Leopoldo Marine, MD, Rishi Gupta, MD, Heather L. Gornik, MD, Vikram S

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Presentation transcript:

Glue embolus complicating the endovascular treatment of a patient with Loeys-Dietz syndrome Leopoldo Marine, MD, Rishi Gupta, MD, Heather L. Gornik, MD, Vikram S. Kashyap, MD Journal of Vascular Surgery Volume 52, Issue 5, Pages 1350-1353 (November 2010) DOI: 10.1016/j.jvs.2010.05.104 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Computed tomography angiography reveals a new 2.6-cm proximal left subclavian artery (LSA) pseudaneurysm (short arrow) and a new 1.4-cm distal left internal carotid artery (ICA) dilation at the bottom of a complete coil (long arrow) in a patient with LDS. Journal of Vascular Surgery 2010 52, 1350-1353DOI: (10.1016/j.jvs.2010.05.104) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Marker catheter angiography via the left subclavian artery (A) documents a large pseudoaneurysm (B) with the vertebral (C), internal mammary arteries (D), and thyrocervical trunk (E) in close proximity. Journal of Vascular Surgery 2010 52, 1350-1353DOI: (10.1016/j.jvs.2010.05.104) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Embolization and stent graft therapy of the LSA pseudoaneurysm using a combined brachial and femoral approach. Multiple coils have been already placed into the vertebral artery in this staged procedure. The brachial glide catheter (left) is used to select a thyrocervical branch for embolization. The femoral angled catheter (bottom) allows contrast injections and eventual guidewire and stent graft placement. Journal of Vascular Surgery 2010 52, 1350-1353DOI: (10.1016/j.jvs.2010.05.104) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Completion imaging after stent graft deployment showing an excluded left subclavian artery (LSA) pseudoaneurysm with no evidence of antegrade flow into the aneurysm, or endoleak from LSA branches. The coil and glue mass in the LSA pseudoaneurysm is seen. Journal of Vascular Surgery 2010 52, 1350-1353DOI: (10.1016/j.jvs.2010.05.104) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 Glue embolus to the mid-brachial artery complicating this endovascular case. Late images (not shown) revealed a patent distal brachial artery allowing a brachial-to-brachial reversed vein bypass. Journal of Vascular Surgery 2010 52, 1350-1353DOI: (10.1016/j.jvs.2010.05.104) Copyright © 2010 Society for Vascular Surgery Terms and Conditions