scholarly journals Novel use of intravascular lithotripsy for coral reef aorta: a case report

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Milan C Chag ◽  
Anuj A Thakre
Keyword(s):  
Coral Reef ◽  
Balloon Catheter ◽  
Renal Arteries ◽  
Uneventful Recovery ◽  
Infrarenal Aorta ◽  
Stent Grafts ◽  
Aortic Stent Graft ◽  
Effective Delivery ◽  
Bilateral Renal Artery ◽  
Renal Artery Stenoses

Abstract Background The coral reef aorta (CRA) is a rare disease of extreme calcification in the juxtarenal aorta. These heavily calcified exophytic plaques grow into the lumen and can cause significant stenoses, leading to visceral ischaemia, renovascular hypertension, and claudication. Surgery or percutaneous intervention with stenting carries a high risk of complications and mortality. Case summary A 67-year-old female had presented with severe hypertension and exercise limiting claudication for 18 months. On evaluation, she was found to have severe bilateral renal artery stenoses with juxtarenal CRA causing subtotal occlusion. Both renal arteries were stented. For CRA, we used intravascular lithotripsy (IVL) assisted plain balloon angioplasty to minimize possibilities of major dissection and perforation and avoided chimney stent-grafts required to protect visceral and renal arteries. We used a double-balloon technique using a 6 × 60 mm IVL Shockwave M5 catheter and a 9 × 30 mm simple peripheral balloon catheter, inflated simultaneously at the site of CRA as parallel, hugging balloons to have an effective delivery of IVL. Shockwaves were given in juxta/infrarenal aorta to have satisfactory dilatation without any complication. The gradient across aortic narrowing reduced from 80 to 4 mmHg. She had an uneventful recovery and has remained asymptomatic at 6-month follow-up. Discussion When CRA is juxtarenal with no safe landing zones for stent-grafts, IVL may be a safe, less complex and effective alternative to the use of juxtarenal aortic stent-graft with multiple chimney or snorkel stent-grafts. This is the first report of a novel use of IVL to treat CRA.

Aortoenteric Fistula Treated With Endovascular Aortic Stent-Graft and Bilateral Chimney Stent-Grafts to Renal Arteries

2012 ◽  
Vol 26 (3) ◽  
pp. 422.e13-422.e16 ◽  
Author(s):  
Glenn Wei Leong Tan ◽  
Daniel Wong ◽  
Sundeep Punamiya ◽  
Bien Peng Tan ◽  
Charles Vu ◽  
...  
Keyword(s):  
Stent Graft ◽  
Renal Arteries ◽  
Aortoenteric Fistula ◽  
Stent Grafts ◽  
Aortic Stent Graft

Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes

Vascular ◽  
2021 ◽  
pp. 170853812110232
Author(s):  
Peixian Gao ◽  
Changliang Li ◽  
Xuejun Wu ◽  
Gang Li ◽  
Dianning Dong ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Bare Metal Stents ◽  
Covered Stent ◽  
Occlusive Disease ◽  
Metal Stents ◽  
Infrarenal Aorta ◽  
Bare Metal ◽  
Stent Grafts ◽  
Aortoiliac Occlusive Disease

Purpose To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. Methods In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. Results A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( n = 7), kissing bare-metal stents ( n = 2), covered stent grafts ( n = 2), bare-metal stents ( n = 1), or the off-label use of iliac limb stent grafts ( n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1–54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan–Meier method. Conclusions Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.

scholarly journals Endovascular Aneurysm Sealing of a Collapsed and Thrombosed Aortic Stent-Graft With Renovisceral Chimney Stent-Grafts

2018 ◽  
Vol 26 (1) ◽  
pp. 72-75
Author(s):  
Fabien Lareyre ◽  
Claude Mialhe ◽  
Carine Dommerc ◽  
Juliette Raffort
Keyword(s):  
Stent Graft ◽  
Mesenteric Artery ◽  
Endovascular Aneurysm Repair ◽  
Stent Grafts ◽  
Aortic Thrombosis ◽  
Aortic Stent Graft ◽  
Aneurysm Repair ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To report the use of the Nellix endovascular aneurysm sealing (EVAS) system in the management of proximal stent-graft collapse associated with thrombosis following endovascular aneurysm repair (EVAR). Case Report: A 76-year-old man was admitted for proximal collapse of an aortic extension following bifurcated AFX stent-graft implantation associated with chimney grafts in both renal arteries and the superior mesenteric artery 1 month prior. Imaging identified thrombosis of the aortic stent-graft and the iliac limbs. A Nellix EVAS was placed into the AFX stent-graft to recanalize the aneurysm lumen and address the aortic thrombosis. There was no endoleak, and the renovisceral chimney stent-grafts remained patent over a follow-up of 25 months. Conclusion: While further studies are required to generalize its use, EVAS appears to be feasible in the management of aortic stent-graft collapse.

Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population

2021 ◽  
pp. 197140092110490
Author(s):  
Stavros Matsoukas ◽  
Devin Bageac ◽  
Kurt Yaeger ◽  
Alejandro Berenstein ◽  
Johanna T Fifi ◽  
...  
Keyword(s):  
Flow Control ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Balloon Catheter ◽  
Retrospective Chart Review ◽  
Endovascular Embolization ◽  
Uneventful Recovery ◽  
Initial Experience ◽  
Low Profile

Background Achieving distal access and flow control are of significant importance for the treatment of intracerebral arteriovenous shunting lesions. The Scepter Mini catheter is a low-profile, dual-lumen balloon catheter, designed to provide navigability in small-caliber, tortuous intracranial vessels. Objective To describe the initial experience of the Scepter Mini catheter in the treatment of pediatric arteriovenous malformations and fistulas. Methods A single-institution, retrospective chart review identified all consecutive uses of the Scepter Mini catheter for endovascular embolization of vascular malformations in the pediatric population. Results Three different arterial pedicles were embolized with the Scepter Mini catheter in two different patients. One patient was diagnosed with a vein of Galen malformation that had undergone multiple treatments and the other with a torcular dural arteriovenous fistula. All cases encompassed quite challenging tortuosity of small-caliber feeders which prevented the use of another microcatheter. The Scepter Mini catheter navigated into feeding arteries of diameters 0.65, 1.9, and 1.25 mm, and its balloon was inflated to achieve excellent blood flow control. Total obliteration (100%) of the shunting lesion was achieved in both cases. No reflux, pedicle rupture or other untoward effects were observed. Both patients had an uneventful recovery. Conclusion The Scepter Mini catheter afforded fast and safe distal access, flow control, and treatment of arteriovenous malformations in this initial pediatric cohort. The catheter’s low profile and easy navigability should support its use in tortuous and small arterial feeders, especially in the pediatric population.

scholarly journals Endovascular Treatment of Spontaneous and Isolated Infrarenal Acute Aortic Syndrome with Unibody Aortic Stent-Grafts

2020 ◽  
Vol 44 (12) ◽  
pp. 4267-4274
Author(s):  
Felice Pecoraro ◽  
Ettore Dinoto ◽  
Domenico Mirabella ◽  
Francesca Ferlito ◽  
Arduino Farina ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Graft ◽  
Abdominal Aorta ◽  
Infrarenal Aorta ◽  
Acute Aortic Syndrome ◽  
Technical Success ◽  
Stent Grafts ◽  
Femoral Access ◽  
Persistent Symptoms

Abstract Introduction Spontaneous acute aortic syndrome (IAAS) is rarely localized in the infrarenal aorta. The endovascular approach is preferred over conventional open surgery with fewer complications. However, dedicated endovascular devices for IAAS treatment are unavailable. The aim was to report a large single-center experience using unibody stent-grafts to address IAAS. Methods From April 2016 to March 2019, a retrospective analysis of patients presenting spontaneous and isolated IAAS was performed. Patients addressed with the unibody stent-graft (AFX endovascular AAA system; Endologix Inc., Irvine, CA) were included in the study. Indications to IAAS treatment were persistent symptoms and/or dilated abdominal aorta (>3 cm). The measured outcomes were technical success; early outcomes (<30 days) including mortality, morbidity, symptoms recurrence, and endoleak occurrence; and late outcomes (>30 days) including mortality, symptoms recurrence, endoleak occurrence, stent-graft patency, and survival. Median follow-up was 23.77 ± 10 months. Results Twenty-one patients with IAAS were included. Indications to treatment were symptoms in 14 (67%) patients and dilated abdominal aorta in 7 (33%). Technical success was achieved in all cases. No perioperative mortality and 1 (4.8%) early femoral access complication was encountered. During the follow-up were registered 1 (4.8%) aortic unrelated death and 1 (4.8%) stent-graft limb stenosis. The 36 months estimated survival and freedom from reintervention were 92% (CI: 37–43; SE: 1.7) and 94% (CI: 37–44; SE: 1.7), respectively. Conclusions The endovascular treatment of IAAS with unibody stent-graft (AFX endovascular AAA system; Endologix Inc.) is safe and effective with promising mid-term outcomes. The use of unibody stent-grafts expands the endovascular indication, despite the usual anatomic IAAS features. Larger studies with longer follow-up are required to validate the outcomes of the reported technique.

