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.