Successful endovascular treatment of aortoenteric fistula secondary to eroding duodenal stent

Aortoenteric fistulas are characterized as either primary or secondary on the basis of their cause. Most aortoenteric fistulas occur between the aorta and duodenum and are a rare but well-known cause of catastrophic gastrointestinal hemorrhage. Conventional treatment of aortoenteric fistulas uses bypass grafting and aortic ligation, but endovascular treatments have become more common. The authors describe the successful endovascular repair of a primary aortoenteric fistula caused by eroding duodenal stent.     

Emergent treatment of a primary aortoenteric fistula with N-butyl 2-cyanoacrylate and endovascular stent

A novel endovascular treatment involving cyanoacrylate injection followed by endovascular stent placement is described in the setting of life-threatening acute exsanguination through a primary aortoenteric fistula. In a patient in unstable condition, N-butyl 2-cyanoacrylate was injected into the fistula tract. Rapid polymerization first provided hemostasis and allowed the patient to be resuscitated and stabilized for several hours, and then an AneuRx endovascular stent-graft was deployed to reinforce the aortic wall and permanently occlude the fistula. This approach can benefit patients whose condition would otherwise be too unstable for open surgery.     

Temporary endovascular control of a bleeding aortoenteric fistula by transcatheter coil embolization

A 67-year-old man presented with gastrointestinal bleeding resulting from a fistula between the aortic stump and the fourth part of the duodenum 14 months after an axillobifemoral bypass, graft excision, and aortic stump closure for aortic graft infection. The patient initially refused any attempt at definitive surgical treatment so coil embolization of the aortic stump was performed via a brachial approach. Coil embolization may be a useful adjunct in the management of such difficult problems. This approach may buy time and allow careful planning of a definitive treatment or may serve as a palliative procedure in inoperable patients.     

Iatrogenic femoral arteriovenous fistula: endovascular treatment with covered stent implantation and 4-year follow-up

Puncture site complications such as arteriovenous fistula after femoral arterial catheterizations are becoming more common with the increasing number of endovascular procedures being performed by interventional radiologists and cardiologists. Covered stent placement with endovascular technique for these lesions represents an appealing treatment alternative because it is only minimally invasive and requires less hospitalization and recovery time compared to surgical repair. Herein, we present an adult patient with a post-catheterization deep femoral artery- to-femoral vein fistula, which was successfully treated with a balloon-expandable Jostent peripheral stent-graft placement. Fourth year follow-up angiography showed the covered stent to be patent.     

Intracranial arteriovenous fistula caused by endovascular stent-grafting and dilatation

A 58-year-old man developed a self-occluding arteriovenous fistula following stent-grafting of the right internal carotid artery (ICA). Due to prolonged ischaemic neurological deficits carotid angiography had been performed 3 weeks previously. It revealed marked atherosclerotic lesions predominantly narrowing the distal right carotid siphon. MRI confirmed ischaemic lesions and massive deficits of perfusion in the right ICA cerebral territory. Stent-grafting was performed successfully, but subsequent angiography revealed a new arteriovenous fistula adjacent to the stent, between the right carotid siphon and the cavernous sinus. On angiography 10 days later, the fistula no longer was present, and flow MRI were normal; the patient was by then asymptomatic. Arteriovenous fistula can thus complicate following endovascular stenting.     

覆膜支架植入抢救艾滋病患者注射毒品所致感染性假性动脉瘤大出血

目的 探讨覆膜支架植入抢救艾滋病患者注射毒品所致感染性假性动脉瘤大出血的效果及安全性.方法 抢救治疗艾滋病患者注射毒品所致感染性假性动脉瘤大出血21例,先行覆膜支架植入术封闭破口、隔绝假性动脉瘤和感染灶,生命体征平稳后作外科手术清创治疗.结果 所有患者植入1枚覆膜支架均一次成功,术后患肢缺血情况改善,外科清创手术全部完成.支架植入术后72 h内清创20例,控制感染并完全康复出院;48 h内清创1例,术中发生大出血,感染未能有效控制,1个月后死于多脏器衰竭.术后随访0.5～4年,20例患者未出现手术相关并发症,患肢功能正常.结论 覆膜支架植入治疗艾滋病患者注射毒品所致股动脉感染性假性动脉瘤大出血,创伤小,随访期无相关并发症,为病灶清创修复创造条件,是一种安全有效的抢救生命措施.     

