Endovascular Infection after Renal Artery Stent Placement

European Journal of Vascular and Endovascular Surgery, 1999

artery (POPA). PTA was carried out via an antegrade left common femoral artery puncture. Both stenoses Endovascular techniques have been used as a thera-were dilated with 6 mm×4 cm (SFA) and 5 mm×4 cm (POPA) balloons (Ultrathin, Boston Scientific, Water-peutical option in patients with femoropopliteal occlusive disease, but closure within the first month has town, MA, USA). The postdilatation angiogram disclosed an intimal flap ) in the dilated SFA been recognised as one of the major problems, reported to be as high as 25%. 1 Septic complications after per-segment and two overlapped Strecker stents (6 mm×4 cm) were deployed with a satisfactory result cutaneous transluminal intra-arterial procedures are rarely encountered. [2][3][4][5] ( . The ABI improved, from 0.7 to 0.9. The patient was on aspirin orally, 325 mg once daily and We present a case of suppurative endarteritis of the femoropopliteal artery which developed after ex-heparin was given at a dose of 5000 IU intravenously before the procedure and was continued (1000 IU/h, tensive endovascular intervention. Medline search of the English literature indicated that this is the first intravenously) for 24 hours. An ultrasound scan the reported case of suppurative bacterial endarteritis after following day showed good patency of the femoro-PTA and stenting of the femoropopliteal artery.

Journal of Vascular Surgery, 2002

En do vas kü ler te da vi; stent en fek si yo nu; as pi ras yon trom bek to mi si; cer ra hi te da vi

European Journal of Vascular and Endovascular Surgery, 2000

Catheterization and Cardiovascular Interventions, 2005

We report the unusual case of a 66-year-old alcoholic male who presented with acute arm ischemia 4 months following ipsilateral subclavian artery stenting. The patient had a petechial rash and Janeway lesions in the distribution of the affected subclavian artery. He had been treated for an infected dialysis graft 10 days prior to entry into the hospital. Subsequent angiogram confirmed a patent stent with intraluminal filling defects and occlusion of the brachial artery. Thrombectomy yielded material that was consistent with septic emboli and CT scan of the chest was suggestive of a mycotic aneurysm around the stent. The subclavian stent was removed surgically and the aneurysm was repaired. Unfortunately, the patient had multiple comorbidities and died of complications during recovery. This is the first case of a subclavian stent infection following septicemia remote from implantation. Catheter Cardiovasc Interv 2005. © 2005 Wiley-Liss, Inc.

The American Journal of Cardiology, 1995

We reviewed the clinical course of 5,042 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) using balloons or new devices: (stent, laser, directional and rotational atherectomy). A vascular complication was defined as the formation of a groin hematoma, bleeding, pseudoaneurysm, fistula, or the need for surgical repair. Vascular complications occurred in 309 (6.1%) patients, and 117 (2.3%) required vascular repair; among these patients, surgery was performed for correction of an an arteriovenous fistula in 12%, repair of pseudoaneurysm in 72%, repair for expanding hematoma and femoral artery lacerations in 10%, and retroperitoneal bleeding in 6%. The correlates of vascular complications were older age (66.8 vs 62.1 years; p < 0.0001), female gender (43% vs 26%; p < 0.0001), increased weight (82.1 +/- 16.46 vs 78.0 +/- 16.6 kg; p < 0.001), higher systolic blood pressure (140 +/- 25 vs 134 +/- 20 mm Hg; p < 0.001), increased heparin dose during the procedure (14,352 +/- 3,879 vs 13,599 +/- 3,508 IU; p = 0.001), administration of heparin after the procedure (232 vs 2,985 patients; p < 0.0001) and intracoronary stenting (14.9% vs 3.5%; p < 0.0001). Fifteen patients of 214 (7.0%) who underwent stent implantation had surgical repair. Vascular complications were not related to the size of the arterial sheath (8.11 +/- 0.8 vs 8.8 +/- 0.7Fr; p = 0.11) and the use of devices other than stents (laser, atherectomy) did not increase the rate of vascular complications.

