On the basis of our preliminary data, we believe that, in selected patients, intraoperative balloon angioplasty of stenosis of the innominate artery with stent placement from the right common carotid artery approach is a safe and effective alternative to conventional operations.
On the basis of the preliminary data, the authors believe that the percutaneous closure of arteriovenous fistulas with stent-grafts is a safe and effective alternative to conventional surgery.
To evaluate the feasibility of percutaneous treatment of iliac aneurysms, a covered stent was inserted in nine men suffering from common iliac artery aneurysms (six cases), external iliac aneurysms (one case), or pseudoaneurysms (two cases). Placement of the stent was successful in all patients. In one patient, an endoprosthesis thrombosed after 15 days, but was successfully treated by thrombolysis and additional stent placement. At the follow-up examinations (mean period 22 months) all stent-grafts had remained patent. No late leakage or stenosis was observed.
A Palmaz stent had dislodged into the left pulmonary artery after TIPS. After transfemoral catheterization of the left pulmonary artery, the stent was retrieved into the right femoral vein employing an angioplastic balloon catheter and finally extracted after surgical venotomy.
Endovascular treatment of arterial injuries with stent-graft is a reliable alternative approach in patients not suitable for embolization or at high risk for surgery. The aim of our study was to evaluate the efficacy and the safety of the BeGraft stent-graft, a low-profile balloon expandable covered stent, for emergency endovascular treatment of iatrogenic arterial injuries.
Between August 2015 and September 2018, 34 consecutive patients (mean age 71 ± 12 years, 9 females) underwent implantation of BeGraft stent-grafts for iatrogenic arterial injuries (22 active bleedings, 11 pseudoaneurysms, and 1 enteric-iliac fistula). The primary endpoints were technical and clinical success and rates of major and minor complications. The secondary endpoint was the patency of the device during the follow-up. Imaging follow-up was performed by duplex ultrasound and/or computed tomography angiography (according to lesion site/target vessel), at 1-6-12-15 and 24 months.
In all 34 patients (100%), the lesion or the defect was effectively excluded with a cumulative amount of 42 stent-grafts. The clinical success was documented in 30/34 patients (88.2%). Neither device- or procedure-related deaths, or major complications occurred. A minor complication was reported in 1 patient (2.9%), successfully treated during the same procedure. Thirty (88.2%) patients were available for a mean follow-up time of 390 ± 168 days (minimum 184, maximum 770), with no observed loss of patency, yielding a 100% Kaplan–Meier cumulative survival patency function. The percentage of patent patients was 30/30 at 6 months, 22/22 at 12 months, and 5/5 at 15 months.
Endovascular treatment of iatrogenic arterial injuries with the BeGraft stent-graft is minimally invasive and effective, with good patency rate at midterm follow-up.
thrombosed PSA aneurysm. He came with complaints of sudden onset of left foot pain of 5 hours' duration. On clinical examination, a pulsatile buttock mass was found with evidence of grade 1 limb ischemia. Magnetic resonance angiography showed a partially thrombosed PSA aneurysm with thrombus ( Fig 1). He underwent a hybrid procedure (left popliteal thromboembolectomy with retrograde stent grafting [12 Â70 mm] of PSA aneurysm; Fig 2).Results: The postoperative period was uneventful, and the patient remains symptom free with no evidence of ischemic changes at 1 year of follow-up.Conclusions: Awareness and recognition of this rare anatomic variation are of prime importance in treating a patient with acute lower limb ischemia, thus avoiding inadvertent interventions.
Thrombosis of vascular accesses is most often due to venous anastomotic outflow stenosis or obstruction. Many percutaneous mechanical devices have been developed to eliminate the clot. Their clinical success rates are usually between 71% and 100%, with low incidence of serious complications. The indigo mechanical thrombectomy system (Penumbra, inc) consists of vacuum-assisted thrombectomy, which enables continuous thrombus aspiration. Preliminary results with this device in treatment of thrombosed vascular access have been recently reported in literature. We want to report the preliminary results of our early experience with Indigo System CAT8, and the new cat d, in the treatment of acute thrombosed av f and avg. Method(s): Between November 2017 and July 2018, 5 patients with acutely thrombosed dialysis fistulae were treated. All procedures were performed within 48 hours of the occurrence of thrombosis. Patients (average age, 71 y; age range, 57-86 y; 3 men and 2 women) were treated with the indigo system. Result(s): Technical success was 80% (4 of 5 patients). Clinical success was 80% (4 of 5 patients); 1 patient had a thrombosed dialysis fistula 24 hours after declotting. No technical or device-related complications were reported. Adjunctive procedures included PTA (60%) and stent graft deployment (40%; 2 of 5 patients). Mean FU was 163 days (range 59-301). Primary patency at one-month was 80%. One patient had a second aspiration for recurrent thrombosis of the fistula at 37 days from the first procedure, leading to a 3-month primary patency of 60% and a secondary patency of 80%. Conclusion(s): Our preliminary experience confirms the safety and the efficacy of mechanical thrombo-aspiration with indigo system in the treatment of thrombosed dialysis AVF and/ or AVG. Our results in terms of clinical success and patency at 3-month are in line with what reported by vascular guidelines.
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