scholarly journals 138 Endovascular Hepatic Artery Stents in The Modern Management of Post-Pancreatectomy Haemorrhage

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L M Finch ◽  
M Baltatzis ◽  
S Byott ◽  
A K Ganapathy ◽  
N Kakani ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Stent Placement ◽  
International Study ◽  
Graft Occlusion ◽  
Bleeding Events ◽  
Stent Deployment ◽  
Arterial Inflow ◽  
Pancreatic Fistulas ◽  
Endovascular Stent Placement

Abstract Aim Post-operative haemorrhage is a potentially lethal complication of pancreatoduodenectomy. This study reports on endovascular hepatic artery stents in the management of post-pancreatectomy haemorrhage. Method This is a retrospective analysis of a prospectively maintained, consecutive dataset of 440 patients undergoing pancreatoduodenectomy over 68 months. Data are presented on bleeding events and outcome, contextualized by the clinical course of the denominator population. International Study Group for Pancreas Surgery (ISGPS) terminology was used for post-pancreatectomy haemorrhage. Results Sixty-seven (15%) had post-operative haemorrhage. Fifty (75%) were male and this gender difference was significant (P = 0.001; two-proportions test). Post-operative pancreatic fistulas were more frequent in the post-operative haemorrhage group (P = 0.029; two-proportions test). The median (IQR) delay between surgery and haemorrhage was 5 (2-14) days. Twenty-six required intervention comprising re-operation alone in 12, embolization alone in 5 and endovascular hepatic artery stent deployment in 5. Four further patients underwent multiple interventions with two having stents. Endovascular stent placement achieved initial haemostasis in 5 (72%). Follow-up was for a median (IQR) of 199 (145-400) days post-stent placement. In two patients the stent remained patent at last follow-up. The remaining 5 stents occluded with a median (IQR) period of proven patency of 10 (8-22) days. Conclusions This study shows that in the specific setting of post-pancreatoduodenectomy haemorrhage with either a short remnant GDA bleed or a direct bleed from the hepatic artery, where embolization risks occlusion with compromise of liver arterial inflow, endovascular hepatic artery stent is an important haemostatic option but is associated with a high risk of subsequent graft occlusion.

Endovascular Stent Placement in Patients With Hepatic Artery Stenoses or Thromboses After Liver Transplant

2008 ◽  
Vol 40 (1) ◽  
pp. 22-26 ◽  
Author(s):  
F. Boyvat ◽  
C. Aytekin ◽  
A. Harman ◽  
Ş. Sevmiş ◽  
H. Karakayali ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Hepatic Artery ◽  
Stent Placement ◽  
Endovascular Stent ◽  
Endovascular Stent Placement

Abstract WMP46: Rotational Ischemic Vertebral Artery Compression (RIVAC) Syndrome Due to Cervical Facet Hypertrophy and Uncinate Process Osteophyte: Review of Seven Consecutive Cases

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Stanley H Kim ◽  
Nathan Dhablania ◽  
Joshua Kim ◽  
Rishabh Gulati ◽  
Jefferson Miley ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Uncinate Process ◽  
Surgical Decompression ◽  
Imaging Method ◽  
Endovascular Stent ◽  
Cerebral Angiogram ◽  
Endovascular Stent Placement ◽  
Vertebral Artery Compression

Introduction: The authors propose a new terminology, Rotational Ischemic Vertebral Artery Compression (RIVAC) syndrome, to describe patients who present with TIA or stroke from compression of the cervical vertebral artery (VA) below C2 by facet hypertrophy or uncinate process osteophyte associated with rotation of the head. The authors review clinical presentation, radiological findings, and management of 7 consecutive cases. Methods: Prospective analysis of 7 consecutive cases of RIVAC syndrome was performed between 2004 and 2012. We reviewed peri-operative imaging, method of treatment, and clinical and angiographic outcome. Results: A total of 6 patients (mean 66+/- 4 years) presented with stroke (N=2) or TIA including reproducible dizziness, vertigo, or syncope (N=4) associated with rotation of the head. Pre-operative dynamic cerebral angiogram showed near complete occlusion of cervical VA (N=2) or severe stenosis (60 to 80%) (N=5) during rotation of the head. The location of cervical VA compression was as follows: right C3-4 (N=1), left C4-5 (N=3), left C5-6 (N=2) and left C6-7 (N=1). Treatment included endovascular stent placement of VA without open surgery (N=1), endovascular stent placement of VA followed by partial left C5-6 factectomy 2 years later (N=1), posterior surgical decompression of VA along with bilateral facet screw fixation (N=4), and anterior cervical discectomy and fusion (N=1). Follow up dynamic cerebral angiograms and CTA angiogram of neck (6 months to 3 years) showed resolution of VA compression on rotation of head in all patients except for one who had lost in follow up. Clinical evaluation (range of 1 to 48 months) showed no recurrent stroke or TIA in all patients (mRS score of 0, N=6 and mRS of 3, N=1). Conclusion: RIVAC syndrome should be recognized as an important cause of posterior circulation TIA or stroke associated with rotation of head. Pre-operative dynamic cerebral angiogram and CT angiogram of neck are essential in localization and characterization of the level and cause of VA compression. Open surgical decompression and fixation appears to be safe and effective treatment of patients with RIVAC syndrome.

