Treatment of iatrogenic and traumatic vascular lesions with percutaneous stent-graft placement

56 SUMMARY Purpose: To assess the efficacy and safety of stent-grafts in the endovascular management of iatrogenic and traumatic pseudoaneurysms and arteriovenous fistulas. Materials and methods: Fourteen stent-grafts were used to repair eleven iatrogenic femoral arteriovenous fistulas, two traumatic pseudoaneurysms, one iatrogenic iliac arteriovenous fistula. Fistulas were in the deep femoral artery ( n=10), superficial femoral artery (n=1) and in the common iliac artery (n=1). Pseudoaneurysms were located in axillary (n=1) and popliteal (n=1) arteries. Implantation was performed from the femoral artery in all cases. Eleven iatrogenic arteriovenous fistulas (one iliac, ten femoral) were treated with Jostent-graft. One of the cases with axillary pseudoaneurysm was treated with Hemobahn stent-graft and Wallgraft was used for a case with popliteal pseudoaneurysm. We used hand-made stent-graft for a traumatic femoral arteriovenous fistula. All the patients were treated appropriately, during and after interventional procedure, with anticoagulant and antiaggregant regimen. Results: Percutaneous treatment of the lesions with a stent-graft was successful in 11 of 14 cases (%78.6). In one of the cases treatment was not succesfull due to technical problems in stent graft implantation (Arteriovenous fistula was between superficial femoral artery and vein). In one patient due to proximity of arteriovenous fistula to the femoral bifurcation and selection of short stent-graft, partial occlusion was maintained. Arteriovenous fistula in common iliac artery was partially occluded to avoid occlusion of internal iliac artery. In this case patient became symptomatic during follow up, fistula was repaired surgically.During follow- up in two of the patients neointimal hyperplasia were detected. The lesion which was located in the axillary artery was treated succesfully with balloon angioplasty. In the other case, there was moderate neointimal hyperplasia in the deep femoral artery, as patient was asymtomatic, no further treatment was required. Conclusion: Percutaneous implantation of stent-grafts is an effective and safe method for the treatment of pseudoaneurysms and arteriovenous fistulas. Thus, it's an alternative therapeutic approach to vascular surgery in selected patients.