Successful Endovascular Stent-Graft Treatment for an Aortoesophageal Fistula Caused by a Descending Thoracic Aortic Aneurysm: Report of a Case

Conventional surgery for aortoesophageal fistula (AEF) is technically difficult, and is associated with high morbidity and mortality. We report a case of primary AEF caused by a descending thoracic aortic aneurysm, which was successfully treated with an endovascular stent-graft technique. The patient has been followed up for 3 years with no signs of infection.     

Aortoenteric Fistula After Endovascular Stent Grafting for an Abdominal Aortic Aneurysm: Report of a Case

We report a case of an aortoenteric fistula (AEF) developing after endovascular stent grafting (EVSG) for an abdominal aortic aneurysm (AAA). A 69-year-old male patient with a history of panperitonitis caused by rectal perforation underwent EVSG for an AAA. A follow-up contrast-enhanced computed tomography (CT) scan, done 12 months after the EVSG, confirmed shrinkage of the AAA with no endoleak. However, 19 months postoperatively, an AEF developed between the AAA and the jejunum. Although there was no endoleak on a subsequent CT scan, we noted enlargement of the AAA and inflammatory changes in the surrounding tissue. The patient was treated surgically and discharged in good health 74 days postoperatively. Thus, one should consider the possibility of this devastating complication, even in patients without an endoleak, after EVSG for AAA.     

Repair of False Para-anastomotic Aortic Aneurysms Using an Endovascular Stent Graft Technique in a Patient with Severe Pulmonary Disease: Report of a Case

Conventional surgery for para-anastomotic aortic aneurysms is technically challenging, and is associated with high morbidity and mortality. This report describes the case of a patient with severe pulmonary diseases in whom false para-anastomotic aortic aneurysms were successfully repaired using an endovascular stent graft technique. Received: November 30, 2000 / Accepted: May 15, 2001     

Endovascular Repair of a Traumatic Arteriovenous Fistula 34 Years After the Injury: Report of a Case

Penetrating extremity injuries can result in the development of arteriovenous fistulas (AVFs), whereby normal blood flow through the capillary bed is bypassed. Late complications of untreated AVFs include proximal arterial dilatation, venous congestion, congestive heart failure, and distal ischemia. We report the case of a 57-year-old man who was referred to us for treatment of a traumatic AVF with multiple sequelae, 34 years after he sustained a shrapnel injury to his right lower leg. We performed successful endovascular repair of this AVF with the patient under spinal anesthesia. Computed tomographic angiography (CTA) done 1 month and 6 months later confirmed AVF exclusion. Patients may present with sequelae of traumatic AVFs many years after their initial injury. Endovascular repair of AVFs offers several advantages over conventional repair and can be performed successfully even in the presence of complex anatomic abnormalities.     

Endovascular Stent Graft Treatment for Iatrogenic Arteriovenous Fistulas after Femoral Catheterisation

This article presents a case report of a 79-year-old patient who was suffering from a large femoral arteriovenous fistula and a stenosis of the external iliac artery and who was treated successfully with stent grafts. The fistula, which consisted of three parts, was caused by a percutaneous transluminal coronary angioplasty. Two Jo-stents and one Medtronic AVE stent were used to cover the fistula and to dilate the stenosis. This article also describes the possible causes of iatrogenic arteriovenous fistulas such as the technique of arterial puncture and its localisation. The treatment of iatrogenic arteriovenous fistulas with stent grafts is a safe alternative for surgery in patients who often suffer from multiple cardiovascular problems. It could become the treatment of choice in the future.     

Endovascular Stent Graft Repair of Aortic Dissection Type B Extending to the Aortic Arch

Objective

To analyse our experience with endovascular stent graft repair of descending aorta dissections that require supraaortic branch vessel revascularisation.

Design

Retrospective study.

Methods

From 2001 to 2009, 22 consecutive patients with the above dissections were retrospectively analysed. Inclusion requirement: aortic landing zone proximal to the left subclavian artery of less than 15 mm. Hybrid, scalloped or fenestrated endovascular stent grafts were selected based on dissection characteristics. Annual follow-up visits (median 27.1 months) included computed tomography angiography. End points include progressive pathology, complications and survival rates.

