Stent Dislocation Research Articles

Report Report from the 12th Conference of the Pediatric Cardiology Section of the Polish Cardiac Society (Zabrze 7–8.06.2013) – “Progress in interventional treatment of congenital heart diseases”

Report Report from the 12th Conference of the Pediatric Cardiology Section of the Polish Cardiac Society (Zabrze 7–8.06.2013) – “Progress in interventional treatment of congenital heart diseases”

Patent Ductus Arteriosus Stenting in Complex Congenital Heart Disease: Early and Midterm Results for a Single-Center Experience at Children Hospital, Mansoura, Egypt

This study aimed to assess the efficacy and outcome of transcatheter ductus arteriosus stenting in newborns and infants with ductal-dependent or decreased pulmonary circulation. Between September 2009 and December 2011, 33 newborns and infants were subjected to patent ductus arteriosus (PDA) stenting as an alternative to a surgical shunt. Of the 33 patients, 20 had pulmonary atresia (PA) with a ventricular septal defect, 4 had PA with an intact ventricular septum, 5 had PA with a double-outlet right ventricle, and 4 had critical pulmonary stenosis. The McGoon ratio ranged from 0.8 to 1.9 (median 1.27). The ages of the patients ranged from 3 to 56 days, and their weight ranged from 2.7 to 4.1 kg. The oxygen saturation ranged from 45 to 61 %, and the pH ranged from 7.13 to 7.27. Premounted coronary stents with diameters of 3, 3.5, and 4 mm were used to cover the whole length of the ductus. The PDA was tortuous in 23 patients and straight in 10 patients. The mean ductal length was 12.2 ± 3.7 mm (range 7.8-23 mm). The mean stent length was 14.3 ± 3.4 mm (range, 8-23 mm), and the mean narrowest ductal diameter was 1.9 ± 0.6 mm (range, 0.8-2.9 mm). Immediately after the procedure, the oxygen saturation was increased from a mean of 75.1 ± 13.2-91.5 ± 6.3 % (p < 0.0001), and the PDA diameter was increased from a mean of 1.9 ± 0.6-4.3 ± 0.8 mm (p < 0.0001). Stent redilation was necessary in two patients 8 days after the procedure, and their oxygen saturation increased 79-88 %. The mean fluoroscopy time was 39.4 ± 15.5 min. Stent dislocation to the left main pulmonary artery was seen in one patient, with another stent placed in the arterial duct. No procedure-related mortality occurred. Two neonates died a few days after the procedure due to sepsis related to the procedure. The surviving patients were discharged home 8-30 days (median, 9.5 days) after the procedure. Stent patency was achieved for 8-550 days. The McGoon ratio increased and ranged from 1.6 to 2.8 (median, 1.87) before the surgical intervention. Glenn anastomosis was possible for 18 patients at the age of 6-8 months. Nine patients experienced worsening of cyanosis about 4 months after stent placemen. Six of these patients required a Blalock-Taussig shunt, whereas stent dilation was possible for the remaining three patients. Four patients died of severe dehydration while awaiting a Glenn shunt. The findings show that PDA stenting can be a good alternative to surgery for initial palliation, especially in infants who will need multiple surgeries. It is safe and feasible but its efficacy gradually lessens after 6 months due to intrastent endothelial hyperplasia.

Use of a specially designed partially covered self-expandable metal stent (PSEMS) with a 40-mm diameter for the treatment of upper gastrointestinal suture or staple line leaks in 11 cases

