ABSTRACT
PURPOSE: To report interdisciplinary management in a case of cement embolization into the inferior vena cava and peripheral pulmonary arteries after percutaneous vertebroplasty. CASE REPORT: A 50-year-old female patient with an osteoporotic compression fracture of the second lumbar vertebra underwent percutaneous vertebroplasty with polymethylmetaacrylate. Thereafter, CT scanning revealed small asymptomatic cement emboli in peripheral pulmonary arteries, along with a hook-shaped cement fragment in the inferior vena cava. Due to the risk that the large cement fragment could migrate to the pulmonary arteries and cause serious complications, they were retrieved from the inferior vena cava by an endovascular technique and extracted through a surgical groin incision. The patient received anticoagulant treatment for 3 months and is free of complaints after 1 year. CONCLUSION: This case shows that this rare complication following vertebroplasty can be successfully managed with an interdisciplinary approach.
Subject(s)
Bone Cements , Embolism/etiology , Embolism/therapy , Polymethyl Methacrylate , Postoperative Complications , Vena Cava, Inferior , Embolism/diagnosis , Female , Humans , Lumbar Vertebrae/injuries , Middle Aged , Spinal Fractures/surgeryABSTRACT
AIM: The aim of the study was to determine the efficacy of PRFA in the palliative treatment of symptomatic bone metastases in regard to pain reduction, safety, and quality of life. METHOD: Over a period of 11 months, ten PRFA were performed in eight patients with painful metastases involving bone, where conventional treatment with radiation therapy, chemotherapy, and treatment with analgesics had failed to reduce the pain efficiently. Pain was measured with the visual analogue scale (VAS: 0 to 10) for the day and night before PRFA was performed, and daily for 7 days after release from the hospital via a dietary book, and at the follow-up periods of 1, 3, 6 weeks and 3 and 6 months after PRFA. Additionally, quality of life was self-assessed by the patient via the health surveys IQOLA SF-36 and EORTC QLQ-C30, and via the Karnofsky Performance Scale (KPS) by the physician at each follow-up. The patients' analgesics use was also recorded at the follow-up intervals and complications were monitored. Analysis of the primary end point was undertaken with paired comparison procedures. RESULTS: Under conventional therapy, pain was specified by the patients as VAS min of 4.1 and VAS max of 9.3. Due to PRFA a reduction of the preinterventional pain (VAS) from 7.4 (+/- 1.9 SD) and 5.0 (+/- 2.7 SD) for day and night, subsequently, to 1.8 (+/- 1.6 SD, minus 75 percent) and 0.7 (+/- 0.7 SD, minus 86 percent) was achieved within one day after admission to the hospital. This significant reduction did not change during the whole follow-up period, and was also reflected in the ability to reduce analgesics and in the improvement of specific domains of SF-36 and QLQ-C30. However, no significant change was detected in the summary scales for mental and physical health. No serious complications were observed. CONCLUSION: PRFA of symptomatic bone metastases is a safe technology to reduce pain intractable to conventional therapy, even in terminally ill patients.
