Emergency and Elective Implantation of Covered Stent Systems in Iatrogenic Arterial Injuries

 

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Zusammenfassung

Ziel: Evaluation der Effektivität und Sicherheit membranüberzogener Stents zur Behandlung von iatrogenen Arterienverletzungen. Material und Methode: Zwischen 03 / 1998 und 12 / 2009 führten wir bei 31 Patienten die Implantation eines membranüberzogenen Stents zur Behandlung iatrogener und traumatischer arterieller Verletzungen durch. 12 / 31 Patienten (38,7 %) waren hämodynamisch instabil. Es wurden sechs verschiedene Stenttypen verwendet. Primäre Endpunkte der Studie waren der technische und klinische Erfolg sowie Minor- und Majorkomplikationen. Ergebnisse: Die initiale Angiografie zeigte bei 19 Patienten (61,3 %) eine aktive Kontrastmittelextravasation und Pseudoaneurysmata bei 12 (38,7 %) Patienten. Folgende Blutungslokalisationen lagen vor: A. axillaris, A. subclavia, A. iliaca communis, A. iliaca externa, A. iliaca interna, A. femoralis communis, A. femoralis superficialis, A. poplitea, A. fibularis, femoro-poplitealer Bypass, popliteocruraler Bypass, A. hepatica communis, aberrante A. hepatica, A. cystica und A. gastroduodenalis. Bei allen Patienten konnte die Blutung durch die Implantation eines membranüberzogenen Stents effektiv kontrolliert werden (100 % technischer Erfolg). Einen klinischen Erfolg infolge der Implantation fanden wir bei 30 von 31 Patienten (96,8 %). Major Komplikationen beinhalteten Todesfälle (4 / 36, 11,1 %), eine akute Armischämie (2,8 %) und eine Stentfraktur mit assoziiertem Pseudoaneurysma bei einem weiteren Patienten (2,8 %). Bei 2 / 31 Patienten (6,5 %) war die Therapie mittels membranüberzogenem Stent nicht suffizient und wurde durch die Implantation weiterer, membranüber-zogener Stents erfolgreich therapiert. Schlussfolgerung: Die notfallmäßige und elektive Implantation von membranüberzogenen Stents stellt eine minimal invasive und effektive Methode zur Behandlung iatrogener, arterieller Gefäßverletzungen dar.

Abstract

Purpose: To evaluate the effectiveness and safety of covered stents for the management of iatrogenic arterial injury. Materials and Methods: Between 03 / 1998 and 12 / 2009, 31 patients underwent selective covered stent implantation after iatrogenic arterial injury. 12 / 31 of these patients (38.7 %) were hemodynamically unstable. Six different endovascular covered stent types were utilized. The primary endpoints of this study were technical and clinical success and rates of minor and major complications. Results: Initial angiograms demonstrated active extravasation in 19 (61.3 %) patients and pseudoaneurysms in 12 (38.7 %) patients. The following sites of bleeding origin were detected: axillary artery, subclavian artery, common iliac artery, external iliac artery, internal iliac artery, common femoral artery, superficial femoral artery, popliteal and fibular artery, femoro-popliteal and popliteo-crural bypasses, common hepatic artery, aberrant hepatic artery, cystic and gastroduodenal artery. In all patients bleeding was effectively controlled by covered stent implantation resulting in an immediate technical success of 100 %. Clinical success attributed to covered stent implantation was documented in 30 of the 31 patients (96.8 %). Major complications included death in four patients (11.1 %), acute thrombosis with arm ischemia in one patient (2.8 %) and stent fracture with associated pseudoaneurysm in another patient (2.8 %). In 2 / 31 patients (6.5 %) covered stent failure was detected and successfully treated by implantation of a second covered stent. Conclusion: Emergency and elective implantation of covered stents may be used for minimally invasive and effective management of iatrogenic arterial injury.

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PD Dr. Ralph Kickuth

Institut für Röntgendiagnostik, Universitätsklinikum Würzburg

Oberdürrbacher Strasse 6

97080 Würzburg

Phone: ++ 49/9 31/3 42 01

Fax: ++ 49/9 31/3 42 09

Email: Kickuth@roentgen.uni-wuerzburg.de