The use of self-expandable stents to treat postoperative leaks and fistula in the upper gastrointestinal (GI) tract is an established treatment for leaks of the upper GI tract. However, lumen-to-stent size discrepancies (i.e., after sleeve gastrectomy or esophageal resection) may lead to insufficient sealing of the leaks requiring further surgical intervention. This is mainly due to the relatively small diameter (≤30 mm) of commonly used commercial stents. To overcome this problem, we developed a novel partially covered stent with a shaft diameter of 36 mm and a flare diameter of 40 mm. From September 2008 to September 2010, 11 consecutive patients with postoperative leaks were treated with the novel large diameter stent (gastrectomy, n = 5; sleeve gastrectomy, n = 2; fundoplication after esophageal perforation, n = 2; Roux-en-Y gastric bypass, n = 1; esophageal resection, n = 1). Treatment with commercially available stents (shaft/flare: 23/28 mm and 24/30 mm) had been unsuccessful in three patients before treatment with the large diameter stent. Due to dislocation, the large diameter stent was anchored in four patients (2× intraoperatively with transmural sutures, 2× endoscopically with transnasally externalized threads). Treatment was successful in 11 of 11 patients. Stent placement and removal was easy and safe. The median residence time of the stent was 24 (range, 18-41) days. Stent dislocation occurred in four cases (36 %). It was treated by anchoring the stent. Mean follow-up was 25 (range, 14-40) months. No severe complication occurred during or after intervention and no patient was dysphagic. Using the novel large diameter, partially covered stent to seal leaks in the upper GI tract is safe and effective. The large diameter of the stent does not seem to injure the wall of the upper GI tract. However, stent dislocation sometimes requires anchoring of the stent with sutures or transnasally externalized threads.

Self-expanding covered metallic stent treatment of esophagojejunostomy fistulas

The purpose of this study is to analyze the outcomes of the self-expanding covered metallic stent (SECMS) therapy in the management of the postoperative anastomotic leaks that seen after total gastrectomy-esophagojejunostomy (EJ) operations. Contrast radiography and endoscopy revealed EJ fistulas in 14 patients. SECMSs were implanted both fluoroscopically and endoscopically to seal fistulas. Postoperative fistula diagnosis times, postoperative covered stent implantation times, primary success rates, clinical success rates, postinterventional oral feeding beginning times, reduction of the drainage from the surgical drains, procedure-related mortality-morbidity, and mortality related with factors other than the procedure were noted. Technical success rate was 100 %. Clinical success rate was 79 %. Reduction of the fluid from surgical drains was observed in all patients. There were no procedure-related mortality. Recurrent fistula was observed in two patients (14 %) at the third and fifth day after the intervention. In one patient (7 %), stent dislocation was observed at the 10th day after the intervention. Non procedure-related mortality was 21 %. No anastomotic stricture, no in-stent stenosis was observed during the follow up period(11.09 ± 3.21 months). From the above results we concluded that SECMS treatment for EJ fistulas is a safe, effective and technically easy procedure.

Sa1578 Predictors of Surgical Resection in Patients With Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound With and Without Fine Needle Aspiration

bloody aspiration, n 1; EUS-guided imaging only through meshes of an intestinal stent, n 1); ii) drainage, n 57 (81.4%; metal stent, n 41/57; 71.9%// polyethylene stent, n 16/57; 28.1%) / long-term drainage (clinical success): mean, 8 (range, 2-18) months in malignancy. The spectrum of various approaches to place the drainage (n 57) comprised: i) rendezvous, n 8/14%; ii) antegrade-intrahepatic, n 3/5.3%; iii) retrograde-intrahepatic, n 35/61.4%; iv) antegrade-extrahepatic, n 9/15.8%; v) antegrade-retrograde, n 2/3.5%. Causes for not possible drainage comprised: i) Dilatation problems at the access site, n 5; ii) frustrating rendesvouz technique, n 2; iii) stent dislocation into abdominal cavity (endoscopic removal achieved), n 3; iv) frustrating placement through the meshes of an intestinal stent, n 2; v) blood aspiration, n 1; vi) failure of fluoroscopy, n 1). Complication profile contented cholangitis (n 3), stent dislocation (n 5; n 1 in mid-term run), postinterventional pain (n 2) & hemobilia (n 1). Reintervention became necessary in 3/70 (4.3%). Conclusion: EUCD (favoring rendesvouz technique) is a feasible & safe alternative treatment option with an acceptable periinterventional risk in selected patients preferentially with advanced & metastasized tumor growth, which aims for an improvement of the quality of life under palliative intention avoiding mostly a reintervention, which has to be still considered an experimental clinical procedure to be only performed in centres with great expertise in interventional endoscopy/EUS but i) broadens the therapeutic spectrum & ii) needs further study-based investigation.

