Endovascular repair of traumatic pseudoaneurysm by uncovered self‐expandable stenting with or without transstent coiling of the aneurysm cavity

Abstract

Various surgical options for internal carotid or subclavian artery pseudoaneurysm repair have been reported; however, in general they have resulted in poor outcomes with high morbidity and mortality rates. Recently, these open surgical procedures have been partly replaced by percutaneous transluminal placement of endovascular devices. We evaluated the potential for using flexible self-expanding uncovered stents with or without coiling to treat extracranial internal carotid, subclavian and other peripheral artery posttraumatic pseudoaneurysm. Three patients with posttraumatic pseudoaneurysm were treated by stent deployment and coiling (two cases) of the aneurysm cavity. In one case, a 5.0 x 47 mm Wallstent (Boston Scientific) was positioned to span the neck of the 9 x 5 mm size pseudoaneurysm (left internal carotid artery) and deployed. Angiography demonstrated complete occlusion of the pseudoaneurysm without coiling. In the second patient, a 5.0 x 31 mm Wallstent (Boston Scientific) was positioned to span the neck of the 9 x 7 mm size pseudoaneurysm (right internal carotid artery) and deployed. A total of six coils (Guglielmi Detachable Coils, Boston Scientific) were deployed into the pseudoaneurysm cavity until it was completely obliterated. In the third case, an 8.0 x 80 mm SMART (Cordis) stent was advanced over the wire, positioned to span the neck of the 10 x 7 mm size pseudoaneurysm of the left subclavian artery, and deployed. Fourteen 40 x 0.5 mm Trufill (Cordis) pushable coils were deployed into the pseudoaneurysm cavity until it was completely obliterated. At long-term follow-up (6-9 months), all patients were asymptomatic without flow into the aneurysm cavity by Duplex ultrasound. We conclude that uncovered endovascular flexible self-expanding stent placement with transstent coil embolization of the pseudoaneurysm cavity is a promising new technique to treat posttraumatic pseudoaneurysm vascular disease by minimally invasive methods, while preserving the patency of the vessel and side branches.

Chopstick Injury: Successful Stent-Graft Therapy for Traumatic Left Subclavian Artery Aneurysm

“…Other published series reported a few cases of stent-graft thrombosis, stenosis, and occlusion observed as complications, but these cases improved by angioplasty or were treated conservatively because the patients were asymptomatic 4 . In our case, mild stenosis occurred due to hyperplasia 8 months after the stent-graft implantation.…”

Stent-Supported Coil Embolization for Carotid Artery Pseudoaneurysm as a Complication of Endovascular Surgery-Case Report-

“…Endovascular embolization techniques using detachable coils can be used for the treatment of pseudoaneurysms. However, wide-neck aneurysms such as our case are difficult to treat, mainly because the detached coils are prone to migrate or herniate into the parent arteries, 3,4,8,12,13) so a modification of the simple coil embolization technique is necessary.…”

“…This method has also been applied to the treatment of traumatic or iatrogenic carotid pseudoaneurysms. 3,8) This stent-supported coil embolization technique consists of stent placement in the parent artery across the aneurysm neck, navigation of a microcatheter into the aneurysm sac through the stent interstices, and coil embolization. 3,4,8,12,13) The stent serves as a mechanical scaffold for intraaneurysm coil implantation, thus preventing coil herniation into the parent vessel, and allowing denser coil packing.…”

“…Therefore, this safe technique is useful to obliterate the aneurysm sac with concurrent preservation of the parent artery. 3,4,8,12,13) Recently, a special covered stent, the surface of which is covered with special materials, has become available. 1,2) This device may also be useful for the endovascular treatment of pseudoaneurysms.…”

False Aneurysms

“…Synthetic grafts should be used only for a chronic FTA that involves large arteries (e.g., common femoral, subclavian). According to some, endovascular procedures can be important in the management of critically injured patients, as well as those with chronic FTA [33][34][35][36][37][38][39][40][41][42][43]. Endovascular repair of a peripheral FTA seems attractive because it theoretically results in less morbidity and shorter hospitalization [33].…”