Exclusion Of Pseudoaneurysm Research Articles

Tratamiento combinado abierto y endovascular de aneurismas anastomóticos postinjerto bifurcado aortobifemoral

Anastomotic aneurysms are subject to the same complications as a true aneurysm and their choice and emergency treatment present very high morbidity and mortality rates. We describe a case in which a combined open and endovascular technique was used to treat the aneurysmatic complication of an aortobifemoral graft. Lesions were identified in a 70-year-old male, 11 years after an aortobifemoral by-pass was performed to treat an aortoiliac ischemic disease. A right femoral pseudoaneurysm was identified by palpation and echo-Doppler. In the pre-operative study, a computerised tomography (CT) scan of the abdom-inopelvic cavity was performed and revealed an aortic anastomotic pseudoaneurysm. The femoral lesion was treated using conventional surgery, a short 8 mm PTFE by-pass from the right-hand branch of the bifurcate to the deep femoral artery. Due to the high surgical risk (ASA IV) and a hostile abdomen, the exclusion of the aortic pseudoaneurysm was performed by implanting a straight stent under intradural anaesthetic. After freeing the stent, a distal leakage of contrast medium was noted and corrected by placing a covered straight stent extension. Immediate arteriographical control did not show any flow of contrast inside the aneurysmatic sac. There were no post-operative complications and the patient remained asymptomatic. The control CT at six months confirmed the complete exclusion of the pseudoaneurysm. In a case in which open surgery represents a high risk, endovascular treatment of uninfected aortic anastomotic pseudoaneurysms is feasible. [ANGIOLOGÍA 2002; 54: 402-8]. El aneurisma anastomótico está sujeto a las mismas complicaciones que un aneurisma verdadero, y su tratamiento, tanto electivo como de urgencia, presenta cifras de morbimortalidad muy elevadas. Describimos un caso en que se utiliza la técnica combinada, cirugía abiertay endovascular, para el tratamiento de la complicación aneurismática de un injerto aortobifemoral. Las lesiones se identifican en un varón de 70 años, 11 años después de la realización de una derivación aortobifemoral por una enfermedad isquémica aortoilíaca. Se identifica un pseudoaneurisma femoral derecho mediante palpación y ecografía Doppler. En el estudio preoperatorio se realiza una tomografía computarizada (TC) abdominopélvica que describe un pseudoaneurisma anastomótico aórtico. Se trata la lesión femoral por cirugía convencional, derivación corta de PTFE de 8 mm desde la rama derecha del bifurcado hasta la arteria femoral profunda. Debido a un alto riesgo quirúrgico (ASA IV) y a un abdomen hostil, bajo anestesia intradural se realiza la exclusión del pseudoaneurisma aórtico por medio de la implantación de una endoprótesis recta. Tras la liberación de la prótesis se verifica una fuga distal de contraste, que se corrige mediante la colocación de una extensión de prótesis recta cubierta. El control arteriográfico inmediato no evidencia ningún flujo de contraste en el interior del saco aneurismático. No hay complicaciones postoperatorias y el enfermo se mantiene asintomático. La TC de control a los seis meses confirma la exclusión completa delpseudoaneurisma. En un caso seleccionado, en que la cirugía abierta represente un riesgo elevado, es factible el tratamiento endovascular de los pseudoaneurismas anastomóticos aórticos no infectados. [ANGIOLOGÍA 2002; 54: 402-8]. O aneurisma anastomótico está sujeito às mesmas complicações que um aneurisma verdadeiro, e o seu tratamento, tanto electivo como de urgencia, apresenta números de morbilidade e mortalidade muito elevados. Descrevemos um caso em que se utiliza a técnica combinada, cirurgia aberta e endovascular, para o tratamento da complicacão aneurismática de um enxerto aortofemoral. As lesões são identificadas num homem de 70 anos de idade, 11 anos após a realizacao de um by-pass aortobifemoral por doenca isquémica aortoilíaca. Um pseudo-aneurisma femoral é identificadoporpalpacao e eco-Doppler. No estudo pré-operatório, realiza-se uma tomografia computorizada (TC) abdominopélvica que descreve um pseudo-aneurisma anastomótico aórtico. A lesao femoral é tratada por cirurgia convencional, by-pass curto de PTFE de 8 mm desde o ramo direito da bifurcação até a artéria femoral profunda. Devido a um alto risco cirúrgico (ASA IV) e a um abdómen hostil, sob anestesia intradural faz-se a exclusão do pseudo-aneurisma aórtico por implantacao de uma endoprótese recta. Após a libertacao da prótese, verifica-se uma fuga distal de contraste, a qual é corrigida com a colocação de uma extensão de prótese recta coberta. O controlo arteriográfico imediato nao evidencia qualquer fluxo de contraste no interior do saco aneurismático. Não existem complicações pós-operatórias e o doente permanece assintomático. A TC de controlo aos seis meses confirma a ausência completa do pseudo-aneurisma. Conclusão. Num caso seleccionado, em que a cirurgia aberta representa um risco elevado, é viável o tratamento endovascular dos pseudo-aneurismas anastomóticos aórticos não infectados. [ANGIOLOGÍA 2002; 54: 402-8].

