1
|
Brendel JM, Mangold T, Lescan M, Schmehl J, Ghibes P, Grimm A, Greulich S, Krumm P, Artzner C, Grözinger G, Estler A. Viabahn stent graft for arterial injury management: safety, technical success, and long-term outcome. CVIR Endovasc 2024; 7:23. [PMID: 38416319 PMCID: PMC10900043 DOI: 10.1186/s42155-024-00435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The Viabahn stent graft has emerged as an integral tool for managing vascular diseases, but there is limited long-term data on its performance in emergency endovascular treatment. This study aimed to assess safety, technical success, and long-term efficacy of the Viabahn stent graft in emergency treatment of arterial injury. METHODS We conducted a retrospective single tertiary centre analysis of patients who underwent Viabahn emergency arterial injury treatment between 2015 and 2020. Indication, intraoperative complications, technical and clinical success, and major adverse events at 30 days were evaluated. Secondary efficacy endpoints were the primary and secondary patency rates assessed by Kaplan-Meier analysis. RESULTS Forty patients (71 ± 13 years, 19 women) were analyzed. Indications for Viabahn emergency treatment were extravasation (65.0%), arterio-venous fistula (22.5%), pseudoaneurysm (10.0%), and arterio-ureteral fistula (2.5%). No intraoperative adverse events occurred, technical and clinical success rates were 100%. One acute stent graft occlusion occurred in the popliteal artery on day 9, resulting in a 30-day device-related major-adverse-event rate of 2.5%. Median follow-up was 402 days [IQR, 43-1093]. Primary patency rate was 97% (95% CI: 94-100) in year 1, and 92% (95% CI: 86-98) from years 2 to 6. One stent graft occlusion occurred in the external iliac artery at 18 months; successful revascularization resulted in secondary patency rates of 97% (95% CI: 94-100) from years 1 to 6. CONCLUSION Using Viabahn stent graft in emergency arterial injury treatment had 100% technical and clinical success rates, a low 30-day major-adverse-event rate of 2.5%, and excellent long-term patency rates.
Collapse
Affiliation(s)
- Jan M Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Tobias Mangold
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Jörg Schmehl
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Patrick Ghibes
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Antonia Grimm
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Simon Greulich
- Department of Cardiology and Angiology, Tübingen University Hospital, Tübingen, Germany
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | | | - Gerd Grözinger
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany.
| | - Arne Estler
- Department of Radiology, Diagnostic and Interventional Radiology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| |
Collapse
|
2
|
Chang HY, Liu ZG, Li YL, Liu B, Wang WJ, Wang W, Wang YZ. Endovascular stenting and coil embolization for management of radiation-induced pseudoaneurysms of the peripheral arteries. J Int Med Res 2021; 49:300060520984933. [PMID: 33845651 PMCID: PMC8047089 DOI: 10.1177/0300060520984933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study was performed to evaluate the safety and efficacy of endovascular stenting and embolization for the management of radiation-induced peripheral arterial pseudoaneurysms. Methods Twelve consecutive patients with radiation-induced peripheral arterial pseudoaneurysms (diameter of 10–30 mm and mean size of 20.42 mm) were admitted to our hospital from 1 January 2015 to 31 October 2019. The patients’ baseline characteristics, perioperative parameters, device characteristics, and curative effects were systematically recorded and analyzed. Results The 12 patients comprised 3 men and 9 women with a mean age of 62.90 ± 13.97 years. The iliac artery was the most commonly involved artery, followed by the subclavian artery. In all patients, the pseudoaneurysms were detected by enhanced computed tomography. Twelve covered stents were deployed (7 or 8 mm in diameter and 50 mm in length). Additional coil embolization was performed in three patients (Patients 8, 9, and 10). The primary and secondary technical success rate was 91.7% and 100%, respectively. Apart from one death caused by rebleeding, no patients developed rebleeding during follow-up. Conclusion Endovascular stenting and coil embolization are feasible and effective for the management of radiation-induced peripheral arterial pseudoaneurysms in highly selected patients.
