Safety and efficacy of covered stent grafts in the treatment of emergent access related complications.

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Michael Wilderman, Kazuya Tateishi, David O'Connor, Sophia Simonian, Anjali Ratnathicam, Kristen Cook, Lucius De Gregorio, Hosam Hmoud, Joseph De Gregorio
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引用次数: 0

Abstract

Background: Large bore percutaneous access is becoming increasingly common. Parallel to this, we observe an increase in vascular access site complications such as bleeding, dissection, thrombosis or pseudo-aneurysms. This study was aimed to evaluate safety and efficacy of covered stent grafts for fixing large bore vascular access injuries.

Methods: A total of 147 Viabahn or Viabahn VBX (WL Gore) stent grafts which were placed across the inguinal ligament in emergent settings in 136 patients, were retrospectively analyzed. The two endpoints were the technical success rate, defined by complete arterial repair, and long-term stent graft patency. We also looked at the need for open conversion, wound infections, and in hospital and 30-day mortality. We followed the patients using duplex ultrasound and computed tomography angiogram to assess for arterial patency, freedom from intervention, stent kinking and clinical symptoms.

Results: 30 Viabahn and 117 Viabahn VBX (WL Gore) stent grafts were placed in the distal external iliac artery and into the proximal common femoral artery of 136 patients. Indications for intervention were bleeding in 92 patients (68 %), flow limiting dissection in 41 patients (30 %) and symptomatic AVF in 3 patients (2 %). Primary technical success rate was 100 %. Limited 3-year follow up (101/136 patients) showed 99 % patency with no evidence of stent fracture, stenosis or kinking except in one patient who needed target lesion revascularization due to neointimal hyperplasia.

Conclusions: Covered stent grafts can be placed safely, efficiently, and effectively in the distal external iliac and common femoral arteries across the inguinal ligament. These stent grafts can be used as an alternative therapeutic option to open surgery in patients with large bore vascular access injuries.

有盖支架移植物治疗紧急入路相关并发症的安全性和有效性。
背景:大口径经皮入路越来越普遍。与此同时,我们发现血管通路部位的并发症也在增加,如出血、夹层、血栓或假性动脉瘤。本研究旨在评估覆盖支架移植物固定大口径血管通路损伤的安全性和有效性:回顾性分析了 136 名患者的 147 个 Viabahn 或 Viabahn VBX(WL 戈尔公司)支架移植物,这些移植物都是在紧急情况下穿过腹股沟韧带植入的。两个终点分别是技术成功率(以动脉完全修复为标准)和支架移植物的长期通畅率。我们还考察了患者是否需要进行开放性转流、伤口感染以及住院和 30 天死亡率。我们使用双相超声波和计算机断层扫描血管造影术对患者进行随访,以评估动脉通畅度、无介入治疗、支架扭结和临床症状:在136名患者的髂外动脉远端和股总动脉近端分别植入了30枚Viabahn和117枚Viabahn VBX(WL戈尔)支架移植物。92 名患者(68%)的介入指征为出血,41 名患者(30%)为血流受限夹层,3 名患者(2%)为症状性动静脉瘘。初次技术成功率为 100%。为期3年的有限随访(101/136例患者)显示,支架通畅率为99%,无支架断裂、狭窄或扭结迹象,只有一名患者因新血管内膜增生而需要进行靶病变血管再通手术:结论:覆盖支架移植物可以安全、高效、有效地穿过腹股沟韧带植入髂外动脉和股总动脉远端。这些支架移植物可作为大口径血管通路损伤患者开放手术的替代治疗方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cardiovascular Revascularization Medicine
Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.30
自引率
5.90%
发文量
687
审稿时长
36 days
期刊介绍: Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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