Risk of deterministic effects during endovascular aortic stent graft implantation

Since the 1990s, stent graft implantation for aortic pathology has become an alternative to extensive surgical procedures in some patients. Indeed, many patients with such pathology are now treated endovascularly. Only limited data concerning the risk of a deterministic effect during aortic stent graft implantation are available Accordingly, 179 consecutive patients treated in our institute between October 2002 and July 2008 with endovascular aortic stent grafts were included in this study. Dosimetric data (kerma area product (KAP) and cumulative dose at the interventional reference point (CD(irp))) from radiograph reports were analysed for 172 patients. On a group of 19 patients, GAFCHROMIC XR type dosimetric films were also used to verify the automatic measurements. Readings from the integrated KAP meter were found to be too high and were therefore corrected - KAP to dose area product (DAP) and CD(irp) to entrance skin dose (ESD). Median DAP was 153 Gy cm2 (35-700 Gy cm2) and median ESD was 0.44 Gy (0.12-2.73 Gy). Recorded dosimetric quantities were found to be good predictors of the skin dose and highlighted 4 patients (2.3%) who received skin doses that might cause possible deterministic effects. Endovascular stent graft implantation is less invasive than a surgical procedure and is widely used; mid-term results are encouraging. In a small number of patients, deterministic effects can occur even in departments with well-trained staff. Operators should inform the patients of possible skin injury after receiving high doses of ionising radiation and proper support must be available should that occur.     

食管胸腔胃吻合口内支架并发食管气管瘘的内支架再置入治疗

目的 探讨食管癌术后食管胸腔胃吻合口狭窄行支架置入后形成食管-气管瘘,再次采取支架置入治疗的疗效.方法 6例食管胸腔胃吻合口狭窄支架置入后并发食管气管瘘.X线监视下,取出原食管支架,再次置入1枚较长的食管覆膜支架,消除食管与支架成角现象.结果 本组原支架取出顺利,未出现严重并发症.均再次置入较原支架长20 ～ 40 mm的支架,支架置入后均出现不同程度咽部疼痛不适,患者能够耐受,进食顺利.结论 食管胃吻合口狭窄支架置入后并发食管-气管瘘,可以置换稍长支架进行补救.     

Pleurobiliary fistula following Tannenbaum biliary stent insertion

We present a case of pleurobiliary fistula following trans-diaphragmatic migration of a new design biliary stent, and relate this iatrogenic complication to the configuration of the endoprosthesis. Correspondence to: J. L. Richenberg     

气管内支架置入抢救气管重度狭窄性急性呼吸困难

目的对晚期肿瘤造成气管狭窄患者突发重度呼吸困难时,紧急采取简便的雾化吸入麻醉联合喉镜直视下行气管内支架置入术的疗效及评价。方法 55例因晚期肿瘤导致气管狭窄突发呼吸困难加重患者,急症气管内支架置入术,其中食管癌32例,肺癌10例,纵隔肿瘤5例,甲状腺癌3例,气管癌3例,软腭癌1例,胃癌1例。抢救后通过症状、体征、影像学改变等观察评价疗效。结果 55例患者抢救均成功,重度呼吸困难即刻改善,并获得继续治疗机会。结论急症采用雾化吸入麻醉联合喉镜直视下气管内支架植入方法简便、迅速、可靠,值得推广。     

带膜支架在血管内治疗外伤性颈动脉海绵窦瘘中的应用

目的 探讨Jostent冠脉带膜支架对于颈动脉海绵窦瘘的血管内治疗效果. 方法 于2001年6月-2007年5月应用Jostent冠脉带膜支架治疗8例外伤性颈动脉海绵窦瘘. 结果 在8例患者中带膜支架被成功放置于靶动脉,导致瘘完全消除并保持载瘘动脉畅通,临床效果满意,无手术相关并发症发生.6例患者于带膜支架放置后6个月获造影随访,显示瘘口未再通,载瘘动脉畅通. 结论 带膜支架对于某些颈动脉海绵窦瘘是有用的血管内治疗手段.带膜支架的制作工艺仍有待发展和优化,以使之适用于脑血管系统.     

