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.

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.

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.

Endovascular Repair of Three Concurrent Mycotic Pseudoaneurysms

2018 ◽  
Vol 52 (6) ◽  
pp. 473-477 ◽  
Author(s):  
Megumi Asai ◽  
Olivier Van Houtte ◽  
Terry R. Sullivan ◽  
Mauricio Garrido ◽  
Danielle M. Pineda
Keyword(s):  
High Risk ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Endovascular Repair ◽  
Endovascular Stent ◽  
Descending Thoracic Aorta ◽  
Endovascular Stent Graft ◽  
Mycotic Pseudoaneurysm ◽  
Risk Patients ◽  
The Right

Introduction: Mycotic pseudoaneurysm has traditionally been repaired surgically with excision of the infected artery and revascularization via extra-anatomical or in situ bypass. There have been reports of endovascular repair for high-risk patients for formal surgical repair. We present a case of a patient with 3 large pseudoaneurysms arising from the right subclavian artery, descending thoracic aorta, and right popliteal artery treated with endovascular and hybrid intervention. Case: A 74-year-old male with remote history of coronary artery bypass graft and recent sternoclavicular joint abscess developed 3 concurrent pseudoaneurysms arising from the right subclavian artery, distal descending thoracic aorta, and right popliteal artery. He underwent right axillary to common carotid bypass with endovascular stent graft placement in the distal innominate and proximal subclavian artery, and subsequently had thoracic endovascular aortic repair and right popliteal stent graft. Four months later, he presented with hemoptysis due to compression of the lung secondary to the pseudoaneurysm. He underwent right anterior thoracotomy and debridement of the pseudoaneurysm. Patient recovered from the procedure and discharged. Conclusion: Endovascular repair of mycotic pseudoaneurysm is an acceptable alternative for high-risk patients. Even when open approach became necessarily, endovascular stent graft decreased blood loss and morbidity.

scholarly journals Endovascular Treatment of Extracranial Internal Carotid Pseudoaneurysm: Description of Three Cases

2016 ◽  
Vol 02 (02) ◽  
pp. e15-e18 ◽  
Author(s):  
Andrea Giorgianni ◽  
Carlo Pellegrino ◽  
Camilla Micieli ◽  
Anna Mercuri ◽  
Renzo Minotto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Surgical Approach ◽  
Stent Placement ◽  
Internal Carotid ◽  
Carotid Dissection ◽  
Endovascular Stent ◽  
Artery Pseudoaneurysm ◽  
Endovascular Stent Placement

The aim of this study is to explore the possibility of endovascular treatment of internal carotid artery pseudoaneurysm (PSA). These lesions are difficult to treat with a surgical approach, especially if they are located extracranially and close to the skull base. Endovascular stent placement in symptomatic and unstable extracranial internal carotid PSA was found to be safe and effective. Depending on hemodynamic aspects, complete local exclusion of aneurysmal formation is achieved in few months. We present three patients with carotid dissection and PSA formation that have been successfully treated by stent placement.

Carotid Artery Pseudoaneurysm after Endovascular Stent Placement: Diagnosis and Follow-up Duplex Ultrasonography

2005 ◽  
Vol 29 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Wei Zhou ◽  
Ruth L. Bush ◽  
Peter H. Lin ◽  
Megan D. Hodge ◽  
Deborah D. Felkai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Graft ◽  
Stent Placement ◽  
Duplex Ultrasound ◽  
Carotid Bifurcation ◽  
Carotid Stenting ◽  
Duplex Scan ◽  
Artery Pseudoaneurysm ◽  
Endovascular Stent Placement

Purpose Carotid artery pseudoaneurysm development after endarterectomy, albeit rare, has been attributed to patch deterioration. We present an unusual case of pseudoaneurysm development 1 year after stent placement for recurrent carotid artery stenosis. Case Report A 64-year-old man had transient hemiparesis develop 1 week after carotid artery endarterectomy (CEA) with patch angioplasty for monocular transient ischemic attack. Carotid angiography reviewed an intimal flap at the distal endarterectomy site, which was successfully treated with carotid stent placement. During a duplex scan 1 year later, he was found to have a symptomatic 2.5-cm pseudoaneurysm at the level of stented carotid bifurcation. This was successfully treated with a combined open and endovascular approach, which consisted of stent-graft placement by means of an open carotid exposure. Completion angiogram showed successful stent-graft exclusion of the pseudoaneurysm. A follow-up duplex scan 6 months later demonstrated diminution of pseudoaneurysm size without endoleak. Conclusion This report highlights the importance of duplex ultrasound surveillance in patients with CEA or carotid stenting, because it can accurately detect recurrent stenosis or carotid pseudoaneurysm. Moreover, a combined open and endovascular therapy using stent graft successfully treated the carotid pseudoaneurysm in our patient.

