Multiple Fractures With Pseudoaneurysm Formation in a Subclavian Artery Stent

Math, Ravi S.; Shankarappa, Ravindranath Khandenahally; Dwarakaprasad, Ramesh; Karur, Satish; Bhairappa, Shivakumar; Jayan, J P Praveen; Manjunath, Cholenahally Nanjappa

doi:10.1161/circulationaha.110.015834

Cited by 5 publications

(8 citation statements)

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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: 52%

“…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%

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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: 52%

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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“…Endoluminal stent placement in supra‐aortic trunk lesions is a viable solution with a satisfying outcome , however durability of these devices is limited, has become a concern following many reports of stent fractures and vessel restenosis . Delayed endovascular stent fracture has been observed in arteries with mechanical stress and can occur from exposures to unfavorable extrinsic or intrinsic stresses and biomechanical forces that differ at different vascular sites .…”

Section: Discussionmentioning

confidence: 99%

Subclavian transectional stent fracture and migration to the aortic carrefour: A case description of retrieval by snare system

Grasso

Costanzo

Tamburino

2013

Cathet Cardio Intervent

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Percutaneous transluminal angioplasty with or without stent has become the treatment of choice for stenotic lesion in subclavian arteries. However, there is a growing concern following many reports of stent fractures, a serious complication of endovascular therapy. We report for the first time a case of delayed left subclavian stent fracture with transection of the protruding ostial part and migration into the aortic carrefour that was retrieved by a snare device.

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“…However, the durability of these devices is unknown, and many reports refer to stent fractures and in-stent restenosis. There are only a few reports of complete stent fractures in the SCA that led to symptomatic in-stent stenosis and pseudoaneurysms, [1][2][3][4] but detection of asymptomatic SCA stent fractures may be difficult. A rare case of an asymptomatic, severe stent fracture in an SCA with progressive restenosis in the early postoperative period is presented, and the mechanism of stent fracture is discussed.…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic Complete Spiral Stent Fracture in Subclavian Artery with Progressive Restenosis in the Early Postoperative Period: A Case Report

Izawa,

Matsumoto,

Nakanishi

et al. 2024

JNET

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Stent fractures may be a risk factor for delayed restenosis, but it is difficult to diagnose asymptomatic stent fractures in the subclavian artery (SCA). We report a rare case of percutaneous transluminal angioplasty and stenting (PTAS) for SCA stenosis with asymptomatic severe stent fracture that showed progressive in-stent stenosis in the early postoperative period.Case Presentation: A 70-year-old woman presented with left arm claudication. Magnetic resonance imaging at the time of admission showed SCA stenosis with severe calcification. Because of the left subclavian steal phenomenon on ultrasonography of the left vertebral artery, she underwent PTAS using a balloon-expandable stainless stent.Ultrasonography the day after treatment showed appropriate stent placement. Computed tomography angiography (CTA) 30 days after PTAS showed an asymptomatic complete spiral stent fracture at the mid-portion of the stent. The in-stent stenosis then gradually progressed on follow-up ultrasonography at the site of the stent fracture. Nine months after the first PTAS, a second PTAS using a self-expandable nitinol stent was performed because the peak systolic velocity exceeded 300 cm/s on Doppler ultrasound. Two years after the second PTAS, no neurological symptoms and no stent deformation were observed. Conclusion:PTAS with a balloon-expandable stainless stent for SCA stenosis with severe calcification may lead to stent fracture. In the case of severe stent fracture, careful follow-up may be needed for the detection of asymptomatic in-stent stenosis in the early postoperative period.Keywords▶ asymptomatic stent fracture, subclavian artery, percutaneous transluminal angioplasty and stenting, calcification, balloon-expandable stent Case PresentationA 70-year-old woman with hypertension and hyperlipidemia was admitted with a 2-month history of left upper limb claudication. Her left radial pulse was weaker than her right one. Left brachial blood pressure was 85/52 mmHg, but that of the right one was 138/82 mmHg. Magnetic

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Multiple Fractures With Pseudoaneurysm Formation in a Subclavian Artery Stent

Cited by 5 publications

References 5 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

Subclavian transectional stent fracture and migration to the aortic carrefour: A case description of retrieval by snare system

Asymptomatic Complete Spiral Stent Fracture in Subclavian Artery with Progressive Restenosis in the Early Postoperative Period: A Case Report

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