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Salvage Retrograde Visceral Stenting Following Endovascular and Open Aortic Procedures
Julia Glaser, MD1, Benjamin Herdrich, MD2, Benjamin M. Jackson, MD1, Edward Y. Woo, MD3, Ronald M. Fairman, MD1, Scott M. Damrauer, MD1, Paul J. Foley, MD1, Grace J. Wang, MD1.
1Hospital of the University of Pennsylvania, Philadelphia, PA, USA, 2Surgical Associates, Wasau, WI, USA, 3Medstar Washington Hospital Center, Washington, DC, USA.
OBJECTIVES:
Retrograde stenting of mesenteric vessels has previously been described as a useful technique for treating acute mesenteric ischemia. We present a series where retrograde visceral stenting (RVS) was used to salvage vessels that were stenotic or occluded following open or endovascular procedures.
METHODS:
We performed a retrospective chart review of cases where RVS was used as a salvage technique following an endovascular or open procedure at a tertiary academic medical center between 2005 and 2012. Patient demographics, technical details of the procedures, length of stay and mortality were determined.
RESULTS:
A total of 6 patients underwent salvage retrograde visceral stenting. The mean age was 75±11 years old and male patients accounted for 67% of the cases (n=4). RVS was used for salvage after an EVAR with 3 vessel snorkel (n=1), EVAR complicated by device migration during deployment (n=2), standard EVAR (n=1), open Type IV TAAA (n=1), and aortic atherectomy (n=1). RVS was used to treat occlusion of the SMA in 4 patients, the renal arteries in 2 patients, and the celiac trunk in 1 patient; the technique was used for multiple vessels in 2 patients. RVS was performed at the time of the index operation in 3 of the cases, and in a delayed fashion (hours to 7 days) following the initial procedure in the others. Uncovered stents were used in 83% (n=5) of cases. Operative time was a mean of 372 ± 68 minutes; this included the initial procedure in 50% of the cases. Technical success was achieved in all patients. Length of stay was a mean of 5.8 days (range 1-11 days) with a mean ICU length of stay of 4.2 days (range 1-11 days). Overall 30-day mortality following cases where RVS was used was 50%. The mortality was highest in the subset of patients with a delay between the initial procedure and when RVS was performed.
CONCLUSIONS:
Retrograde visceral stenting is a useful strategy for salvage and should be considered in situations where there is inadvertent encroachment on the visceral vessels following open or endovascular procedures. Mortality is high overall and is likely reflective of the dire clinical situation of the patient.
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