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Postcatheterization Pseudoaneurysms and Arteriovenous Fistulas: Repair with Percutaneous Implantation of Endovascular Covered Stents¹

¹ From the Franz Volhard Clinic at the Max Delbrück Center for Molecular Medicine, Universitätsklinikum Charité, Medical Faculty of Humboldt University, Campus Berlin-Buch, Wiltberg Strasse 50, 13125 Berlin, Germany. Received May 1, 1998; revision requested July 6; final revision received April 26, 1999; accepted July 6. Address reprint requests to C.T. (e-mail: thalhammer@em.uni-frankfurt.de)

PURPOSE: To assess the effectiveness and safety of endovascular covered stents in the management of pseudoaneurysms and arteriovenous fistulas after cardiac and vascular catheterization.

MATERIALS AND METHODS: Twenty-six endovascular covered stents were used to repair 16 pseudoaneurysms, nine arteriovenous fistulas, and one combined lesion after femoral arterial puncture for diagnostic coronary angiography and/or angioplasty. Fistulas and aneurysms were in the superficial femoral artery in 16 cases, in the deep femoral artery in six cases, and in the common femoral artery in four cases. Implantation was performed from the opposite femoral artery in most cases. It was not possible to treat three additional cases transcutaneously for technical reasons (three of 29 cases).

RESULTS: Percutaneous closure of the lesions with an endovascular covered stent was successful in 26 of 29 cases. Initial follow-up showed good stent patency. Two major complications were observed after stent implantation. During follow-up (about 1 year in 23 of 26 patients [88%]), stent thromboses were detected in four of 23 patients (17%) with follow-up color duplex flow imaging.

CONCLUSION: Implantation of endovascular covered stents is an effective and safe method for the percutaneous closure of pseudoaneurysms and arteriovenous fistulas. Thus, endoluminal vascular repair with covered stents offers an alternative therapeutic approach to vascular surgery in selected patients.

Index terms: Arteries, femoral, 92.1268, 92.12983, 92.12986, 92.458 • Arteriovenous malformations, extremities, 92.12983, 92.12986, 92.458, 92.716 • Fistula, arteriovenous, 92.12983, 92.12986, 92.458, 92.7173 • Interventional procedures, complications, 92.126, 92.458 • Stents and prostheses, 92.1268

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