Covered stents for injuries of subclavian and axillary arteries

Abstract

Covered stents are a feasible alternative to open repair in properly selected patients with subclavian or axillary artery injury, resulting in shorter procedure time and less blood loss.

Use of a stent graft in tumor erosion of the common femoral artery with life-threatening bleeding

“…The second case was an endovascular stent graft exclusion of an infl ammatory breast cancer related axillary artery bleeding with hypovolemic shock [3]. The majority of large artery injuries involve traumatic vascular injuries such as penetrating or blunt trauma caused by gunshots, stab wounds, vehicle collisions, iatrogenesis, and others [4].…”

“…In recent years, several stent grafts have increasingly been used in endovascular repair of thoracic and abdominal aneurysms, repair of traumatic subclavian arteries and iatrogenic vascular injuries, and in exclusion of peripheral arterial aneurysms [4,5]. Like bare-metal stents, covered stents are available in self-expandable (Fluency ® , Flair Endovascular Stent Graft ® from Bard Peripheral Vascular, Inc. or Viabahn Endoprosthesis ® from Gore & Associates) and balloon-expandable (V12 Vascular Covered Stent ® from Maquet Vascular Systems) versions.…”

Endovascular repair of the left subclavian artery after gunshot wound: an alternative to surgical treatment

“…Such traumas lead to various types of lesion, including arterial wall rupture, intimal tearing, dissection, pseudoaneurysms and/or the development of arteriovenous fistulas. Associated lesions include injuries to the brachial plexus and the aerodigestive tracts [3][4][5][6][7] . Subclavian artery lesions are feared because they are associated with a high morbidity and mortality rate, and because adequate surgical exposure is difficult to obtain.…”

“…The factors which increase surgical risk are anatomical deformations caused by large haematomas, severe haemorrhaging prior to clamping and the associated neuro-vascular lesions. The endovascular treatment of subclavian injuries reduces the risk of surgery-induced damage to the surrounding structures, as well as blood loss 7,12 . A retrospective analysis of several small series of patients shows that mortality and morbidity rates are lower in patients treated by the endovascular approach (5%) than in patients treated by surgery (10-40%).…”

“…However, given the rarity of these incidents, it is not possible to perform a randomised prospective study 2 . Several authors have assessed the feasibility of endovascular treatment and concluded that almost 50% of subclavian artery injuries could be treated using an endovascular approach 7,13 . Endovascular treatment is appropriate for the following anatomical conditions: intimal lesions, dissections, pseudoaneurysms, arteriovenous fistulas and focal arterial ruptures.…”