Endovascular treatment of proximal arsastomotic aneurysms after aortic prosthetic reconstruction

To describe the efficacy and value of endovascular stent-grafts for the treatment of aortic anastomotic pseudoaneurysms. Three patients with proximal aortic anastomotic pseudoaneurysms 8--15 years after prosthetic reconstruction were treated by transfemoral stent-graft implantation. In two patients the pseudoaneurysms were excluded by Talent prostheses [tube graft (n = 1), bifurcated graft (n = 1)]. In one patient an uniiliac Zenith stent-graft was implanted and an extra-anatomic crossover bypass for revascularization of the contralateral lower extremity was performed. All procedures were successful with primary exclusion of the pseudoaneurysms. During the follow-up (mean 16 months) one endoleak occurred due to migration of the tube stent-graft. The endoleak was sealed successfully by implanting an additional bifurcated stent-graft. Stent-graft exclusion of aortic pseudoaneurysms offers a minimally invasive and safe alternative to open surgical reconstruction.

Endovascular Vein Graft for the Treatment of Popliteal Pseudoaneurysm

Recent reports have documented the use of covered stents for the treatment of traumatic injuries to the vascular system. We report the first use of an autologous vein-covered Palmaz stent for the treatment of a popliteal artery pseudoaneurysm. A 5-foot-2-inch, 320-pound woman was referred to the authors' institution with new onset of pain and ecchymosis in the popliteal fossa while on Coumadin therapy for treatment of a deep venous thrombosis. She had undergone left total knee replacement 13 months previously. A contrast computed tomography (CT) scan confirmed an 8-cm aneurysm behind the knee. The patient was offered endovascular treatment of this aneurysm as an alternative to bypass surgery. Intraoperative arteriography was performed through a superficial femoral artery cutdown and demonstrated a large popliteal pseudoaneurysm. A 2-cm Palmaz stent was attached to a 6-mm-wide-by-2-cm-long side branch of greater saphenous vein and was used to occlude the neck of the pseudoaneurysm. Completion arteriogram confirmed exclusion of the pseudoaneurysm, and the patient regained a dorsalis pedis pulse after the procedure. Patency at 12 months was confirmed by duplex examination, with the presence of a normal ankle-brachial index (ABI) and normal velocities. The use of endovascular stent grafts made with autogenous tissue offers an attractive alternative to open surgical procedures in technically complex cases. This case demonstrates that a combined open surgical and endovascular approach can be successfully used for the management of traumatic injuries to the popliteal artery. Further investigation will be necessary to evaluate the long-term efficacy of this approach in managing popliteal artery injuries.

In Vivo Crushing of an Aortic Stent Enables Endovascular Repair of a Large Infrarenal Aortic Pseudoaneurysm

Purpose: To report an unusual approach to endovascular exclusion of a large aortic pseudoaneurysm. Methods and Results: A 63-year-old male had an unsuccessful endovascular repair of an aortic anastomotic pseudoaneurysm that left an expanded, uncovered Palmaz stent lying obliquely within the aorta. After nearly 3 years, the pseudoaneurysm enlarged to 7 cm, and the patient became symptomatic. Repair of the pseudoaneurysm was accomplished by crushing the indwelling stent to allow placement of a stent-graft. Conclusions: Malpositioned stents that are hindering an endoluminal procedure may be crushed against the arterial wall in vivo to facilitate passage of endovascular instruments or devices.

Acute traumatic rupture of the thoracic aorta: Delayed treatment with endoluminal covered stent. A report of two cases

Acute traumatic rupture of the thoracic aorta: Delayed treatment with endoluminal covered stent. A report of two cases

Iatrogenic Arteriovenous Fistula as a Complication of a Polytetrafluoroethylene (PTFE) Graft for Hemodialysis

The authors describe 2 patients who developed an iatrogenic arteriovenous fistula between a straight forearm polytetrafluoroethylene (PTFE) graft and an in situ cephalic vein after posterior puncture of the graft with a hemodialysis cannula. Diagnosis of this iatrogenic fistula was by careful inspection of the PTFE graft. The distal PTFE graft was functional, but the proximal graft was thrombosed at the ill-placed puncture site. Superficial veins on the anterior forearm exhibited a thrill and bruit. Treatment was simple ligation of the fistula and revascularization of the thrombosed segment of the PTFE graft. When the fistula occurred with a pseudoaneurysm, treatment was ligation of the fistula, exclusion of the pseudoaneurysm, and interposition graft to maintain vascular continuity. This complication of vascular access is not documented in the literature.

Demyelinating Diseases

Pseudoaneurysm treatment with overlapping stents may be a useful technique to reduce flow and enhance thrombosis in the aneurysmal sac. We treated a pseudoaneurysm of the left carotid artery in a patient with a history of bilateral carotid thromboendarterectomy by placing three stents and overlapping them at the level of the aneurysmal neck. Nine month follow-up revealed almost complete pseudoaneurysm exclusion and patency of the carotid artery.