Results

Surgery was successful in all except for one operative complication. Two patients died within 30 days after surgery, one to cerebral infarction and the other to myocardial infarction. No postoperative complications occurred in the remaining patients. Thrombosis formed in the aortic false lumen of the graft exclusion segment in all patients. The maximum diameter of this segment decreased in 18 patients and was stable in two. In 19 patients, blood flow remained in the false lumen distal to the exclusion area not covered by stent. Patency was seen at mid- and long-term follow-up, without proximal endoleak, graft displacement or deaths.

Conclusion

Endovascular stent graft methods show promise in endovascular stent graft repair of proximal descending aortic dissections involving the distal arch.     

Endovascular Repair of Abdominal Aortic Aneurysms with Aortocaval Fistula

OBJECTIVES: To examine the risk of high-flow type II endoleak following endovascular repair of abdominal aortic aneurysm with aortocaval fistula. DESIGN: Case reports. SUBJECTS: Two patients with abdominal aortic aneurysms with aortocaval fistula. METHODS: Both patients had an endovascular repair of their aortic aneurysms. RESULTS: The aneurysms were successfully treated in both patients, without any endoleak on completion angiography. Apart from a transient type II lumbar endoleak in one of the patients, no endoleak was found after 3 and 12 month follow-up. Seven other cases have been published, reporting one type II and one type Ic endoleak. CONCLUSION: We found no evidence that endovascular repair of abdominal aortic aneurysm with aortocaval fistula is associated with a higher incidence of persistent endoleak.     

覆膜支架在自体动静脉内瘘狭窄治疗中的应用研究

目的:评价覆膜支架治疗自体动静脉内瘘(AVF)狭窄的临床疗效。方法:回顾性分析深圳大学第三附属医院2018年1月—2020年10月收治的45例AVF狭窄患者的临床资料,根据手术方式分为两组:覆膜支架组(17例)和球囊扩张组(28例),比较两组患者的临床效果。结果:覆膜支架组的6个月及12个月初级通畅率明显高于球囊扩张组(100.00% vs 78.57%, P=0.040; 100.00% vs 64.29%, P=0.005),差异有统计学意义。两组的6个月及12个月次级通畅率差异无统计学意义,两组术后并发症的发生率差异无统计学意义。结论:覆膜支架治疗AVF狭窄与单纯球囊扩张相比,可以明显提高6个月及12个月的初级通畅率,对于反复狭窄的AVF,植入覆膜支架后可明显延长患者的再次干预时间。     

Endovascular Stent Graft Treatment of a Traumatic Aortocaval Fistula

Aortocaval fistula (ACF) is an infrequently reported sequela of trauma. Most ACF have been repaired via an open approach. During the past 10 years, there has been one reported case of spontaneous ACF and two cases of traumatic ACF repaired using an endovascular technique. We present a third case of traumatic ACF repaired with an endovascular stent graft. A 40-year-old male sustained two gunshot wounds to the right chest and one to the right upper abdomen. He was taken from the emergency department directly to the operating room, where an exploratory laparotomy was performed. Through-and-through injuries to the stomach and transverse colon were repaired primarily. Subsequently, the patient developed abdominal compartment syndrome. An urgent exploratory laparotomy was performed, revealing a nonbleeding hematoma on the posterior lateral surface of the right lobe of the liver, which was left undisturbed. Open abdominal management was instituted with vacuum pack closure. On the nineteenth hospital day, the patient again had a significant decrease in hematocrit. An aortogram was performed in order to evaluate the patient for intrahepatic arterial bleeding amenable to transcatheter embolization. There was no evidence of hepatic arterial bleeding. However, a supraceliac ACF was identified. The patient was taken to the operating room, and an AneuRx aortic extension cuff was advanced under fluoroscopy and deployed to cover the fistula. Completion angiography revealed total obliteration of the ACF and appropriate placement of the stent graft. Postoperatively, the patient was returned to the intensive care unit, where his hospital course was complicated by ventilator-associated pneumonia and sepsis. Repeat computed tomographic scanning 6 months and 1 year following this repair demonstrated patency of the graft without evidence of graft migration or aortocaval communication. Further research and experience are necessary with this technique regarding long-term outcome and technical aspects. In particular, the sizing problems associated with repair of acute traumatic ACF in emergency situations should be addressed. The endovascular approach provides an attractive and exciting alternative to traditional methods for repair of ACF.     

