[Therapy of acute traumatic vascular injuries using covered stents]. / Therapie akuter, traumatischer Gefässläsionen mittels ummantelter Stents.

PURPOSE: Evaluation of percutaneously implanted covered stents in acute vascular bleeding as therapeutic alternative to conventional surgical treatment. MATERIALS AND METHODS: 8 patients aged 26 to 83 years with acute vascular lesions caused by traumas, and subsequent haemorrhage, were transferred to our department. Because of general inoperability or difficult surgical access, interdisciplinary evaluation favoured an interventional treatment. In 6 patients stents could be placed percutaneously to the aorta, subclavian and iliac arteries. In one case we had to implant three stents into the thoracic aorta. RESULTS: In 7 interventionally treated patients the stents could be placed exactly on the lesions (88%). The bleeding could be stopped immediately in 6 cases (75%). In one patient we had to implant successfully two more stents in reintervention (12%). In another patient the available prosthesis was too short, so that the patient had to be referred to the OR for surgical treatment (12%). There were no complications during the treatment. CONCLUSION: First results in the use of covered stents as interventional treatment of acute vascular lesions are encouraging and may represent a possible alternative to surgical therapy in locally limited bleedings, presupposing that all different types and sizes of industrially produced covered stents are available. Further investigations to compare surgical and interventional techniques are warranted.

Endoluminal grafting of infrarenal aortic aneurysms.

BACKGROUND: The department policy regarding therapy fo infrarenal aortic aneurysms is reviewed, based on the treatment results of a 12-months period. METHODS: From October 1996 to August 1997, 60 patients with infrarenal aortic aneurysms were admitted to our department. Of these 31 (52%) were found to be anatomically or pathomorphologically suitable for endovascular treatment, based on the premises that: 1. Whenever the anatomy is suitable and confirmed with CT or angiography, repair is by means of stent placement. 2. In emergencies and in cases where the anatomical relationships are unfavourable, patients undergo conventional open surgery. RESULTS: In all 31 patients treated endovascularly, stent placement was technically successful. Procedure-associated mortality was zero. The following stenting complications occurred: seven endoleaks, one thrombotic iliac occlusion, one femoral arterial dissection, two puncture-related inguinal hematomas. Elective open surgery was performed in the other 29 patients. One of these died from the effects of renal failure. CONCLUSIONS: This comparison shows that endovascular treatment of infrarenal aortic aneuryms is possible in a large proportion of patients and is not associated with an unfavourable rate of complications. Endovascular treatment can significantly reduce patients' postoperative hospitalization (three days) and time spent in intensive care.