Physician-modified endograft for repairing iatrogenic innominate artery injury: A case report and literature review

Abstract

Background

Innominate artery (IA) injury resulting from right subclavian vein (RSV) puncture is a relatively rare and life-threatening iatrogenic vascular injury.

Methods

In a 72-year-old female patient, in whom iatrogenic IA injury occurred during the RSV puncture, a 6-Fr sheath had entered into ascending aorta through IA. Due to the concern about the difficulty in hemostasis after removing the sheath, the patient was immediately transferred to our hospital. In emergency situations, when there were no covered stents of appropriate sizes available, we ultimately opted to physician-modified endograft (PMEG) for endovascular repair. A 16 × 124 mm Medtronic iliac branch (Endurant, Medtronic Vascular, Santa Rosa, CA, USA) was released on a sterile operating table, trimmed to 16 × 37 mm, and then reassembled into the delivery sheath.

Results

The right subclavian artery (RSA) was exposed in the right supraclavicular fossa and punctured. After established the guidewire pathway from the RSA puncture site to the ascending aorta, the PMEG was delivered to IA and precisely deployed. Subsequently, the 6-Fr sheath was removed, and final angiography confirmed patent blood flow in IA, right common carotid artery, and RSA, with no bleeding. The patient recovered well and discharged.

Conclusion

In emergencies, PMEG can be tailored to fit the anatomical structure of IA, providing a viable and effective alternative for managing complex iatrogenic IA injury.