Transluminal Stent-graft Placement Research Articles

Treatment of aberrant subclavian artery combined with aortic dissection and analysis of interim results

Objective This retrospective study is to investigate the clinical features,treatment methods,and follow-up results of aberrant subclavian artery (ASA) combined with aortic dissection (AD). Methods Totally 17 patients with ASA combined with AD (ASA+AD) admitted to our hospital from August 2013 to February 2018,were included. Among these patients,there were 14 acute cases and 3 chronic cases; 13 males and 4 females; aged from 28 to 82 years,with the mean age of (54±14) years. All the ASAs in these 17 patients were located behind the esophagus. There were 15 cases of aberrant right subclavian artery (ARSA),including 13 cases of Stanford type B AD (TBAD) and 2 cases of Stanford type A AD (TAAD). The other 2 cases of aberrant left subclavian artery (ALSA) was combined with TBAD. In these 15 patients combined with TBAD,8 cases received the hybridization treatment,4 patients underwent the simple transluminal stent-graft placement,and 3 cases were subjected to the conservative treatment. All the other 2 patients combined with TAAD received the surgical treatment. Results Out of these 17 patients,16 cases were successfully followed up,while 1 patient was lost in the follow-up period (who received the conservative treatment). The follow-up period lasted from 5 to 58 months,with an average of (30±15) months. In the patients receiving the hybridization treatment,1 case reported perioperative death,and another 1 case suffered from severe endoleakage. In the patients receiving the simple transluminal stent-graft placement,1 case reported coldness in right upper extremity,combined with numbness. One case receiving the surgical treatment reported severe endoleakage within 3 months after operation. Moreover,2 cases reporting severe inner leakage underwent the secondary embolization treatment,obtaining satisfactory embolization effects. For the one case reporting coldness in right upper extremity,combined with numbness,after endovascular repairing treatment,the symptoms were significantly relived after drug treatment,without surgical treatment. No sever complications had been reported for the other patients during the follow-up period. Conclusion Patients with ASA+AD should be clearly diagnosed before surgery,and specific surgical plans should be determined according to specific conditions. Surgical treatment should be preferred for the patients of ASA combined with TAAD. For the patients of ASA combined with TBAD,the TEVAR or hybridization treatment or fenestration treatment could be considered,according to the condition of the arch branch vessels. Key words: Subclavian artery; Aorta; Aneurysm, dissecting; Radiology, interventional; Vascular surgical procedures

Occupational radiation exposure in vascular interventional radiology: A complete evaluation of different body regions

PurposeTo perform a complete evaluation on radiation doses, received by primary and assistant medical staff, while performing different vascular interventional radiology procedures. Materials and methodsWe evaluated dose received in different body regions during three categories of vascular procedures: lower limb angiography (Angiography), lower limb percutaneous transluminal angioplasty (Angioplasty) and stent graft placement for abdominal aortic aneurysm treatment (A. A. A. Treatment). We positioned the dosimeters near the eye lens, thyroid, chest, abdomen, hands, and feet of the interventional physicians. Equivalent dose was compared with annual dose limits for workers in order to determine the maximum number of procedures per year that each physician could perform. We assessed 90 procedures. ResultsWe found the highest equivalent doses in the A. A. A. Treatment, in which 90% of the evaluations indicated at least one region receiving more than 1mSv per procedure. Angioplasty was the only procedural modality that provided statistically different doses for different professionals, which is an important aspect on regards to radiological protection strategies. In comparison with the dose limits, the most critical region in all procedures was the eye lens. ConclusionsSince each body region of the interventionist is exposed to different radiation levels, dose distribution measurements are essential for radiological protection strategies. These results indicate that dosimeters placed in abdomen instead of chest may represent more accurately the whole body doses received by the medical staff. Additional dosimeters and a stationary shield for the eye lens are strongly recommended.

Transluminal stent graft placements for the treatment of Standford B type aortic dissection

Transluminal stent graft placements for the treatment of Standford B type aortic dissection

Repeated transluminal endovascular Inoue stent graft placement for progressive dilatation of prosthetic graft that had been repaired with Inoue stent graft placement for dilatation 23 years after extraanatomical bypass

A 76-year-old man had undergone aneurysm exclusion and ascending abdominal aortic extraanatomical bypass for a thoracoabdominal aortic aneurysm in 1978. In 1983 hemoptysis occurred, and resection and closure of the central stump of the aorta and a left lower lobectomy were performed. Dilatation (phi50 mm) of a prosthetic graft (Cooley Graft phi18 mm) used for extraanatomical bypass was noted in 2001 and was repaired by placement of an Inoue stent graft. However, the aneurysm diameter increased further (phi70 mm), although no endoleak was noted: Placement of an Inoue stent graft covering the whole length of the prosthetic graft was repeated in 2006. The postoperative course was smooth, no endoleak occurred, and the patient was discharged 2 weeks after surgery.