Endosonografie (EUS)-gestützte transluminale Cholangiodränage (EUCD) – eine neue Option der interventionellen Endoskopie im interdisziplinären Management des obstruktiven Ikterus

ERCP and PTCD are considered the gold standard in the interventional treatment of biliary obstruction, in particular, with palliative intention. If ERCP and PTCD are not possible, an alternative drainage procedure such as the EUS-guided cholangiodrainage (EUCD) can be used. AIM / METHOD: By the mean of a compact review, indication, technique, variants of approach, number of treated patients and therapeutic procedures reported by various authors, success rate, spectrum and management of complications as well as recommendations for an appropriate follow-up-investigation protocol for EUCD based on our own clinical experiences and compared to published data are described. EUCD is an interventionally endoscopic / -sonografic procedure, which is used in case of postoperatively changed anatomy of the upper GI tract (BII gastric resection, PPPHR, Whipple procedure, [sub-]total gastrectomy, Roux-en-Y reconstruction) and, thus, if papilla of Vater (papilla) can not be reached or catheterized or if the patient denies PTCD in subjects with recurrent, advanced or metastasized tumor lesion(s) of the upper abdomen, hepatobiliary system as well as pancreas and associated obstruction of the biliary tree - / + jaundice. EUS-guided transluminal puncture from the upper GI tract into various extra- / intrahepatic segments of the biliary system, recanalization of the tumor stenosis with stent insertion through the access site or bypassing the tumor (stent-based retro- or antegrade drainage of the biliary tree). Derived from this, there are various approaches and procedures - EUCD i) combined with rendesvouz technique, ii / iii) transhepatically with retro- (permanent hepaticoenterostomy) / antegrade internal drainage, iv) extrahepatically with antegrade drainage (permanent choledocho-enterostomy), which are distinguished according to tumor site, possible direction of translumenal puncture, insertion of a guide wire and final stent placement. Within the spectrum of complications (rateLit.: 0 - 25 %), bleeding, perforation, stent dislocation / -migration/-occlusion and slight postinterventional pain are relevant. Currently, approximately 200 cases have been published worldwide; the clinical experience of the reporting institution is based on more than > 70 interventions. With regard to the limited diffusion process, EUCD cannot be considered a standard procedure yet. The advantages comprise low tissue trauma, primary internal drainage and the possible endoscopic re-intervention in case of complications. The high technical challenge in performing EUCD is a disfavourable aspect for broader use in clinical practice. However, the disclosed treatment results demonstrating an acceptable complication rate show that EUCD can be competitively considered to ERCP und PTCD with a great chance for primary success. EUCD is an elegant, not yet fully established, but rather still experimental procedure of interventional endoscopy / EUS, which needs great expertise of the endoscopist in an interdisciplinary centre of visceral medicine as one of the main predictions. In experienced hands, a safe procedure can be provided, for which a systematic follow-up and a multicentre evaluation of periinterventional management are still needed in order to achieve a final assessment of EUCD for guideline approval.

