Patient A
A 72-year-old male with ischemic heart disease treated with a coronary bypass 5 years ago, developed acute pulmonary edema and respiratory distress due to severe aortic stenosis. He was intubated and later underwent tracheostomy. On the 40th day following surgery (POD 40), the patient presented to the emergency department (ED) with an active bleeding exiting the stomal area. Immediately upon arrival to the hospital the tracheostomy cuff was inflated. The patient was rushed to CTA, followed by an urgent diagnostic angiography in the IR unit. A large right subclavian artery pseudoaneurysm was detected (Fig 1.A-C). Through a 10Fr. sheath right brachial artery approach, three stent grafts sized 12-13.5mm, were placed in an overlapping manner. Next, a 10mm balloon expandable stent was placed in the subclavian artery origin, followed by remodeling with a 12mm balloon inflation. The patient was then transferred to the ICU and was discharged after a week. No complications due to the angiography were seen. Six months following the procedure, the patient remained asymptomatic.
Patient B
A 75-year-old woman was brought to the ED following a sentinel bleeding from the tracheostomy cannula. She had been put on assisted ventilation and underwent tracheostomy 3 months prior due to a right-sided hemisphere stroke. Upon arrival to the ED, acute intractable bleeding begun. The patient was immediately transferred to the operating room (OR), for laryngo-tracheoscopy. During the procedure the bleeding had already stopped, and the origin was not traced. She was then transferred to CTA, which demonstrated the source of the bleeding from a TIAF (Fig 2). The patient was rushed to the IR unit, where a 12mm stent graft was inserted to the innominate and subclavian arteries, covering the right common carotid artery origin, through a 10Fr. sheath right brachial approach. A control of the bleeding was achieved. As the patient had already suffered from a right sided stroke, no sequelae following the procedure was seen. A post procedural CTA demonstrated accurate stent position without evidence of residual bleeding. In the ICU the patient had undergone a successful cardiac resuscitation following an arrest, due to significant blood loss. The patient was weaned from mechanical ventilation 3 days after the procedure. On follow-up, 9 months after the incident, she remained asymptomatic.