Double region of interest timing bolus technique following endovascular aortic repair: Short-term prognosis analysis

Vascular ◽  
2019 ◽  
Vol 28 (3) ◽  
pp. 233-240
Author(s):  
Nobuo Tomizawa ◽  
Shingo Ito ◽  
Tastuya Nakao ◽  
Hiroaki Arakawa ◽  
Kodai Yamamoto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Stent Placement ◽  
Region Of Interest ◽  
Good Prognosis ◽  
Endovascular Stent ◽  
Kaplan Meier ◽  
Scan Speed ◽  
The Mean ◽  
Endovascular Stent Placement

Objectives To compare the incidence rate of reintervention in patients with and without complication findings at aortic computed tomography using double region of interest timing bolus (DRTB) method after endovascular stent placement of the aorta. Methods We included 40 patients who underwent computed tomography of the aorta using DRTB method after endovascular stent placement. DRTB method allows to scan the aorta with a short injection time of 9 s by synchronizing the scan speed to the aortic flow. Complication findings at computed tomography were defined as endoleak, rupture, occlusion, and infection. The primary endpoint was reintervention, which was defined as any of the following three events: conversion to open repair, graft revision, or secondary intervention. Results The mean contrast medium during computed tomography angiography was 38.6 ± 3.9 mL. Complication findings at computed tomography were present in 10 patients (25%): endoleak ( n = 9) and infection ( n = 1). During a median follow-up of 7 months (interquartile range, 4–11 months), two patients experienced reintervention. Kaplan–Meier curves by complication findings showed that event rate at 6 months was significantly higher in patients with complication findings than in patients without (20% vs 0%, p =  0.01). No patients without complication findings at computed tomography experienced reintervention. Conclusions No complication findings at computed tomography after intervention of the aorta resulted in good prognosis in patients who underwent aortic computed tomography using DRTB method.

Long-term Follow-up after Endovascular Stent Placement for Treatment of Nutcracker Syndrome

2005 ◽  
Vol 16 (3) ◽  
pp. 428-431 ◽  
Author(s):  
Soo Jin Kim ◽  
Chang Won Kim ◽  
Suk Kim ◽  
Tae Hong Lee ◽  
Jun Woo Lee ◽  
...  
Keyword(s):  
Stent Placement ◽  
Nutcracker Syndrome ◽  
Endovascular Stent ◽  
Long Term Follow Up ◽  
Endovascular Stent Placement

scholarly journals Endovascular repair of de novo post-stenotic aortic coarctation aneurysms with complex collateral supply: two cases with long and medium term follow-up

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Omar Abdel-Hadi ◽  
John Thomson ◽  
Simon J. McPherson
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Coarctation ◽  
De Novo ◽  
Aortic Aneurysms ◽  
Medium Term ◽  
First Case ◽  
Case Presentations ◽  
Selective Embolisation

Abstract Purpose To report the technical details and outcomes of the endovascular repair of two cases of de novo post-stenotic aortic coarctation aneurysms complicated by complex collateral supply. Case presentations Two patients with thoracic aortic aneurysms complicated by complex aneurysm sac collaterals distal to a previously untreated thoracic aortic coarctation have been treated at our institution. Open surgical intervention was deemed to carry a high risk of haemorrhage due to the degree and complexity of arterial collateralisation. In the first case, selective embolisation of collateral vasculature was performed prior to successful exclusion of the aneurysm with a thoracic endovascular stent-graft and then balloon-expandable stent dilatation of the coarctation stenosis. In the second case, the additional technique of using a jailed sheath within the aneurysm sac allowed for selective embolisation of previously inconspicuous collaterals after deployment of the stent-graft and stent combination. Results Technical success was achieved in both patients with successful occlusion of the aneurysm, with no recorded complications or aneurysm sac perfusion in the long and medium term follow up periods respectively. Conclusion De novo post stenotic aortic coarctation aneurysms are rare. Endovascular repair is a safe and durable technique that provides a less invasive alternative to open surgical repair. The use of a jailed sheath allows for complete selective embolisation of complex collaterals avoiding a type II aneurysm endoleak.

Complications after Endovascular Repair of Type B Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Reinhard S. Pamler ◽  
Thomas Kotsis ◽  
Johannes Görich ◽  
Xaver Kapfer ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.

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