Long-term results of stent graft treatment of subclavian artery injuries: Management of choice for stable patients?

Toit, D. F. Du; Lambrechts, A; Stark, Hugo; Warren, Brian

doi:10.1016/j.jvs.2007.11.009

Cited by 125 publications

(85 citation statements)

References 19 publications

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“…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.…”

Section: Discussionsupporting

confidence: 82%

“…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. [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).…”

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: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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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“…There have been some reports of months) 9 . Among them, five patients showed significant stenosis (>50%), and three patients showed stent graft oc-clusion.…”

Section: Discussionmentioning

confidence: 99%

“…All stenosis lesions were treated by angioplasty and were found to be patent during the follow-up. All occlusive lesions were treated conservatively, with no requirement for open surgery to improve symptoms or to achieve limb salvage during the long-term follow-up 9 .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Traumatic chopstick injury is very rare, especially in the vascular system. We present an unusual case of a 19-year-old man who presented at the emergency department after being stabbed with a chopstick by his elder brother. Computed tomography revealed a left subclavian artery pseudoaneurysm, which increased from 4 mm to 7 mm in diameter within 47 days. We successfully deployed a Niti-S stent graft for the increasing aneurysm, thereby avoiding a surgical operation. Balloon angioplasty was added for re-stenosis 8 months after the first intervention. (J Nippon Med Sch 2017; 84: 41 44)

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“…[9] However, application of covered endovascular endoprostheses in the subclavian artery has been more widely accepted as a reliable minimally invasive modality to exclude arteriovenous fistulas and aneurysms, facilitating a reduction in hospitalization time and blood loss and avoiding the need for general anesthesia. [13][14][15] In a recent study of du Toit et al [16] concerning the long-term results of stent graft treatment of subclavian artery injuries with a mean follow-up period of 49 months, significant stenosis or occlusion occurred in eight of the 25 patients available for long-term followup. These patients all presented with non-incapacitating claudication, and the stenotic lesions were all treated successfully with angioplasty and remained patent on follow-up.…”

Section: Discussionmentioning

confidence: 99%

Urgent endovascular treatment of iatrogenic subclavian artery rupture: report of three cases.

Leonardou¹,

Pappas²

2012

Ulus Travma Acil Cerrahi Derg

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Long-term results of stent graft treatment of subclavian artery injuries: Management of choice for stable patients?

Cited by 125 publications

References 19 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

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

Urgent endovascular treatment of iatrogenic subclavian artery rupture: report of three cases.

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