Collapse
Affiliation(s)
- Hai-Yang Chang
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Zhen-Guo Liu
- Department of Oncology, Gaoqing People's Hospital, Gaoqing, Shandong Province, People's Republic of China
| | - Yu-Liang Li
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Bin Liu
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Wu-Jie Wang
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Wei Wang
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Yong-Zheng Wang
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| |
Collapse
|
3
|
Piñana C, Gramegna LL, Folleco E, Requena M, Hernandez D, Tomasello Weitz A. Preliminary Experience Using a Covered Stent Graft in Patients with Acute Ischemic Stroke and Carotid Tandem Lesion. Cardiovasc Intervent Radiol 2020; 43:1679-1686. [PMID: 32676962 DOI: 10.1007/s00270-020-02594-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/04/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Endovascular treatment with a covered heparin-bonded stent graft has been shown to be feasible and safe for treatment of peripheral artery disease, but its role in carotid disease remains unclear. The purpose of this study was to determine the feasibility and safety of a covered stent graft in treating cervical carotid artery disease in a consecutive series of patients with acute ischemic stroke (AIS) due to tandem lesion in a single high-volume Comprehensive Stroke Center. METHODS A retrospective review of all patients that underwent carotid endovascular interventions during mechanical thrombectomy for AIS using a self-expanding covered stent graft at Vall d'Hebron University Hospital between 2016 and 2018 was conducted. Patient clinical and angiographical characteristics as well as postoperative outcome and follow-up were recorded. RESULTS A total of eight patients were treated with the covered stents, and we observed significant improvement in stroke severity at 24 h in 5/8 patients (mean NIHSS 18 ± 5 vs 12 ± 8, p = 0.02). Successful recanalization (TICI 2b-3) after thrombectomy was achieved in 5/8 (62.5%) patients. One stent occluded during the procedure. At 3-month follow-up, stents were patent in three (37.5%) patients (two with mRS 3 and one with mRS 1). The stents of the remaining four patients (62.5%) were occluded (one with mRS 2 and three with mRS 4), although the patients did not show signs of stroke recurrence. CONCLUSION The preliminary results of our study show that the self-expanding covered stent graft did not achieve satisfactory patency at 90-days among patients with AIS and tandem lesions, suggesting that its use in the carotid circulation may not be recommended in the context of AIS.
Collapse
Affiliation(s)
- Carlos Piñana
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Edgar Folleco
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Requena
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain.,Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Hernandez
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello Weitz
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain. .,Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain.
| |
Collapse
|
4
|
Giannopoulos S, Trinidad E, Aronow H, Soukas P, Armstrong EJ. Εndovascular Repair of Extracranial Carotid Artery Aneurysms: A Systematic Review. Vasc Endovascular Surg 2020; 54:254-263. [PMID: 31894734 DOI: 10.1177/1538574419895383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Both true and false extracranial carotid artery aneurysms (ECAA) are a potential source of morbidity and mortality. While ECAA have historically been treated surgically, endovascular reconstruction with stenting is an emerging treatment option. The aim of our study was to report clinical/radiologic outcomes following endovascular repair of ECAAs. METHODS A comprehensive systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS A total of 68 case reports and case series, comprising 162 patients, were included. Most patients presented with at least one symptom or sign related to the ECAA (89.5%; N = 145/162). In 42.6% (N = 69/162) and 46.3% (N = 75/162) of the cases polytetrafluoroethylene covered and uncovered stents were deployed respectively. Immediate post-procedural imaging demonstrated complete aneurysm exclusion in 86.4% (N = 140/162) of the cases and minimal filling of the aneurysm sack in 10.5% (N = 17/162) of all cases. Perioperative adverse event rates were 3.1% for stroke, 1.2% for transient ischemic attack (TIA) and 4.3% for mortality. During a mean follow-up of 21.8months, there were additionally observed one stroke, two TIAs and three deaths. Overall 88.6 % of the patients (N = 117/132) remained asymptomatic, partially recovered or at least did not suffer from new neurologic deficits during follow up, with no signs of stenosis or occlusion of the carotid artery. CONCLUSIONS Endovascular stenting for the treatment of ECAAs is feasible with acceptable short- and long-term clinical and radiologic outcomes. Prospective real-world studies are needed to further validate the safety and the long-term patency of endovascular repair.
Collapse
Affiliation(s)
- Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Evan Trinidad
- Department of Internal Medicine, UCHealth University of Colorado Hospital, Denver, CO, USA
| | - Herbert Aronow
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Peter Soukas
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| |
Collapse
|
5
|
Lu WL, Wang B, Wu F, Wang MY, Pan JX, Xu H. Covered Stent–Assisted Open Surgery in the Treatment of an Extracranial Carotid Artery Pseudoaneurysm. Ann Vasc Surg 2019; 57:238-243. [DOI: 10.1016/j.avsg.2018.08.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/11/2018] [Accepted: 08/08/2018] [Indexed: 12/18/2022]
|
6
|
Onishi Y, Kimura H, Kanagaki M, Oka S, Fukumoto G, Otani T, Matsubara N, Kawabata K. Placement of a Viabahn stent-graft for hepatic artery pseudoaneurysm complicated by arterial dissection caused by a guiding sheath. Radiol Case Rep 2019; 14:711-713. [PMID: 30988861 PMCID: PMC6447732 DOI: 10.1016/j.radcr.2019.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/24/2022] Open
Abstract
A 69-year-old man was transferred to our hospital for massive hemorrhage from a right hepatic artery pseudoaneurysm 5 months after surgery for gastric cancer. Stent-graft placement was planned to avoid fatal hepatic infarction, and a guiding sheath was advanced deeply into the tortuous and stenotic right hepatic artery beyond the pseudoaneurysm for safe deployment of a stent-graft. However, this advancement caused arterial dissection of the right hepatic artery. After the guiding sheath was pulled back, a Viabahn stent-graft was successfully advanced over a guidewire to exclude the pseudoaneurysm. We consider that a Viabahn stent-graft is more flexible than a guiding sheath and that advancing a Viabahn stent-graft directly from a proximally placed guiding sheath is safer than advancing a guiding sheath into a tortuous and stenotic abdominal artery.
