Abstract:

Introduction: pseudo-aneurysm of subclavian artery is a rare pathology and most often develops due to trauma or iatrogenic causes. Despite the rarity of this pathology, it can be accompanied by the risk of lethal rupture or distal embolism. Article presents a case report of endovascular treatment of post-traumatic pseudo-aneurysm of right subclavian artery with a stent-graft.

Aim: was to demonstrate advantages of endovascular treatment of pseudo-aneurysms, based on case report of patient with post-traumatic pseudo-aneurysm of right subclavian artery.

Material and methods: a case report of a patient with post-traumatic pseudo-aneurysm of right subclavian artery, polytrauma and pulmonary embolism is presented.

Results: successful endovascular treatment of pseudo-aneurysm of right subclavian artery with the implantation of stent-graft was performed. Postoperative period was uneventful, and the patient was discharged with improved health.

Conclusions: endovascular treatment is the preferred method, due to its less invasiveness and lower complication frequency in comparison with open surgery.

Abstract:

Aim: was to estimate results of endovascular treatment of subclavian arteries lesions.

Materials and methods: study analyzes results of endovascular treatment of patients with occlusive-stenotic lesions of subclavian arteries. For the period 2014-2018, 87 endovascular interventions were performed on subclavian arteries. Indication for surgery was occlusion of subclavian artery or stenosis of more than 70% with the development of steal-syndrome. Before surgery, all patients underwent duplex scanning of brachiocephalic vessels and CT angiography of branches of the aortic arch with cerebral phase. There was no difference in severity of symptoms and comorbidity between patients with stenosis or occlusions (р>0,05). In case of stenosis, direct stenting of subclavian artery was performed. For occlusions, mechanical recanalization was performed using hydrophilic wires, balloon angioplasty followed by stenting. In all cases, we used a balloon-expandable stent.

Results: technical success was achieved in 98,8% of interventions. There were no lethal outcomes, myocardial infarction, or stroke. In one patient, brachial artery thrombosis occurred in early postoperative period; thrombectomy from the brachial artery was performed with restoration of blood flow. Patency of subclavian artery after 1 and 3 years was 100% and 94%, respectively.

Conclusions: endovascular interventions for occlusive-stenotic lesions of subclavian arteries is an effective and safe method of treatment of vertebrobasilar insufficiency.

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Abstract:

Traumatic lesions of peripheral arteries which lead to pseudoaneurysm formation is the rare pathology Originally surgical treatment was the main method of pseudoaneurysms' treatment. However, now endovascular procedures are preferable as a method such patients' treatment. The case of successful endovascular treatment of posttraumatic pseudoaneurysm of subclavian artery with stent-graft implantation is shown This clinical case report demonstrates main advantages of endovascular method of such location pseudoaneurysms treatment.

Abstract:

Article presents a case of successful re-stenting of the left subclavian artery with good medium-term outcome in 59 years patient with a return of symptoms of vertebrobasilar insufficiency due to proximal fracture of previously implanted stent. The leading cause of stents destruction in the aortic arch branches are excessive mechanical load due to constant compression and/or vessel displacement, its compression due closeness of beating heart and movements of the shoulder girdle, which is likely had happened in our case - fracture of proximal segment. After analyzing the movement of vessels during the cardiac cycle, we found that stents in proximal aortic arch branches had been influenced mainly by bending, tension/compression. As a consequence - metal fatigue, which led it to the progressive destruction. Most stent fractures are asymptomatic, but in case of return of previous clinic - reintervention should be done. In this case, endovascular treatment is considered to be the method of first choice.

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