Perforation complicating carotid artery stenting: the use of a covered stent.

Carotid artery angioplasty and stenting has emerged as an effective strategy for the treatment of significant carotid artery stenosis. Perforation during carotid artery stenting is a very rare potential complication of the procedure. We describe a case of carotid artery perforation that occurred during postdilation of the carotid artery stent. In our case this potentially serious complication was successfully treated with a covered stent-graft.     

A late complication of percutaneous radial artery cannulation

Radial artery pseudoaneurysms occurring as a late complication of percutaneous radial artery cannulation are rare, while those which are infected are exceptional. Known risk factors are age-related with patients being in their seventies and onwards, the duration of the radial artery catheter and staphylococcal catheter-related infections. We report the case of an 82-year-old patient who developed a mycotic radial artery pseudoaneurysm as a late complication of arterial catheterization.     

Intercostal artery pseudoaneurysm after computed tomography-guided percutaneous fine needle aspiration lung biopsy

Intercostal artery pseudoaneurysm is a rare but life-threatening complication. Herein we report an unusual case of an intercostal artery pseudoaneurysm caused by computed tomography-guided percutaneous fine needle aspiration lung biopsy and successfully treated with endovascular embolization. Radiologists performing percutaneous fine needle aspiration lung biopsies should be aware of this rare potential complication.     

使用4F导管经股动脉径路行冠脉造影115例体会

目的　探讨使用 4F造影导管经股动脉径路行冠脉造影的可行性及安全性。方法　选择 1 1 5例疑诊冠心病的病人作为研究对象 ,使用常规股动脉穿刺方法 ,均全部使用Judkins冠脉造影法 ,采用Cordis公司的 4F动脉鞘及造影导管。造影结束后 2min病人可早期活动。结果　全部病例均顺利完成冠脉造影 ,一次性置入 4F动脉鞘 ,术后 2min早期活动后 ,穿剌点伤口皮下血肿形成、出血、迷走神经反射发生率均明显低于常规动脉鞘。结论　使用 4F动脉鞘及造影管经股动脉行冠脉造影 ,是一种安全可靠且成功率高的方法 ,具有并发症少、患者可早期活动、痛苦小、易于接受的特点。     

Fracture of a drug-eluting stent in the tibioperoneal trunk following bifurcation stenting.

PURPOSE: To report a complication of stent placement at a bifurcation in the infrapopliteal arteries. CASE REPORT: A 60-year-old man presented with a complex subtotal stenosis in the anterior tibial artery and the tibioperoneal trunk. Two drug-eluting stents were implanted by means of the crush technique, successfully recanalizing the trifurcation. One week later, the patient was readmitted with a thrombotic occlusion of the popliteal artery. Fluoroscopy showed a fracture of the larger stent in the tibioperoneal trunk. After successful local thrombolysis, a stent fragment was located in the popliteal artery and removed with an Amplatz snare. Long-term follow-up was uneventful. CONCLUSION: Fracture may be a more common complication of bifurcation stenting when undertaken in a territory at high risk for this complication.     

Page kidney: Rare cause of acute kidney injury after complicated renal artery angioplasty

The authors present a case of a patient who experienced a rare complication after attempted renal angioplasty and stenting, Page kidney. This patient presented with new onset hypertension secondary to bilateral renal artery stenosis and was referred for revascularization given hypertension refractory to medical management. The right renal artery underwent successful angioplasty and stenting; however, the left renal artery experienced recoil stenosis. Post‐procedure the patient developed acute kidney injury secondary to Page kidney from subcapsular and extracapsular hematoma. This was managed conservatively with transfusions and the hematoma and acute kidney injury self‐resolved over the next 4 months. This case highlights the importance of revascularization for refractory hypertension secondary to hemodynamically significant bilateral renal artery stenosis, the rare complication of Page kidney with attempted revascularization of renal artery stenosis and the involvement of a hypertension specialist in the decision of revascularization of renal artery stenosis.     

Acute cerebral rescue during carotid artery stenting: A stroke of good fortune?

Major stroke is a potentially devastating complication of carotid artery revascularization. Carotid artery stenting, unlike endarterectomy, offers the opportunity to attenuate this complication by allowing for the instantaneous detection and early endovascular treatment of neurologic defects complicating the procedure. We report a case that highlights the utility of aggressive endovascular cerebral rescue during a carotid artery stent procedure. © 2008 Wiley‐Liss, Inc.     

Brucella endocarditis complicated with a mycotic aneurysm of the superior mesenteric artery: a case report

Brucella endocarditis, although a rare complication of brucellosis, is the main cause of death attributable to this disease. Mycotic aneurysm is an important extracardiac complication of infective endocarditis. Mycotic aneurysm of the superior mesenteric artery is extremely rare. In the present case, we report a patient with Brucella melitensis endocarditis complicated with a superior mesenteric artery aneurysm. To our knowledge, this is the first such reported case.     

Percutaneous transluminal angioplasty of transplant renal artery stenosis

Renal artery stenosis after renal transplant is a dreaded complication. We report two cases of post-renal transplant stenosis in internal iliac artery used for end-to-end anastomosis with the graft renal artery. Both patients were successfully treated by percutaneous transluminal angioplasty with stenting of the internal iliac artery.     

Rescue PTCA complicated by pulmonary artery rupture after tPA and abciximab

Since the introduction of pulmonary artery catheterization for hemodynamic monitoring, several complications associated with its use have been described. Pulmonary artery rupture is an infrequent complication of flow-directed pulmonary artery catheters. We report a case of pulmonary artery rupture complicating rescue PTCA in the presence of systemic platelet inhibition with abciximab (Reopro), anticoagulation, and thrombolytic therapy. With the increasing use of these medications in patients undergoing acute coronary interventions, particularly those patients requiring hemodynamic monitoring, this uncommon but potentially fatal complication may be seen more frequently. Cathet. Cardiovasc. Intervent. 46:89–91, 1999. © 1999 Wiley-Liss, Inc.     

