Dataset Information

Dog-bone inflation to salvage and redeploy a deformed, dislodged expandable stent in the external iliac artery.

ABSTRACT: A 64-year-old man with a history of right external iliac artery stenosis after stenting with a self-expandable stent was admitted for repetitive in-stent restenosis (ISR). To treat ISR, we selected a balloon expandable stent (BES) that was prepared with negative suction before being inserted into the sheath. BES dislodged when the stent balloon was incompletely inflated and was simultaneously deformed in a funnel shape. When BES was retrieved using a short noncompliant balloon, it dislodged again because of an imbalanced proximal inflation of the balloon. We finally retrieved BES using a long noncompliant balloon and deployed it with dog-bone inflation without any additional devices. <Learning objective: To report an easy method for retrieving and redeploying a deformed, dislodged stent without using an additional device. Retrieving a relatively large peripheral stent that becomes deformed and dislodged is difficult and may require surgery. Balloon catheter retrieval is a useful strategy to salvage and redeploy the dislodged stent. However, a large size short noncompliant balloon catheter had the risk for dislodging the retrieved deformed stent again. To retrieve and salvage a deformed and dislodged stent, a long balloon and dog-bone inflation may be useful.>.

SUBMITTER: Chung WJ

PROVIDER: S-EPMC6149551 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Dog-bone inflation to salvage and redeploy a deformed, dislodged expandable stent in the external iliac artery.

Chung Wen-Jung WJ Takeji Yasuaki Y Soga Yoshimitsu Y Ando Kenji K

Journal of cardiology cases 20171120 1

A 64-year-old man with a history of right external iliac artery stenosis after stenting with a self-expandable stent was admitted for repetitive in-stent restenosis (ISR). To treat ISR, we selected a balloon expandable stent (BES) that was prepared with negative suction before being inserted into the sheath. BES dislodged when the stent balloon was incompletely inflated and was simultaneously deformed in a funnel shape. When BES was retrieved using a short noncompliant balloon, it dislodged agai ...[more]

PMID: 30279841

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Project description:Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. Although generally well tolerated, in severe cases, pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular CIAA repair or EVAR in conjunction with unilateral external-internal iliac artery bypass.Single-center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or CIAA repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, postoperative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded.The cohort of 10 patients was all men with a mean age of 71 years (range: 56-84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery-internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100%, and there were no perioperative deaths. One patient developed transient paraplegia, 1 patient had buttock claudication on the side of his hypogastric embolization contralateral to his iliac bypass, and 1 developed postoperative impotence. 20% of patients sustained long-term complications (buttock claudication and postoperative impotence). Mean LOS was 2.8 days (range: 1-9 days). Postoperative imaging was obtained in 90% of patients, and mean follow-up was 10.8 months (range: 0.5-36 months). All bypasses remained patent.Although branched graft technology continues to evolve, strategies to maintain adequate pelvic circulation are necessary to avoid the devastating complications of pelvic ischemia. We have demonstrated that a hybrid approach combining EVAR or isolated endovascular common iliac artery exclusion with a unilateral external-internal iliac bypass via a retroperitoneal approach is well tolerated with a short LOS and excellent patency rates.

Dataset Information

Dog-bone inflation to salvage and redeploy a deformed, dislodged expandable stent in the external iliac artery.

Publications

Dog-bone inflation to salvage and redeploy a deformed, dislodged expandable stent in the external iliac artery.

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