Endovascular Repair of Peripheral Aneurysms, Pseudoaneurysms, and Arteriovenous Fistulas

doi:10.1007/s100169900043

Annals of Vascular Surgery

Volume 11, Issue 3, May 1997, Pages 256-263

https://doi.org/10.1007/s100169900043 Get rights and content

Endovascular repair of peripheral arterial lesions was performed in 10 patients including two iliac aneurysms, two iliac anastomotic pseudoaneurysms, one subclavian pseudoaneurysm, one axillary anastomotic disruption, two prosthetic pseudoaneurysms, and two posttraumatic arteriovenous (AV) fistulas. The indications for repair were aneurysm size in five cases, massive hematoma in one, threatened prosthetic dialysis graft in two, venous hypertension with nonhealing ulcer in one, and arm pain in one. Vascular access was obtained through surgical cutdown in all cases, via the femoral artery in five patients, the proximal brachial artery in three, and a prosthetic graft in two. Stented prosthetic grafts were used in five cases (1 polyester and polytetrafluoroethylene 4 [PTFE]), and PTFE-covered stents in five cases. Concomitant procedures were done in four patients including two open repairs of a common femoral artery aneurysm, a transluminal dilatation of a proximal aortic anastomotic stenosis, and an iliac artery transluminal angioplasty. Eight of 10 cases were technically successful. Completion arteriography revealed complete exclusion of all lesions, except for one minimal proximal stented graft leak in a pseudoaneurysm, and an incomplete obliteration of an AV fistula. No complications occurred. Operative time ranged from 45 min to 5 hours. Postoperative hospital stay was 1 day in five patients, 2 days in three patients, and 4 days in two patients. Follow-up contrast CT scan, arteriography, or duplex scanning demonstrated complete exclusion of all lesions except an AV fistula, and decrease in size in three aneurysms. The proximal leak initially present in a stented graft resolved. All grafts and covered stents remained patent at 2–19 months of followup. Endovascular exclusion of peripheral arterial aneurysms, pseudoaneurysms, and AV fistulas can be done with a high degree of technical success, low morbidity, and short hospital stay. Shortterm follow up is encouraging, however, long term follow up of these procedures is warranted to assess durability of the repair and absence of complications.

References (13)

JC Parodi et al.
Transfemoral intraluminal graft implantation for abdominal aortic aneurysms
Ann Vasc Surg
(1991)
J May et al.
Treatment of complex abdominal aortic aneurysms by a combination of endoluminal and extraluminal aortofemoral grafts
J Vasc Surg
(1994)
JC Parodi
Endovascular repair of abdominal aortic aneurysms and other arterial lesions
J Vasc Surg
(1995)
FJ Veith et al.
Endovascular Graft Committee, Guidelines for development and use of transluminally placed endovascular prosthetic grafts in the arterial system
J Vasc Surg
(1995)
E Criado et al.
An aortic aneurysm model for the evaluation of endovascular exclusion prostheses
J Vasc Surg
(1995)
Chuter TAM, Risberg B, Hopkinson BR, Wendt G, Scott RAP, Walker PJ, Viscome S, White G. Clinical experience with a...

There are more references available in the full text version of this article.

