Endovascular Treatment for Visceral Vessel Complication After Branched Graft Replacement: Initial Results
Ryota Kawasaki1,
Koji Sugimoto1,
Takanori Taniguchi1,
Masato Yamaguchi1,
Masahiko Fujii1,
Kazuro Sugimura1 and
Yutaka Okita2
1 Department of Radiology, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe
650-0017, Japan.
2 Department of Cardiovascular Surgery, Kobe University, Kobe, Japan.
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Fig. 1A —19-year-old man with celiac artery and superior mesenteric
artery (SMA) obstruction (patient 1 in Tables
1 and
2). Inferior mesenteric artery
angiogram reveals SMA and celiac artery obstruction. Proper hepatic artery
displays diffuse narrowing, while SMA is well visualized because of sufficient
blood supply from inferior mesenteric artery.
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Fig. 1B —19-year-old man with celiac artery and superior mesenteric
artery (SMA) obstruction (patient 1 in Tables
1 and
2). Celiac artery angiogram
reveals graft thrombosis. After thrombolysis with urokinase (120,000 U),
lesion was successfully crossed using microguidewire.
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Fig. 1C —19-year-old man with celiac artery and superior mesenteric
artery (SMA) obstruction (patient 1 in Tables
1 and
2). Final angiogram clearly
reveals proper hepatic artery and dilated stent lumen.
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Fig. 2A —77-year-old man with left renal artery stenosis and oliguria
(patient 4 in Tables 1 and
2). Left renal artery angiogram
shows stenosis of graft. Balloon dilatation was repeated, but stenosis
recurred due to recoil.
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Fig. 2B —77-year-old man with left renal artery stenosis and oliguria
(patient 4 in Tables 1 and
2). Stent insertion was
attempted, but lesion could not be crossed by delivery system. Thereafter,
several sessions of balloon angioplasty were performed that eventually
resulted in treatment failure.
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Fig. 2C —77-year-old man with left renal artery stenosis and oliguria
(patient 4 in Tables 1 and
2). Contrast-enhanced CT scan
obtained 76 days after treatment shows severe kinking of branch and no
enhancement of left kidney.
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Fig. 3B —41-year-old man with left renal artery stenosis (patient 2 in
Tables 1 and
2). Stent (Wallstent, Boston
Scientific) was placed, but balloon catheter could not be inserted into stent
because of coning at proximal end and protrusion of stent into aortic
graft.
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Fig. 4A —51-year-old man with right renal artery obstruction (patient
3 in Tables 1 and
2). Aortogram only reveals
graft branch ostium of right renal arteries. Patient was suffering from
oliguria despite well-depicted left renal artery and parenchyma.
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Fig. 4B —51-year-old man with right renal artery obstruction (patient
3 in Tables 1 and
2). Right renal angiogram
obtained after crossing lesion with microguidewire reveals that peripheral
blood flow was maintained by renal capsular artery.
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Fig. 4C —51-year-old man with right renal artery obstruction (patient
3 in Tables 1 and
2). Final angiogram after
balloon-expandable stent deployment via left brachial artery reveals restored
blood flow.
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Fig. 5B —79-year-old man with left subclavian artery obstruction and
left arm ischemia (patient 6 in Tables
1 and
2). Crossing lesion was
difficult via femoral access but was successful via brachial access.
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Fig. 5C —79-year-old man with left subclavian artery obstruction and
left arm ischemia (patient 6 in Tables
1 and
2). Balloon-expandable stent
was placed via femoral access using pull-through method. Residual stenosis was
observed in proximal portion.
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Fig. 5D —79-year-old man with left subclavian artery obstruction and
left arm ischemia (patient 6 in Tables
1 and
2). Additional stent was
deployed via brachial access because delivery system could not be easily
inserted to cross stenosis.
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Copyright © 2008 by the American Roentgen Ray Society.
