Covered Stents for True Subclavian Aneurysms in Patients with Degenerative Connective Tissue Disorders

Purpose: To report the endovascular repair of rare true aneurysms of the subclavian artery in patients with degenerative connective tissue disorders. Case Reports: Two patients, one with Marfan syndrome and the other with idiopathic cystic medial necrosis, presented with 3 subclavian artery aneurysms. A Wallgraft and 2 Viabahn covered stents were used to successfully exclude these aneurysms. After 3 months, the Wallgraft thrombosed, but the contralateral Viabahn remained patent at the most recent examination 13 months after treatment. The other patient with the unilateral aneurysm had a patent Viabahn stent-graft at 10 months. Conclusions: Patients with degenerative connective tissue disorders may benefit from less invasive treatment with stent-grafts. The more flexible Viabahn stent-graft may be better able to adapt to arterial tortuosity. However, the long-term results of this new technique have not yet been established.

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Elective and Emergent Endovascular Treatment of Subclavian Artery Aneurysms and Injuries

Journal of Endovascular Therapy ◽

10.1177/152660280301000113 ◽

2003 ◽

Vol 10 (1) ◽

pp. 58-65 ◽

Cited By ~ 29

Author(s):

Maria Schoder ◽

Manfred Cejna ◽

Thomas Hölzenbein ◽

Georg Bischof ◽

Fritz Lomoschitz ◽

...

Keyword(s):

Stent Graft ◽

Subclavian Artery ◽

Artery Aneurysm ◽

Graft Patency ◽

Long Term Results ◽

Stent Grafts ◽

Central Venous ◽

Luminal Narrowing

Purpose: To demonstrate our short and long-term results after transbrachial treatment of subclavian artery aneurysms and injuries with stent-grafts in elective and emergency settings. Methods: Ten of 12 consecutive patients (6 men; mean age 63.8 years, range 38–80) were treated electively with commercially prepared endografts delivered via a transbrachial access to repair a subclavian artery aneurysm (n = 3) or an injury from a misplaced central venous catheter (n = 7). Two patients required emergency treatment for a ruptured atherosclerotic aneurysm in one and an unintentional arterial puncture during placement of a central venous access in the other. Stent-graft patency during follow-up was assessed by physical examination with comparison of brachial blood pressures in all patients; computed tomography angiography (CTA) was performed in available patients. Results: Successful deployment of stent-grafts with sealing of the lesion was achieved in all cases. There were 2 (17%) procedural complications. One patient developed an access-site hematoma that required surgical revision. The second patient, who had a right subclavian injury, suffered an embolic cerebral infarction. The primary stent-graft patency during follow-up (mean 11.6 months) was 100%. CTA examinations in 7 patients at a mean 18 months showed strut dislocation at the thoracic outlet without luminal narrowing in 1 patient. A 50% intraluminal narrowing due to compression between the clavicle and the first rib occurred in another patient. Six patients with a mean follow-up of 23 months (range 0.3–4.5 years) are still alive with patent stent-grafts. Conclusions: Endovascular stent-graft treatment of subclavian artery aneurysms and injuries is a less invasive alternative to surgical repair. Long-term results must still be confirmed in further studies.

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Regarding “Long-term results of stent graft treatment of subclavian artery injuries: Management of choice for stable patients?”

Journal of Vascular Surgery ◽

10.1016/j.jvs.2008.07.091 ◽

2009 ◽

Vol 49 (1) ◽

pp. 279 ◽

Cited By ~ 1

Author(s):

Douglas C. Smith ◽

Brad Carlson

Keyword(s):

Stent Graft ◽

Subclavian Artery ◽

Long Term Results

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Uncommon Connective Tissue Disorders in Childhood

Scottish Medical Journal ◽

10.1177/003693307401900202 ◽

1974 ◽

Vol 19 (2) ◽

pp. 65-75 ◽

Cited By ~ 1

Author(s):

K. M. Goel ◽

R. A. Shanks

Keyword(s):

Systemic Lupus Erythematosus ◽

Renal Failure ◽

Connective Tissue ◽

Lupus Erythematosus ◽

Placental Transfer ◽

Progressive Systemic Sclerosis ◽

The Other ◽

Connective Tissue Disorders ◽

Systemic Lupus ◽

Lupus Syndrome

Nineteen cases of the rarer connective tissue disorders diagnosed between 1948 and 1972 have been reviewed. Of these 6 were of systemic lupus erythematosus (SLE), 3 of dermatomyositis and 5 each of progressive systemic sclerosis (PSS) and polyarteritis nodosa (PAN). Of the 6 cases of SLE, 4 were of true SLE, one of ethosuximide induced lupus syndrome and one newborn with placental transfer of lupus erythematosus factor. Three cases of true SLE died of renal failure. None of the patients with dermatomyositis or PSS died. Of the 5 cases of PAN, 2 died and one could not be traced. The disease is quiescent in the other two.

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Covered Stents for True Subclavian Aneurysms in Patients With Degenerative Connective Tissue Disorders

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2003)010<0647:csftsa>2.0.co;2 ◽

2003 ◽

Vol 10 (3) ◽

pp. 647-652 ◽

Cited By ~ 13

Author(s):

Karthikeshwar Kasirajan ◽

Brian Matteson ◽

John M. Marek ◽

Mark Langsfeld

Keyword(s):

Connective Tissue ◽

Covered Stents ◽

Connective Tissue Disorders

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Intentional Left Subclavian Artery Occlusion by Thoracic Aortic Stent-Grafts without Surgical Transposition

Journal of Endovascular Therapy ◽

10.1177/152660280100800508 ◽

2001 ◽

Vol 8 (5) ◽

pp. 472-476 ◽

Cited By ~ 62

Author(s):

Klaus A. Hausegger ◽

Peter Oberwalder ◽

Kurt Tiesenhausen ◽

Josef Tauss ◽

Olaf Stanger ◽

...

