In Vivo Crushing of an Aortic Stent Enables Endovascular Repair of a Large Infrarenal Aortic Pseudoaneurysm

Dorros, Gerald; Jaff, Michael R.; Parikh, Ashish; Sehgal, Rajesh; Thota, Venkat; Ramireddy, Keshav; Carballo, Richard E.

doi:10.1177/152660289800500412

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Clinically, it already proved its interest, particularly in patients with short necks [28] or in highly specific situations [29]. With the non-invasive techniques now available, it is feasible to properly and regularly assume the biofunctionality and the biostability of such devices in vivo.…”

Section: Resultsmentioning

confidence: 99%

Analysis of Explanted Latecba Modular Stent-grafts Deployed Transrenally to Repair AAAs with Short Necks in 29 Dogs

Guidoin

Peirano

Barone³

et al. 2009

Artificial Cells, Blood Substitutes, and Biotechnology

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Twenty-nine modular stent-grafts deployed transrenally to repair AAAs with short necks in dogs were harvested at autopsy of the animals after scheduled durations of implantations of 10 days, one month, three months, and six months. Analyses of the explanted devices included non-destructive techniques such as gross observations, X-rays CT scan, IVUS and angioscopy. Further to appropriate dissection, histological investigations were carried out by means of scanning electron microscopy (SEM) and light microscopy. All the 29 specimens were extensively encapsulated with fibrous tissues but the fibrous capsule was thin in six of them; four capsules were ulcerated. The X-rays confirmed the stability of the devices that were still straight (12), slightly bent (12) or bent (4). The modules were misaligned in only one case. IVUS and angioscopy confirmed the patency of all the stent-grafts with thin internal capsules both proximally and distally with variable capsulation in the mid-section of the grafts. The left renal artery orifices were found to be patent at dissection with no obstruction to flow. The luminal flow surface of the stent-grafts was smooth and glistening proximally and distally containing endothelial like cells and vasa-vasorum. Poor healing was noted in the aneurysm area. Transrenal deployment of this modular stent-graft is feasible and gave excellent results with regard to biofunctionality and biocompatibility. The device proved to be safe and efficient.

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Section: Resultsmentioning

confidence: 99%

Analysis of Explanted Latecba Modular Stent-grafts Deployed Transrenally to Repair AAAs with Short Necks in 29 Dogs

Guidoin

Peirano

Barone³

et al. 2009

Artificial Cells, Blood Substitutes, and Biotechnology

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“…There are several reports of externally deformed, crushed, or collapsed metallic intravascular stents (1–11). 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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confidence: 99%

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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False Anastomotic Aneurysms

et al. 2007

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This retrospective study covers the period from 1991 to 2002, during which 3,623 patients were operated on because of aneurysmal or occlusive disease of aortoiliac and femoropopliteal segments. Among them, 87 patients (2.4%) developed a false anastomotic aneurysm in the 12-year follow-up period and were treated operatively. Most frequently, in 53 patients (6.9%), a false anastomotic aneurysm developed after aortobifemoral bypass performed owing to aortoiliac occlusive disease. The cause of false anastomotic aneurysm was infection in 21 cases (24.7%); resection and revascularization were performed with a Dacron graft in 46 cases (52.9%), with a polytetrafluoroethylene graft in 10 cases (11.5%), and with the great saphenous vein in 16 cases (18.4%). Homograft implantation in 4 patients (4.6%) or extra-anatomic bypasses in 11 cases (12.6%) were performed when graft infection was suspected. Of 87 patients who underwent surgery, 74 (85.5%) had good early results without infection, reintervention, limb loss, and mortality. The presence of infection as a cause of false anastomotic aneurysm and comorbidity increased the mortality rate significantly after the reoperation, whereas the type of graft used in treatment had no influence on early results.

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In Vivo Crushing of an Aortic Stent Enables Endovascular Repair of a Large Infrarenal Aortic Pseudoaneurysm

Cited by 3 publications

References 9 publications

Analysis of Explanted Latecba Modular Stent-grafts Deployed Transrenally to Repair AAAs with Short Necks in 29 Dogs

Analysis of Explanted Latecba Modular Stent-grafts Deployed Transrenally to Repair AAAs with Short Necks in 29 Dogs

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

False Anastomotic Aneurysms

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