Outcomes of stent-graft repair for anastomotic femoral pseudoaneurysm. A case series

Vascular ◽  
2021 ◽  
pp. 170853812110451
Author(s):  
Marco Franchin ◽  
Federico Fontana ◽  
Luca Luzzani ◽  
Michela Lanza ◽  
Gabriele Piffaretti ◽  
...  
Keyword(s):  
High Risk ◽  
Stent Graft ◽  
Case Series ◽  
Common Femoral Artery ◽  
Related Complication ◽  
Stent Grafting ◽  
Stent Graft Repair ◽  
Novel Coronavirus ◽  
Post Hoc

Objective This study aims to report a case series of anastomotic femoral pseudoaneurysms (PSA) treated with stent-grafting (SG) in patients at high-risk for the open surgical approach. Methods It is a retrospective, observational cohort study. Between 1 January 2002 and 1 April 2020, post-hoc analysis of the database including patients who received repair for femoral PSA identified those treated with SG. All but one patient were approached through a contralateral percutaneous transfemoral access, and the SG was always deployed from the common femoral artery to the profunda femoris artery. For this study, primary outcomes of interest were early (≤ 30 days) survival and patency rate. Results We identified 10/823 cases of the entire PSA cohort (1.2%). There were 9 men and 1 woman: the mean age was 76 years ± 9 (range: 64–92). Urgent intervention was performed in 4 patients. The median operative time was 30 min (IQR: 25–36). Access-related complication was never observed. In-hospital mortality occurred in 1 patient due to novel coronavirus-19–related pneumonia. Median follow-up was 24 months (IQR: 12–37); 5 patients died. At the last radiologic follow-up available, all SGs were patent without necessity of reintervention. Conclusion Stent-graft repair for anastomotic femoral PSA may be considered a reasonable alternative for patients at high-risk for open surgical repair.

scholarly journals Unibody design for aortic disease with a narrow aortic bifurcation: tips and tricks for success

2021 ◽  
Vol 20 ◽  
Author(s):  
Ricardo de Alvarenga Yoshida ◽  
Renato Fanchiotti Costa ◽  
Débora Ortigosa Cunha ◽  
Rafael Mendes Palhares ◽  
Rodrigo Gibin Jaldin ◽  
...  
Keyword(s):  
Surgical Management ◽  
Stent Graft ◽  
Abdominal Aorta ◽  
Aortic Aneurysms ◽  
Technical Success ◽  
Shaggy Aorta ◽  
Stent Grafting ◽  
Aortic Pathology ◽  
Stent Graft Repair

Abstract Background Surgical management of patients with abdominal aortic diseases associated with distal narrowing is a challenging situation. Objectives To evaluate outcomes of unibody bifurcated endovascular stent graft repair. Methods This is a retrospective, observational, multi-institutional database study of a cohort of consecutive cases, approved by the local Ethics Committee. Records were reviewed of patients diagnosed from 2010 to 2020 with “shaggy” aorta, saccular aneurysm, penetrating aortic ulcer, and isolated aortic dissection located in the infrarenal abdominal aorta. All patients were treated with a unibody bifurcated stent graft. Main outcomes were technical success, procedure complications, long-term patency, and mortality in the follow-up period up to 5 years. Data on demographics, comorbidities, surgical management, and outcomes were analyzed. Results Twenty-three patients were treated with unibody bifurcated stent graft repair, including 7 cases of “shaggy” aorta, 3 isolated dissections of the abdominal aorta, 4 penetrating aortic ulcers, and 9 saccular aneurysms. Immediate technical success was achieved in 100% of cases. At follow-up, all stent grafts remained patent and there were no limb occlusions. The patients were symptom-free and reported no complications related to the procedure. There were 5 deaths during the follow-up period (median= 4 years), but none were related to the procedure and there were no aorta-related deaths. Conclusions The present study shows that unibody bifurcated stent grafting is safe and effective in this group of patients with narrow distal abdominal aorta and complex aortic pathology. The results were similar for both infrarenal aortic aneurysms and aorto-iliac atherosclerotic disease.

Aortic Arch Reconstruction by Transluminally Placed Endovascular Branched Stent Graft

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Kanji Inoue ◽  
Hiroaki Hosokawa ◽  
Tomoyuki Iwase ◽  
Mitsuru Sato ◽  
Yuki Yoshida ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Aortic Aneurysms ◽  
Therapeutic Modality ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Stent Graft Repair ◽  
Aortic Dissections

