318 Unmasking Unusual Penile Complications in External Iliac Artery Stenting

Introduction Distal embolisation following percutaneous transluminal angioplasty (PTA) is a recognised complication, occurring in 7.9%-23.7% of procedures. Whilst ischaemic complications have been reported following internal iliac artery embolisation, most commonly causing buttock claudication and erectile dysfunction, distal embolisation into the internal pudendal artery has been scarcely reported. Case Report A 65-year-old diabetic smoker attended for elective bilateral external iliac artery (EIA) stenting for chronic limb threatening ischaemia via retrograde left femoral approach. Pre-procedural CT demonstrated lining thrombus at the aortic bifurcation and the left common iliac artery (CIA). Following discharge, they attended the emergency department with a painful necrotic lesion on the left posterior side of the scrotum, which was excised by the urology team with sections showing necrotic and acutely inflamed tissue. A painful, necrotic lesion had also developed on the left side of the glans penis which was treated conservatively. Discussion The posterior scrotum and penis are supplied by the internal pudendal artery, a terminal branch of the anterior division of the internal iliac artery (IIA). This patient embolised from their left CIA and aortic bifurcation lining thrombus into the left internal pudendal artery resulting in ischaemic ulceration of the penis and scrotum. The scrotal tissue has healed completely, whereas the penile wound is still healing 6 months later. Conclusions Internal pudendal artery embolus following iliac PTA is a rare, but important, complication which can lead to significant distress for patients. Education and councelling of these risks to patients could lead to earlier recognition, treatment, and better desired outcomes.