Behandlung von akuten Blutungen mit gecoverten Stents

Der Einsatz von gecoverten Stent-Systemen stellt eine wichtige Säule des endovaskulären Managements akuter arterieller Blutungen unterschiedlicher Ätiologie dar. Die Implantation dieser Stents zielt dabei auf die Abdichtung eines blutenden Gefäßsegments unter Aufrechterhaltung des Perfusionsstroms in die Peripherie ab. Dieser Artikel erläutert Indikationen, technische Umsetzung, Besonderheiten und Limitationen dieser Therapieoption.

Abstract

The use of covered stents is an important part of the endovascular management of acute arterial haemorrhage of various aetiologies. The aim of covered stenting is to seal a bleeding vessel segment while maintaining peripheral blood flow. This article discusses the indications, technical implementation, characteristics and limitations of this therapeutic option with regard to arterial haemostasis. In addition, images are presented to illustrate the feasibility of this endovascular technique. Finally, the limiting factors for the use of covered stents are critically discussed.

Schlüsselwörter

gecoverte Stents - akute arterielle Blutung - endovaskuläre Therapie

Keywords

covered stents - acute arterial haemorrhage - endovascular therapy

• Literatur

• 1 Goltz JP, Bastürk P, Hoppe H. et al. Emergency and elective implantation of covered stent systems in iatrogenic arterial injuries. Fortschr Röntgenstr 2011; 183: 618-630
• 2 Augustin AM, Torre GD, Kocot A. et al. Endovascular therapy of arterioureteral fistulas. Vasa 2021; 50: 193-201
• 3 Marin ML, Veith FJ, Panetta TF. et al. Transluminally placed endovascular stented graft repair for arterial trauma. J Vasc Surg 1994; 20: 466-472
• 4 Kickuth R, Anderson S, Kocovic L. et al. Endovascular treatment of arterial injury as an uncommon complication after orthopedic surgery. J Vasc Interv Radiol 2006; 17: 791-799
• 5 Thalhammer C, Kirchherr AS, Uhlich F. et al. Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation implantation of endovascular covered stents. Radiology 2000; 214: 127-131
• 6 Kickuth R, Anderson S, Peter-Salonen K. et al. Hemophilia A pseudoaneurysm in a patient with high responding inhibitors complicating total knee arthroplasty: embolization: a cost-reducing alternative to medical therapy. Cardiovasc Intervent Radiol 2006; 29: 1132-1135
• 7 Kickuth R, Rattunde H, Gschossmann J. et al. Acute lower gastrointestinal hemorrhage: minimally invasive management with microcatheter embolization. J Vasc Interv Radiol 2008; 19: 1289-1296
• 8 Müller-Wille R, Herold T, Jung EM. et al. Onyx (Ethylene-vinyl-Alcohol-Copolymer) – a novel approach to the endovascular treatment of acute bleeding. Fortschr Röntgenstr 2009; 181: 767-773
• 9 Yeo KK, Rogers JH, Laird JR. Use of stent grafts and coils in vessel rupture and perforation. J Interv Cardiol 2008; 21: 86-99
• 10 Patel AV, Marin ML, Veith FJ. et al. Endovascular graft repair of penetrating subclavian artery injuries. J Endovasc Surg 1996; 3: 382-388
• 11 Dinkel HP, Eckstein FS, Triller J. et al. Emergent axillary artery stent-graft placement for massive hemorrhage from an avulsed subscapular artery. J Endovasc Ther 2002; 9: 129-133
• 12 Vaidhyanath R, Blanshard KS. Insertion of a covered stent for treatment of a popliteal artery pseudoaneurysm following total knee arthroplasty. Br J Radiol 2003; 76: 195-198
• 13 Baltacioglu F, Cimsit NC, Cil B. et al. Endovascular stent-graft applications in iatrogenic vascular injuries. Cardiovasc Intervent Radiol 2003; 26: 434-439
• 14 Parodi JC, Schonholz C, Ferreira LM. et al. Endovascular stent-graft treatment of traumatic arterial lesions. Ann Vasc Surg 1999; 13: 121-129
• 15 Stampfl U, Sommer CM, Bellemann N. et al. The use of balloon-expandable stent grafts for the management of acute arterial bleeding. J Vasc Interv Radiol 2012; 23: 331-337
• 16 Morris CS, Bonnevie GJ, Najarian KE. et al. Nonsurgical treatment of acute iatrogenic renal artery injuries occuring after renal artery angioplasty and stenting. AJR Am J Roentgenol 2001; 177: 1353-1357
• 17 Hassold N, Wolfschmidt F, Bley T. et al. Pseudoaneurysms of the right hepatic artery causing obstructive jaundice: Endovascular management. Vasa 2014; 43: 298-302
• 18 Carrafiello G, Lagana D, Mangini M. et al. Percutaneous treatment of traumatic upper-extremity arterial injuries: a single-center experience. J Vasc Interv Radiol 2011; 22: 34-39
• 19 Nicholson AA, Patel J, McPherson S. et al. Endovascular treatment of visceral aneurysms associated with pancreatitis and a suggested classification with therapeutic implications. J Vasc Interv Radiol 2006; 17: 1279-1285
• 20 Hassold N, Wolfschmidt F, Dierks A. et al. Effectiveness and outcome of endovascular therapy for late-onset postpancreatectomy hemorrhage using covered stents and embolization. J Vasc Surg 2016; 64: 1373-1383
• 21 Hilfiker PR, Razavi MK, Kee ST. et al. Stent-graft therapy for subclavian artery aneurysms and fistulas: single-center mid-term results. J Vasc Interv Radiol 2000; 11: 578-584
• 22 Schoder M, Cejna M, Hölzenbein T. et al. Elective and emergent endovascular treatment of subclavian artery aneurysms and injuries. J Endovasc Ther 2003; 10: 58-65
• 23 Bierdrager E, Van Rooij WJ, Sluzewski M. Emergency stenting to control massive bleeding of injured iliac artery following lumbar disc surgery. Neuroradiology 2004; 46: 404-406
• 24 Xenos ES, Freeman M, Stevens S. et al. Covered stents for injuries of subclavian and axillary arteries. J Vasc Surg 2003; 38: 451-454
• 25 Rami P, Williams D, Forauer A. et al. Stent-graft treatment of patients with acute bleeding from hepatic artery branches. Cardiovasc Intervent Radiol 2005; 28: 153-158
• 26 Maynar M, Baro M, Qian Z. et al. Endovascular repair of brachial artery transection associated with trauma. J Trauma 2004; 56: 1336-1341
• 27 Boufi M, Belmir H, Hartung O. et al. Emergency stent graft implantation for ruptured visceral artery pseudoaneurysm. J Vasc Surg 2011; 53: 1625-1631
• 28 Zarrinpar A, Kerlan RK. A guide to antibiotics for the interventional radiologist. Semin Intervent Radiol 2005; 22: 69-79
• 29 Chehab MA, Thakor AS, Tulin-Silver S. et al. Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29: 1483-1501
• 30 Goltz JP, Janssen H, Petritsch B. et al. Launching a Permanent Out-of-Hour Interventional Radiology Service: Single-Center Experience from a German University Hospital. Fortschr Röntgenstr 2014; 186: 136-141