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Comparison of Open and Endovascular Aneurysm Repair in Native Arteriovenous Fistulas
2024, Annals of Vascular Surgery
Arteriovenous accesses develop aneurysms (FA) during their active use, resulting in pain, erosion, bleeding, and difficulty in cannulation. This study aims to evaluate the outcomes of open and endovascular management of single FA in arteriovenous fistulas (AVF).
A retrospective review of all upper extremity primary AVFs over 12 years was undertaken at a single center. Patients undergoing elective open and endovascular repair of a single FA were identified. Thirty-day outcomes, cannulation failure, line placement, re-intervention, and functional dialysis (continuous hemodialysis) for 3 consecutive months were examined.
Three hundred and seventy nine patients presented with a single FA that met the requirements for intervention: 126 (33%) underwent endovascular repair, and the remainder 253 (67%) underwent open repair. Preoperative fistulogram identified anatomically significant issues in 91% of the cases, and these were treated by balloon angioplasty: 10% within the fistula tract, 44% within the outflow tract, and 47% in the central veins. In open repair, 57% underwent plication, 35% underwent resection and re-anastomosis, and the remainder (8%) underwent interposition grafting. In endovascular repair, successful placement of a stent was achieved in all cases with 1 ± 2 (mean ± standard deviation [SD]) covered stents (diameter: 6 –8 mm) placed, achieving successful exclusion of the FA. The combination of early thrombosis and cannulation failures led to the greater need for a tunneled central line in endovascular repair (6.5% vs. 2.4%; endovascular versus open repair; P = 0.04). As a result, the mean time for establishing renewed access in the index AVF was significantly higher in endovascular repair (2 ± 3 vs. 2 ± 2 weeks, mean ± SD; endovascular open repair versus open repair; P = 0.001). In follow-up, there were more secondary interventions per year in the endovascular compared to open repair groups (3.1 vs. 1.4 secondary interventions per year; endovascular versus open repair; P = 0.04). Median functional dialysis durations were superior in the open repair (48 ± 6%, mean + standard error) compared to the endovascular repair at 5 years. (26 ± 7%; P = 0.03).
Open repair results in a more rapid return to access use, lower need for a tunneled central line, lower secondary re-intervention rates, and superior functional dialysis durations compared to endovascular repair. Open FA repair should be considered for symptomatic single FA repairs before endovascular FA repair.
Late diagnosed post traumatic femoral arteriovenous fistula revealed by leg ulcer
2020, JMV-Journal de Medecine Vasculaire
Stenting of Subclavian Artery True and False Aneurysms: A Systematic Review
2018, Annals of Vascular Surgery
Aneurysms of the subclavian artery are usually the result of trauma, atherosclerosis, or thoracic outlet syndrome. Until the 90s, open surgical repair was considered the only therapeutic choice, exhibiting high complication rates. Since the first report of endovascular repair of subclavian aneurysms in 1991, promising results have been published. The aim of this review was to summarize all available data on subclavian artery (SA) true and false aneurysm stenting to reach conclusions regarding morbidity, mortality, and other procedure-related characteristics.
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Eligible studies were sought in the Medline (PubMed), ClinicalTrials.gov, and Cochrane library–Cochrane Central Register of Controlled Trials (CENTRAL) databases through February 2017 using the following MeSH terms: “endovascular”, “hybrid”, “aneurysm”, “pseudo-aneurysm”, “pseudo-aneurysm”, “false aneurysm”, “arterial injury”, “subclavian artery”, “axillo-subclavian,” and “axillosubclavian artery”. The reference lists of eligible articles and pertinent reviews were screened for potential relevant studies.
Seventy-three studies encompassing data on 142 patients who underwent endovascular or hybrid SA aneurysm repair were deemed eligible. One hundred forty-seven stents and stent grafts were used. Median age of all patients was 56 years, and males comprised 46% of the study sample. Trauma was the most common mechanism of injury. Pulsatile mass or hematoma was the most frequent presenting sign. Pseudoaneurysms were the most frequent type of aneurysms, followed by true aneurysms. Most authors used self-expanding polytetrafluoroethylene-covered stents. Access was obtained by either brachial, femoral, or both arteries. Through-and-through technique was also used in angulated vessels. All-cause mortality was 10.6%, slightly higher to that already reported in literature and lower to the respective rate of the open repair. Reintervention rate was 8.5% despite the high 15.5% complication rate.
