A simplified pull-through angioplasty technique without a snare device. A technical note

Removal of central venous port-catheter by the combination of interventional radiological procedures

We encountered a patient with an infection related to an implanted central venous port-catheter that necessitated removal of the system. As the catheter had tightly adhered to the venous wall, removal was impossible with standard methods. After trial and error, we used a guiding catheter that was advanced over the implanted catheter to detach the fibrin sheath on the implanted catheter that had adhered to the vessel wall. At that time, a pull-through technique was used. After we succeeded in detaching the adhesion with the guiding catheter, we were able to withdraw the implanted catheter.

Transfemoral subclavian artery stenting through a shaped guiding catheter without pull-through technique: A case report

Transfemoral subclavian artery stenting can be challenging unless the placement of the guiding catheter is secured. Herein, we present a patient with subclavian artery stenosis treated with endovascular stenting using a shaped guiding catheter. A 79-year-old woman was admitted to our department because of a cold sensation and numbness of her left arm. Computed tomography revealed stenosis of the left subclavian artery (SA), located just proximal to the ostium of the left vertebral artery (VA). Doppler ultrasound showed reverse flow in the left VA. We planned to stent for the SA stenosis under the balloon protection of the left VA. The balloon protection device was easily navigated into the left VA through brachial access. After that, a self-expandable stent was successfully placed from just proximal to the VA origin to the ostium of the SA using a highly stable shaped guiding catheter. The patient recovered from the symptoms and was discharged 4 days after the procedure. The high stability of the shaped guiding catheter is advantageous during endovascular treatment of the subclavian artery.

Endovascular Repair for Giant Right Subclavian Artery Aneurysm With Gore Viabahn and Pull-Through Procedure: A Case Report

Background

Giant true subclavian artery aneurysms (SAAs) (>5 cm) are rare. Technical and anatomical considerations complicate the endovascular treatment of SAAs and pose some challenges. Here, we present a giant right SAA that was successfully excluded using stent grafts with the pull-through technique after two interventional steps and discuss the pull-through technique details as well as the lessons to be learned from this case.

Methods

A 50-year-old man presented at our department complaining of dyspnea and hoarseness. Computed tomography angiography (CTA) showed a giant right SAA with partial intraluminal thrombus and severe angulated aneurysm necks originating from the proximal right subclavian artery, approximately 70 × 71 mm in size.

Outcomes

An 8 × 100-mm Gore Viabahn was selected to exclude the SAA. A decision was made to stabilize the wire tension using the pull-through technique. Final angiography showed that the SAA was essentially excluded, and slight endoleak was observed. At 6 months, imaging showed that the aneurysm was not obviously shrinking, there was still an endoleak and stent graft dislodgement was observed. Angiography confirmed a type Ia endoleak, which was managed by the placement of a 10 × 50-mm Gore Viabahn, again with the assistance of the pull-through technique. At the 25-month follow-up, CTA showed that the SAA was satisfactorily excluded, with no endoleak, and the SAA was reduced in size.

Conclusions

Endovascular treatment of SAAs is a safe, reliable and minimally invasive approach. The pull-through technique may improve wire tension and device stabilization. Additionally, size selection and positioning should be reappraised under a severely angulated aneurysm neck.

Combined Pull through and Balloon Anchoring Bailout Technique to Repair a Failed Bifurcated Endovascular Aortic Repair

BACKGROUND

To describe a bailout technique used to manage the left stump of a bifurcated endograft that was stuck above a narrowed distal aortic neck.

METHODS

An 80-year-old man with a suprarenal aneurysm was treated with a custom-made 4-vessel fenestration endograft. During the procedure, the left stump of the distal bifurcated graft module was chased out of a narrow distal aortic neck and became stuck horizontally at the bottom of the aortic aneurysmal sac. Through a femoral to left subclavian artery through-and-through percutaneous access, a balloon-anchoring technique was successfully used to return the endograft stump into the narrowed aortic neck and exclude the aneurysm.

CONCLUSIONS

The combined technique of a through-and-through and anchoring balloon was found to be suitable for introducing an endograft limb into a narrow distal aortic neck.