Advanced Search

Home > Journals > Italian Journal of Vascular and Endovascular Surgery > Past Issues > Italian Journal of Vascular and Endovascular Surgery 2004 March;11(1) > Italian Journal of Vascular and Endovascular Surgery 2004 March;11(1):19-24



A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
Indexed/Abstracted in: EMBASE, Scopus

Frequency: Quarterly

ISSN 1824-4777

Online ISSN 1827-1847


Italian Journal of Vascular and Endovascular Surgery 2004 March;11(1):19-24


Aneurysm of the carotid artery: hybrid endovascular treatment

Calabrese E., Rashad N., Barbera G., Quattrone C., Calabretta L., Pellegrino O.

Vascular Surgery, The National Center for Limb Salvage, Pavia, Italy

The aim of ­this ­study was to ­describe a ­hybrid endo­vas­cu­lar tech­nique of ­stent-­graft of the ­extra-cra­ni­al carot­id ­artery, uti­liz­ing an arte­ro-­venous ­shunt ­with ­flow inver­sion as a way to ­achieve cere­bral pro­tec­tion. A 74-­year-old man who suf­fered recur­rent transient ischemic attaks (TIA), had under­gone carot­id endar­te­rec­to­my ­with saph­e­nous ­patch enlarge­ment, 2 ­years ear­li­er and he now devel­oped a symp­to­mat­ic pseu­do-aneu­rysm, par­tial­ly ­filled ­with ­soft throm­bi, ­along the ­course of the saph­e­nous ­vein ­patch. An intro­duc­er was insert­ed ­into the ­left carot­id ­through a ­small inci­sion at the ­base of the ­neck. It was ­then con­nect­ed to a 2nd intro­duc­er in the femo­ral ­vein, to pro­duce A-V shunt­ing. The com­mon carot­id was tem­po­rar­i­ly ­clamped and a Wallstent was insert­ed in the inter­nal carot­id and ­across the bifur­ca­tion. The ­more prox­i­mal ­part of the pseu­do­aneu­rysm in the com­mon carot­id was cov­ered by insert­ing a Wallgraft ­through the femo­ral ­artery, over­lap­ping it par­tial­ly ­with the pre­vi­ous­ly insert­ed Wallstent. Cerebral pro­tec­tion dur­ing the crit­i­cal ­part of the pro­ce­dure was pro­vid­ed by the A-V ­shunt and by the inver­sion of ­flow in the ­left inter­nal carot­id ­artery. Exclusion of the pseu­do­aneu­rysm was ­achieved with­out neu­ro­log­i­cal com­pli­ca­tions. A mul­ti­slice vol­ume-ren­der­ing CT-­scan and an angio­gram per­formed 1 ­year ­post-pro­ce­dure con­firmed paten­cy of the sequen­tial ­stents. The ­patient ­remained ­free of TIA epi­sodes dur­ing a 1 year fol­low-up. Hybrid pro­ce­dures, ­with ­direct punc­ture and clamp­ing of the carot­id ­artery, ­when asso­ciat­ed ­with A-V shunt­ing, can pro­vide a ­safe ­access for ­high-­risk carot­id ­stent-graft­ing.

language: English


top of page