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Beji H, Kallel Y, Mroua B, Zribi S, Bouassida M, Touinsi H. Cystic mass with arteriovenous malformations of the lesser omentum. ANZ J Surg 2023; 93:722-723. [PMID: 35876717 DOI: 10.1111/ans.17926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hazem Beji
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Yassine Kallel
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Bassem Mroua
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Slim Zribi
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Mahdi Bouassida
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Hassen Touinsi
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
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El-Ghandour NMF. Commentary: Microsurgical Resection of a T8 Spinal Cord Arteriovenous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e205-e206. [PMID: 36562626 DOI: 10.1227/ons.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022] Open
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Kulkarni CB, Sutphin P, Iqbal S, Kalva SP. Diagnosis and Management of Persistent Pulmonary Arterio-venous Malformations following Embolotherapy. Acad Radiol 2023; 30:441-452. [PMID: 36089478 DOI: 10.1016/j.acra.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023]
Abstract
Embolotherapy is the primary treatment for pulmonary arterio-venous malformations (PAVMs). Approximately, 2-25% of PAVMs demonstrate persistence following embolization. Early identification and treatment of persistent PAVMs are critical to mitigating life threatening complications. The presence of prior embolic devices and complex angioarchitecture of persistent PAVMs pose technical challenges during repeat embolotherapy. In this article, we review patterns of persistence, factors affecting the persistence, endovascular treatment techniques, and outcomes.
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Affiliation(s)
- Chinmay Bhimaji Kulkarni
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India.
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Bornstein E, Chervenak FA, Kulla P, Delaney K, Timor-Tritsch IE. Prenatal diagnosis and characterization of extra-axial, supratentorial pial arteriovenous malformation using high-resolution transvaginal neurosonography. Ultrasound Obstet Gynecol 2023; 61:421-424. [PMID: 36056756 DOI: 10.1002/uog.26058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/01/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Affiliation(s)
- E Bornstein
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine, NY, USA
| | - F A Chervenak
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine, NY, USA
| | - P Kulla
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine, NY, USA
| | - K Delaney
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine, NY, USA
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55
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Aldea S, Bourdillon P, Piotin M, Le Guerinel C. Microsurgical Resection of a T8 Spinal Cord Arteriovenous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e204. [PMID: 36398972 DOI: 10.1227/ons.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Pierre Bourdillon
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Department of Interventional Neuro radiology, Rothschild Foundation Hospital, Paris, France
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Coccia E, Valeri L, Zuntini R, Caraffi SG, Peluso F, Pagliai L, Vezzani A, Pietrangiolillo Z, Leo F, Melli N, Fiorini V, Greco A, Lepri FR, Pisaneschi E, Marozza A, Carli D, Mussa A, Radio FC, Conti B, Iascone M, Gargano G, Novelli A, Tartaglia M, Zuffardi O, Bedeschi MF, Garavelli L. Prenatal Clinical Findings in RASA1-Related Capillary Malformation-Arteriovenous Malformation Syndrome. Genes (Basel) 2023; 14:genes14030549. [PMID: 36980822 PMCID: PMC10048332 DOI: 10.3390/genes14030549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Pathogenic variants in RASA1 are typically associated with a clinical condition called “capillary malformation-arteriovenous malformation” (CM-AVM) syndrome, an autosomal dominant genetic disease characterized by a broad phenotypic variability, even within families. In CM-AVM syndrome, multifocal capillary and arteriovenous malformations are mainly localized in the central nervous system, spine and skin. Although CM-AVM syndrome has been widely described in the literature, only 21 cases with prenatal onset of clinical features have been reported thus far. Here, we report four pediatric cases of molecularly confirmed CM-AVM syndrome which manifested during the prenatal period. Polyhydramnios, non-immune hydrops fetalis and chylothorax are only a few possible aspects of this condition, but a correct interpretation of these prenatal signs is essential due to the possible fatal consequences of unrecognized encephalic and thoracoabdominal deep vascular malformations in newborns and in family members carrying the same RASA1 variant.
