title: Emergency and elective implantation of covered stent systems in iatrogenic arterial injuries.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of covered stents for the management of iatrogenic arterial injury.
  
  
  METHODS
  Between 03 / 1998 and 12 / 2009, 31 patients underwent selective covered stent implantation after iatrogenic arterial injury. 12 / 31 of these patients (38.7 %) were hemodynamically unstable. Six different endovascular covered stent types were utilized. The primary endpoints of this study were technical and clinical success and rates of minor and major complications.
  
  
  RESULTS
  Initial angiograms demonstrated active extravasation in 19 (61.3 %) patients and pseudoaneurysms in 12 (38.7 %) patients. The following sites of bleeding origin were detected: axillary artery, subclavian artery, common iliac artery, external iliac artery, internal iliac artery, common femoral artery, superficial femoral artery, popliteal and fibular artery, femoro-popliteal and popliteo-crural bypasses, common hepatic artery, aberrant hepatic artery, cystic and gastroduodenal artery. In all patients bleeding was effectively controlled by covered stent implantation resulting in an immediate technical success of 100 %. Clinical success attributed to covered stent implantation was documented in 30 of the 31 patients (96.8 %). Major complications included death in four patients (11.1 %), acute thrombosis with arm ischemia in one patient (2.8 %) and stent fracture with associated pseudoaneurysm in another patient (2.8 %). In 2 / 31 patients (6.5 %) covered stent failure was detected and successfully treated by implantation of a second covered stent.
  
  
  CONCLUSIONS
  Emergency and elective implantation of covered stents may be used for minimally invasive and effective management of iatrogenic arterial injury.
authors.affiliation: Institut für Röntgendiagnostik, Universitätsklinikum Würzburg.
authors.forename: J P
authors.initials: JP
authors.lastname: Goltz
authors.forename: P
authors.initials: P
authors.lastname: Bastürk
authors.forename: H
authors.initials: H
authors.lastname: Hoppe
authors.forename: J
authors.initials: J
authors.lastname: Triller
authors.forename: R
authors.initials: R
authors.lastname: Kickuth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D001158:Arteries / Q000293:injuries*; D004630:Emergencies; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000401:mortality / Q000628:therapy; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*