Subclavian artery (SCA) injuries associated with central venous catheter (CVC) insertion are uncommon yet lethal complications that typically require surgical treatment. This case report presents the case of a 94...Subclavian artery (SCA) injuries associated with central venous catheter (CVC) insertion are uncommon yet lethal complications that typically require surgical treatment. This case report presents the case of a 94-year-old man with an iatrogenic right SCA injury resulting from a misplaced CVC. Computed tomography revealed the catheter piercing the right internal jugular vein to enter the right SCA and then reaching the aortic arch. Emergent endovascular treatment was performed, and a 13-mm × 50-mm self-expanding Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) was placed via the right brachial artery. The misplaced catheter was successfully removed under simultaneous postdeployment balloon dilatation. This case highlights the utility of the Viabahn stent graft for iatrogenic right SCA injury caused by a misplaced CVC and presents some insights and tips for a safer procedure.展开更多
目的探讨TASC(Ⅱ)D型股动脉闭塞的腔内治疗方法及效果。方法回顾性分析2012年1月—2013年5月采用腔内治疗TASC(Ⅱ)D型股浅动脉闭塞26例(26肢)患者的临床资料。其中采用球囊扩张内支架置入13例(裸支架组,共植入支架31枚)、Silverhawk斑...目的探讨TASC(Ⅱ)D型股动脉闭塞的腔内治疗方法及效果。方法回顾性分析2012年1月—2013年5月采用腔内治疗TASC(Ⅱ)D型股浅动脉闭塞26例(26肢)患者的临床资料。其中采用球囊扩张内支架置入13例(裸支架组,共植入支架31枚)、Silverhawk斑块旋切6例(Silverhawk斑块旋切组)、Viabahn覆膜支架2例(Viabahn覆膜支架组)。腔内手术未成功通过病变者5例给予前列地尔等扩血管药物治疗。通过手术前后踝肱指数(ABI)、螺旋CT血管成像(CTA)、数字减影血管造影(DSA)及症状改善情况来评价疗效;并于术后6个月复查CTA。结果 26例中成功开通目标动脉21例(技术成功率80.7%),造影证实血流通畅,残留狭窄小于30%,术后患肢缺血症状缓解。术后1周ABI高于术前(0.77±0.10 vs 0.43±0.15,t=7.948,P<0.05)。6个月一期通畅比例分别为裸支架组9/13,Silver-hawk斑块旋切组4/6,Viabahn覆膜支架2/2。结论腔内治疗TASC(Ⅱ)D型股动脉闭塞可提高近期通畅率,Viabahn覆膜支架是治疗的新手段。展开更多
Background: Endarterectomy has long been the standard for common femoral artery (CFA) occlusive disease. Hybrid procedures utilizing endovascular and open techniques have recently been used for revascularization. The ...Background: Endarterectomy has long been the standard for common femoral artery (CFA) occlusive disease. Hybrid procedures utilizing endovascular and open techniques have recently been used for revascularization. The purpose of this study was to evaluate the effectiveness of the use of a stent graft to stabilize the distal flap and prevent further dissection after extensive endarterectomy. Methods: All patients from Monmouth Medical Center in Long Branch, NJ from September 2008 to March 2013 who underwent an extensive common and superficial femoral (SFA) endarterectomy combined with the use of a Viabahn (Gore Medical) stent graft to stabilize the distal flap were included in the study. These stents were deployed in the proximal SFA after extensive endarterectomy, under direct visualization, without the aid of fluoroscopy. Due to the location in the SFA, these flaps were not amenable to suture tacking. Results: Fifteen patients met these criteria and were included in our study. Twelve patients underwent femoral endarterectomy for severe claudication and three patients for limb salvage. Technical success was achieved in all 15 patients. Five patients also had stents placed proximally to increase inflow and one patient had an additional stent placed distally to improve outflow. There were no intraoperative or postoperative complications. Conclusion: Stent graft placement allows a more extensive endarterectomy to be performed by stabilizing the distal flap allowing a safe transition into the true lumen that is not possible with suture tacking.展开更多
文摘Subclavian artery (SCA) injuries associated with central venous catheter (CVC) insertion are uncommon yet lethal complications that typically require surgical treatment. This case report presents the case of a 94-year-old man with an iatrogenic right SCA injury resulting from a misplaced CVC. Computed tomography revealed the catheter piercing the right internal jugular vein to enter the right SCA and then reaching the aortic arch. Emergent endovascular treatment was performed, and a 13-mm × 50-mm self-expanding Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) was placed via the right brachial artery. The misplaced catheter was successfully removed under simultaneous postdeployment balloon dilatation. This case highlights the utility of the Viabahn stent graft for iatrogenic right SCA injury caused by a misplaced CVC and presents some insights and tips for a safer procedure.
文摘目的探讨TASC(Ⅱ)D型股动脉闭塞的腔内治疗方法及效果。方法回顾性分析2012年1月—2013年5月采用腔内治疗TASC(Ⅱ)D型股浅动脉闭塞26例(26肢)患者的临床资料。其中采用球囊扩张内支架置入13例(裸支架组,共植入支架31枚)、Silverhawk斑块旋切6例(Silverhawk斑块旋切组)、Viabahn覆膜支架2例(Viabahn覆膜支架组)。腔内手术未成功通过病变者5例给予前列地尔等扩血管药物治疗。通过手术前后踝肱指数(ABI)、螺旋CT血管成像(CTA)、数字减影血管造影(DSA)及症状改善情况来评价疗效;并于术后6个月复查CTA。结果 26例中成功开通目标动脉21例(技术成功率80.7%),造影证实血流通畅,残留狭窄小于30%,术后患肢缺血症状缓解。术后1周ABI高于术前(0.77±0.10 vs 0.43±0.15,t=7.948,P<0.05)。6个月一期通畅比例分别为裸支架组9/13,Silver-hawk斑块旋切组4/6,Viabahn覆膜支架2/2。结论腔内治疗TASC(Ⅱ)D型股动脉闭塞可提高近期通畅率,Viabahn覆膜支架是治疗的新手段。
文摘Background: Endarterectomy has long been the standard for common femoral artery (CFA) occlusive disease. Hybrid procedures utilizing endovascular and open techniques have recently been used for revascularization. The purpose of this study was to evaluate the effectiveness of the use of a stent graft to stabilize the distal flap and prevent further dissection after extensive endarterectomy. Methods: All patients from Monmouth Medical Center in Long Branch, NJ from September 2008 to March 2013 who underwent an extensive common and superficial femoral (SFA) endarterectomy combined with the use of a Viabahn (Gore Medical) stent graft to stabilize the distal flap were included in the study. These stents were deployed in the proximal SFA after extensive endarterectomy, under direct visualization, without the aid of fluoroscopy. Due to the location in the SFA, these flaps were not amenable to suture tacking. Results: Fifteen patients met these criteria and were included in our study. Twelve patients underwent femoral endarterectomy for severe claudication and three patients for limb salvage. Technical success was achieved in all 15 patients. Five patients also had stents placed proximally to increase inflow and one patient had an additional stent placed distally to improve outflow. There were no intraoperative or postoperative complications. Conclusion: Stent graft placement allows a more extensive endarterectomy to be performed by stabilizing the distal flap allowing a safe transition into the true lumen that is not possible with suture tacking.