Changes in False Lumen After Transluminal Stent-Graft Placement in Aortic Dissections: Six Years' Experience

Changes in False Lumen After Transluminal Stent-Graft Placement in Aortic Dissections: Six Years' Experience

Stent grafting of acute hepatic artery bleeding following pancreatic head resection

The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemorrhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump.

The effect of transluminal stent-graft placement on blood flow of abdominal branch vessels in type B aortic dissection

目的 探讨覆膜血管内支架置入术对主动脉夹层腹部重要血管分支血流的影响. 方法 35例B 型主动脉夹层接受覆膜血管内支架治疗,通过术前后电子束CT、MRI与DSA资料分析,比较术前后腹部重要血管分支影像学变化. 结果 35例共计140支腹腔内脏主要血管分支(包括腹腔动脉、肠系膜上动脉及左右肾动脉),术前经影像学资料综合判断,血流受损血管58支,其中14支为动力型受损,占10.0%(14/140支);44支为静力型血流受损,占31.4%(44/140支).覆膜血管内支架置入后14支动力型受损的血管分支血流全部改善;44支静力型分支均显示不同程度血流改善,管腔狭窄程度减轻,对比剂充盈和排空速度加快,术后无缺血并发症. 结论覆膜血管内支架置入术不仅能改善B 型主动脉夹层所致的血管分支动力型缺血,对多数静力型受损的血管也有明显的即时血流改善作用,但中远期效果有待进一步观察。

Extended total arch replacement by means of the open stent-grafting method to treat intimal tears after transluminal stent-graft placement for a ruptured acute type B aortic dissection

J Thorac Cardiovasc Surg Hirano, Kan Takada and Isao Yada Tomoaki Suzuki, Takatsugu Shimono, Noriyuki Kato, Uhito Yuasa, Koji Onoda, Tadanori aortic dissection intimal tears after transluminal stent-graft placement for a ruptured acute type B Extended total arch replacement by means of the open stent-grafting method to treat http://jtcs.ctsnetjournals.org/cgi/content/full/123/2/354 the World Wide Web at: The online version of this article, along with updated information and services, is located on

Acute aortic dissection with critical stenoses of the true lumen treated by transluminal stent-graft placement and findings one year after treatment

Clinical summary. A 54-year-old woman with a sudden onset of back pain was admitted to a satellite hospital of Mie University. Contrast-enhanced computed tomography (CT) revealed a DeBakey type IIIb, Stanford type B acute aortic dissection. The patient was treated medically. Nineteen days after admission, she had acute renal failure (blood urea nitrogen, 54 mg/dL; creatinine, 3.8 mg/dL) and left leg ischemia. CT disclosed severe stenosis of the true lumen at the level of the left renal artery. She was referred to Mie University Hospital for evaluation and treatment of acute aortic dissection. Her left femoral pulse was not palpable. The patient immediately underwent digital subtraction angiography (DSA), which showed that the intimal tear was located in the midportion of the descending thoracic aorta and that stenoses of the true lumen were located at the level of the diaphragm and distal to the level of the left renal artery. The left external iliac artery also had a critical stenosis. The true lumen of the right iliac artery was completely obliterated. However, the right leg was perfused by blood flow through the false lumen (Fig 1, A). Emergency transluminal stent-graft placement was subsequently performed. The stent graft was constructed of a selfexpanding, Gianturco stainless steel Z stent (Cook Critical Care, Inc, Bloomington, Ind) covered with a balloon-expandStanford type B acute aortic dissection is mainly treated medically. However, emergency surgery for type B dissection with rupture, impending rupture, end-organ ischemia, or some combination thereof is mandatory. Surgical outcomes are poor for patients with an acute type B aortic dissection with endorgan ischemia. Recently, transluminal stent-graft placement became an alternative for the treatment of aortic dissection.1,2 However, transluminal stent-graft placement for stenosis of the true lumen is not common, and the fate of a narrowed true lumen is not clear after stent-graft treatment. We report the case of a patient with acute type B aortic dissection with critical stenoses of the true lumen treated by transluminal stentgraft placement. We also discuss the effects on a narrowed true lumen 1 year after the treatment. ACUTE AORTIC DISSECTION WITH CRITICAL STENOSES OF THE TRUE LUMEN TREATED BY TRANSLUMINAL STENT-GRAFT PLACEMENT AND FINDINGS ONE YEAR AFTER TREATMENT