Endovascular SA aneurysm repair is a technically feasible technique, useful in both elective and emergency cases. Although preliminary results quote its safety and efficacy, larger cohort studies are warranted to elucidate its benefit in treating SA aneurysms.
Endovascular Treatment of Aorto-Iliac-Femoral Anastomotic Pseudoaneurysms: A Multicentric Study
2017, Annals of Vascular Surgery
The purpose of this study was to assess the effectiveness of anastomotic pseudoaneurysms (APAs) endovascular treatment following aorto-iliac-femoral surgical reconstruction.
We retrospectively evaluated 54 patients who underwent aorto-iliac-femoral bypass (72 APAs). Follow-up was performed with echo-color-Doppler and/or computed tomography angiography at 1, 3, and 6 months after the procedure and then yearly. We compared clinical success in terms of mortality between aortic APAs and nonaortic APAs (iliac-femoral-popliteal).
Immediate technical success was 100%. No periprocedural complications occurred. Six patients died during follow-up due to causes not related to APA and 5 due to sepsis at 3 months after the procedure. Thirty-day mortality was 9% overall, and we did not register any statistically significant different between aortic APA and nonaortic APA groups. During a mean follow-up of 25.5 months (range: 3–72), we registered 3 occlusions of stent-graft leg, respectively, at 3 days, 7 days, and 24 months after the procedure, 2 type I endoleaks and 1 type III endoleak. Primary clinical success rate was 87.2%, and secondary clinical success was 95.7%.
Endovascular treatment resulted as a valid alternative to open surgery and could be proposed as the treatment of choice for APAs especially in patients with a high surgical risk.
Primer in Cerebrovascular Disease: Innominate and Subclavian Disease
2017, Primer on Cerebrovascular Diseases: Second Edition
Diseases of the subclavian and innominate arteries, including stenosis and aneurysm, are rare entities that are most commonly identified as incidental findings on routine imaging. When present, symptoms may result from distal embolization, low-flow state, mass effect, or rupture. All patients with occlusive disease should be treated with an aspirin and statin. While there is no formal consensus for the treatment of asymptomatic patients, all symptomatic lesions merit surgical intervention. Among patients with suitable anatomy an endovascular approach is considered first line. There are no formal guidelines to direct postoperative imaging; however, due to the risk of restenosis, routine surveillance with duplex or computerized tomography imaging is warranted following open or endovascular intervention for stenosis.
Giant true aneurysm of superficial femoral artery in patient with multiple atherosclerotic aneurysms: A case report
2017, International Journal of Surgery Case Reports
True atherosclerotic aneurysms of superficial femoral artery (SFA) are rare and often associated with other peripheral or aortic aneurysms.
We report the case of a 84-year-old patient presenting a giant degenerative ruptured aneurysm of the superficial femoral artery. The patient underwent successful aneurysm resection and bypass grafting, with a satisfying long-term follow-up and patency of the graft. The patient was also operated one year before, for a ruptured aneurysm of the abdominal aorta.
This case report is rare, because we described a case of patient with multiple atherosclerotic aneurysms, who present, for the second time, a life threating ruptured aneurysm. In this report, we see extreme and rapid evolution of SFA Aneurysm before being symptomatic.
Degenerative aneurysms of the lower extremity most commonly involve the popliteal artery, while they are rarely detected in the femoral region (Leon et al., 2008). In this region, aneurysms most frequently involve the common femoral artery (CFA), whereas true aneurysms of the superficial femoral artery (SFA) represent only 15% to 25% of femoral arterial aneurysms [1], [2], [3], [4], [5].
Degenerative aneurysms of the SFA display peculiar characteristics (in terms of clinical onset, diagnostic timing, and clinical behavior) so that they differ from other peripheral aneurysms. Because the relative rarity of this location, our case report can be useful to participate to increase the number of reported cases, and define the therapeutic approach for this rare location.

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: Presented at the 20th Annual Meeting of the Southern Association for Vascular Surgery, Naples, FL, January 27, 1996.

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Endovascular Repair of Peripheral Aneurysms, Pseudoaneurysms, and Arteriovenous Fistulas

Ann Vasc Surg

J Vasc Surg

J Vasc Surg

J Vasc Surg

J Vasc Surg