Background —Recently, thoracic aortic stent grafting has emerged as an alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. However, its application has been limited to descending thoracic aortic aneurysms distal to the aortic arch. We report our initial clinical experience of endovascular branched stent graft repair for aortic arch aneurysms. Methods and Results —Endovascular grafting with Inoue branched stent grafts was attempted for 15 patients with thoracic aortic aneurysms and aortic dissections under local anesthesia (n=14) or general anesthesia (n=1). Single-branched stent grafts were used in 14 patients, and a triple-branched stent graft in one. The branched stent grafts were delivered through a 22F or a 24F sheath under fluoroscopic guidance and implanted across the aneurysmal aortic arch. In 2 patients, the single-branched stent graft did not pass through the 22F sheath used. Complete thrombosis of the aneurysm was ultimately achieved in 11 patients (73%). Of 4 persistent leaks, 1 minor leak spontaneously thrombosed and 1 major leak was successfully treated by additional straight stent graft placement. In 1 patient, the right external iliac artery ruptured during the withdrawal of the sheath and was successfully repaired by the implantation of a straight stent graft. One patient with severe stenosis of the aortic graft section was successfully managed by additional stent deployment. Peripheral microembolization to a toe occurred in 1 patient, and cerebral infarction occurred in 1 other patient. Two patients who had failed to receive endovascular stent grafts died during an average follow-up of 12.6 months, 1 of pneumonia and the other of rupture of a concomitant abdominal aortic aneurysm. Conclusions —This report demonstrates the technical feasibility of endovascular branched stent graft repair for aneurysms located at the aortic arch. Careful, longer follow-up and further extensive clinical trials are awaited toward establishing this technique as a recommendable alternative to surgical treatment of thoracic aortic aneurysms.

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.

scholarly journals Trimethylamine N-oxide and incident atherosclerotic events in high-risk individuals with diabetes: an ACCORD trial post hoc analysis

2019 ◽  
Vol 7 (1) ◽  
pp. e000718 ◽  
Author(s):  
Andrea Cardona ◽  
Aaron O'Brien ◽  
Matthew C Bernier ◽  
Arpad Somogyi ◽  
Vicki H Wysocki ◽  
...  
Keyword(s):  
High Risk ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Antihypertensive Medications ◽  
Ascvd Risk ◽  
Post Hoc ◽  
Design And Methods

IntroductionType 2 diabetes mellitus (T2D) confers high atherosclerotic cardiovascular disease (ASCVD) risk. The metabolite trimethylamine N-oxide (TMAO) derived via gut flora has been linked to excess ASCVD.Research design and methodsWe analyzed data, biospecimens, and major adverse cardiovascular events (MACEs) from the prospective multicenter randomized Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial to assess its value in 330 high-risk individuals with T2D without evident atherosclerotic disease at enrollment.ResultsIncident cardiovascular events occurred in 165 cases; 165 controls matched by age, sex, and treatment arm experienced no incident events during follow-up. Cases and controls (mean age 64.5 years) had similar mean glycated hemoglobin (HbA1c) (8.2%) and mean 10-year ASCVD risk (23.5%); groups also had similar use of statins and antihypertensive medications at baseline and follow-up. Baseline plasma TMAO levels did not differ between groups after adjusting for ASCVD risk score, HbA1c, and estimated glomerular filtration rate, nor did TMAO distinguish patients suffering incident MACE from those who remained event-free.ConclusionsTMAO’s prognostic value for incident ASCVD events may be blunted when applied to individuals with T2D with poor glycemic control and high baseline ASCVD risk. These results behoove further translational investigations of unique mechanisms of ASCVD risk in T2D.

The Use of Closure Devices for Aortic Stent-Graft Insertion: Outcomes Following a Paradigm Shift to Percutaneous Access in a Tertiary Vascular Center

2019 ◽  
Vol 53 (7) ◽  
pp. 536-540 ◽  
Author(s):  
Alan D. White ◽  
Can Hazar ◽  
David Jarosz ◽  
Paul Walker ◽  
David Shaw ◽  
...  
Keyword(s):  
Success Rate ◽  
Stent Graft ◽  
Case Series ◽  
High Success Rate ◽  
Complication Rates ◽  
Surgical Closure ◽  
Aortic Stent Graft ◽  
Curved Planar Reformation ◽  
Graft Insertion

Background: This retrospective case series aims to evaluate the efficacy of the Perclose ProGlide system for postoperative hemostasis following aortic stent-graft insertion. Material and Methods: A prospectively maintained database of patients with a minimum follow-up of 12 months following percutaneous aortic procedures was interrogated. Preprocedural computed tomography (CT) scans were reviewed to assess existing stenosis in the common femoral artery (CFA). Arteries with an estimated stenosis of greater than 25% on visual inspection underwent quantification using multiplanar and curved planar reformation. The preoperative and 1-year follow-up CTs of these patients were assessed for change in stenosis. Analysis was performed by 2 independent reviewers, with senior authors reviewing any discrepancies. Results: One hundred forty-two endovascular aortic aneurysm repairs (EVARs) were performed. The ProGlide system was used in 235 arteries, yielding a high success rate in obtaining postprocedural hemostasis (94%). There were 13 postprocedural access-related complications, including 5 patients requiring surgical closure due to inadequate seal. Two patients required thrombectomy due to distal embolization. One patient required CFA endarterectomy at 6 months for the treatment of preexisting short distance claudication. Vessel analysis was performed in 31 arteries. Mean preoperative stenosis was 32% (range: 20%-57%). Mean postoperative stenosis was 32% (21%-57%). No significant change in degree of stenosis was detected (defined as a 5% change). Conclusions: The ProGlide system yielded a high success rate in obtaining postoperative hemostasis with low rate of conversion to surgical closure and low complication rates. There was no evidence of worsening vessel stenosis in arteries with preprocedural stenotic disease. Level of Evidence: Level 4, Case Series.