Successful Endovascular Treatment of Bleeding Aortoenteric Fistula: A Case Report

Aortoenteric fistula (AEF) is an infrequent but disastrous complication of open abdominal aortic repair. Left untreated, it has a 100% fatality rate. The traditional approaches to the repair of secondary AEF (SAEF) are associated with average mortality rates of 21-59% and numerous major complications. Here, we report a case of acute gastrointestinal bleeding due to SAEF, successfully treated with endovascular stent graft repair. At 1-year follow-up, the patient was doing well without any signs of recurrent fistula. Endovascular treatment of AEF provides another treatment option that may be particularly valuable in patients whose comorbidities would preclude open repair.     

主动脉弓三分支型移植物在血管模拟装置中的腔内修复实验

目的:研究一体化三分支型主动脉弓腔内移植物在新型血管模拟装置中模拟腔内修复主动脉弓的可行性。方法:设计并制作主动脉弓一体化三分支型覆膜支架,其分支针对主动脉弓上的3个分支动脉;用新型血管模拟装置测试此种移植物,优化移植物的腔内操作,评估移植物在模拟装置内释放的可行性。结果:新型血管模拟装置运作正常,移植物可顺利装载入输送系统并导入血管模拟装置内释放,其主体和分支在位良好。结论:设计制作了新型主动脉弓分支型移植物,其输送系统能顺利将移植物送达靶血管准确位置;新型体外血管模拟装置能模拟人体血管腔内环境并对上述移植物进行体外测试。     

Surgical Treatment of an Aortoesophageal Fistula Caused by Stent Implantation for Esophageal Stenosis: Report of a Case

An aortoesophageal fistula is uncommon, but almost always fatal. We report a case of an aortoesophageal fistula that developed after stent dilation for an esophageal stricture caused by benign esophagitis. As soon as esophageal hemorrhaging was identified by endoscopy, the patient was transferred to the operating theater; however, the uncontrollable and massive bleeding resulted in pulseless shock. The digestive surgeon put side-clamps on the descending aorta and esophagus and transferred the patient to our hospital. We identified an aortoesophageal fistula, 3.0 mm in diameter, in the descending aorta, and performed a graft replacement of the descending aorta and esophagectomy. It was immediately evident that the edge of the stent had been sticking into the aortic wall, which had caused the fistula. To our knowledge, this is the first report of successful surgical treatment of an aortoesophageal fistula caused by esophageal stent dilatation.     

一体化单分支支架对部分主动脉弓部行腔内隔绝术

目的 设计制作新型一体化带单分支的主动脉腔内支架,以此种支架对动物行主动脉弓分支区腔内血管重建的实验,探讨其腔内重建主动脉弓的可行性.方法 设计并制作适合于动物实验的一体化单分支覆膜支架,其分支针对左锁骨下动脉(LSA);在X线透视引导下,对猪行主动脉弓腔内血管重建;术后第3个月观察支架形态结构、主动脉血流动力学变化及内漏发生状况.结果 8例均完成支架的植入,平均手术时间(93.5±12.1)min;术后第3个月造影显示支架位置及形态良好,冠状动脉及分支动脉血流通畅,未发现支架贴壁不良的情况;头部CT未发现脑梗塞;支架植入后第3个月,LSA的血压为(138.0±8.8) mm Hg(1 mm Hg =0.133 kPa),降主动脉的动脉压为( 141.3±8.5) mmHg,与术前比较差异均无统计学意义(P＞0.05);对支架周围的血管壁组织切片检查未发现血管内膜损伤.结论 应用一体化单分支支架部分重建猪的主动脉弓在技术上可行,有助于探索腔内重建人体主动脉弓.     