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Affiliation(s)
- Emanuele Coccia
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Department of Medical and Surgical Science, Postgraduate School of Medical Genetics, Alma Mater StudiorumUniversity of Bologna, 40126 Bologna, Italy
| | - Lara Valeri
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Paediatrics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Roberta Zuntini
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Stefano Giuseppe Caraffi
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-0522-296158/+39-0522-296244
| | - Francesca Peluso
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Luca Pagliai
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Antonietta Vezzani
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Zaira Pietrangiolillo
- Neonatal Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francesco Leo
- Neonatal Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Nives Melli
- Neonatal Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Valentina Fiorini
- Neonatal Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Greco
- Postgraduate School of Paediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Francesca Romana Lepri
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Elisa Pisaneschi
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Annabella Marozza
- Medical Genetics Unit, Careggi University Hospital, 50134 Florence, Italy
- Medical Genetics Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50121 Florence, Italy
| | - Diana Carli
- Department of Public Health and Pediatric Sciences, Regina Margherita Children’s Hospital, Azienda Ospedaliero-Universitaria di Torino, 10126 Turin, Italy
| | - Alessandro Mussa
- Department of Public Health and Pediatric Sciences, Regina Margherita Children’s Hospital, Azienda Ospedaliero-Universitaria di Torino, 10126 Turin, Italy
| | | | - Beatrice Conti
- Clinical Genetics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Iascone
- Laboratory of Medical Genetics, Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Giancarlo Gargano
- Neonatal Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Antonio Novelli
- Translational Cytogenomics Research Unit, Laboratory of Medical Genetics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Marco Tartaglia
- Molecular Genetics and Functional Genomics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Orsetta Zuffardi
- Unit of Medical Genetics, Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Maria Francesca Bedeschi
- Clinical Genetics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Livia Garavelli
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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57
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Shoji MK, Tran AQ, Lee WW, Dubovy S, Kossler A. Ophthalmic artery occlusion following n-butyl cyanoacrylate embolization of an orbital arteriovenous malformation. Orbit 2023; 42:87-93. [PMID: 34365893 PMCID: PMC10954302 DOI: 10.1080/01676830.2021.1955937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/10/2021] [Indexed: 01/28/2023]
Abstract
A 33-year-old pregnant woman presented with six months of right-sided proptosis. Neuroimaging revealed a right orbital arteriovenous malformation arising from the second segment of the ophthalmic artery. As she was 9 weeks pregnant, the decision was made to monitor her closely. Over the following six months, her proptosis progressed, accompanied by decreased visual acuity, afferent pupillary defect, and red desaturation concerning for compressive optic neuropathy. After planned c-section, she underwent embolization with n-butyl cyanoacrylate. Upon awakening after embolization, she had no light perception vision from her right eye and was found to have ophthalmic artery obstruction. She ultimately developed a blind painful right eye and underwent enucleation with histopathology demonstrating glue in the central retinal artery, posterior ciliary arteries, and choroid. This case highlights ophthalmic artery occlusion as a rare complication of orbital arteriovenous malformation embolization and demonstrates correlating histopathological findings, which have not previously been reported.
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Affiliation(s)
- Marissa K. Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Ann Q. Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York, NY
| | - Wendy W. Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Sander Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Andrea Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA
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58
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Fish FA, Chan SM, Pollak J, Schlachter T. Transpleural Systemic Artery-to-Pulmonary Artery Shunts: A Potential Mimicker of Pulmonary Arteriovenous Malformations. J Vasc Interv Radiol 2023; 34:300-303. [PMID: 36283590 DOI: 10.1016/j.jvir.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- From Adam Fish
- Department of Interventional Radiology, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT, 06520.