scholarly journals Secondary Aortic Dissection after Endoluminal Treatment of an Intramural Hematoma of the Thoracoabdominal Aorta: Endovascular Extension with Two Stent Grafts and Scarce Distal Landing

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Peter I. Kalmar ◽  
Peter Oberwalder ◽  
Peter Schedlbauer ◽  
Jürgen Steiner ◽  
Rupert H. Portugaller
Keyword(s):  
Vessel Wall ◽  
Interventional Procedures ◽  
Intramural Hematoma ◽  
Stent Grafts ◽  
Thoracoabdominal Aorta ◽  
Descending Aorta ◽  
Significant Challenge ◽  
Aortic Stent Graft ◽  
Endoluminal Treatment

Secondary dissection in the descending aorta after endovascular therapy may demand subsequent interventional procedures. This can set a particularly significant challenge for the endovascular specialist. When implanting an aortic prosthesis, a sufficient contact between the covered segment and the healthy vessel wall is advisable. However, our case shows that, in individual cases, it is indeed efficient to place an aortic stent graft on top of the distal end of the dissection. This is proven by a three-year follow-up CT-angiography.

Captopril-Induced Functional Renal Insufficiency in Patients with Bilateral Renal-Artery Stenoses or Renal-Artery Stenosis in a Solitary Kidney

1983 ◽  
Vol 308 (7) ◽  
pp. 373-376 ◽  
Author(s):  
Donald E. Hricik ◽  
Philip J. Browning ◽  
Richard Kopelman ◽  
Warren E. Goorno ◽  
Nicolaos E. Madias ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Solitary Kidney ◽  
Artery Stenosis ◽  
Bilateral Renal Artery ◽  
Renal Artery Stenoses

Segmental Arterial Mediolysis: Angioplasty of Bilateral Renal Artery Stenoses with 2-Year Imaging Follow-up

2004 ◽  
Vol 15 (7) ◽  
pp. 763-767 ◽  
Author(s):  
Michael C. Soulen ◽  
Debbie L. Cohen ◽  
Maxim Itkin ◽  
Raymond R. Townsend ◽  
David A. Roberts
Keyword(s):  
Renal Artery ◽  
Segmental Arterial Mediolysis ◽  
Bilateral Renal Artery ◽  
Renal Artery Stenoses

Phase-contrast MR angiography for detection of arteriosclerotic renal artery stenosis

1997 ◽  
Vol 38 (2) ◽  
pp. 287-291 ◽  
Author(s):  
S. H. Duda ◽  
F. Schick ◽  
F. Teufl ◽  
M. Müller-Schimpfle ◽  
C. Erley ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Phase Contrast ◽  
Mr Angiography ◽  
False Negative ◽  
False Negative Rate ◽  
Renal Arteries ◽  
Artery Stenosis ◽  
Renal Artery Stenoses

Purpose: to compare the accuracy of 3-D phase-contrast (PC) MR imaging with a 2-D time-of-flight (TOF) technique in the detection of arteriosclerotic renal artery stenosis. Material and Methods: Twenty-two patients with 28 angiographically proven renal artery stenoses were examined in a prospective blinded fashion by using 2-D TOF MR angiography (MRA) with venous saturation (FLASH) and 3-D PC MRA. the renal arteries were subdivided into 3 segments and graded for the presence of stenoses on a scale of 0–4 by 3 radiologists in blind. Results: the accuracy of TOF and PC imaging in detecting renal artery stenoses was 65% and 77% respectively. Both 2-D TOF and 3-D PC MRA depicted 84% of the stenoses of the proximal renal artery greater than 50% in diameter. Renal artery stenoses greater than 50% and more than 15 mm in distance from the aorta were detected in 40% of cases with the 2-D TOF sequence and in 76% with the 3-D PC technique (p<0.05). the rate of false-negative results was 32%. Conclusion: PC MRA is better at visualizing stenoses in the middle segment of the renal arteries and supplements conventional TOF techniques with additional information. However, even when the two techniques are combined, the false-negative rate in the MR imaging of stenoses of the renal arteries still needs to be reduced.

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