Collapse
Affiliation(s)
- Yasuyuki Onishi
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Hiroyuki Kimura
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Mitsunori Kanagaki
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Shojiro Oka
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Genki Fukumoto
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Tomoaki Otani
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Naoko Matsubara
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| | - Kazuna Kawabata
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki 660-8550, Japan
| |
Collapse
|
7
|
Baptista-Sincos APW, Simplício AB, Sincos IR, Leaderman A, Neto FS, Moraes A, Aun R. Flow-diverting Stent in the Treatment of Cervical Carotid Dissection and Pseudoaneurysm: Review of Literature and Case Report. Ann Vasc Surg 2017; 46:372-379. [PMID: 28689955 DOI: 10.1016/j.avsg.2017.06.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/04/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The endovascular technique has been recommended over the past few years to extracranial carotid dissection and pseudoaneurysm with promising results, especially after medical therapy failure. Flow-diverting stents are an alternative for complex cases. These stents have proven to be effective treatment devices for intracranial aneurysms. METHODS The reference list of Pham's systematic review, published in 2011, and Seward's literature review, published in 2015, was considered, as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE and Literatura Latino-Americana e do Caribe em Ciências da Saúde. RESULTS For carotid dissection and pseudoaneurysm, our review yielded 3 published articles including 12 patients. The technical success rate of flow-diverting stent was 100% with no procedural complication described. Mean clinical follow-up was 27.2 months (range 5-48), and in 5 months' angiographic follow-up, all lesions had healed. No new neurological events were reported during the clinical follow-up. CONCLUSIONS Flow diverter stent use on intracranial and peripheral vascular surgery demonstrates satisfactory initial results, but it is still under investigation. There are very few cases treated till now and the initial results with flow-diverting stents to cervical carotid dissection are promising. In well-selected cases, where simple embolization or conventional stent is not appropriate, this technic may be considered.
Collapse
Affiliation(s)
| | - Aline Bigatão Simplício
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Igor Rafael Sincos
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Alex Leaderman
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Fernando Saliture Neto
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Adjaldes Moraes
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Ricardo Aun
- Department of Surgery, Vascular and Endovascular Division of Albert Einstein Hospital, São Paulo, SP, Brazil
| |
Collapse
|
8
|
Urgent Endovascular Treatment of Proximal Right Subclavian Artery Pseudoaneurysm Using Kissing Technique. Ann Vasc Surg 2015; 29:1319.e1-4. [DOI: 10.1016/j.avsg.2015.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/08/2015] [Accepted: 02/13/2015] [Indexed: 11/19/2022]
|
9
|
Endovascular Treatment of Bilateral Carotid Artery Pseudoaneurysms after Blunt Carotid Injury. Ann Vasc Surg 2014; 28:263.e11-6. [DOI: 10.1016/j.avsg.2013.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 04/07/2013] [Accepted: 06/04/2013] [Indexed: 01/31/2023]
|
10
|
Pulli R, Dorigo W, Pratesi G, Fargion A, Pratesi C. Single-Center Experience on Endovascular Repair of Noninfected Extracranial Internal Carotid Artery Pseudoaneurysms. Ann Vasc Surg 2013; 27:672.e13-7. [DOI: 10.1016/j.avsg.2012.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/10/2012] [Accepted: 07/13/2012] [Indexed: 10/26/2022]
|
11
|
Pulli R, Dorigo W, Alessi Innocenti A, Pratesi G, Fargion A, Pratesi C. A 20-year Experience with Surgical Management of True and False Internal Carotid Artery Aneurysms. Eur J Vasc Endovasc Surg 2013; 45:1-6. [DOI: 10.1016/j.ejvs.2012.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
|
12
|
Endoprosthesis Placement for Treatment of a Left Common Carotid Artery Pseudoaneurysm after Attempted Central Venous Access. J Vasc Access 2010; 11:365-6. [DOI: 10.5301/jva.2010.5811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2010] [Indexed: 11/20/2022] Open
|