IS Case 267: Fractured vascular stent
Imaging Sciences URMC 2009
Publication Date: 2009-07-29
History
Patient is a 76-year-old female with decreased flow and increased pressures in dialysis fistula.
Findings
There is a vascular stent in the axilla, which is fractured. A glidewire is seen traversing the fractured stent.
Discussion
Vascular stents are available in balloon expandable and self-expanding types. Balloon expandable stents are deployed with a balloon, and self-expanding stents exert a radial force against the vessel wall.
Vascular stents are extremely useful in treating vascular stenosis, thrombosis and traumatic injuries. However, certain areas must be avoided for non-emergent stenting. Usually, it is not advisable to stent across a joint. This includes the popliteal vessels, the external iliac as it crosses under the ligament, the axillary vessels and the distal brachial artery. Over time, a stent in these locations will be destroyed from chronic, repetitive trauma, and the fractured metallic pieces may even embolize.
In this case, the patient had a stent placed in the axillary vein for stenosis, at an outside institution. The stent is now fractured and there is clear separation between the larger two pieces. Fistulagram (not shown) demonstrated stenosis in the fractured stent which was successfully angioplastied.
References
- Scheinert D, Scheinert S, Sax J, et al. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol. 2005 Jan 18;45(2):312-5. PMID: 15653033 [PubMed]
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