scholarly journals Vertebral Dissecting Aneurysm Treated with Wingspan Stent Deployment and Detachable Coils

2009 ◽  
Vol 15 (1) ◽  
pp. 113-116 ◽  
Author(s):  
M. Lv ◽  
X. Lv ◽  
Y. Li ◽  
X. Yang ◽  
Z. Wu
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Stent Placement ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Stent Deployment ◽  
Detachable Coils

We describe the first documented endovascular treatment of vertebral dissecting aneurysm using a Wingspan stent and detachable coils. A 54-year-old man presented with a nonruptured vertebral dissecting aneurysm. Because of the dissecting nature of the vertebral aneurysms, a 3×15-mm Wingspan stent was placed in the left vertebral artery. One month later, several detachable coils were introduced into the aneurysm. Six-month follow-up angiogram confirmed the obliteration. Vertebral dissecting aneurysm can be treated with Wingspan stent placement and detachable coils.

Stent placement for the treatment of a symptomatic intracranial arterial dissection in an adolescent

2010 ◽  
Vol 6 (2) ◽  
pp. 154-158 ◽  
Author(s):  
Mandy J. Binning ◽  
Alexander A. Khalessi ◽  
Adnan H. Siddiqui ◽  
L. Nelson Hopkins ◽  
Elad I. Levy
Keyword(s):  
Stent Placement ◽  
Internal Carotid ◽  
Ct Perfusion ◽  
Treatment Options ◽  
Young Patients ◽  
Arterial Dissection ◽  
Stroke Study ◽  
Endovascular Stent Placement ◽  
Stroke In Young

Intracranial arterial dissection is an important cause of stroke in young patients. Treatment options include observation, antiplatelet or anticoagulation regimens, and endovascular stent placement. The authors describe the case of a 14-year-old boy who presented with a symptomatic, posttraumatic dissection extending from the intracranial internal carotid artery to the middle cerebral artery. Images obtained approximately 48 hours after this incident revealed a subacute right frontal lobe infarct, and a CT stroke study (CT angiography and CT perfusion) confirmed the vascular injury and associated decreased perfusion, prompting revascularization with a self-expanding stent. The patient did well clinically after stent placement and showed no evidence of restenosis on follow-up angiography 3 and 6 months later. This report is, to the authors' knowledge, the first description of the use of a stent for a symptomatic intracranial dissection in an adolescent.

scholarly journals Primary Stenting for Recurrent Stenosis Following Carotid Endarterectomy

2009 ◽  
Vol 36 (03) ◽  
pp. 332-335 ◽  
Author(s):  
Miguel Bussière ◽  
David M. Pelz ◽  
Stephen P. Lownie
Keyword(s):  
Carotid Endarterectomy ◽  
Effective Treatment ◽  
Stent Placement ◽  
Peak Systolic Velocity ◽  
Internal Carotid Artery Stenosis ◽  
Stent Deployment ◽  
Primary Stenting ◽  
One Year ◽  
Angioplasty And Stenting

Abstract:Background:Carotid angioplasty and stenting is an accepted alternative treatment for severe restenosis following carotid endarterectomy. Balloons may not be required to effectively treat these lesions, given their altered histopathology compared to primary atherosclerotic plaque and tendency to be less calcified. Primary stenting using self-expanding stents alone may, therefore, be a safe and effective treatment for restenosis post-carotid endarterectomy.Methods:We review our experience in the treatment of 12 patients with symptomatic severe restenosis following carotid endarterectomy with primary stent placement alone.Results:Self-expanding stent placement alone reduced the mean internal carotid artery stenosis from 85% to 29%. Average peak systolic velocity determined at the time of ultrasonography decreased from 480 cm/s at initial presentation to 154 cm/s post-stent deployment and further decreased to 104 cm/s at one year follow-up. The stented arteries remained widely patent with no evidence of restenosis. A single peri-procedural ipsilateral transient ischemic event occurred. There were no cerebral or cardiac ischemic events recorded at one year of follow-up.Conclusions:In this series, primary stent placement without use of angioplasty balloons was a safe and effective treatment for symptomatic restenosis following carotid endarterectomy.