Endovascular Grafting of a Popliteal Aneurysm Using the Saphenous Vein

1998 ◽  
Vol 5 (1) ◽  
pp. 64-70 ◽  
Author(s):  
Pedro Puech-Leão ◽  
Paulo Kauffman ◽  
Nelson Wolosker ◽  
Alexandre Maiera Anacleto
Keyword(s):  
Stent Graft ◽  
Saphenous Vein ◽  
Suture Technique ◽  
Endovascular Stent ◽  
Promising Technique ◽  
Invasive Treatment ◽  
Endovascular Stent Graft ◽  
Stent Grafting ◽  
Popliteal Aneurysm

Purpose: To report the successful endovascular exclusion of a popliteal aneurysm using a saphenous vein stent-graft. Methods and Results: A 1.9-cm popliteal aneurysm in a 75-year-old man was excluded by an endovascular stent-graft constructed from a segment of a greater saphenous vein to which a Palmaz stent was attached at its proximal end. The operation was performed through an open posterior approach to the distal popliteal artery. The stent-graft was introduced in retrograde fashion and passed up to the superficial femoral artery, where the proximal stent was deployed. Distally, a conventional anastomosis was performed with standard suture technique. Follow-up at 2 months shows continued exclusion of the aneurysm and patency of the bypass. Conclusions: Saphenous stent-grafting is a promising technique in the less invasive treatment of popliteal aneurysms. Further experience and longer follow-up are required before this technique can replace open surgery in clinical practice.

Case Series Regarding Parastomal Variceal Bleeding: Presentation and Management

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
John Romano ◽  
Charles V. Welden ◽  
Jordan Orr ◽  
Brendan McGuire ◽  
Mohamed Shoreibah
Keyword(s):  
Portal Hypertension ◽  
High Risk ◽  
Literature Review ◽  
Variceal Bleeding ◽  
Coil Embolization ◽  
Case Series ◽  
Treatment Modalities ◽  
Post Procedure ◽  
Lost To Follow Up

Parastomal variceal bleeding (PVB) is a serious complication occurring in up to 27% of patients with an ostomy and concurrent cirrhosis and portal hypertension. The management of PVB is difficult and there are no clear guidelines on this matter. TIPS, sclerotherapy, and /or coil embolization are all therapies that have been shown to successful manage PVB. We present a case series with five different patients who had a PVB at our institution. The aim of this case series is to report our experience on the management of this infrequently reported but serious condition. We also conducted a systemic literature review focusing on the treatment modalities of 163 patients with parastomal variceal bleeds. In our series, patient 1 had embolization and sclerotherapy without control of bleed and expired on the day of intervention due to hemorrhagic shock. Patient 2 had TIPS in conjunction with embolization and sclerotherapy and had no instance of rebleed 441 days after therapy. Patient 3 did not undergo any intervention due to high risk for morbidity and mortality, the bleed self-resolved and there was no further rebleed, this same patient died of sepsis 73 days later. Patient 4 had embolization and sclerotherapy and had no instance of rebleed 290 days after therapy. Patient 5 had TIPS procedure and was discharged five days post procedure without rebleed, patient has since been lost to follow-up.

Endovascular Treatment of External Iliac Artery Injuries after Hip Arthroplasty

2003 ◽  
Vol 10 (3) ◽  
pp. 672-675 ◽  
Author(s):  
Roberto Adovasio ◽  
Fabio Pozzi Mucelli ◽  
Giovanni Lubrano ◽  
Cristiana Gasparini ◽  
Manuel Belgrano ◽  
...  
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Elderly Women ◽  
Case Reports ◽  
External Iliac Artery ◽  
Hip Surgery ◽  
Hip Prostheses ◽  
Arterial Lesions ◽  
Stent Graft Repair

Purpose: To report endovascular repair of injuries to the external iliac artery during hip surgery. Case Reports: Two elderly women with histories of chronically infected hip prostheses were found to have iatrogenic leaking pseudoaneurysms of the external iliac artery due to hip surgery trauma in the past. Both were treated successfully with a Jostent Peripheral Stent-Graft. The first patient died 17 months after treatment, and the second was well, with an excluded false aneurysm, at the 6-month follow-up. Conclusions: Stent-graft repair may be an appropriate and effective treatment for some traumatic arterial lesions.

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