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

Endovascular stent–graft repair of thoracic aortic aneurysms

Conventional repair of aneurysms of the descending thoracic aorta entails thoracotomy and graft interposition. For elderly patients and those with previous operations, obesity, respiratory insufficiency, or other comorbidities, such a procedure entails significant mortality and morbidity. Transluminal stent-graft placement offers an alternative approach with potentially less morbidity and quicker recovery; however, the effectiveness and durability of stent-grafts remain uncertain. Methods: Since July 1992, thoracic aortic stent-grafts have been placed in 44 patients with a variety of pathologic conditions. Each graft was individually constructed from self-expanding, stainless-steel Z stents covered with a woven Dacron polyester fabric graft. Graft dimensions were determined from spiral computed tomographic scans. All implants were performed in the operating theater under fluoroscopic and transesophageal echocardiographic guidance. Follow-up was by computed tomography and contrast angiography in all cases. Patient data: There were 36 men and 8 women. Mean age was 66 years (range 35 to 88 years). Mean aneurysmal diameter was 6.3 cm (range 4.0 to 9.4 cm). Etiologies included 23 degenerative aneurysms, four posttraumatic aneurysms, four pseudoaneurysms, and one chronic aortic dissection. Results: There were three early deaths (<30 days) and two late deaths. One early death resulted from graft failure. There were two instances of paraparesis or paraplegia, with one associated early death. A single stent was deployed in 27 patients, two stents were required in 14 patients, and three stents were required in three patients. In 23 patients, vascular access was attained through the femoral artery; abdominal aortic access, either native or graft, was necessary in the remaining 21 patients. Twelve grafts were placed in conjunction with open abdominal aortic surgical procedures. Mean follow-up (98% complete) was 12.6 months (range 1 to 34 months). One late death occurred from aneurysmal expansion and rupture in a patient with a persistent midgraft leak. The second late death may have resulted from aneurysmal rupture. Immediate thrombosis was achieved in 36 patients, and late thrombosis was achieved in three others. Failure to achieve complete aneurysmal thrombosis occurred in five patients, however, and one individual (previously noted) died of aneurysmal expansion and rupture; the remaining four are being carefully monitored. Only one patient has required conversion of the stent to an open procedure; a contained rupture of the false lumen of a chronic dissection eventually necessitated total descending thoracic aortic exclusion. Conclusions: These early results support the hypothesis that endovascular stent-graft placement may be a safe and durable treatment for selected patients with aneurysmal disease of the descending thoracic aorta. Large introducer size (26F outer diameter) and relatively limited angulation capability, as well as imprecise deployment techniques, currently limit its applicability. Distal embolization and stent migration have not been observed. Failure to achieve complete aneurysmal thrombosis may allow continued aneurysmal expansion and rupture. Further follow-up is clearly necessary to evaluate the true long-term effectiveness of this procedure. (J T HORAC C ARDIOVASC S URG 1996;111:1054-62)

Percutaneous endoluminal placement of stent-grafts for the treatment of isolated iliac artery aneurysms.

To evaluate the feasibility of stent-grafts for treatment of isolated iliac artery aneurysms (IAAs). Nine IAAs in eight patients were treated with transluminally placed endovascular stent-grafts. All patients were men (median age, 72 years). In three, the aneurysm involved both the common and internal iliac arteries. In one, common and external iliac arteries were involved. The other aneurysms involved only the common iliac artery. Two aneurysms were treated with balloon-expandable stents covered with polytetrafluoroethylene (PTFE) graft material, three were treated with self-expanding Z-stents covered with a woven polyester graft, and four were treated with self-expanding Z-stents covered with PTFE. Transluminal placement of the stents was successful in all patients with thrombosis of the aneurysms. There were no distal thromboembolic events, deaths, or infections. The median follow-up period was 8.5 months. Initial results suggest that transluminal stent-graft placement for treating isolated IAAs is a safe and effective alternative to surgery in selected patients. Long-term follow-up data are needed before this approach can be recommended for the primary treatment of IAAs.