Emergency management of iatrogenic arterial injuries with a low-profile balloon-expandable stent-graft

Abstract

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.

Iatrogenesis in the Context of Residential Dementia Care: A Concept Analysis

“…The notion that iatrogenic damages were unfortunate but largely unavoidable adverse consequences of necessary treatment was present in 13 of the 31 articles (41.9%). All of these articles described medical care and they presented iatrogenic damages as “potentially life-threatening complications” ( Ruffino et al, 2020 , p. 1) of necessary surgeries, a “vessel injury” sustained during tumor resection ( Nariai et al, 2020 ), an “adverse clinical condition” ( Gomes et al, 2017 , p. 511) that results from the provision of many types of care, an “unsolved drawback” of revolutionary new investigations ( Micheletti et al, 2020 , p. 1) and as “another pattern of vascular trauma” similar to blunt or penetrating traumas that might occur in the community ( Lui et al, 2020 , p. 5). Sharpe and Faden (1998) identify this tendency to describe iatrogenesis as an unavoidable consequence of progress as a “utilitarian understanding” (p. 64).…”

Life-threatening subclavian artery bleeding following percutaneous coronary intervention with stent implantation: A case report and review of literature

“…Some clinicians have used balloon tamponade for a few minutes as a treatment for vascular bleeding, but this method is thought to be unreliable, as bleeding may resume later, especially in the great vessels. Although multiple therapeutic modalities have been applied to seal vascular injury, endovascular treatment with covered stents appears to be less time-consuming and more effective, especially for large, life-threatening perforations, with high success rates of immediate control of bleeding[ 30 , 31 ].…”

Coronary stent-graft use to salvage a juxta-anastomotic arterial rupture complicating a case of radio-cephalic fistuloplasty

“…Whilst BeGraft is commonly used in coronary intervention, a small number of studies have reported application of a BeGraft coronary stent-graft within a comparable non-coronary context such as in traumatic or iatrogenic injury to the anterior tibial artery and other small vessels including the renal, gluteal and ascending cervical arteries (Brunoro et al 2019 ; Ruffino et al 2020 ).…”