Subject(s)
Bone Neoplasms/secondary , Catheter Ablation , Palliative Care , Adult , Aged , Bone Neoplasms/surgery , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Pain Measurement , Quality of Life , Treatment OutcomeABSTRACT
PURPOSE: To report the consequences of endoluminal deployment of stent-grafts in the thoracic aorta with intentional occlusion of the left subclavian artery. CASE REPORTS: Three patients with an aortic type-B dissection and 1 with a thoracic aneurysm were treated endoluminally with Talent stent-grafts implanted over the ostium of the left subclavian artery without prior surgical subclavian-carotid transposition. The primary intimal tears were sealed and the degenerative aneurysm excluded; blood pressure in the left arm was significantly diminished immediately after the stent-graft was released, but adequate collateral retrograde perfusion via the left vertebral artery was apparent in all patients. No neurological deficit and no symptoms of left arm ischemia were observed in a follow-up that ranged from 14 to 20 months. CONCLUSIONS: Our limited experience shows that occlusion of the left subclavian artery with a stent-graft is well tolerated. If ischemic symptoms occur, a transposition procedure can be performed on an elective basis.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Arterial Occlusive Diseases/etiology , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis/adverse effects , Stents/adverse effects , Subclavian Artery/surgery , Aged , Aortic Dissection/diagnostic imaging , Aortic Dissection/physiopathology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/physiopathology , Arm/blood supply , Arm/physiopathology , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/physiopathology , Collateral Circulation/physiology , Humans , Male , Middle Aged , Radiography , Subclavian Artery/diagnostic imaging , Subclavian Artery/physiopathology , Vertebral Artery/diagnostic imaging , Vertebral Artery/physiopathologyABSTRACT
PURPOSE: To determine the outcome of a new polytetrafluoroethylene (PTFE)-covered stent-graft in the treatment of occlusive lesions of the femoropopliteal arteries. MATERIALS AND METHODS: Eighteen patients with intermittent claudication (Fontaine stages IIb-IV; Rutherford classes I/2-III/5) and occlusive lesions of the superficial femoral and/or popliteal artery were treated with use of a new PTFE-covered stent-graft (Hemobahn). Indication for stent-graft insertion was an unsatisfactory result after balloon dilation. RESULTS: Successful stent-graft placement was achieved in 17 patients (94%). In one patient, additional insertion of a Palmaz stent was necessary because of a stent-graft wrinkle. Mean ankle-brachial index increased from 0.72 +/- 0.15 preoperatively to 0.94 +/- 0.17 postoperatively (P =.028). Fifteen patients (83%) experienced an initial improvement of at least one clinical stage. Primary patency was 61% +/- 11% at 3 months and 49% +/- 12% at 6 months. Stent-graft occlusion was observed in 13 patients (72%). In four patients, the stent-graft was reopened percutaneously by balloon angioplasty (n = 2) and/or rotational thrombectomy (n = 2). Therefore, the secondary patency rate was 67% +/- 11% at 3 months and 61% +/- 11% at 6 months. Patency rates proved to be significantly lower for stent-grafts longer than 10 cm (P =.03). Intimal hyperplasia at the proximal or distal end of the stent-graft was observed in seven patients (39%). Complications such as access site hematoma (n = 3), distal thromboembolism (n = 2), and abscess formation around the stent-graft (n = 1) were observed. CONCLUSION: Despite excellent initial angiographic results, the patency rate in lesions treated with the Hemobahn stent-graft in this small study was unsatisfactory. Use of stent-grafts longer than 10 cm and the occurrence of intimal hyperplasia proved to be major factors in the reduction of long-term patency rates.
Subject(s)
Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis , Femoral Artery/surgery , Popliteal Artery/surgery , Stents , Aged , Aged, 80 and over , Arterial Occlusive Diseases/complications , Female , Femoral Artery/diagnostic imaging , Femoral Artery/pathology , Humans , Intermittent Claudication/complications , Male , Middle Aged , Polytetrafluoroethylene , Popliteal Artery/diagnostic imaging , Popliteal Artery/pathology , Prosthesis Design , Radiography , Reoperation , Treatment Outcome , Vascular PatencyABSTRACT
PURPOSE: To describe the efficacy and value of endovascular stent-grafts for the treatment of aortic anastomotic pseudoaneurysms. METHODS: 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. RESULTS: 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. CONCLUSION: Stent-graft exclusion of aortic pseudoaneurysms offers a minimally invasive and safe alternative to open surgical reconstruction.
