Successful management of Palmaz-Schatz stents deformed by inadvertent angioplasty outside the stents

Chu, Tony N.T.; Ling, Frederick S.

doi:10.1002/(sici)1097-0304(199708)41:4<435::aid-ccd22>3.0.co;2-j

Cathet. Cardiovasc. Diagn.

1997

DOI: 10.1002/(sici)1097-0304(199708)41:4<435::aid-ccd22>3.0.co;2-j

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Successful management of Palmaz-Schatz stents deformed by inadvertent angioplasty outside the stents

Tony N.T. Chu

Frederick S. Ling

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Cited by 3 publications

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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).…”

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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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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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Percutaneous Salvage of Crushed Bilateral Aorto-Iliac Stents: Case Report

Soares

Coiner

Gunlock

et al. 2002

CardioVascular and Interventional Radiology

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There are multiple reports of externally deformed or crimped intravascular stents. Percutaneous salvage has been described in multiple anatomic locations including the carotid artery, coronary artery bypass grafts, and hemodialysis conduits. We report successful percutaneous salvage of severely crushed aortoiliac stents in a patient status post low anterior resection, chemotherapy, and radiation therapy for rectal carcinoma. A review of the literature describing approaches to externally deformed stents in other anatomic regions, the limited experience with crushed iliac stents, and our technique is presented.

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Le préjudice réparable : la perte de chance

Béry¹

2013

Orthod Fr

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La chance est la probabilité que quelque chose se produise et, en ce sens, la perte de chance peut se définir comme le préjudice résultant de la disparition de la probabilité d’un événement favorable (a contrario, la non-réalisation du risque). C’est un préjudice autonome, qu’il convient de distinguer du préjudice final. Le préjudice moral est une notion très proche de la perte de chance bien que reposant sur l’indemnisation d’un préjudice final d’affection.

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Successful management of Palmaz-Schatz stents deformed by inadvertent angioplasty outside the stents

Cited by 3 publications

References 14 publications

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

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

Percutaneous Salvage of Crushed Bilateral Aorto-Iliac Stents: Case Report

Le préjudice réparable : la perte de chance

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