Initial experience with venous stents in exertional axillary-subclavian vein thrombosis

Meier, George H.; Pollak, Jeffrey; Rosenblatt, Melvin; Dickey, Kevin W.; Gusberg, Richard J.

doi:10.1016/s0741-5214(96)70043-5

Cited by 126 publications

(73 citation statements)

References 12 publications

(1 reference statement)

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“…Although self-expanding stents are expected to be more resistant to external forces (vs. stainless steel stents), 3) they are still prone to fracture, with reported fracture intervals of 4 months to 2 years. [4][5][6] However, the stent graft perforation and fracture in the present case occurred at postoperative day 5, and the injuries occurred at almost the same site in the axillary artery (before and after stent graft placement). Therefore, we speculate that the cause was not a fatigue fracture in the stent, and that the injury was related to the clavicle nonunion or the 30-year-old wire that had remained in situ.…”

Section: Discussionmentioning

confidence: 53%

“…2,3) The present case confirms that association, as the EVT provided rapid resolution of the patient's symptoms in an emergent setting (without the risk of brachial plexus injury during open repair). However, EVT can also result in stent deformity or fracture, [4][5][6] and this complication may be related to several factors. The first factor is compression of the stent by the surrounding structures, especially the clavicle and first rib, as in the present case.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, Meier et al have reported that first rib resection is a potential preventative treatment, although this theory has not been confirmed. 5) The second factor is frequent vessel mobility that is caused by upper limb movement, as frequent flexion and extension can cause stent fatigue and fracture. Although self-expanding stents are expected to be more resistant to external forces (vs. stainless steel stents), 3) they are still prone to fracture, with reported fracture intervals of 4 months to 2 years.…”

Section: Discussionmentioning

confidence: 99%

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Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

Nagato

Touma

Ohno

et al. 2015

Annals of Vascular Diseases

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We report the case of a 62-year-old man who experienced a left axillary artery pseudoaneurysm that was secondary to nonunion of a 30-year-old left midshaft clavicle fracture. He initially underwent endovascular repair using a self-expanding nitinol stent graft, which was perforated at postoperative day 5. Therefore, we performed open repair with concomitant clavicle resection, and no complications were observed during an approximately 6-year follow-up. We recommend performing clavicle resection with vascular repair to prevent recurrence in similar cases.Keywords: axillary artery pseudoaneurysm, clavicle nonunion, early stent graft perforation clavicle. Computed tomography (CT) revealed nonunion of a 30-year-old left midshaft clavicle fracture after improper fixation using a wire (Fig. 1A). The patient also reported experiencing paresthesia around his left shoulder at approximately 1 month before his admission. Enhanced CT revealed a pseudoaneurysm that originated from the first segment of the left axillary artery at the first rib (Fig. 1B). Based on these findings, the patient underwent EVT using a self-expanding Fluency Plus stent graft (10 mm × 40 mm). He reported that the pain resolved immediately and the abnormal pulsation disappeared. Therefore, he was discharged at postoperative day 5, and was cautioned to avoid abduction movement (>90°) of his left upper limb.However, the same pain and abnormal pulsation returned on the night after his discharge. He was re-admitted to our hospital and underwent CT and angiography, which revealed a recurrent pseudoaneurysm due to stent graft perforation ( Fig. 2A-2C). Both the covering graft material and the stent structure were compromised, and the stent was dilated and perforated at the midpoint (type III endoleak), although no type I or type II endoleaks were observed. Therefore, two balloon catheters were placed proximal and distal to the perforation, and were inflated to control the pressure in the pseudoaneurysm.The patient was then transferred to the operating theater for resection of the pseudoaneurysm. A diagonal skin incision was made across his clavicle (from the upper proximal side to the lower distal side), and we resected a part of the clavicle that was proximal to the nonunion. We also attempted to dissect the proximal and distal axillary arteries outside the pseudoaneurysm. However, severe adhesion made the dissection difficult, and although we secured the distal axillary artery, we could not secure the proximal axillary artery. There was a risk of brachial plexus injury if we performed further dissection, and we elected to open the pseudoaneurysm. We controlled the bleeding from the perforation digitally, placed a proximal vascular clamp (as well as a distal clamp after dissecting the vessel), and removed the stent graft. Next, we replaced the injured vessel with a 10-mm woven double velour tube

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

Nagato

Touma

Ohno

et al. 2015

Annals of Vascular Diseases

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“…3,20 The use of subclavian angioplasty and stenting following surgical decompression may further improve outcomes, 21 although the utility of subclavian stenting in the absence of surgical decompression has been disappointing. 22 The duration of anticoagulation prior to surgery has also been debated, and some have even proposed withholding surgery for patients who are asymptomatic on warfarin after initial thrombolysis. 23 The most critical element in successful treatment, however, appears to be the prompt delivery of thrombolysis.…”

Section: Treatmentmentioning

confidence: 99%

Life-threatening acute and chronic thromboembolic pulmonary hypertension and subclavian vein thrombosis

Meier

Rubenfire

2006

Clin Cardiol

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Summary:Severe thromboembolic pulmonary hypertension is an infrequent but potentially fatal complication of effort thrombosis (Paget-Schroetter syndrome) of the upper extremity. It has been sporadically reported in the literature, but in most cases has affected young, otherwise healthy athletes. Because this syndrome has been rarely described, it is likely underdiagnosed, and optimal evaluation and treatment has not been established. We describe three young athletic persons who developed thrombosis of the subclavian vein after repetitive motion of the upper extremity, and in whom life-threatening pulmonary hypertension resulted from acute and chronic pulmonary emboli. We then review the mechanism, clinical presentation, diagnosis, and available therapeutic modalities.

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“…Most surgeons agree that percutaneous venoplasty should not be attempted prior to surgical decompression. This practice can lead to even greater endothelial damage and potentially complicate further surgical treatment (17)(18)(19).…”

mentioning

confidence: 99%

Minimally invasive treatments for venous compression syndromes

Hulsberg

McLoney

Partovi

et al. 2016

Cardiovasc. Diagn. Ther.

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The management of venous compression syndromes has historically been reliant on surgical treatment when conservative measures fail. There are, however, several settings in which endovascular therapy can play a significant role as an adjunct or even a replacement to more invasive surgical methods.We explore the role of minimally invasive treatment options for three of the most well-studied venous compression syndromes. The clinical aspects and pathophysiology of Paget-Schroetter syndrome (PSS), nutcracker syndrome, and May-Thurner syndrome are discussed in detail, with particular emphasis on the role that interventionalists can play in minimally invasive treatment.

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Initial experience with venous stents in exertional axillary-subclavian vein thrombosis

Abstract: Trials to evaluate stents as an adjunct to conventional therapy seem warranted. The use of stents alone without first-rib resection, however, appears to be associated with stent fracture.

Cited by 126 publications

References 12 publications

Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

Life-threatening acute and chronic thromboembolic pulmonary hypertension and subclavian vein thrombosis

Minimally invasive treatments for venous compression syndromes

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