Subject(s)
Aneurysm, False/surgery , Angioscopy , Aorta, Abdominal , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis/adverse effects , Aged , Anastomosis, Surgical , Aneurysm, False/etiology , Aortic Aneurysm, Abdominal/etiology , Humans , Middle Aged , Vascular Surgical ProceduresABSTRACT
PURPOSE: To evaluate the feasibility of endoluminal stent-grafts in the treatment of acute type B aortic dissections. METHODS: In five patients with acute aortic type B dissections, sealing of the primary intimal tear with an endoluminal stent-graft was attempted. Indication for treatment was aneurysm formation in two patients and persistent pain in three patients. One of the latter also had an unstable dissection flap compromising the ostium of the superior mesenteric artery. The distance from the intimal tear to the left subclavian artery was <0.5 cm in four patients, who had typical type B dissections. In one patient with an atypical dissection the distance from the primary tear to the left subclavian artery was 4 cm. This patient had no re-entry tear. Talent tube grafts (World Medical Manufacturing Cooperation, Sunrise, FL, USA) were used in all patients. RESULTS: Stent-graft insertion with sealing of the primary tear was successful in all patients. The proximal covered portion of the stent-graft was placed across the left subclavian artery in four patients (1x transposition of the left subclavian artery). Left arm perfusion was preserved via a subclavian steal phenomenon in the patients in whom the stent-graft covered the orifice of the left subclavian artery. The only procedural complication we observed was an asymptomatic segmental renal infarction in one patient. In the thoracic aorta thrombosis of the false aortic lumen occurred in all patients. In one patient the false lumen of the abdominal aorta thrombosed after 4 weeks; in the other three patients the status of the abdominal aorta remained unchanged compared with the situation prior to stent-graft insertion. As a late complication formation of a secondary aneurysm of the thoracic aorta was observed at the distal end of the stent-graft 3 months after the primary intervention. This aneurysm was treated by coaxial insertion of an additional stent-graft without complications. CONCLUSION: Endoluminal treatment of acute type B aortic dissections seems to be an attractive alternative treatment to surgical repair. Thrombosis of the false lumen of the thoracic aorta can be induced if the primary tear is sealed with a stent-graft. This could protect the dissected thoracic aorta from delayed rupture.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation/methods , Stents , Acute Disease , Aged , Aged, 80 and over , Aortic Dissection/diagnostic imaging , Angioplasty , Aortic Aneurysm, Thoracic/diagnostic imaging , Blood Vessel Prosthesis , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Postoperative Care , Radiography, InterventionalABSTRACT
Portal venous decompression with transjugular intra-hepatic portosystemic shunt (TIPS) is a new approach in the treatment of Budd-Chiari syndrome. We report on a 31-year-old female with Budd-Chiari syndrome due to anti-phospholipid antibodies with compression of the inferior vena cava treated with TIPS and stenting of the inferior vena cava. TIPS was complicated by massive intra-hepatic haematoma which was managed conservatively. Treatment options and pathogenic mechanisms of Budd-Chiari syndrome under the rare coincidence of aplastic anaemia and anti-phospholipid syndrome are discussed. TIPS may be considered for venous decompression in Budd-Chiari syndrome, but physicians should be aware of potential TIPS' complications in these patients.