血管内支架治疗门静脉良性狭窄引起的门静脉高压

目的　评价血管内支架在门静脉主干良性狭窄导致的门静脉高压中的应用价值。方法　 6例门静脉良性狭窄患者 (其中炎症性狭窄 3例 ,肝硬化肝移植术后 3例 )实施了门静脉支架置入术 ,观察术后门静脉压力变化、支架通畅、临床症状、并发症及患者存活情况。结果　 6例患者均成功置入门静脉支架 (共 6枚 ) ,门静脉压力由术前的 (37 3± 4 7)cmH2 O(1cmH2 O =0 0 98kPa)降至术后的 (18 0± 1 9)cmH2 O (P <0 0 0 1) ,患者门静脉高压症状完全缓解 ,无手术相关的严重并发症。平均随诊 2 6个月 (5～ 36个月 ) ,所有患者门静脉保持通畅 ,除 1例患者死于肝移植后其他并发症外 ,其他患者均存活。结论　门静脉支架置入治疗门静脉主干良性狭窄引起的门静脉高压是安全及有效的     

Delayed esophageal hemorrhage caused by a metal stent: Treatment with embolization

We report a case of life-threatening esophageal hemorrhage after metal stent implantation successfully treated by arterial embolization. An 85-year-old woman was admitted in shock secondary to massive hematemesis and melena. Recent medical history revealed esophageal cancer treated 8 weeks previously by endoesophageal radiotherapy (40 Gy) and endoscopic placement of a covered Wallstent prosthesis. Selective arteriography of the fifth posterior right intercostal artery showed massive contrast extravasation in the esophagus. Embolization was performed with 150–250-μm polyvinyl alcohol particles. Follow-up at 5 months was uneventful. Arteriography and embolization are advised when severe hemorrhage occurs after esophageal implantation of metal stents.     

覆膜支架治疗自膨式金属胆道支架植入后迟发性出血1例

胆道金属支架植入术是治疗恶性胆道梗阻性黄疸常用的治疗方法,但仍存在许多并发症,如感染、支架阻塞等.胆道支架植入后迟发性出血罕见,现将采用覆膜支架植入治疗以消化道出血为首发表现的自膨式金属胆道支架(self-expandable metallic biliary stent,SEMS)植入后迟发性出血病例报道如下.     

Prophylactic endovascular radiotherapy to prevent intimal hyperplasia after stent implantation in femoropopliteal arteries

Purpose: Recurrent stenosis or occlusion by intimal hyperplasia occurs in up to 40% of patients with tantalum stent implantations in femoropopliteal arteries and greatly restricts their usefulness. We evaluated the effect of prophylactic endovascular radiotherapy on stenosed/occluded\ stents. Methods: We investigated prophylactic endovascular radiotherapy with a surface dose of 12 Gy using an iridium 192 source as a means to reduce or eliminate recurrent stenosis in 4 patients with stenosed/occluded stents, 6–8 months after the original implantation. Confirmatory diagnostic atherectomy, PTA or laser recanalization and endovascular radiotherapy were performed. Results: None of the four has developed recurrent obstruction within 23 to 30 months after this treatment, which up to now shows no short-term or long-term complications. Conclusion: We conclude that this limited experience is promising enough to warrant further study.     

气道金属支架治疗支气管结核伴全肺不张9例

目的评价气道内金属支架植入治疗支气管结核伴一侧全肺不张的疗效及安全性。方法对9例因支气管结核引起支气管管腔完全闭塞、一侧全肺不张患者,采用微波、高频电、球囊扩张加气道内金属支架植入治疗,分别在支架植入后1周及4～6个月期间观察患者气道狭窄段的腔径。结果9例支气管结核患者于支架植入后3d内,原先不张的患肺均完全复张;在支架植入7d后,原闭塞支气管的腔径恢复至(9.17±1.24)mm:9例患者中有3例出现了不同程度的肉芽增殖再狭窄,采用腔内冷冻治疗,同时配合定期的球囊扩张,可有效控制再狭窄。结论对于支气管结核所致的一侧全肺不张患者,与传统外科手术相比,腔内金属支架植入疗法可以有效地保护患者的肺功能,是有效、安全、微创的治疗方法。     

带膜血管内支架置入治疗主动脉夹层动脉瘤患者的护理

主动脉夹层动脉瘤是心脏大血管急症.起病突然,常有剧烈疼痛、休克和压迫症状,同时伴有心血管系统、胃肠道系统、泌尿系统、神经系统等多器官损害,其病死率于发病后24 h内为21%.若治疗不及时或护理不当,半数以上在2周内病死.近年来,通过血管腔内技术用支架型人工血管治疗主动脉瘤已倍受推崇.2002年8月至2004年4月,我院采用经股动脉覆膜支架置入术治疗胸主动脉夹层动脉瘤患者16例,效果好,创伤小,安全性高,术后恢复快.现将护理体会报告如下.