Endovascular Repositioning of a Pipeline Embolization Device Dislocated from the Vertebral into the Basilar Artery Using a Stent-in-Stent Technique

Stent dislocation is a rarely encountered problem in interventional neuroradiology. This article describes the repositioning of a pipeline embolization device (PED) dislocated from the vertebral artery (VA) into the basilar artery (BA) using a stent-in-stent technique. Based on this case additional in vitro measurements were performed. In a patient, a larger PED (4.0 × 20 mm) was partially opened in a PED (3.0 × 20 mm) floating freely within the distal BA. The microcatheter with the partially opened stent was pulled back hereby pulling back the stent-in-stent construct into the VA. In vitro the maximum tensile force that could be applied to a 3.5 mm and a 4.5 mm PED before dislodgement out of a 3.0 mm PED was determined. Videomorphometric analyses of the stent-in-stent construct were performed while applying traction to the construct. Repositioning of a dislocated PED is feasible using a stent-in-stent technique. Higher dislodgement forces can be applied using a larger PED (4.5 mm, 0.36 N) whereas dislodgement occurred faster using a smaller PED (3.5 mm, 0.26 N). Before dislodgement occurs, elongation and tapering of both stents can be seen. Finally, it was found that incidental extraction of the 4.5 mm PED out of the delivering microcatheter during traction is possible. Repositioning of a lost PED is feasible using a stent-in-stent technique. Principally, dislodgement force is higher using a larger PED, while in this case care has to be taken to avoid incidental extraction of the second PED out of the microcatheter.

Efficacy of implantation of a modified temporary metallic stent for cardia achalasia

Objective To study the efficacy and safety of implantation of a modified temporary self- expanding metallic stent for cardia achalasia. Methods A total of 30 patients diagnosed as having cardia aehalasia were randomly divided into 2 groups, group A （traditional stents） and group B （modified stents） （n = 15 in each group）. Two clays after stent implantation at the cardia by endoscopy, stents were withdrawn with endoscope guided by X-ray. LES Pressure, X-ray images （including the diameter of the most dilated part of esophageal and the most narrow part of cardia） and the symptoms of dysphagia were compared before and half year after the treatment. The width changes of the most narrow stenting part on the point of stenting and 2 days after removal were compared. The side effects and complications during the treatment were recor- ded. Results All thirty stents were successfully implanted and removed. Stent dislocation occnred in 2 ca- ses in group A, but none in group B. Dysphagia had significant improvement after the treatment in both groups （ P 〈 0. 05 ）, but the recurrence rate of group A （26. 7% ） was significantly higher than group B （6. 67% ） in 6 months （ P 〈 0. 05）. LES pressure and X-ray images of both groups significantly improved af- ter treatment （ P 〈 0. 001 ）, and those of group B were superior to group A （ P 〈0. 05 ）. There was no differ- ence in adverse reaction between the two groups. No perforation occured in any group. Conclusion Self-ex- panding metallic stents is safe for patients with cardia achalasia, with implantation convenience, symptomaticimprovement, low recurrence, and few complications or dislocation. Key words: Esophageal achalasia; Temporary metallic stent; Dilatation of esophagus

Serious Complication of Percutaneous Angioplasty with Stent Implantation in so Called "Chronic Cerebrospinal Venous Insufficiency" in Multiple Sclerosis Patient

We report female patient, age 51, with clinically definitive multiple sclerosis (CDMS) since 1998, who underwent two PTA procedures with stent implantation for CCSVI in 2010. Expanded disability status scale (EDSS) worsened since the procedure from 4.5 to 6. Total number of three stents was implanted (two of them in the right internal jugular vein). In six month time, in 2011, patient was referred for independent examination by computer tomography (CT) phlebography for right-sided neck pain. Dislocation of stents on the right side and thrombosis of left sided stent was found. Conservative approach was used so far. Our short report is showing possible complications of PTA and stenting in jugular veins in so called CCSVI and bringing information about neurological state (EDSS) worsening in a subject. Continuation of stent migration in the future is probable, possibly resulting in pulmonary embolism with fatal risk for the patient. We strongly ask for restriction of PTA procedure in so called CCSVI, which concept was not proven to be relevant to MS.