Subject(s)
Budd-Chiari Syndrome/surgery , Hematoma/etiology , Liver Diseases/etiology , Portasystemic Shunt, Transjugular Intrahepatic/adverse effects , Adult , Anemia, Aplastic/complications , Anemia, Aplastic/diagnosis , Angiography , Antibodies, Antiphospholipid/blood , Anticoagulants/administration & dosage , Budd-Chiari Syndrome/complications , Budd-Chiari Syndrome/diagnosis , Female , Follow-Up Studies , Hematoma/diagnostic imaging , Hematoma/drug therapy , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/diagnosis , Humans , Liver Diseases/diagnostic imaging , Liver Diseases/drug therapy , Liver Function Tests , Portasystemic Shunt, Transjugular Intrahepatic/methods , Treatment Outcome , UltrasonographyABSTRACT
We report about a patient with a thoracic aneurysm caused by an acute type-B dissection. Due to the concomitant affections the risk of surgery was distinctly increased, the reconstruction was performed endo vascular by stentgraft implantation (Talent, World Medical Systems, Sunrise FL) after transposition of the left subclavian artery to create a sufficient neck for the proximal stent placement. Endoluminal treatment seems to be a promising, less invasive alternative method in the treatment of acute aortic dissections.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Stents , Subclavian Artery/transplantation , Acute Disease , Aortic Dissection/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortography , Carotid Artery, Common/diagnostic imaging , Carotid Artery, Common/surgery , Female , Humans , Middle Aged , Postoperative Complications/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Transfemoral placement of an endovascular stent-graft is increasingly be-ing used as an alternative to surgical repair in the treatment of abdominal aortic aneurysm, especially in high-risk patients. However, complications frequently occur after stent-graft placement. Helical computed tomographic (CT) angiography is a fast, minimally invasive procedure that is quickly becoming the imaging modality of choice for assessment of these complications. Thirty-nine patients who were treated for abdominal aortic aneurysm with stent-graft placement underwent helical CT angiography at routinely scheduled follow-up intervals or whenever complications were suspected. The resulting images were evaluated for the presence, extent, and origin of endovascular leaks. In addition, the position, shape, and patency of the stent-grafts were assessed. Findings included both graft-related (n = 4) and non-graft-related (n = 3) leaks, thrombosis of a graft limb (n = 3), distal migration of the stent-graft (n = 5), angulation of bifurcated stent-grafts distal to the main graft (n = 6), shrinkage of the abdominal aortic aneurysm (n = 7), enlargement of the aneurysm with secondary graft-related leaks (n = 2), and an aortoduodenal fistula (n = 1). Helical CT angiography can depict complications that develop after treatment of abdominal aortic aneurysms with endovascular stent-grafts. Long-term follow-up is required to determine the full spectrum and frequency of complications that may develop after initially successful repair.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortography/methods , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis , Stents , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Anastomosis, Surgical/adverse effects , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/pathology , Aortic Diseases/etiology , Blood Vessel Prosthesis/adverse effects , Duodenal Diseases/etiology , Female , Follow-Up Studies , Foreign-Body Migration/etiology , Humans , Image Processing, Computer-Assisted/methods , Intestinal Fistula/etiology , Longitudinal Studies , Male , Middle Aged , Minimally Invasive Surgical Procedures , Prosthesis Failure , Stents/adverse effects , Thrombosis/etiology , Vascular Fistula/etiology , Vascular PatencyABSTRACT
During recent years, considerable clinical experience has been gained with endoluminal stent-graft procedures. Several studies have shown promising results up to a period of 4.5 years. However, long-term follow-up studies are still limited. Late endoleaks caused by stent-graft migration, disconnection of single components in modular stent-grafts, and limb thrombosis have been observed as long-term complications. We report a case in which a migrated and kinked bifurcated stent-graft caused an aortoduodenal fistula 20 months after stent-graft insertion. To our knowledge, such a complication has not been reported before.