| | - Shin Mei Chan
- Department of Interventional Radiology, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT, 06520
| | - Jeffrey Pollak
- Department of Interventional Radiology, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT, 06520
| | - Todd Schlachter
- Department of Interventional Radiology, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT, 06520
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Jogo A, Yamamoto A, Mukai K, Kageyama K, Kaminou T, Miki Y. Transportal Balloon-Occluded Retrograde Transvenous Obliteration for a Pancreatic Arteriovenous Malformation Using the Outflow Debranching Technique. J Vasc Interv Radiol 2023; 34:927-931. [PMID: 36603768 DOI: 10.1016/j.jvir.2022.12.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Atsushi Jogo
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Kaori Mukai
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Ken Kageyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Toshio Kaminou
- Advanced Imaging and Minimally Invasive Therapy Center, Tsukazaki Hospital, Himeji, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Taniguchi A, Hirakawa K, Mayama I. [ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY WITHOUT TRANSCATHETER ARTERIAL EMBOLIZATION FOR A PATIENT WITH PROSTATE CANCER AND PELVIC ARTERIOVENOUS MALFORMATION: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2023; 114:30-33. [PMID: 38246624 DOI: 10.5980/jpnjurol.114.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
We performed robot-assisted laparoscopic radical prostatectomy (RARP) without transcatheter arterial embolization (TAE) for a 72-year-old male patient with prostate cancer and pelvic arteriovenous malformation (AVM). Though lymphatic dissection was made contralateral to the AVM, the operation time (robotic: 2h 40 min, and total: 3h 2 min) was not long. Moreover, the blood loss amount of 250 ml was less than those in the past reports of preoperative TAE. Robotic surgery, a dissection of an abnormal arterial branch from the internal iliac artery before the division of the bladder neck, bunching of the deep dorsal vein complex, and resection of the vascular pedicle connecting with AVM in the final step of prostatectomy, contributed to the safe operation. Moreover, the surgical margin was negative in the pathological report,and the prostate specific-antigen was 0.006 ng/ml 3months following the operation. In addition, CT revealed the same size of AVM and no postoperative complication. It has been demonstrated that in the absence of TAE for pelvic AVM, RARP for prostate cancer is safe and effectively controls cancer.
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Affiliation(s)
| | | | - Ikumi Mayama
- Tokeidai Memorial Hospital, Department of Urology
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61
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Yan Y, Jia Y, Lategan B, Alexander Z, Awadalla A, Goubran A. Acquired uterine arteriovenous malformation in a patient with cornual pregnancy: A case report. Medicine (Baltimore) 2022; 101:e31629. [PMID: 36451408 PMCID: PMC9704990 DOI: 10.1097/md.0000000000031629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Acquired uterine arteriovenous malformation (uAVM) is a rare disease and could occur after dilation and curettage, cesarean section, or neoplastic processes. PATIENT CONCERNS A 29-year-old female presented with acute right lower abdominal pain and positive beta human chorionic gonadotropin (β-hCG). DIAGNOSIS A 6 cm ectopic right cornual pregnancy was found on ultrasound examination. INTERVENTIONS She underwent a laparoscopic resection of the cornual ectopic pregnancy. She returned with extensive vaginal bleeding 6-month post surgery, and eventually diagnosed with arteriovenous malformation at the previous surgical site by Color Dopplor endovaginal ultrasound. Percutaneous transcatheter uterine artery embolization (UAE) was attempted, however, vaginal bleeding continued. She was taken to the operation room for a hysteroscopic ablation of uAVM. OUTCOMES Complete cessation of the bleeding was achieved without hysterectomy. CONCLUSION We report an extremely unusual case of acquired uAVM after a wedge resection of cornual pregnancy. Ultrasound evaluation of patients with post-operative persistent bleeding should be considered for evaluation of a possible arteriovenous malformation.