Przemieszczenie stentu wieńcowego do tętnicy biodrowej – powikłanie ze szczęśliwym zakończeniem

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Dziuba M, Lenczewski P, Chiżyński K, et al. Coronary stent deployment to the iliac artery – a complication with a successful treatment. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(2):146-152. doi:10.5114/pwki.2012.29656. APA Dziuba, M., Lenczewski, P., Chiżyński, K., Zielińska, M., Religa, W., & Kaszyński, M. et al. (2012). Coronary stent deployment to the iliac artery – a complication with a successful treatment. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(2), 146-152. https://doi.org/10.5114/pwki.2012.29656 Chicago Dziuba, Michał, Piotr Lenczewski, Krzysztof Chiżyński, Marzenna Zielińska, Wojciech Religa, Marek Kaszyński, and Ludomir Stefańczyk et al. 2012. "Coronary stent deployment to the iliac artery – a complication with a successful treatment". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 8 (2): 146-152. doi:10.5114/pwki.2012.29656. Harvard Dziuba, M., Lenczewski, P., Chiżyński, K., Zielińska, M., Religa, W., Kaszyński, M., Stefańczyk, L., and Kidawa, M. (2012). Coronary stent deployment to the iliac artery – a complication with a successful treatment. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(2), pp.146-152. https://doi.org/10.5114/pwki.2012.29656 MLA Dziuba, Michał et al. "Coronary stent deployment to the iliac artery – a complication with a successful treatment." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 8, no. 2, 2012, pp. 146-152. doi:10.5114/pwki.2012.29656. Vancouver Dziuba M, Lenczewski P, Chiżyński K, Zielińska M, Religa W, Kaszyński M et al. Coronary stent deployment to the iliac artery – a complication with a successful treatment. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(2):146-152. doi:10.5114/pwki.2012.29656.

Anchor-wire technique for multiple plastic biliary stents to prevent stent dislocation

In endoscopic placement of multiple plastic biliary stents (PBSs), we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion. We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis. Although proximal dislocation of the first PBS was observed, we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire. We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath. It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb. Here we introduce this "anchor-wire technique", which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.

Healing Occurs in Most Patients That Receive Endoscopic Stents for Anastomotic Leakage; Dislocation Remains a Problem

There is controversy about the best way to treat esophageal anastomotic leakage. We evaluated the effects of treatment with self-expanding metal stents in patients with esophageal anastomotic leakage after esophagectomy or gastrectomy for cancer. We investigated outcomes and procedure-related complications of 115 patients who received endoscopic stents for anastomotic leakage after esophagectomy or gastrectomy at a university hospital from 2004 to 2009. We also performed a systematic literature review on stent therapy and compared outcomes with that of other treatment regimens for esophageal anastomotic leakage. Among the 115 patients who received stents, the in-hospital mortality rate was 9% and complete anastomotic healing was achieved in 70% (95% confidence interval [CI], 64%-76%). Stent dislocation occurred in 53% of the patients (95% CI, 43%-62%), in all patients with esophagocolonostomy, in 61% with esophagojejunostomy, and in 49% with esophagogastrostomy. Three percent of patients (95% CI, 1%-5%) needed laparotomy to remove dislocated stents. Elective endoscopic stent removal was performed in 80% of the patients after a median of 54 days (range 17-427 d); 12% of these patients developed symptomatic anastomotic strictures after stent removal. Anastomoses completely heal in 70% of patients that receive endoscopic stents for anastomotic leakage after esophagectomy or gastrectomy. Stent therapy should be used in the management of patients with adequately perfused esophageal anastomotic leakage. However, stent dislocation remains a common problem after surgery.

