Endovascular treatment of carotid-jugular fistula after gunshot wound

Transcription

1 Endovascular treatment of carotid-jugular fistula after gunshot wound Instituto Dante Pazzanese de Cardiologia São Paulo, Brazil Carrijo, LBS; Tannus, MM; Cano, MN; Izukawa, NM; Moreira, SM; Kambara, AM Contact

2 Disclosure Speaker name: Liza Batista Siqueira Carrijo I have the following potential conflicts of interest to report: x Consulting Gore Medical Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest

3 Background Penetrating neck injuries: ± 1% of all trauma patients Mortality: 3 6% Ischemic stroke Exsanguination Mechanism of injury: Firearm: 60% Stab wound: 40% BESTARNES BW, ARTHURS ZM. Endovascular Management of Vascular Trauma. Perspectives in Vascular Surgery and Endovascular Therapy. Volume 18 Number 2 June O BRIEN PJ, COX MW. A Modern Approach to Cervical Vascular Trauma. Perspectives in Vascular Surgery and Endovascular Therapy 23(2) 90 97

4 Background Traumatic AVF of the neck and head: the complications from arterial trauma. ± 4% of congestive heart failure cerebral ischemia thromboembolism rupture Kong JH, Park SM, Kim TH, Choi DH, Lee DY, Daegu, South Korea. Late-Onset Congestive Heart Failure in a Patient With a 58-Year-Old Huge Traumatic Carotid-Jugular Fistula and Pseudoaneurysm: Endovascular Treatment With a Stent-Graft. Ann Vasc Surg 2010; 24: 955.e5-955.e10

5 Background Treatment goal: occlude the fistula preserve artery patency Preference for endovascular approach: severe deformity of the native vasculature risk of bleeding nerve damage intracranial embolization FOX CJ, GILLESPIE DL, WEBER MA, COX MW, HAWKSWORTH JS, CRYER CM, RICH NM, O DONNEL SD. Delayed evaluation of combatrelated penetrating neck trauma. J. Vasc. Surgery 2006; 41 (1): REDEKOP G, MAROTTA T, WEILL A. Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents. J Neurosurg 2001; 95;

6 Case report 17 year-old male, history of gunshot wound at left cervical region (08/2016), with exit port on the right. Negative neck exploration. 10 months follow-up presented with bruit on the left. Referred for arteriography.

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10 Case report Preoperative echocardiogram no signs of right ventricular overload

11 Endovascular treatment Approach devices: bilateral femoral artery approach 7x60mm Fluency + 9x60mm Fluency No post-dilatation Intraoperative arteriography residual AVF flow

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13 No clinical complication Follow-up visit complete disappearance of cervical bruit. Dual antiplatelet therapy 6 months Control Doppler patency of stent grafts and jugular vein with phasic flow, no residual fistula

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16 Discussion Covered stents - exclusion of vascular injury DuBose et al, 2008 (review of 31 studies involving 113 patients) overall patency of 79.6% (2 years) stroke rate - 3.5% x stenting rate for atherosclerotic cerebrovascular disease (4.7%)

17 Discussion Lack of long-term data young trauma patient - patent carotid for the next 50 years Long-term antiplatelet therapy with clopidogrel or aspirin Du TOIT DF, COOLEN D, LAMBRECHTS A, ODENDAAL JV, WARREN BL. The Endovascular Management of Penetrating Carotid Artery Injuries: Long-term Follow-up. Eur J Vasc Endovasc Surg (2009) 38, 267e272

18 Conclusion Covered stents - safe and effective approach for selected cases of cervical AV fistulas; low levels of complications Most reports - high technical success rates low neurological complications X uncertain longterm outcomes in young patients

19 Thank you