stent grafting
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Author(s):  
Ezhilmathi Alavandar ◽  
Shobana Umapathy ◽  
Santhosh Poyyamoli ◽  
Venkatesh Kasi Arunachalam ◽  
Pankaj Mehta ◽  
...  

Abstract Objectives Our objective was to analyze the clinical presentation, imaging findings, and the management of segmental arterial mediolysis (SAM) in different case scenarios within our medical institution. Materials and Methods We retrospectively analyzed 13 cases of SAM in our institution from July 2017 to March 2020. The images from the cases were collected from picture archiving and communication system (PACS) along with other pertinent clinical information from the hospital's information system. All the patients we studied underwent contrast-enhanced computed tomography (CT) using a third-generation Siemens SOMATOM Force dual-source CT scanner. Once the dual-phase scanning was completed, the images were analyzed using the workstation's syngo.via software. Results Three out of the 13 cases required stent-grafting of the renal/celiac artery, and the involved branch of the superior mesenteric artery was embolized in one case. The rest of the cases were managed conservatively with antiplatelets/anticoagulants. Subsequent follow-ups of the patients were conducted and showed stabilization/regression of the initial findings without finding any evidence of worsening. Conclusion SAM should be considered when making a differential diagnosis of acute abdominal pain when associated with dissection or aneurysms in splanchnic arteries, and in cases of unexplained intra-abdominal hemorrhaging. The radiologist needs to be aware of this possibility to raise suspicion, alert the clinician, and guide appropriate management.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tieyan Li ◽  
Lin Zou ◽  
Yunzhen Feng ◽  
Guoliang Fan ◽  
Yuanfeng Xin

Abstract Background Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic disease. KD patients have a high risk of rupture, dissection, and compression of adjacent structures. Although several treatment options have been proposed (traditional surgery, hybrid operation, and endovascular intervention), a consensus regarding optimal surgical management has not yet been established. Case presentation A case of successful hybrid repair of distal aortic arch dissection aneurysm by dissecting KD and ARSA with debranching of right and left common carotid arteries, left subclavian artery, and stent grafting was presented. Conclusions The hybrid operation is suitable for elderly patients or those with high risks. Along with intervention, the hybrid operation needs to be developed as a minimally invasive method.


Author(s):  
Takao Ohki ◽  
Koji Maeda ◽  
Takeshi Baba ◽  
Kenjirou Kaneko ◽  
Kota Shukuzawa ◽  
...  

Vascular ◽  
2021 ◽  
pp. 170853812110451
Author(s):  
Marco Franchin ◽  
Federico Fontana ◽  
Luca Luzzani ◽  
Michela Lanza ◽  
Gabriele Piffaretti ◽  
...  

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.


Author(s):  
Augusto D’Onofrio ◽  
Giorgia Cibin ◽  
Michele Antonello ◽  
Raphael Caraffa ◽  
Franco Grego ◽  
...  

Objective Ascending aorta stent-grafting (AASG) is a new option that has shown initial promising results. In selected cases, when neither conventional surgery nor transfemoral retrograde approach are feasible, antegrade transapical (TA) access can be performed. The aim of this single-center retrospective study was to evaluate outcomes of patients undergoing AASG through a TA approach. Methods We analyzed all patients undergoing AASG through a TA approach at our institution. Three different devices were used, including Relay Stent-Graft System (Terumo Aortic, UK), Gore Conformable Thoracic Aortic Graft (W. L. Gore & Associates, Inc., USA), and Valiant Thoracic Stent Graft (Medtronic, Ireland). All patients underwent clinical and computed tomographic angiogram (CTA) evaluation before hospital discharge. Results From May 2010 to December 2019, 3 consecutive patients underwent AASG at our institution. Mean age was 69 years. Three different types of endografts were used in 1 patient each. All patients stayed in the intensive care unit for 24 hr and mean hospital stay was 12 days. We did not observe any major adverse event. One patient died of pneumonia 2 months after the procedure and the other 2 patients are alive and in good clinical conditions at a mean follow-up of 56 months. Predischarge CTA showed good anatomic results with no endoleaks in all cases. Conclusions This initial experience shows that AASG is feasible and provides encouraging clinical and anatomic results in selected high-risk patients.


2021 ◽  
Vol 10 (17) ◽  
pp. 3952
Author(s):  
Adrian Zehnder ◽  
Jon Lutz ◽  
Patrick Dorn ◽  
Fabrizio Minervini ◽  
Peter Kestenholz ◽  
...  