NEW METHOD OF COVERED WALLSTENTS FOR DISTAL MALIGNANT BILIARY OBSTRUCTION TO REDUCE EARLY STENT‐RELATED COMPLICATIONS BASED ON CHARACTERISTICS

We previously reported a low occlusion rate with covered Wallstents for malignant biliary obstruction, but stent-related complications other than occlusion posed a problem. A modified covered Wallstent insertion method based on stent characteristics was evaluated to reduce stent-related complications. A total of 138 patients with distal malignant biliary obstruction received covered Wallstent placement. From October 2001 to October 2003, 69 patients received covered Wallstent placement (Group 1). Thereafter, we modified our stent insertion method and 69 patients received stent placement using this modified method from November 2003 to January 2007 (Group 2). The modified insertion method consists of endoscopic sphincterotomy carried out in patients without pancreatic duct invasion and longer stent placement with the center of the stent located in the center of the biliary stricture to prevent pancreatitis, kinking of the bile duct, and stent dislocation. A comparative analysis was carried out using prospectively collected data in these two cohorts. Tumor ingrowth was not observed, and stent occlusion rate was 18.8% in Group 1 and 23.2% in Group 2. The overall rates of stent-related complications did not differ (39.1% in Group 1 and 30.4% in Group 2), but stent-related complications within 3months decreased from 22 episodes in Group 1 to 13 episodes in Group 2. Median event-free survival was prolonged by modified stent insertion method (125days in Group 1 and 268days in Group 2, P=0.020), although cumulative survival and stent patency were not significantly different. Our modified method of covered Wallstent placement showed improved event-free survival.

Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study

Management of anastomotic biliary strictures after liver transplantation deserves optimization. To evaluate placement and removal of partially covered self-expandable metal stents (PCSEMSs) in this setting. Prospective, multicenter, uncontrolled study. Three French academic hospitals with liver transplantation units and tertiary referral endoscopy centers. Twenty-two patients (18 men, 4 women, aged 49.7 ± 12 years) with anastomotic biliary stricture. Seventeen (77.3%) presented stricture recurrence after plastic stenting. PCSEMSs were placed across the stricture for 2 months and then removed. Patients were followed by clinical examination and liver function tests 1, 3, 6, 9, and 12 months after PCSEMS removal. The ability to remove PCSEMS. PCSEMS placement was successful in all patients, after sphincterotomy in 21 patients. Stent-related complications included minor pancreatitis (3 patients), transient pain (1 patient), and cholangitis (1 patient). Stent removal was achieved in all patients but 2 whose stents had migrated distally. Partial stent dislocation was noted in 5 patients (upward in 4, downward in 1). Complications associated with stent removal were minor, including self-contained hemorrhage (1 patient) and fever (1 patient). The stricture persisted at the end of treatment in 3 patients (13.6%), all of whom had stent migration or dislocation. Recurrence of anastomotic stricture after initial success occurred in 9 of 19 patients (47.4%) within 3.5 ± 2.1 months. Sustained stricture resolution was observed in 10 of 19 patients (52.6%), 45.6% from an intent-to-treat perspective. Uncontrolled study with limited follow-up. Temporary placement and removal of PCSEMSs in anastomotic biliary strictures after liver transplantation is feasible, although sometimes demanding. Stent migration may impair final outcome.

