Severe Deformity of a Palmaz-Schatz Stent After Normal Surgical Manipulation

Tovar, Eduardo A.; Blau, Nenad; Borsari, Alan; Landa, Daniel; Packer, J

doi:10.1016/s0003-4975(96)01078-8

Cited by 8 publications

(2 citation statements)

References 6 publications

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“…Such trauma could also occur during cardiac manipulation in off-pump coronary surgery. In reoperations, stented venous can also be deformed during normal manipulation [13,14]. If planned, any graft may be used to bypass the stented vessel.…”

Section: Resultsmentioning

confidence: 99%

Early Coronary Artery Bypass Grafting Following Life-Saving Percutaneous Coronary Intervention

Yay¹

2014

Ann Clin Anal Med

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The mean time interval between percutaneous coronary intervention and coronary artery bypass grafting was found to be statistically significant regarding stent patency (p=0.007). Discussion: Bypass grafting to a previously stented coronary artery may be the relevant approach even if the angiographic findings are normal, because intraoperative manipulation and systemic effects of cardiopulmonary bypass if used will result in deformity or occlusion of the stent.

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Section: Resultsmentioning

confidence: 99%

Early Coronary Artery Bypass Grafting Following Life-Saving Percutaneous Coronary Intervention

Yay¹

2014

Ann Clin Anal Med

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“…There are several reports of externally deformed, crushed, or collapsed metallic intravascular stents (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Endovascular approaches to the resultant stenoses or thromboses have achieved restoration of blood flow in select cases, including hemodialysis access (10).…”

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How I Do It: Thrombosed Arteriovenous Graft Resulting from a Crushed Stent in a Nonambulatory Hemodialysis Patient

Wasse¹

2008

Seminars in Dialysis

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There are several reports of externally deformed, crushed, or collapsed metallic intravascular stents (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Endovascular approaches to the resultant stenoses or thromboses have achieved restoration of blood flow in select cases, including hemodialysis access (10). Described below is a case of a thrombosed arteriovenous graft (AVG) that resulted from external compression and subsequent collapse of a previously placed stent. The technique used to restore patency to the graft has not been described in the previous literature. Case ReportAn 83-year-old patient with end-stage renal disease (ESRD) on hemodialysis presented with a thrombosed left upper extremity arteriovenous graft (AVG). The patient was unable to ambulate independently and relied on her grandson to lift her from her wheelchair. On examination, the AVG was superficial and thrombosed.A thrombectomy was performed by initially passing a catheter over a wire to the central veins, and an angiogram was taken as the catheter was pulled back towards the AVG (Fig. 1). The angiogram showed a crushed intravascular stent just proximal to the venous anastomosis. Another stent was seen just distal to the crushed stent. The patient underwent successful expansion of the proximal stent and dilatation of the vein with a 7 × 4 mm balloon (Fig. 2). Thrombectomy of the AVG using standard techniques was successful (Fig. 3). DiscussionSeveral options exist for percutaneous revascularization of a collapsed or crushed metallic intravascular stent. One report describes bilateral iliac artery stent collapse and intervention with angioplasty balloon dilation (11). The authors concluded that since the pressure gradient measured across both stented segments was 0 mmHg, no further intervention was necessary (11). Another report describes a similar technique in a hemodialysis access. In this case, manipulation of a guide wire across the collapsed stent was followed by predilation of the stent with a PTA balloon measuring 6 mm × 4 cm, and then deployment of a self-expandable stent within the lumen of the previously collapsed stent. This series of interventions was followed by mechanical thrombolysis to achieve patent venous runoff by angiography (10).Our case is the first published report of revascularizing an occluded hemodialysis access circuit in the setting of a crushed bare-metal stent by inflation of an angioplasty balloon within the lumen of the stent, without subsequent restenting. In performing the procedure, the operator must be cautious not to allow the guidewire (and subsequently the angioplasty balloon) to traverse the struts of the stent. In addition, the operator must ascertain if the stent has been

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Percutaneous Salvage of Crushed Bilateral Aorto-Iliac Stents: Case Report

Soares

Coiner

Gunlock

et al. 2002

CardioVascular and Interventional Radiology

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There are multiple reports of externally deformed or crimped intravascular stents. Percutaneous salvage has been described in multiple anatomic locations including the carotid artery, coronary artery bypass grafts, and hemodialysis conduits. We report successful percutaneous salvage of severely crushed aortoiliac stents in a patient status post low anterior resection, chemotherapy, and radiation therapy for rectal carcinoma. A review of the literature describing approaches to externally deformed stents in other anatomic regions, the limited experience with crushed iliac stents, and our technique is presented.

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Severe Deformity of a Palmaz-Schatz Stent After Normal Surgical Manipulation

Cited by 8 publications

References 6 publications

Early Coronary Artery Bypass Grafting Following Life-Saving Percutaneous Coronary Intervention

Early Coronary Artery Bypass Grafting Following Life-Saving Percutaneous Coronary Intervention

How I Do It: Thrombosed Arteriovenous Graft Resulting from a Crushed Stent in a Nonambulatory Hemodialysis Patient

Percutaneous Salvage of Crushed Bilateral Aorto-Iliac Stents: Case Report

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