Surgical Clinics of North America, 1995

The earliest report of percutaneous endovascular therapy of vascular occlusion or stenoses was by Charles Dotter in 1963. During a diagnostic angiogram, a catheter was passed retrograde across an occluded segment of iliac artery.9 This observation prompted the development of therapeutic angioplasty. The first intentional percutaneous transluminal angioplasty (PTA) was performed in 1964 by Dotter and Judkins. 9 Early PTA techniques employed a series of coaxial Teflon dilators introduced over a guide wire. The dilator approach was modified and used with some success in Europe but received little attention in the United States. 29 The number of dilators required for large vessels led to the development of balloon catheter devices. Early experience with balloon catheters was unsuccessful owing to the excessive compliance of the latex balloon material, which generated weak lateral forces and inflated in the direction of least resistance. In 1973, Porstman 29 developed a caged catheter that had Teflon strips that could be spread using a latex balloon. The fear of excessive damage to the arterial wall and thrombus formation prevented wide acceptance of this system. The breakthrough for the eventual acceptance of balloon angioplasty in the United States occurred in 1974 when Gruntzig and Hopff14 introduced a single-lumen rigid balloon made of polyvinyl chloride (PVC). The low compliance of PVC allowed radial forces of 4 to 5 atmospheres to be exerted over a predetermined diameter and reduced the risk of vessel rupture and distal embolization. 14 By 1976, the catheter had been modified to a double-lumen single-end hole design, the same design in use today.B With the use of such balloon catheters, successful treatment of iliac and femoral-popliteal atherosclerotic disease led to the use of angioplasty for the treatment of renal and coronary artery stenosis.

Annals of Vascular Surgery, 2018

In recent years, endovascular procedures have become a first-line therapy for peripheral arterial disease. As a result, an increased number of patients received stent grafts to treat their persistent superficial femoral artery (SFA) lesions. Although the risk of stent-graft infection in that location exists, it is exceptionally rare. Successful management of this condition requires removal of the infected stent graft in combination with appropriate antibiotic therapy and debridement of necrotic tissue, as well as revascularization, with avoidance of prosthetic material. We describe 2 cases of infected stent grafts in the SFA that presented late after the original intervention. An 83-year-old man presented 8 years after the original operation, and a 57-year-old woman presented 2 years after the original operation. Both infected stent grafts were excised, and complete destruction of the native arterial wall was evident during exploration.

2013

Purpose. We evaluated the effectiveness of endovascular treatment with percutaneous transluminal balloon angioplasty (PTA)/stenting of transplanted renal artery stenosis (TRAS). Materials and methods. Between January 2005 and December 2010, 17 patients (4 women, 13 men; mean age 60.9 years) with TRAS underwent PTA/stenting. The parameters analysed were: technical success, pre-and posttreatment serum creatinine (SCr) and blood pressure (BP), average number of antihypertensive drugs administered before and after treatment and vessel patency on colour Doppler ultrasound (CDUS) at 1, 3, 6 and 12 months and once a year thereafter. Results. Technical success was 100%. During a mean follow-up of 28.3±18.7 months, there was a statistically significant reduction in SCr and BP values. In 18 % of cases, moderate (<60%) restenosis was observed on CDUS without renal failure and not requiring new treatment. There was a reduction in antihypertensive drugs from an average of 3.5±0.5 to 1.5±0.5. Conclusions. Consistent with the literature data, our experience shows that endovascular treatment with PTA/ stenting is a safe and effective option for managing TRAS and can thus be considered the method of choice. Keywords Transplanted renal artery stenosis • Endovascular treatment • PTA/stenting Riassunto Obiettivo. Scopo del nostro lavoro è stato valutare l'efficacia del trattamento endovascolare mediante angioplastica percutanea transluminale (PTA)/stenting delle stenosi dell'arteria renale trapiantata (TRAS). Materiali e metodi. Da gennaio 2005 a dicembre 2010, 17 pazienti (4 femmine e 13 maschi; età media 60,9 anni) affetti da TRAS sono stati sottoposti a PTA/stenting. È stato valutato il successo tecnico della procedura e sono stati confrontati i valori di creatininemia e di pressione arteriosa, il numero di farmaci anti-ipertensivi somministrati prima e dopo il trattamento e la pervietà del vaso trattato mediante eco-color Doppler (ECD) a 1, 3, 6, 12 mesi e successivamente una volta l'anno. Risultati. Il successo tecnico è stato del 100%; ad un followup medio di 28,3±18,7 mesi, si è osservata una riduzione statisticamente significativa dei valori di creatinina sierica e di pressione arteriosa. All'ECD nel 18% dei casi si è riscontrata re-stenosi di grado moderato (<60%), non associata ad alterazioni della funzionalità d'organo e non meritevole di nuovo trattamento. Si è passati da una assunzione di 3,5±0,5 farmaci anti-ipertensivi a 1,5±0,5. Conclusioni. Nella nostra esperienza, in linea con i dati della letteratura, il trattamento endovascolare mediante PTA/ stenting rappresenta una opzione sicura ed efficace nella gestione delle TRAS, costituendo la prima scelta terapeutica. Parole chiave Stenosi arteria renale trapiantata • Trattamento endovascolare • PTA/stenting VASCULAR AND INTERVENTIONAL RADIOLOGY RADIOLOGIA VASCOLARE E INTERVENTISTICA