Mediastinal Dislocation of the Esophageal Stents

Purpose: Abstract: We report a case of mediastinal abscess associated with dislocation of esophageal stents and disruption of esophagogastric anastomosis. Introduction: Esophageal stents are mostly used as a non-surgical alternative for palliation of esophageal cancers. Though the complication rate is low, serious complications like rupture of esophageal wall and respiratory arrest may occur. Case Report: Our case is a 62 year- old white man diagnosed with stage III, T2N1M0 adenocarcinoma of distal esophagus in April of 2009. He had neoadjuvent chemoradiation followed by esophagectomy with gastric pull-through in September of 2009. One week after the surgery he developed esophagogastric anastomotic leak leading to sepsis. He had multiple stents placed to stop the leak and had indwelling chest tube for drainage. In December of 2009, he presented with intractable cough associated with swallowing and vomiting for three days. He was found to be in severe respiratory distress and in septic shock. CT scan of the chest showed dislocation of the stents (Image 1), air fluid level with possibility of abscess in right chest and mediastinum and diffuse patchy pulmonary infiltrates. He had surgical exploration of chest that revealed two migrated esophageal stents with abscess in the mediastinum. Discussion:Esophageal stents are self-expanding metal or plastic stents. Their use is mostly limited to palliation of symptoms for patients with esophageal cancer. Esophageal stents have also been used in patients with benign conditions such as refractory strictures, perforation, and postoperative leaks. Complications include chest pain, foreign body sensation, obstruction, aspiration, malposition, bleeding, migration. Severe complications like perforation and respiratory arrest are rare. Conclusion: There is always a possibility of esophageal stents getting dislodged if the supporting tissue around the ends of the stent is friable. Our case had radiation therapy to the esophagus preoperatively which induced radiation esophagitis rendering already diseased esophageal wall further weak. Patients with persistent anastomotic leaks are at high risk for stent dislocation and migration.Figure: [463] Dislocated stent in the mediastinum.

E0541 Percutaneous valved stent implantation above the coronary ostia: a new transitional treatment for acute aortic valve rupture

ObjectiveTo investigate the feasibility of percutaneous valved stent implantation above the coronary ostia as a transitional treatment for acute aortic valve rupture.BackgroundIn recent years, some experimental and clinical studies about...

Emergency endovascular repair of complicated Stanford type B aortic dissections within 24 hours of symptom onset in 30 cases

To investigate the results of emergency endovascular repair of complicated Stanford type B aortic dissections within 24 hours of symptom onset. A retrospective analysis of the clinical data of 30 patients with complicated Stanford type B aortic dissections who underwent emergency endovascular repair between June 2007 and October 2008. Endovascular repairs were performed within 24 hours of symptom onset. Stent-grafts were deployed at the first entry tear through the femoral artery under fluoroscopic guidance. Follow-up computed tomography scans were performed at 1, 3, 6, 12, and 18 months after treatment. The mean patient age was 64 years (range, 43-83 years). There were 3 cases associated with rupture, 6 cases associated with refractory hypertension, 15 cases associated with persistent pain, 2 cases associated with retrograde dissection, and 4 cases associated with malperfusion. The technical success rate was 100%, and the incidence of immediate postoperative endoleaks was 13.4%. One patient died of dissection rupture within 30 days. The mean follow-up period was 12 ± 8 months. A small, persistent endoleak (<10%) occurred in 1 patient, and 1 patient died of acute liver failure 2 months after the operation. No stent dislocation, false lumen expansion, or paraplegia occurred. The false lumen was completely thrombosed in 6 patients and partially thrombosed in 19 patients. The mortality rate was 6.67%. Our results suggest that emergency endovascular repair of complicated Stanford type B aortic dissections within 24 hours of symptom onset is associated with good outcomes and can decrease mortality.

A comparative study between temporary esophageal stenting and balloon dilatation for achalasia

