Management of neuroform stent dislodgement and misplacement.
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A self-expanding stent has recently been introduced for the treatment of wide-neck aneurysms. We describe two cases of stent malposition within large aneurysms. In the first case, the stent was dislodged during microcatheterization. This was managed by placement of a second stent through the interstices of the first followed by aneurysm coiling. In the second case, after deployment, the proximal portion of the stent moved into the aneurysm as the exchange guidewire was removed. This patient was treated by vessel sacrifice. (+info)
Laparoscopic management of complicated ventriculoperitoneal shunts.
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Intra-abdominal migration of the catheter and formation of a cerebrospinal fluid pseudocyst are both rare complications of a ventriculoperitoneal shunt. Traditionally, each condition is treated by a formal laparotomy. Laparoscopic management of the complications in two patients is described. (+info)
Factors affecting the displacement force exerted on a stent graft after AAA repair--an in vitro study.
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OBJECTIVES: To investigate the distraction forces affecting grafts used to treat abdominal aortic aneurysms in an in vitro model. METHOD: Using a standard cardiac pump and a rigid plastic circulation system, distraction forces were measured with a gramometer attached to a PTFE graft while the pressure inside a rigid aortic sac was varied. RESULTS: If the pressure in the 'aneurysm sac' is maintained at the same level as the systemic pressure, the displacement force is zero. The displacement force is affected adversely by the level of systemic pressure, as this rises the displacement forces rise in an almost linear fashion. CONCLUSIONS: These observations may have important consequences for stent graft design and use in vivo pressurisation of a sealed sac may therefore not necessarily be an adverse event. Systemic hypertension is obviously important and its control may be necessary to prevent graft migration. (+info)
Intravesical migration of a GyneFix intrauterine device.
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A case of intravesical migration of a GyneFix intrauterine device (IUD) is described, in which the patient presented with supra-pubic pain and urinary symptoms. The diagnosis was made 34 months after the insertion of the IUD, by ultrasound scan. The GyneFix was removed endoscopically. A description of the GyneFix device, the possible adverse effects and incidences of its complications, the importance of post-insertion follow-up, and the need for awareness of the possibility of intravesical migration are discussed. (+info)
Stent graft migration after endovascular aneurysm repair: importance of proximal fixation.
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OBJECTIVE: We reviewed the incidence of stent-graft migration after endovascular aneurysm repair in a prospective multicenter trial and identified factors that may predispose to such migration. METHODS: All patients who received treatment during the course of the multicenter AneuRx clinical trial were reviewed for evidence of stent-graft migration over 5 years, from 1996 to 2001. Post-deployment distance from the renal arteries to the proximal end of the stent graft and the proximal fixation length (length of the infrarenal neck covered by the stent graft) were determined in patients for whom pre-procedure and post-procedure computed tomography scans were measured in an independent core laboratory. RESULTS: Stent-graft migration was reported in 94 of 1119 patients, with mean time after device implantation of 30 +/- 11 months. Freedom from migration was 98.6% at 1 year, 93.4% at 2 years, and 81.2% at 3 years (Kaplan-Meier method). Subset (n = 387) analysis revealed that initial device deployment was lower in 47 patients with migration, as evidenced by a greater renal artery to stent-graft distance (1.1 +/- 0.7 cm), compared with 340 patients without migration (0.8 +/- 0.6 cm; P =.006) on post-implantation computed tomography scan. Proximal fixation length was shorter in patients with migration (1.6 +/- 1.4 cm) compared with patients without migration (2.3 +/- 1.4 cm; P =.005). There was significant variation in migration rate among clinical sites (P <.001), ranging from 0% to 30% (median, 8%), with a greater than twofold difference in migration rate between the lowest quartile (6%) and the highest quartile (15%) clinical sites. Univariate and multivariate analysis revealed that renal artery to stent-graft distance (P =.001) and proximal fixation length (P =.005) were significant predictors of migration, and that each millimeter increase in distance below the renal arteries increased risk for subsequent migration by 5.8% and each millimeter increase in proximal fixation length decreased risk for migration by 2.5%. Pre-implantation aortic neck length, neck diameter, degree of device oversizing, correct versus incorrect oversizing, device type (stiff vs flexible), placement of proximal extender cuffs at the original procedure, and post-procedure endoleak were not significant predictors of migration. Migration was treated with placement of extender modules in 23 patients and surgical conversion in 7 patients; 64 patients (68%) with migration have required no treatment. CONCLUSIONS: Stent-graft migration among patients treated in the AneuRx clinical trial appears to be largely related to low initial deployment of the device, below the renal arteries, and short proximal fixation length. Significant variation in migration rate among clinical sites highlights the importance of the technical aspects of stent-graft deployment. Advances in intraoperative imaging and deployment techniques that have been made since completion of the clinical trial facilitate precision of device placement below the renal arteries and should increase proximal fixation length. Whether this, together with increased iliac fixation length, will result in lower risk for migration remains to be determined in long-term follow-up studies. (+info)
Endovascular therapy or conventional vascular surgery? A complex choice.
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Endovascular therapy and open vascular surgery have advantages and disadvantages. A single therapeutic option is rarely ideal for all patients. Rather, the two options are tools that are best used selectively; their availability allows for therapy to be tailored to optimize patient care. (+info)
Double guidewire method: a novel technique for correction of migrated Tenckhoff peritoneal dialysis catheter.
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Twenty-two consecutive patients with a continuous ambulatory peritoneal dialysis (CAPD) catheter malfunctioning due to catheter migration were treated with a novel radiological manipulation technique, the "double guidewire method." The first guidewire is used to correct the direction of the catheter tip and the second wire is used to anchor the CAPD catheter so that an ideal course of the catheter can be maintained during removal of the first guidewire. Immediate catheter repositioning was achieved in 19 of 22 patients, and durable repositioning success was achieved in 13 patients. In conclusion, the "double guidewire method" is a simple but effective technique for prolonging CAPD catheter life in patients with malfunction due to catheter migration. (+info)
Clinical results of a scleral fixation of the posterior chamber intraocular lens, through sclerotomies, 1 mm posterior to the limbus.
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The aim of this study was to evaluate the clinical outcomes of scleral fixation of a posterior chamber intraocular lens and an anterior vitrectomy through sclerotomies, 1 mm posterior to the limbus. The study comprised of seven eyes that required a scleral fixation. Sclerotomies, 1 mm posterior to the limbus, were performed using a 20G sclerotome at the 2 and 8 o'clock positions. Group 1 was defined as four eyes requiring scleral fixation of the secondary IOL (Intraocular lens), and group 2 as three eyes where dislocated IOLs were repositioned and fixed to the sclera via sclerotomy sites. In all the eyes, the knot of string (10-0 prolene, W1713, Ethicon, USA) was buried. Postoperatively, the visual acuity was greatly improved, by more than 4 lines in the Snellen visual acuity chart, with the exception of one case of macular degeneration. The scleral fixation of the IOL through sclerotomies, 1 mm posterior to the limbus, had advantages in that the scleral fixation of the IOL could be achieved through sclerotomy sites, and the anterior vitrectomy parallel to the iris plane. (+info)