Journal of Vascular and Interventional Radiology, 2008

Annals of Vascular Surgery, 2008

The current study was designed to investigate our hypotheses that balloon-expandable covered stents display acceptable function over longitudinal follow-up in patients with complex vascular pathology and provide a suitable alternative for the treatment of recurrent in-stent restenosis. All stents were Atrium iCast, which is a balloon-mounted, polytetrafluoroethylene-covered stent with a 6F/7F delivery system. A retrospective review was performed of 49 patients with 66 stented lesions. Data were analyzed with life tables and t-tests. The most commonly treated vessels were the iliac (61%) and renal (24%) arteries. Indications for covered stent placement were unstable atheromatous lesions (50%), recurrent in-stent restenosis (24%), aneurysm (8%), aortic bifurcation reconstruction (7.5%), dissection (4.5%), endovascular aneurysm repair-related (4.5%), and stent fracture (1.5%). Patency was assessed by angiogram or duplex ultrasonography. The primary end point was patency and secondary end points were technical success and access-site complications. Mean follow-up was 13 months (range 1.5-25). The technical success rate was 97%. Unsuccessful outcomes were due to deployment error (n ¼ 1) and stent malpositioning (n ¼ 1). The cohort (n ¼ 64) 6-and 12-month primary patency rates were 96% and 84%, respectively. Twelve-month assisted primary patency was 98%. Iliac artery stents (n ¼ 38) had a primary patency of 97% at 6 months and 84% at 12 months with an assisted primary patency of 100% at 12 months. Renal artery stents (n ¼ 16) had a primary patency of 92% at 6 months and 72% at 12 months with an assisted primary patency of 92% at 6 and 12 months. Stents placed for recurrent in-stent restenosis (n ¼ 16) had a primary patency of 85%, assisted primary patency of 93%, and a 15% restenosis rate at 12 months. Specifically, stents placed for renal artery recurrent in-stent restenosis (n ¼ 10) had a primary patency of 73%, assisted primary patency of 82%, and a restenosis rate of 27%. The restenosis rate included two renal artery occlusions in patients noncompliant with clopidogrel use and resulted in ipsilateral kidney loss in both patients. In-stent peak systolic velocities decreased significantly (p < 0.05) from preoperation to 12 months in iliac stents and to 18 months in renal stents. Ankle-brachial index increased significantly in iliac stents from preoperation (0.62 ± 0.18) to 18 months (0.86 ± 0.16). Successful exclusion of atheromatous lesions and aneurysm/dissection/endoleak was 100%. Access-site complications occurred in 6%: pseudoaneurysm (n ¼ 2), dissection (n ¼ 1), and bleeding (n ¼ 1). Balloon-expandable covered stents have an acceptable primary patency with an excellent assisted patency after salvage angioplasty. The clinical utility of this technology is broad for the treatment of aneurysms, extravasation, unstable atheromatous lesions, and recurrent in-stent restenosis.