In thoracic outlet syndrome (TOS) the narrowing between bony and muscular structures in the region of the thoracic outlet/inlet results in compression of the neurovascular bundle to the upper extremity. Venous compression, resulting in TOS (vTOS) is much more common than a stenosis of the subclavian artery (aTOS) with or without an aneurysm. Traditional open surgical approaches to remove the first rib usually lack good exposure of the entire rib and the neurovascular bundle. Between January 2015 and July 2021, 24 consecutive first rib resections for venous or arterial TOS were performed in 23 patients at our institutions. For our completely portal approach we used two 8mm working ports and one 12/8 mm camera port. Preoperatively, pressurized catheter-based thrombolysis (AngioJet®) was successfully performed in 13 patients with vTOS. Operative time ranged from 71–270 min (median 128.5 min, SD +/− 43.2 min) with no related complications. The chest tube was removed on Day 1 in all patients and the hospital stay after surgery ranged from 1 to 7 days (median 2 days, SD +/− 2.1 days). Stent grafting was performed 5–35 days (mean 14.8 days, SD +/− 11.1) postoperatively in 6 patients. The robotic approach to first rib resection described here allows perfect exposure of the entire rib as well as the neurovascular bundle and is one of the least invasive surgical approaches to date. It helps improve patient outcomes by reducing perioperative morbidity and is a procedure that can be easily adopted by trained robotic thoracic surgeons. In particular, patients with a/vTOS may benefit from careful and meticulous preparation and removal of scar tissue around the vessels.


2021 ◽  
Vol 8 ◽  
Author(s):  
Wei Wang ◽  
Jianqiang Wu ◽  
Jiang Shao ◽  
Fang Xu ◽  
Yuexin Chen ◽  
...  

Objective: The combination of isolated common and internal iliac artery aneurysms (CIIAA) are rare, life-threatening, abnormal conditions with relatively complex treatment. This study aimed to evaluate the clinical characteristics and treatment outcomes of CIIAA.Methods: We retrospectively reviewed 26 patients with CIIAA consecutively treated between January 2010 and August 2020 at Peking Union Medical College Hospital. Demographic, clinical characteristic, treatment strategy and outcome data were collected and analyzed.Results: Twenty-six patients (24 men and 2 women) with a mean age of 70 years were included. There was a total of 72 aneurysms, and the mean diameters of the common iliac artery aneurysms (CIAA) and internal iliac artery aneurysms (IIAA) were 36 and 38 mm, respectively. Ten patients (38%) presented with bilateral CIAA and unilateral IIAA, and eight (31%) had CIAA with ipsilateral IIAA. All patients were treated with endovascular repair, and the overall primary technical success rate was 100%. The surgical techniques mainly included combined bifurcated stent grafting and embolization (n = 11), combined straight stent grafting and embolization (n = 8), and internal iliac artery (IIA) reconstruction (n = 7). There were no patient deaths or reintervention during hospitalization. The mean follow-up time was 43 months, and the patency rate of the stent was 96.2%. The overall reintervention rate was 7.7%. During the follow-up period, there were no aneurysm-related deaths.Conclusions: Endovascular repair involving stent graft placement, coil embolization and IIA revascularization is a safe and effective treatment for isolated CIIAA.


2021 ◽  
pp. 112972982110294
Author(s):  
David B Kingsmore ◽  
Karen S Stevenson ◽  
Peter C Thomson ◽  
Ram Kasthuri ◽  
Stephen Knight ◽  
...  

Background: Early-cannulation arteriovenous grafts (ecAVG) have good initial patency, but frequent episodes of reintervention for venous stenosis (VS) and thrombosis limit their use. Stent grafts (SG) have shown promise in reducing re-interventions and improving functional patency for dysfunctional ecAVG and recurrent VS. There is little data on the impact of stent grafts as the first elective procedure for VS. The aim of this study was to determine firstly, if treating VS whilst asymptomatic has a better outcome than treating after presentation with thrombosis; and secondly, to determine the best initial treatment for asymptomatic VS: SG or angioplasty. Methods: A retrospective study was performed of 259 ecAVG with a sutured anastomosis. The case-mix and outcomes of 153 who presented with VS was analysed by presentation (elective at surveillance or emergency following thrombosis), and then for only elective patients, by treatment (SG vs angioplasty). Results: There was no significant difference in case-mix and time to presentation by mode of presentation (100 elective and 53 with thrombosis) other than a higher rate of pro-thrombotic disorders in thrombosed ecAVG. Thrombosed ecAVG had poorer outcomes with increased re-intervention rates and thrombosis in the following year, and reduced long-term functional patency. In patients presenting electively, primary SG rather than angioplasty led to significantly reduced thrombosis rates, a longer time to re-intervention in the following year, and superior long-term functional patency. The use of SG was the same in both groups. Both the mode of presentation and the type of intervention performed were independently predictive of a poorer subsequent functional patency. Conclusions: Primary elective stent-grafting may be the optimal strategy to reducing maintenance costs with ecAVG.


2021 ◽  
Vol 22 ◽  
Author(s):  
Jan Śnieżyński ◽  
Bartosz Wilczyński ◽  
Tomasz Skoczylas ◽  
Grzegorz T. Wallner

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