Keyword(s):

Stent Graft ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Case Reports ◽

Artery Occlusion ◽

Left Vertebral Artery ◽

Stent Grafts ◽

Subclavian Artery Occlusion ◽

Limited Experience ◽

Type B Dissection

Purpose: To report the consequences of endoluminal deployment of stent-grafts in the thoracic aorta with intentional occlusion of the left subclavian artery. Case Reports: Three patients with an aortic type-B dissection and 1 with a thoracic aneurysm were treated endoluminally with Talent stent-grafts implanted over the ostium of the left subclavian artery without prior surgical subclavian-carotid transposition. The primary intimal tears were sealed and the degenerative aneurysm excluded; blood pressure in the left arm was significantly diminished immediately after the stent-graft was released, but adequate collateral retrograde perfusion via the left vertebral artery was apparent in all patients. No neurological deficit and no symptoms of left arm ischemia were observed in a follow-up that ranged from 14 to 20 months. Conclusions: Our limited experience shows that occlusion of the left subclavian artery with a stent-graft is well tolerated. If ischemic symptoms occur, a transposition procedure can be performed on an elective basis.

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Thoracic Aortic Stent Grafting in Patients with Connective Tissue Disorders: A Word of Caution

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31815887e0 ◽

2007 ◽

Vol 2 (4) ◽

pp. 184-187 ◽

Cited By ~ 3

Author(s):

Siamak Mohammadi ◽

Jean-Pierre Normand ◽

Pierre Voisine ◽

François Dagenais

Keyword(s):

Connective Tissue ◽

Stent Graft ◽

Balloon Dilatation ◽

False Aneurysm ◽

Type I ◽

Connective Tissue Disorders ◽

Stent Grafts ◽

Descending Aorta ◽

Stent Grafting ◽

Marfan Patient

Objective Use of thoracic Stent-graft in patients with connective tissue disorders (CTD) remains limited. We herein report 3 patients with CTD who underwent stent grafting. Methods and Results Case 1; A male Marfan patient was operated for thoraco-abdominal aneurysm. On computed tomography (CT), large false aneurysm at the proximal anastomosis was documented which was excluded with a 30 mm Talent stent-graft with 10–15% oversize. Case 2; A female with Ehlers-Danlos syndrome had undergone resection of descending aortic thoracic aneurysm presented with an enlarging aneurysm distal to the graft. Three Talent stent-grafts (15% oversize) were deployed with balloon dilatation to exclude the aneurysm. The immediate postoperative period was complicated by an extensive intramural hematoma of the descending aorta with hemothorax, managed conservatively. Case 3; A female Marfan patient had undergone Bentall procedure and mitral repair followed with resection of the proximal descending aorta. Three months later a false aneurysm at the distal anastomosis was treated with a 24 mm Valiant stent-graft (30% oversize). Aortic dissection distal to stent was documented on the early postoperative CT. The dissected aneurysm enlarged significantly with a type I distal endoleak during follow-up. Concomitantly, the patient presented a class III dyspnea owing to a severe mitral regurgitation. The patient underwent a successful MVR and stent-graft explantation with replacement of the descending aorta. Conclusion Significant complications supervened when stent-grafts were deployed in native aorta. We thus recommend that deploying a stent-graft in a CTD diseased aorta should be considered a relative contraindication. In cases with prohibitive or high risk surgery, use of a stent-graft with minimal radial force and minimal oversizing without balloon dilatation should be considered.

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Long-term results of stent graft treatment of subclavian artery injuries: Management of choice for stable patients?

Journal of Vascular Surgery ◽

10.1016/j.jvs.2007.11.009 ◽

2008 ◽

Vol 47 (4) ◽

pp. 739-743 ◽

Cited By ~ 84

Author(s):

Daniel F. du Toit ◽

Anton V. Lambrechts ◽

Hugo Stark ◽

Brian L. Warren

Keyword(s):

Stent Graft ◽

Subclavian Artery ◽

Long Term Results

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Treatment of an asymptomatic penetrating aortic ulcer in a young patient

VASA ◽

10.1024/0301-1526/a000024 ◽

2010 ◽

Vol 39 (2) ◽

pp. 175-179

Author(s):

Hakimi ◽

Geisbüsch ◽

Gross ◽

Hyhlik-Dürr ◽

Hausser ◽

...

Keyword(s):

Electron Microscopy ◽

Connective Tissue ◽

Aortic Arch ◽

Open Surgery ◽

Open Repair ◽

Thoracic Endovascular Aortic Repair ◽

Concomitant Disease ◽

Connective Tissue Disorders ◽

Penetrating Aortic Ulcer ◽

Pathological Analysis

We want to report and discuss the indication for open surgery for an asymptomatic penetrating aortic ulcer (PAU) in the era of thoracic endovascular aortic repair (TEVAR). A 31-year-old female presented with the diagnosis of an aneurysm in the distal aortic arch. With respect to the patients young age, the controversial status of connective tissue disorders and in the absence of concomitant disease, open repair was indicated. There was no proof of a mycotic plaque or connective tissue disease in the microbiological-, pathological analysis and at electron-microscopy. The patient was discharged on the thirteenth postoperative day. In spite of good preliminary results of TEVAR in PAU, in selective cases there is still an indication for open surgery.

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