Objective To compare the short- and long- term effects and safety of endoscopic balloon dilatation vs. placement of specially designed reclaimable self-expanding anti-reflux esophageal stents for achalasia. Methods A total of 129 patients with achalasia were divided into 2 groups to receive either endoscopic scopic balloon dilatation（,l=63）or endoscopic placement of specially designed reclaimable self-expandinganti-reflux esophageal stents （n = 66）. The dysphagia symptom scores were recorded before and 1-month,6-month and 12-month after the procedure, respectively. The change in width of esophagus, procedure related complications, length and costs of hospitalization were also analyzed. Results Dysphagia symptom score was significantly decreased after the treatment in both groups （P 〈 0.05）. The effective rates evaluated at 1-month, 6-month and 12-month after the procedure in balloon dilatation group were 100. 0% , 96. 7% and 91.5% , respectively, which in stenting group were 100.0% , 98. 0% and 97.1% , respectively. There was no significant difference in changes of symptom score at 1-month and 6-month after treatment between the 2 groups （P 〉 0.05） , while at 12-month after treatment, the decrease of symptom score in stenting group was significantly higher than that in balloon dilatation group （P〈0. 05）. After the treatment, the significant widening of the stricture and narrowing of the dilated esophagus were achieve in both groups （P 〈 0.05）,while no significant difference between these 2 groups was observed in changes of width （P 〉 0. 05）. Procedure related complications in balloon dilatation group included esophageal perforation （n =1） and upper gastrointestinal bleeding （n=4） , which was not occurred in stenting group, but complications included hyperplasia of granulation tissue （n = 1）, stent dislocation （n =2） and defulvium （n = 1） was observed inthe latter group. The length of hospitalization was similar in 2 groups （P 〉 0. 05） , and the cost of hospitalization in stenting group was significantly higher than that of balloon dilatation group （P 〈 0. 05）. Conclusion Compared with endoscopic balloon dilatation, the specially designed reclaimable self-expanding antireflux stents is a more ideal method for achalasia, with similar short-term effect, but better long-term effect and safety. Key words: Esophageal achalasia; Endoscopes; Balloon dilation; Stents

Treatment of Complex Airway Lesions After Lung Transplantation With Self-Expandable Nitinol Stents: Early Experience

Airway complications (AC) are considered a serious cause of morbidity after lung transplantation (LT). Mechanical dilatation, laser vaporization, and silicone stent placement usually solve it. However, the use of self-expandable metallic stents (SENS) may be indicated in selected cases. Ten lung transplant recipients with AC were treated with SENS. Six patients underwent LT for cystic fibrosis, 2 for idiopathic pulmonary fibrosis, 1 for bronchiectasis, and 1 for emphysema. All patients received at least 1 treatment attempt with dilatation and silicone stent placement. The indications for SENS placement were the presence of a tortuous airway axis with stenosis and malacia of the right main bronchus in 5 patients; a long stenosis of the main and intermediate right bronchus involving the upper lobe orifice in 3 patients; or malacia that could not be stabilized with silicone stents in 3 cases. In 1 patient the procedure was bilateral. Functional improvement was immediate with a mean forced expiratory volume at 1 second (FEV 1) gain of 35%. No stent dislocation was observed. Symptoms did not occur again in 5 patients with previous recurrent episodes of pneumonia. One stenosis, which was due to the ingrowth of granulation tissue occurred at 6 months after the procedure, was successfully treated with mechanical dilatation and laser vaporization. The deployment of SENS in a selected group of patients with AC after LT was easy, safe, and effective.

Endoscopic and Percutaneous Preoperative Biliary Drainage in Patients with Suspected Hilar Cholangiocarcinoma

IntroductionControversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCCA) requiring major liver resection. The current study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) in patients with resectable HCCA. MethodsOne hundred fifteen consecutive patients were explored for HCCA between 2001 and July 2008 and assigned by initial PBD procedure to either EBD or PTBD. ResultsOf these patients, 101 (88%) underwent PBD; 90 patients underwent EBD as primary procedure, and 11 PTBD. The technical success rate of initial drainage was 81% in the EBD versus 100% in the PTBD group (P = 0.20). Stent dislocation was similar in the EBD and PTBD groups (23% vs. 20%, P = 0.70). Infectious complications were significantly more common in the endoscopic group (48% vs. 9%, P < 0.05). Patients in the EBD group underwent more drainage procedures (2.8 vs. 1.4, P < 0.01) and had a significantly longer drainage period until laparotomy (mean 15 weeks vs. 11 weeks in the PTBD group; P < 0.05). In 30 patients, EBD was converted to PTBD due to failure of the endoscopic approach. ConclusionsPreoperative percutaneous drainage could outperform endoscopic stent placement in patients with resectable HCCA, showing fewer infectious complications, using less procedures.