Heart, Lung and …, 2010

A 68-year-old hypertensive male underwent stenting for critical stenosis of the right renal artery through right femoral approach. The stent missed the ostium and repeated attempts at stenting the ostium did not succeed. Brachial approach was resorted to and ostium could be stented successfully. While deploying the stent the balloon was slightly inside the guiding catheter and the catheter tip got partially detached. The whole assembly was withdrawn to the brachial artery and the detached fragment was snared and removed.

Journal of Vascular and Interventional Radiology, 1995

A prospective, randomized comparison of percutaneous transluminal angioplasty (PTA) with surgery in the treatment of occlusive disease of the iliac, superficial femoral, or popliteal arteries began in 1983. Radiologists and vascular surgeons independently assessed index lesions on arteriograms to decide whether their respective treatments were appropriate. Of 263 male patients randomized, 255 received vascular intervention (surgery, 126 patients; PTA, 129 patients). The groups were comparable when stratified for systemic risk factors and anatomic distribution of disease. Because eligibility criteria required that all lesions randomized for treatment be suitable for PTA, the severity of disease was less than that of the general population having vascular disease. Claudication was the principal indication for intervention. The immediate failure rate for PTA was 15.5% (20 of 129 patients). Surgery was performed with one in-hospital death (0.8%) and 17 complications (13.5%). There were two late deaths ascribable to surgical complications and none to PTA. At 4.5 years, 50 deaths (20%) (28 from surgery; 22 with PTA) and 24 major amputations of legs included in the study (13 with surgery; 11 with PTA) have occurred. The baseline ankle-brachial indexes (ABIs) of 0.51-0.01 for surgery and 0.50-. 0.02 for PTA increased by 0.32-0.02 and 0.28 +-0.02, respectively, after treatment and was not different between the groups through 36 months (surgery, 0.28-+ 0.04; PTA, 0.30-0.05). The 17 patients undergoing surgery after unsuccessful PTA had a mean ABI increase of 0.32-0.07; the durability of hemodynamic improvement was similar in both groups of patients.

Expert Review of Cardiovascular Therapy, 2005

Renal angioplasty and stenting have become the first treatments to be proposed to patients presenting with renal artery stenosis. The immediate technical success rate is high, with a low complication rate and good long-term patency. In most reports, renal stenting has been proven to improve blood pressure. However, despite good immediate-and long-term results, postprocedural deterioration of renal function is a concern, and may occur after renal artery angioplasty and stenting in 20 to 40% of patients, which limits the immediate benefits of this technique. Of the causes of this deterioration in renal function, atheroembolism seems to play an important role. Contrary to earlier beliefs that atheroembolization is not an issue during percutaneous catheter interventions, there is now mounting evidence that distal atherosclerotic debris commonly embolizes from lesions in many vascular territories during percutaneous interventions. Atheroembolism seems to be the root cause of many procedural complications wherever atherosclerotic lesions are treated. Distal embolization was first demonstrated in saphenous vein grafts and now, clinical data are proving that similar embolization and distal-organ complications also occur during catheter treatment in certain native coronary lesions, carotid stenting and renal artery stenting, demonstrating the role and efficacy of protection devices to reduce the incidence of end-organ complications. The same protection devices (protection balloon and filters) utilized for coronary or carotid procedures may be used to protect the kidney from atheroembolism. In this review, the authors discuss recently published data concerning the techniques and results of renal angioplasty and stenting procedures performed under protection, and evaluate the benefits of this technique on renal function and its role in the future. Indications for this technique need to be discussed.

Turkiye Klinikleri Cardiovascular Sciences, 2015