Endovascular Exclusion Of Subclavian Artery Pseudoaneurysm

Successful surgical treatment of right subclavian artery aneurysm with a hypoplastic left vertebral artery using temporary cerebral perfusion to prevent cerebral ischemia

A 71-year-old man had a right subclavian artery aneurysm (dimension, 30 × 38 mm) that was adjacent to the right common carotid artery and exceedingly close to the right vertebral artery. The patient had a marked hypoplastic left vertebral artery, dominant right vertebral artery, and an incompletely formed and underdeveloped circle of Willis in the skull. While performing a median sternotomy and supraclavicular incision during the operation, we used temporal shunting for the cerebral perfusion. The subclavian artery aneurysm was resected, and a 10-mm diameter woven Dacron graft was used for reconstructing the subclavian artery. The postoperative course was uneventful, and the patient was discharged from the hospital 18 days after surgery. Temporal shunting for maintaining cerebral perfusion was useful in preventing cerebral ischemia, and the median sternotomy plus supraclavicular incision approach afforded an unobstructed view of the surgical field.

Glue embolus complicating the endovascular treatment of a patient with Loeys-Dietz syndrome

A 34-year-old [corrected] woman was diagnosed with Loeys-Dietz syndrome. Five months later, the patient presented with a symptomatic 2.6-cm subclavian pseudoaneurysm. Staged endovascular treatment was initiated with left vertebral artery embolization, followed by sac ablation and stent graft exclusion. The pseudoaneurysm cavity was filled with n-butylcyanoacrylate ("glue") via a microcatheter. Despite balloon occlusion of the pseudoaneurysm orifice, a small amount of glue debris embolized to the brachial artery, necessitating a vein bypass. In this case, distal embolization of glue may have been avoided by leaving a microcatheter in the aneurysm sac for glue injection after first deploying the stent graft.

Endovascular grafts for treatment of traumatic injury to the aortic arch and great vessels

BACKGROUND

Treatment of traumatic vascular injury using endovascular techniques has evolved as endovascular capabilities have advanced over the past several decades. Several endovascular techniques have been employed to address the challenges of traumatic arterial injury, including coil embolization and the use of stents, which may be either bare metal or covered with graft material. Compared with traditional surgical repair, endovascular stent grafting for the repair of traumatic arterial injury offers the advantage of decreased morbidity because a remote access site may be used, avoiding surgical dissection and lengthy operating times.

METHODS

A Medline (1995-2007) search was performed to find all studies discussing the use of endovascular means to treat supradiaphragmatic arterial trauma.

RESULTS

In this review of 195 studies published between January 1995 and December 2007, the overall technical success rate of endovascular treatment of supradiaphragmatic arterial injury was 96.7%, and the complication rate was 6.4%.

CONCLUSION

The results of this review suggest a potential morbidity and mortality benefit over traditional open repair; however, long-term data are lacking. Long-term follow-up for stent durability is of particular concern in the trauma population, which tends to comprise younger patients with minimal atherosclerotic disease. The success of endovascular techniques is also limited by the availability of skilled interventionalists, properly outfitted angiography suites, and suitable stent graft devices. Despite these challenges, the potential advantages of endovascular stenting make it a welcome addition to the armamentarium of the vascular interventionalist who treats arterial traumatic injuries.