Stent graft exclusion of a pseudoaneurysm in a Blalock‐Taussig shunt

Abstract

This case is the first report of slow-growing pseudoaneurysm after vessel dissection secondary to two stents implantation into classic Blalock Taussig shunt in a patient with pulmonary atresia and ventricular septal defect. Pseudoaneurysm was successfully excluded by a percutaneous approach with self-expandable stent graft deployment from the aorta to the middle of the Blalock Taussig shunt. Nearly 3 years after the procedure, the classic BT is patent, and there were no restenosis or thrombosis in spite of the very long length of the stented segment.

Percutaneous stent implantation for occluded central shunts in adults: A case report and review of current evidence

“…However, corrective surgery was not possible in most patients because of pulmonary artery hypoplasia and anatomic issues. Recently, percutaneous techniques including transcatheter thrombolysis, mechanical thrombectomy, balloon angioplasty, and stent insertion have become attractive alternatives to surgery with interesting advantages ( 18 , 50 , 51 ). When compared to surgery, catheter interventions offer decreased bleeding risk, post-interventional wound pain, and infection, as well as shorter hospital stay ( 25 ).…”

“…Successful placement of covered coronary stents, after coil embolization was described in several cases with complicated large pseudoaneurysm formations ( 86 ). In addition, it has been reported that slow-growing pseudoaneurysm after BTS stent implantation was successfully excluded with a self-expandable stent graft without complication in the immediate and short-term follow-up ( 50 ).…”

“…Femoral artery tear, spasm, and loss of a femoral pulse have been also reported ( 20 ) and the use of a long sheath was associated with a higher risk of arterial access damage ( 18 ). Several possible adverse effects including vessel rupture, dissection, vasospasm, vessel occlusion, aneurysm formation, overdilation ( 91 – 93 ), and pseudoaneurysm are possible complications of stent insertion ( 50 ). Pulmonary hemorrhage caused by a tear of the pulmonary artery and occlusion of the distal pulmonary artery were also reported ( 30 ).…”

Interventions Involving the Use of Covered Coronary Artery Stents for Pseudoaneurysms of Blalock-Taussig Shunts

“…Pseudoaneurysms can be treated using either the surgical or the transcatheter approach. 2 The transcatheter approach is preferred in patients who are critically ill or having active hemorrhage. Both of our patients had massive hemoptysis; therefore, an operation with or without cardiopulmonary bypass may have been more risky for them.…”

“…The primary complications of shunt-related pseudoaneurysm include rupture and massive pulmonary hemorrhage. [1][2][3][4] We describe two children herein who had recurrent pulmonary hemorrhage secondary to pseudoaneurysms of the left subclavian artery following modified Blalock-Taussig shunt procedures.…”