Subject(s)
Aorta, Abdominal/pathology , Aortic Aneurysm, Abdominal/surgery , Aortic Diseases/etiology , Blood Vessel Prosthesis Implantation/adverse effects , Duodenal Diseases/etiology , Intestinal Fistula/etiology , Stents/adverse effects , Vascular Fistula/etiology , Blood Vessel Prosthesis/adverse effects , Follow-Up Studies , Foreign-Body Migration/etiology , Humans , Male , Middle Aged , Prosthesis Failure , ReoperationABSTRACT
PURPOSE: To evaluate the safety and efficacy of the Talent stent-graft (TSG) system in the endoluminal treatment of infrarenal abdominal aortic aneurysms (AAAs). PATIENTS AND METHODS: Endoluminal treatment of an AAA was attempted in 30 men with a mean age of 70.5 years (range, 51-83 years). Seven patients had AAAs suitable for treatment with a tube graft. In the other patients, treatment with a bifurcated TSG was planned. All procedures were performed as a combined surgical-radiologic procedure in an angiographic room. RESULTS: Primary technical success was achieved in 25 of 30 patients (83%). Technical failures were due to misplacement of the TSG (n = 2) with proximal leakage as a consequence, inability to gain access via the iliac arteries (n = 1), and a distal leakage (n = 2). Secondary interventions (n = 2) and spontaneous thrombosis of a distal leak (n = 1) increased the secondary technical success rate to 93% (28 of 30). Two procedures were converted to open surgery (conversion rate = 6%). One patient died during the first 30 days after uncomplicated stent-graft insertion because of myocardial infarction (30-day mortality = 5%). No complications occurred during a mean follow-up of 15.4 months (range, 6-19 months). The maximum diameter of the AAA decreased in eight patients and remained unchanged in the remaining patients. No increase in diameter was observed. No late endoleak or migration of the TSG was observed. CONCLUSION: The TSG-system revealed satisfactory initial and early follow-up results. Treatment of AAAs with this stent-graft system is feasible. The technical success rate in carefully selected patients should be 90% or more. However, long-term observations are necessary to determine if the encouraging early results of this type of therapy can be preserved during long-term follow-up.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Biocompatible Materials , Blood Vessel Prosthesis Implantation/instrumentation , Polyethylene Terephthalates , Stents , Aged , Aged, 80 and over , Angiography , Aortic Aneurysm, Abdominal/diagnostic imaging , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prosthesis Failure , Retrospective Studies , Safety , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Three patients with dialysis access graft shunts, having a symptomatic pseudoaneurysm and a hemodynamically significant stenosis at the anastomosis between the graft shunt and the subclavian vein, were treated with percutaneous transluminal angioplasty and insertion of a Wallstent. Pseudoaneurysms were excluded by percutaneous insertion of a Cragg Endo-Pro stent-graft with a diameter of 6 mm and a length of 6-10 cm. All three aneurysms were excluded successfully. In two patients, the stent-graft was punctured repeatedly during follow-up and the aneurysms recurred after 7 and 8 months, respectively. The patency of the dialysis shunt after stent-graft insertion was 8 (n = 1) and 9 months (n = 2). Due to the recurrence of the aneurysm (n = 2) or recurrent thrombosis (n = 1) the use of these shunts was discontinued.
Subject(s)
Aneurysm/therapy , Angioplasty, Balloon/instrumentation , Catheters, Indwelling/adverse effects , Graft Occlusion, Vascular/therapy , Renal Dialysis/adverse effects , Stents , Aged , Aneurysm/etiology , Angioplasty, Balloon/methods , Follow-Up Studies , Graft Occlusion, Vascular/etiology , Graft Survival , Humans , Middle Aged , Recurrence , Vascular PatencyABSTRACT
PURPOSE: To report the early clinical experience with the Talent stent-graft system in the treatment of infrarenal aortic aneurysms. MATERIALS AND METHODS: The study group comprised 15 males aged from 51-79 years. A bifurcated Talent stent-graft was implanted in 9 patients with type B or C aneurysms, a tube graft in 6 patients with a type A aneurysm. The stent-grafts were introduced via a surgical femoral cut-down, for a bifurcated graft a bilateral surgical access was needed. All procedures were performed as teamwork by radiologists and vascular surgeons under general anaesthesia in the angiography suite. RESULTS: Primary and secondary technical successes were 80 and 86%, respectively. Technical failures were due to access site problems (n = 1; elective open repair), malpositioning of the prosthesis (n = 1; immediate conversion to open surgery), and primary distal leakage (n = 1; elective occlusion by means of distal stent-graft extension). One patient died 15 days after an uneventful stent-graft insertion (30-day mortality 6%). No complications were observed during a mean follow-up period of 7.8 months. The aneurysmal diameter decreased in 6 patients and remained unchanged in the others. CONCLUSIONS: The Talent system revealed satisfactory early results which are comparable to competitive stent-graft systems. An advantage of this stent-graft device is the availability in a wide range of dimensions. A major disadvantage is the large introducer system (french size 22-27).