Infected Viabahn Stent Graft in the Superficial Femoral Artery

We present a case of an infected stent graft in the superficial femoral artery (SFA). A 67-year-old woman underwent excision of an infected Viabahn stent graft. At exploration there was no apparent artery around the majority of the stent graft, suggesting that the SFA had been autolysed.Infected stents and stent grafts are rare in the SFA position. The risk of infection is likely minimised with standard treatments including drainage of infection prior to stent graft placement and periprocedural antibiotic administration. Successful management will, in most cases, require excision of the stent graft and adjunctive arterial reconstruction, as necessary.     

Successful Repair of an Aortoesophageal Fistula Caused by a Thoracic Aortic Aneurysm: Report of a Case

Aortoesophageal fistula occurring as a complication of a thoracic aortic aneurysm is difficult to repair because of the contaminated surgical field. We report the case of a 67-year-old man in whom an aortoesophageal fistula developed secondary to a dissecting thoracic aortic aneurysm. We performed in situ graft repair of the aneurysm, then covered the site with omentum and resected the esophagus to prevent graft infection. About 5 months later, the esophagus was reconstructed subcutaneously using an ascending colon pedicle. The patient recovered well and has resumed leading a normal life.     

Successful Surgical Closure of an Esophagobronchial Fistula Caused by a Foreign Body in the Esophagus of a Female Octogenarian with a Delayed Diagnosis: A Case Report

Esophagobronchial fistula (EBF) caused by an esophageal foreign body is rare in adults. All surgical interventions in the reported cases were performed via right thoracotomy. We have successfully treated an 88-year-old woman with EBF caused by a thick 2 × 2 cm piece of cake decorating paper that was swallowed accidentally. There was a 2-month interval between ingestion of the foreign body and correct diagnosis. The bronchial opening of the EBF was on the cephalic wall of the proximal left main bronchus (LMB), so we planned a primary repair of the bronchial wall with sutures via left thoracotomy. We performed a division of the fistula and primary closure of the openings on the esophageal and bronchial walls and covered the suture sites with an intercostal muscle flap and pericardial fat, respectively. The patient resumed oral intake on postoperative day 11 and was subsequently transferred to other hospital for rehabilitation.     

Endovascular repair of the aortic arch in pigs by improved double-branched stent grafts

Introduction

This study aimed to evaluate the feasibility of total endovascular repair of the aortic arch in pigs using improved integrated double-branched stent grafts.

Methods

Improved self-expandable stent grafts with a main body and two integrated branches were prepared for the repair of the aortic arch in six pigs. The feasibility of using these stent grafts was evaluated with arteriography, computed tomography (CT), computed tomography angiography (CTA) and autopsy three months following the procedure.

Results

The double-branched stent grafts were placed successfully in the aortic arch in all six pigs. All pigs survived for at least three months and their biological behaviour was normal. Arteriography, CTA and animal necropsy revealed good fixation in all cases. Aortic valve function and coronary ostia remained intact, and CT of the head did not detect any lesion of cerebral infarction.

Conclusions

Endovascular repair of the aortic arch with an integrated double-branched stent graft is safe and feasible in animal studies.     

腔内隔绝术治疗主动脉夹层22例分析

目的 探讨主动脉夹层腔内隔绝术(EVGE)治疗的方法及手术时机,并评价其治疗效果.方法 回顾性分析我院2008年6月至2011年8月收治的22例行EVGE治疗的主动脉夹层患者的临床资料,20例为Stanford B型,2例为Stanford A型.结果 22例患者手术均获成功,无移位及扭曲,破口封堵满意.术后平均随访时间12.5个月,无内漏,无死亡病例.结论 带膜支架EVGE治疗主动脉夹层具有创伤小,术后恢复快,但远期效果有待进一步观察.