery angioplasty and stent placement, a patient in a fully anticoagulated state developed hypotension and flank pain. Review of the intraprocedural angiogram demonstrated transcortical position of the guide wire. Computed tomography of the abdomen revealed a large perinephric hematoma.

Endovascular therapy for atherosclerotic occlusion and stenosis from the infrarenal aorta to the infrapopliteal arteries.

Aortoiliac and peripheral vascular disease that cannot be treated medically is generally treated by vascular surgeons and/or interventional radiologists. Advances in technology have allowed endovascular therapy to become a therapeutic option for atherosclerotic disease from the aorta to the femoropopliteal region. Distal peripheral disease is still approached surgically; however, further technological advances may lead to a more active role for endovascular therapy at this level.