Slonim S M, Dake M D, Razavi M K, Kee S T, Samuels S L, Rhee J S, Semba C P
Section of Cardiovascular and Interventional Radiology, Stanford University Medical Center, California, USA.
J Vasc Interv Radiol. 1999 Jul-Aug;10(7):851-9. doi: 10.1016/s1051-0443(99)70127-2.
To report experience with techniques for management of misplaced or migrated endovascular stents.
During a 5-year period, percutaneous management of 27 misplaced or migrated endovascular stents (16 Palmaz, 11 Wallstents) in 25 patients was attempted. The 17 venous and 10 arterial stents were rescued from the aorta (n = 9), inferior vena cava (IVC) (n = 4), transjugular intrahepatic portosystemic shunt/IVC (n = 2), right atrium (n = 3), right ventricle (n = 2), pulmonary artery (n = 2), iliac vein (n = 2), iliac artery (n = 1), superior vena cava (n = 1), and superior mesenteric vein (n = 1).
Stent management was successful in 26 of 27 cases (96%). Eleven stents were removed percutaneously, two were repositioned and removed with a minor surgical procedure, and 13 were repositioned and deployed in a stable alternate location. The only complication was the development of tricuspid insufficiency in the single case in which the procedure failed (4% complication rate). This patient's stent was eventually surgically removed from the right ventricle.
Misplaced or migrated endovascular Palmaz and Wallstents can be effectively managed with few complications by using a variety of percutaneous techniques.
报告处理放置不当或移位的血管内支架的技术经验。
在5年期间，尝试对25例患者的27个放置不当或移位的血管内支架（16个帕尔马兹支架、11个华尔支架）进行经皮处理。这些支架包括17个静脉支架和10个动脉支架，分别位于主动脉（9个）、下腔静脉（4个）、经颈静脉肝内门体分流术/下腔静脉（2个）、右心房（3个）、右心室（2个）、肺动脉（2个）、髂静脉（2个）、髂动脉（1个）、上腔静脉（1个）和肠系膜上静脉（1个）。
27例中有26例（96%）支架处理成功。11个支架经皮取出，2个重新定位后通过小手术取出，13个重新定位并放置在稳定的替代位置。唯一的并发症是1例手术失败患者发生三尖瓣关闭不全（并发症发生率4%）。该患者的支架最终通过手术从右心室取出。
通过使用多种经皮技术，放置不当或移位的血管内帕尔马兹和华尔支架可以得到有效处理，并发症很少。
