Transluminally placed endovascular stented graft repair for arterial trauma

doi:10.1016/0741-5214(94)90147-3

Journal of Vascular Surgery

Volume 20, Issue 3, September 1994, Pages 466-473

Presented at the Eighteenth Annual Meeting of the Southern Association for Vascular Surgery, Scottsdale, Ariz., Jan. 26-29, 1994.

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Abstract

Purpose: Intravascular stents have become important tools for the management of vascular lesions; however, stents in combination with vascular grafts have only recently reached clinical application. This report describes an experience with stented grafts for the treatment of penetrating arterial trauma. Methods: Seven transluminally placed stented grafts were used to treat one arteriovenous fistula and six pseudoaneurysms. These grafts were successfully inserted percutaneously or through open arteriotomies that were remote from the site of vascular trauma. The devices were composed of balloon-expandable stainless steel stents covered with polytetrafluoroethylene grafts. Results: Patency up to 14 months was achieved (mean follow-up 6.5 months) with these stented grafts. The use of stented grafts appears to be associated with decreased blood loss, a less invasive insertion procedure, reduced requirements for anesthesia, and a limited need for an extensive dissection in the traumatized field. These advantages are particularly important in patients with central arteriovenous fistulas or false aneurysms who are critically ill from other coexisting injuries or medical comorbidities. Conclusions: The use of stented grafts already appears justified to treat traumatic arterial lesions in critically ill patients. Although the early results with the seven cases in this report are encouraging, documentation of long-term effectiveness must be obtained before these devices can be recommended for widespread or generalized use in the treatment of major arterial injuries. (J VASC SURG 1994;20:466-73.)

Section snippets

PATIENTS AND METHODS

Seven endovascular stented graft repairs of traumatic arterial lesions were performed in seven patients at Montefiore Medical Center in New York over a 14-month period. Details regarding the injury and the endovascular repair in the seven patients are presented in Table I.Informed consent for the placement of a stent graft device was obtained from each patient. All procedures were performed under fluoroscopic guidance in the operating room with the patient prepared for a standard surgical

RESULTS

As shown in Table I, seven patients received seven stented grafts to treat traumatic arterial lesions. The mean age of the patients was 41 years (range 20 to 78). Six patients were men. Four injuries occurred as a result of gunshot wounds (Fig. 2).

. A, Axillary-subclavian artery arteriogram of patient with large pseudoaneurysm (open arrow) after stab wound to chest resulted in hemopneumothorax (arrow indicates chest tube). B, After transluminal insertion of stent graft device, pseudoaneurysm was

DISCUSSION

Prompt diagnosis and treatment of penetrating vascular trauma are required to avoid the late sequelae that may occur when important injuries are not appropriately treated. 10, 11, 12, 13 Traumatic arteriovenous fistulas and pseudoaneurysms involving nonessential vessels, such as branches of the hypogastric or deep femoral arteries, have been effectively treated by catheter-directed arterial embolization. 14, 15 Injuries to vital arteries have uniformly required direct surgical repair of the

References (23)

ML Marin et al.
Percutaneous transfemoral insertion of a stented graft to repair a traumatic femoral arteriovenous fistula
J VASC SURG
(1993)
J May et al.
Transluminal placement of a prosthetic graft-stent device for treatment of subclavian artery aneurysm
J VASC SURG
(1993)
DV Feliciano et al.
Delayed diagnosis of arterial injuries
Am J Surg
(1987)
TF Panetta et al.
Percutaneous transcatheter embolization for arterial trauma
J VASC SURG
(1985)
A Balko et al.
Transfemoral placement of intraluminal polyurethane prosthesis for abdominal aortic aneurysm
J Surg Res
(1986)
JC Parodi et al.
Transfemoral intraluminal graft implantation for abdominal aortic aneurysms
Ann Vasc Surg
(1991)
RR Keen et al.
Autogenous vein graft repair of injured extremity arteries: Early and late results with 134 consecutive patients
J VASC SURG
(1991)
T Drapanas et al.
Civilian vascular injuries: a critical appraisal of three decades of management
Ann Surg
(1970)
HF Burnett et al.
Peripheral arterial injuries: a reassessment
Ann Surg
(1976)
MO Perry et al.
Management of arterial injuries
Ann Surg
(1971)

DV Feliciano et al.

Civilian trauma in the 1980s: a 1-year experience with 456 vascular and cardiac injuries

Ann Surg

(1984)

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^*: From the Division of Vascular Surgery, Department of Surgery, and the Division of Interventional Radiology, Department of Radiology (Drs. Cynamon and Bakal), Montefiore Medical Center/Albert Einstein College of Medicine, New York.

^**: Supported in part by grants from the U.S. Public Health Service (HL 02990-01), the James Hilton Manning and Emma Austin Manning Foundation, The Anna S. Brown Trust, and the New York Institute for Vascular Studies.

^*: Reprint requests: Michael L. Marin, MD, Division of Vascular Surgery, Montefiore Medical Center, 111 E. 210th St., New York, NY 10467.

^**: 0741-5214/94/$3.00 + 0 24/6/56319

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Transluminally placed endovascular stented graft repair for arterial trauma*,**,*,**

Abstract

Section snippets

PATIENTS AND METHODS

RESULTS

DISCUSSION

J VASC SURG

J VASC SURG

Am J Surg

J VASC SURG

J Surg Res

Ann Vasc Surg

J VASC SURG

Civilian vascular injuries: a critical appraisal of three decades of management

Ann Surg

Peripheral arterial injuries: a reassessment

Ann Surg

Management of arterial injuries

Ann Surg

Civilian trauma in the 1980s: a 1-year experience with 456 vascular and cardiac injuries

Ann Surg