Plexus between internal mammary graft and pulmonary vasculature after minimally invasive coronary surgery

We report a complication associated with minimally invasive direct coronary artery bypass grafting surgery The patient suffered a nonfatal anterior myocardial infarction 1 day after he underwent minimally invasive bypass grafting using the internal mammary artery. Two months later, coronary arteriography revealed a fistulous connection between the left internal mammary graft and the left pulmonary vasculature. To our knowledge, this particular complication has not been reported following minimally invasive coronary surgery.     

Successful management and long term outcome of an accidental subclavian artery injury with a 9 french dilator during pacemaker implantation with collagen-based closure device

Subclavian artery puncture and dilation with 9 Fr dilator during pacemaker implantation is a rare complication. We present a case, where this complication occurred and the injury was sealed with collagen-based closure device without any complications. Long term follow-up and the control angio-CT revealed no further late vascular complications. Therefore, use of a collagen based closure device for treating accidental iatrogenic subclavian artery injury can be a simple, successful alternative therapy when surgical direct vascular repair is not possible or not available.     

Pseudoaneurysm after transradial cardiac catheterization: Case series and review of the literature

Introduction : Radial artery access for diagnostic and therapeutic procedures offers clear advantages in terms of vascular complications. While radial artery occlusion may occasionally complicate radial artery access, new methods of hemostasis are now utilized to avoid this complication. In contrast, pseudoaneurysm following radial artery access is an extremely uncommon complication. Methods : We describe a series of patients who developed radial artery pseudoaneurysm after their procedure. Results : Five patients developed radial pseudoaneurysm after diagnostic and interventional procedures, likely reflecting inadequate hemostasis following the procedure and delayed bleeding complicating systemic anticoagulation. Conclusions : While uncommon, radial artery pseudoaneurysm may complicate cardiac catheterization procedures, with anticoagulation an important contributor. The clinical presentation, likely precipitating mechanisms and treatment options are discussed. © 2011 Wiley Periodicals, Inc.     

Mammary to innominate arteriovenous fistula: endovascular management of an anecdotal complication

An internal thoracic artery pseudoaneurysm associated with an arteriovenous fistula to the innominate vein is a very rare complication after implantation of a cardioverter-defibrillator. We report the successful endovascular management of this unusual complication.     

Emergency coronary artery stenting for coronary dissection complicating diagnostic cardiac catheterisation.

Dissection of a coronary artery is a recognised and significant complication of diagnostic coronary angiography that often requires emergency coronary artery bypass grafting. A coronary stent was used to treat this complication. This technique has potential advantages in terms of speed of reperfusion and availability in centres performing diagnostic angiography without surgical cover on site.     

疑诊冠心病患者经桡动脉冠脉造影术510例分析

目的　探讨经桡动脉径路行冠脉造影的可行性和安全性。方法　 5 10例临床疑诊为冠心病的患者接受了经桡动脉径路冠脉造影术。结果　 5 0 3例获得成功 ,7例失败 ,其中 3例为穿刺失败 ,1例为桡动脉走行畸形 ,2例是由于无名动脉过于迂曲致导管操作极度困难而失败 ,1例为左锁骨下动脉闭塞。所有病例无严重并发症发生 ,只有 1例于术后发生桡动脉闭塞。结论　桡动脉径路行冠脉造影具有止血容易、病人术后无须长时间卧床和并发症少的优点 ,操作成功率高 ,临床应用安全     

Trapped rotablator: Kokesi phenomenon

We experienced a rare complication of rotational atherectomy. The burr was trapped at the angled, calcified narrowing in the left anterior descending coronary artery. The burr was retrieved after the resection of the pulmonary artery and the left coronary artery. We will discuss the cause and prevention of this complication. Cathet. Cardiovasc. Intervent. 49:82–84, 2000. © 2000 Wiley‐Liss, Inc.     

Management of early hepatic artery occlusion after liver transplantation with failed rescue

Hepatic artery thrombosis is a serious complication after liver transplantation which often results in biliary complications, early graft loss, and patient death. It is generally thought that early hepatic artery thrombosis without urgent re-vascularization or re-transplantation almost always leads to mortality, especially if the hepatic artery thrombosis occurs within a few days after transplantation. This series presents 3 cases of early hepatic artery thrombosis after living donor liver transplantation, in which surgical or endovascular attempts at arterial re-vascularization failed. Unexpectedly, these 3 patients survived with acceptable graft function after 32 mo, 11 mo, and 4 mo follow-up, respectively. The literatures on factors affecting this devastating complication were reviewed from an anatomical perspective. The collective evidence from survivors indicated that modified nonsurgical management after liver transplantation with failed revascularization may be sufficient to prevent mortality from early hepatic artery occlusion. Re-transplantation may be reserved for selected patients with unrecovered graft function.     

Retroperitoneal hemorrhage from inferior epigastric artery: value of femoral angiography for detection and management.

Laceration of the inferior epigastric artery during cardiac catheterization is under-reported in the literature, but it is a serious complication leading to retroperitoneal hemorrhage and even death. We report on two cases of retroperitoneal bleeding from unintentional puncture of the inferior epigastric artery during cardiac catheterization. Femoral angiography is a valuable tool to promptly recognize this complication.     

Coronary occlusion following diagnostic angiography: salvage by intracoronary stenting

Catheter-induced coronary artery dissection and occlusion is a rare but serious complication of diagnostic cardiac angiography. This report describes the successful management of this complication with an intracoronary stent after prolonged balloon inflations and intracoronary thrombolytic therapy were unsuccessful.