Initial Experience With Intentional Stent-Graft Coverage of the Subclavian Artery During Endovascular Thoracic Aortic Repairs

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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A Case of Transluminal Stent-Graft Implantation at Right Subclavian Artery Pseudoaneurysm in Behcet's Syndrome

Korean Circulation Journal ◽

10.4070/kcj.1999.29.11.1240 ◽

1999 ◽

Vol 29 (11) ◽

pp. 1240 ◽

Cited By ~ 2

Author(s):

Dae Kyeong Kim ◽

Young Sup Yoon ◽

Seung Hyuk Choi ◽

Dong Il Lee ◽

Do Yun Lee ◽

...

Keyword(s):

Stent Graft ◽

Subclavian Artery ◽

Behçet’S Syndrome ◽

Artery Pseudoaneurysm ◽

Behçet's Syndrome ◽

Behcet’S Syndrome ◽

Stent Graft Implantation ◽

Graft Implantation ◽

Behcet's Syndrome

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Hemoptysis caused by a left subclavian pseudoaneurysm: endovascular solution for a challenging case

Vascular ◽

10.1258/vasc.2011.cr0266 ◽

2013 ◽

Vol 21 (3) ◽

pp. 159-162 ◽

Cited By ~ 3

Author(s):

Lucas Ribé Bernal ◽

Juan Luis Portero ◽

María Vila ◽

Diego Fernando Ruiz ◽

Luis Manuel Reparaz

Keyword(s):

Stent Graft ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Massive Hemoptysis ◽

Artery Pseudoaneurysm ◽

Parenchymal Lesion ◽

Lesion Treatment ◽

Thoracic Stent Graft

This is one of the first reports of a left subclavian pseudoaneurysm in a patient presenting with massive hemoptysis. We present a challenging case of a patient who consulted for hemoptysis. Imaging revealed a left subclavian artery pseudoaneurysm that caused a pulmonary parenchymal lesion. Treatment with a self-expanding thoracic stent-graft and a subclavian occluder was successful.

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Anatomical repair for Kommerell diverticulum with deep site in-situ fenestration

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318785250 ◽

2018 ◽

Vol 26 (6) ◽

pp. 467-469

Author(s):

Masami Shingaki ◽

Yoshihiko Kurimoto ◽

Kiyofumi Morishita ◽

Toshio Baba ◽

Tsuyoshi Shibata ◽

...

Keyword(s):

Stent Graft ◽

Subclavian Artery ◽

Endovascular Repair ◽

Left Subclavian Artery ◽

The Third ◽

Deep Site ◽

Main Component ◽

Thoracic Stent Graft ◽

Kommerell Diverticulum

An 83-year-old woman with a Kommerell diverticulum was treated by anatomical endovascular repair with a deep site in-situ fenestration instead of complex debranching techniques. The main component of the thoracic stent-graft was deployed just distal to the third cervical branch to completely exclude the Kommerell diverticulum. A deep site in-situ fenestration was made on the main component using a radiofrequency needle through the left subclavian artery, and a stent-graft was deployed to bridge the main component to the left subclavian artery. Six months postoperatively, the Kommerell diverticulum was completely excluded with excellent left subclavian artery patency.

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Handmade stent graft fenestration to preserve left subclavian artery in thoracic endovascular aortic repair†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz049 ◽

2019 ◽

Vol 56 (3) ◽

pp. 587-594 ◽

Cited By ~ 5

Author(s):

Huey-Shiuan Kuo ◽

Jih-Hsin Huang ◽

Jer-Shen Chen

Keyword(s):

Carotid Artery ◽

Stent Graft ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Technical Success ◽

Aortic Stent Graft ◽

Aortic Pathologies

Abstract OBJECTIVES This study aimed to evaluate the efficacy and safety of a handmade fenestrated stent graft over an aortic stent graft for preserving the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR). METHODS From July 2015 to October 2018, a total of 32 consecutive patients with various thoracic aortic pathologies who underwent TEVAR in which handmade fenestration over a thoracic aortic stent graft was used for LSA were included. Outcomes including technical success, procedure-related complications, perioperative mortality and morbidity and graft patency were analysed. RESULTS Twenty-four patients (75.00%) presented with aortic dissection, 5 patients (15.63%) with thoracic aortic aneurysm and 2 patients (6.25%) with penetrating aortic ulcer; 1 patient (3.13%) required re-TEVAR due to endoleak and sac expansion from previous TEVAR for thoraco-abdominal aneurysm. TEVAR was performed in a zone 2 landing with single fenestration for LSA (26 patients, 81.25%), zone 1 landing with double fenestration for both LSA and left common carotid artery (5 patients, 15.63%) or zone 1 landing with single fenestration for LSA and a chimney graft for left common carotid artery (1 patient, 3.13%). The technical success rate, defined as the successful alignment of fenestration to LSA, was 93.75%. At a mean follow-up of 17.3 months, 4 cases of endoleak and 2 cases of stent graft-induced new entry were noted, 3 of which were treated endovascularly. CONCLUSIONS Our preliminary results demonstrate the viability of preserving LSA blood flow in TEVAR using a handmade stent graft fenestration to treat various aortic pathologies in various clinical situations and the technical feasibility and short-term results that may justify the use of this method in emergency cases.

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Initial Experience with the Begraft Balloon Expandable Covered Stent-Graft System for Endovascular Treatment of Penetrating Aortic Ulcer

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.1097 ◽

2019 ◽

Vol 58 (6) ◽

pp. e441-e442

Author(s):

Łukasz Kruszyna ◽

Grzegorz Oszkinis

Keyword(s):

Endovascular Treatment ◽

Stent Graft ◽

Covered Stent ◽

Initial Experience ◽

Penetrating Aortic Ulcer ◽

Covered Stent Graft

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

Journal of Endovascular Therapy ◽

10.1177/152660280301000335 ◽

2003 ◽

Vol 10 (3) ◽

pp. 647-652 ◽

Cited By ~ 20

Author(s):

Karthikeshwar Kasirajan ◽

Brian Matteson ◽

John M. Marek ◽

Mark Langsfeld

Keyword(s):

Connective Tissue ◽

Stent Graft ◽

Subclavian Artery ◽

Case Reports ◽

The Other ◽

Long Term Results ◽

Covered Stents ◽

Connective Tissue Disorders ◽

Invasive Treatment ◽

Cystic Medial Necrosis

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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