Letter to the Editor
Endovascular Stent for Iatrogenic Penetrating Injury of the Thoracic Aorta
Vascular and Endovascular Surgery 2014, Vol. 48(5-6) 438 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1538574414539051 ves.sagepub.com
Antonio Bozzani, MD1
Vagefi et al1 reported, in their recent article, an interesting case of a 74-year-old woman affected by pericardial effusion and treated with percutaneous pericardiocentesis. The procedure was complicated by descending thoracic aorta penetrating injury repaired by an endovascular procedure: a 20-mm diameter - 3.75-cm long Aneurx aortic cuff stentgraft (Medtronic Inc, Santa Rosa, California) was positioned. Pericardiocentesis was first conceptualized in the 17th century. It can be performed in the emergency setting for cardiac tamponade or on an elective basis for recurrent pericardial effusions. By relieving the excessive pressure these fluids impose on the heart, symptomatic patients can find instant relief, and life-threatening situations can be managed. Also, with echocardiographic guidance, which is now indicated for all elective procedures, the pericardiocentesis have minimal risk.2 The most frequent complications are cardiac muscle perforation (mainly right ventricle), cardiac arrhythmias, coronary arteries puncture (mainly right coronary artery), pneumothorax, right atrium puncture, pain after piercing the pericardium, hemothorax, arterial puncture (left internal thoracic artery), infection, stomach or colon penetration, and liver
injury. To date, no cases of descending thoracic aorta puncture has been described. Congratulations to the authors for this rare and welldocumented case that shows how even a common procedure such as pericardiocentesis can hide many pitfalls.3 This case report confirms that the endovascular procedures are once again the treatment of choice for emergencies descending thoracic aorta. References 1. Vagefi PA, Patel MS, La Muraglia GM. Endovascular stent for iatrogenic penetrating injury of the thoracic aorta. Vasc Endovasc Surg. 2014;48(4):333-336. 2. Kil UH, Jung HO, Koh YS, Park HJ, Park CS, Kim PJ, et al. Prognosis of large, symptomatic pericardial effusion treated by echo-guided percutaneous pericardiocentesis. Clin Cardiol. 2008; 31:531-537. 3. Bozzani A, Arici V, Bellinzona G, Pirrelli S, Forni E, Odero A. Iatrogenic pulmonary artery rupture due to chest-tube insertion. Tex Heart Inst J. 2010;37(6):732-733.
1
Vascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
Corresponding Author: Antonio Bozzani, P.le Golgi 19, 27100 Pavia, Italy. Email: [email protected]
Downloaded from ves.sagepub.com at UNIV NEBRASKA LIBRARIES on April 13, 2015
Endovascular Stent for Iatrogenic Penetrating Injury of the Thoracic Aorta
Vascular and Endovascular Surgery 2014, Vol. 48(5-6) 438 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1538574414539051 ves.sagepub.com
Antonio Bozzani, MD1
Vagefi et al1 reported, in their recent article, an interesting case of a 74-year-old woman affected by pericardial effusion and treated with percutaneous pericardiocentesis. The procedure was complicated by descending thoracic aorta penetrating injury repaired by an endovascular procedure: a 20-mm diameter - 3.75-cm long Aneurx aortic cuff stentgraft (Medtronic Inc, Santa Rosa, California) was positioned. Pericardiocentesis was first conceptualized in the 17th century. It can be performed in the emergency setting for cardiac tamponade or on an elective basis for recurrent pericardial effusions. By relieving the excessive pressure these fluids impose on the heart, symptomatic patients can find instant relief, and life-threatening situations can be managed. Also, with echocardiographic guidance, which is now indicated for all elective procedures, the pericardiocentesis have minimal risk.2 The most frequent complications are cardiac muscle perforation (mainly right ventricle), cardiac arrhythmias, coronary arteries puncture (mainly right coronary artery), pneumothorax, right atrium puncture, pain after piercing the pericardium, hemothorax, arterial puncture (left internal thoracic artery), infection, stomach or colon penetration, and liver
injury. To date, no cases of descending thoracic aorta puncture has been described. Congratulations to the authors for this rare and welldocumented case that shows how even a common procedure such as pericardiocentesis can hide many pitfalls.3 This case report confirms that the endovascular procedures are once again the treatment of choice for emergencies descending thoracic aorta. References 1. Vagefi PA, Patel MS, La Muraglia GM. Endovascular stent for iatrogenic penetrating injury of the thoracic aorta. Vasc Endovasc Surg. 2014;48(4):333-336. 2. Kil UH, Jung HO, Koh YS, Park HJ, Park CS, Kim PJ, et al. Prognosis of large, symptomatic pericardial effusion treated by echo-guided percutaneous pericardiocentesis. Clin Cardiol. 2008; 31:531-537. 3. Bozzani A, Arici V, Bellinzona G, Pirrelli S, Forni E, Odero A. Iatrogenic pulmonary artery rupture due to chest-tube insertion. Tex Heart Inst J. 2010;37(6):732-733.
1
Vascular Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
Corresponding Author: Antonio Bozzani, P.le Golgi 19, 27100 Pavia, Italy. Email: [email protected]
Downloaded from ves.sagepub.com at UNIV NEBRASKA LIBRARIES on April 13, 2015
