Pulmonary artery stenting in a patient with Takayasu’s arteritis using a novel balloon-expandable covered stent

Patients with Takayasu’s arteritis have pulmonary artery involvement more commonly than previously appreciated. The majority of these lesions are in segmental or sub-segmental arteries, but there are some patients who have severe stenosis of the main pulmonary arteries. Interventional treatment of these patients is technically feasible, but there are only limited case reports describing such intervention. Balloon angioplasty and stenting in these lesions often require high pressure inflations to achieve adequate results and thus has increased risk due to the possibility of pulmonary artery rupture. The recently approved Viabahn BX balloon-expandable covered stent may be an optimal device for main pulmonary artery stenosis as it is relatively low profile, can be over-expanded to large vessel diameter without compromise or disruption of the polytetrafluoroethylene covering and virtually eliminates the risk of catastrophic pulmonary artery rupture. We report here the first known use of this novel stent for treatment of severe pulmonary artery stenosis.

Extracorporeal cardiopulmonary resuscitation after pulmonary artery rupture

Pulmonary artery rupture during pulmonary balloon valvuloplasty is a rare and life-threatening complication. Here, we present a pulmonary artery rupture in a 10-month-old infant. The patient had a tamponade, ineffective cardiac massage for 40 minutes and extreme hemodilution due to blood loss. Extracorporeal life support was used for three days. The patient was discharged without any neurological sequelae.

Endovascular catheter knot untying: A new technique

Indwelling vascular catheters may be maintained for extended periods of time especially for critically ill or hospitalized patients requiring frequent blood draws. If they become knotted within the vasculature, serious iatrogenic sequelae can result, such as: pneumothorax, atrial arrhythmias, ventricular arrhythmias, pulmonary embolism, pulmonary hemorrhage, intracardiac rupture, pulmonary artery rupture, balloon rupture, bacteremia, and death. Surgical cut-down may be indicated for removal of knots that preclude catheter retrieval and are refractory to intravascular removal modalities. Three such knots were untied using the intraluminal technique described in this report. The technique utilizes balloon angioplasty in conjunction with a wire to safely and effectively untie knotted catheters. Keywords: Vascular catheters, Arrhythmias, Angioplasty balloon.