Primary conservative treatment for peritonitis-absent symptomatic isolated dissection of the superior mesenteric artery with severely compressed true lumen

Vascular ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 132-141 ◽  
Author(s):  
Gang Fang ◽  
Genying Xu ◽  
Yuan Fang ◽  
Jue Yang ◽  
Tianyue Pan ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Medical Treatment ◽  
Stent Placement ◽  
Mesenteric Artery ◽  
Treatment Algorithm ◽  
Endovascular Stent ◽  
True Lumen ◽  
The Mean ◽  
Endovascular Stent Placement

Objectives The purpose of this study was to evaluate the safety and efficacy of primary conservative treatment (PCT) for peritonitis-absent symptomatic spontaneous isolated dissection of the superior mesenteric artery (S-SIDSMA) with severely compressed true lumen. Methods From January 2013 to December 2018, PCT was used in 26 cases of peritonitis-absent S-SIDSMA with severely compressed true lumen in our center based on our previous proposed treatment algorithm for S-SIDSMA. The demographics, duration from the onset to the admission, duration from the start of the conservative treatment to the alleviation of the symptoms, and in-hospital and follow-up clinical and angiographic outcomes were prospectively recorded and then analyzed. Results Among the 26 included patients, 84.6% were male. The mean age of the patients was 54.7 years. The mean duration from the onset to the admission was 3.1 days (range, 1–14 days). Symptoms in 22 patients were markedly or completely relieved during the first five-day medical treatment. Endovascular stent placement was attempted in the remaining four patients, which was successfully performed in three (75%) of them. The technical failure occurred in a patient whose compressed true lumen failed to be cannulated. Medical treatment was then continued in this patient, and his symptoms were relieved after a two-day medical treatment. During the mean follow-up period of 14.3 months, endovascular stent placement was performed in three patients due to the recurrence of the abdominal pain and the chronic intestinal ischemia. No patient showed dissection progression during the follow-up. The complete remodeling rate of the stent group was significantly higher than that of the medical group (83.3% vs. 25%, P = 0.021). Conclusions Based on our previous proposed treatment algorithm for S-SIDSMA, PCT could achieve satisfactory results both clinically and morphologically in peritonitis-absent S-SIDSMA with severely compressed true lumen.

scholarly journals Stent Graft Placement by Pseudoaneurysm of the Hepatic Arteries: Efficacy and Patency Rate in Follow-up

2021 ◽  
Author(s):  
F. Pedersoli ◽  
V. Van den Bosch ◽  
P. Sieben ◽  
E. Barzakova ◽  
M. Schulze-Hagen ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Stent Graft ◽  
Graft Occlusion ◽  
Technical Success ◽  
Short Term ◽  
Stent Occlusion ◽  
Stent Graft Implantation ◽  
Graft Implantation

Abstract Purpose To investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm. Materials and Methods A retrospective analysis of patients who had undergone endovascular treatment of hepatic artery pseudoaneurysms between 2011 and 2020 was performed. Medical records were examined to obtain patients’ surgical histories and to screen for active bleeding. Angiographic data on vascular access, target vessel, material used and technical success, defined as the exclusion of the pseudoaneurysm by means of a stent graft with sufficient control of bleeding, were collected. Vessel patency at follow-up CT was analyzed and classified as short-term (< 6 weeks), mid-term (between 6 weeks and 1 year), and long-term patency (> 1 year). In case of stent occlusion, collateralization and signs of hepatic hypoperfusion were examined. Results In total, 30 patients were included and of these, 25 and 5 had undergone stent graft implantation and coiling, respectively. In patients with implanted stent grafts, technical success was achieved in 23/25 patients (92%). Follow-up CT scans were available in 16 patients, showing stent graft patency in 9/16 patients (56%). Short-term, mid-term, and long-term short-term stent patency was found in 81% (13/16), 40% (4/10), and 50% (2/4). In patients with stent graft occlusion, 86% (6/7) exhibited maintenance of arterial liver perfusion via collaterals and 14% (1/7) exhibited liver abscess during follow-up. Conclusion Stent graft provides an effective treatment for hepatic artery pseudoaneurysms. Even though patency rates decreased as a function of time, stent occlusion was mainly asymptomatic due to sufficient collateralization.

Endovascular repair of subclavian artery aneurysms: results from a single-center experience

Perfusion ◽  
2017 ◽  
Vol 32 (8) ◽  
pp. 670-674 ◽  
Author(s):  
XiXiang Gao ◽  
LiQiang Li ◽  
YongQuan Gu ◽  
LianRui Guo ◽  
ShiJun Cui ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Treatment Outcomes ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Endovascular Repair ◽  
Stent Placement ◽  
Imaging Findings ◽  
Endovascular Stent ◽  
Endovascular Stent Placement

Objective: To present our experience of the endovascular treatment of subclavian artery aneurysms (SAAs) and analyze the clinical manifestations, imaging findings and treatment outcomes. Methods: In this retrospective study, nine patients with SAAs underwent endovascular stent placement in our center between July 2011 and June 2016. Clinical features, imaging findings, treatment outcomes and follow-up results of these SAA patients were retrospectively analyzed. Results: Nine patients were diagnosed with SAAs by computer tomography angiography (CTA). Five patients underwent percutaneous endovascular stent placement in the subclavian artery. Three patients underwent endovascular repair of the SAAs with coil embolization and stent graft. One patient underwent stent graft implantation by the simultaneous kissing stent technique. Five patients had their symptoms relieved and thrombosis occurred in one case. The mean follow-up period was 17 months, ranging from 8 to 40 months. Conclusion: For patients with SAAs, endovascular treatment is a feasible choice, with a high success rate, few complications and good clinical outcomes.

Sign in / Sign up

Export Citation Format

Share Document