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Affiliation(s)
- Yi Yan
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Yong Jia
- Department of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Belinda Lategan
- Department of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Zarine Alexander
- International Medical Graduate Programs, Room 260 Brodie Centre 727 McDermot Avenue, University of Manitoba, Winnipeg, MB, Canada
| | - Alaa Awadalla
- Obstetrics, Gynecology and Reproductive Sciences 260 Brodie Centre, 727 McDermot Avenue University of Manitoba, Bannatyne Campus Winnipeg, MB, Canada
| | - Ashraf Goubran
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Ultrasound Department, Radiology & Diagnostic Imaging, St. Boniface General Hospital, Winnipeg, MB, Canada
- *Correspondence: Ashraf Goubran, Ultrasound Department, Radiology & Diagnostic Imaging, St. Boniface General Hospital, 409 Taché Ave, Winnipeg, MB R2H2A6, Canada (e-mail: )
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Shin YM, Kim Y, Yang J, Yang B, Choi IA, Lee KM. Recurrent pulmonary arteriovenous malformation in a patient with Sjögren syndrome: A case report. Medicine (Baltimore) 2022; 101:e30954. [PMID: 36254021 PMCID: PMC9575738 DOI: 10.1097/md.0000000000030954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pulmonary manifestations of Sjögren syndrome (SS) are variable and may involve the airway or lung parenchyma and increase the risk of vascular and malignant disease. However, to date, only one case of pulmonary arteriovenous malformation (AVM) has been reported in a patient with SS. Here, we report a rare case of recurrent pulmonary AVMs with aggravating multiple cysts in a patient with SS during a period of 14 years. PATIENT CONCERNS A 45-year-old woman was diagnosed with SS and pulmonary AVM in the right lung. Her AVMs were embolized successfully and she was followed up annually for 14 years. Eleven years after the initial treatment, her chest computed tomography showed new pulmonary AVMs in the left lung with aggravating multiple cysts. DIAGNOSIS We diagnosed her with SS according to the American-European consensus group criteria of 2010. Chest computed tomography and angiographic findings confirmed the recurrence of pulmonary AVMs. INTERVENTIONS The patient's recurrent pulmonary AVMs were successfully treated by embolization. OUTCOMES Although her multiple cystic lung lesions had been aggravating during 14 years, she received embolization for the pulmonary AVMs twice and developed no complication related to these procedures. Currently, the patient is 56 years old and still alive with good performance state. LESSONS To date, only one case of pulmonary AVM has been reported in a patient with SS. The patient died 2.5 years after the diagnosis without recurrence of AVM. Here, we present a rare case of recurrent pulmonary AVMs associated with aggravating multiple cysts in both lungs, which were observed during long-term follow-up, in a patient with SS.
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Affiliation(s)
- Yoon Mi Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Yook Kim
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jiyoul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - In Ah Choi
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki Man Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- * Correspondence: Ki Man Lee, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776 1Sunhwan-ro, Seowon-gu, Cheongju 28644, Republic of Korea (e-mail: )
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Lilje D, Wiesmann M, Hasan D, Ridwan H, Hölzle F, Nikoubashman O. Interventional embolization combined with surgical resection for treatment of extracranial AVM of the head and neck: A monocentric retrospective analysis. PLoS One 2022; 17:e0273018. [PMID: 36048777 PMCID: PMC9436082 DOI: 10.1371/journal.pone.0273018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The aim of this study was to demonstrate the efficacy and feasibility of treating patients with extracranial arteriovenous malformations (AVM) of the head and neck with interventional embolization followed by surgical resection. Methods We reviewed the charts of all patients between 2012 and 2021 with extracranial AVM of the head and neck scheduled for interdisciplinary treatment according to University Hospital RWTH Aachen’s protocol and conducted standardized interviews using a newly developed questionnaire. Interview results, as well as clinical examination and radiographic outcome results were analyzed to help determine the efficacy of our treatment approach. Results We included 10 patients (8 female, 2 male), with a mean age of 33.5 (11–61) years who were scheduled for treatment of the AVM with interventional embolization followed by surgical resection. In 6 of the 10 patients (60%) the lesion was located in extracranial soft tissue only. In one patient (10%), the lesion was located in bone tissue only. A combined intraosseous and oral soft tissue lesion was seen in the remaining 3 patients (30%). Radiographic resolution was achieved in 62.5% of cases and a significant decrease of symptoms was identified (p = 0.002). None of the patients reported dissatisfaction and no major complications occurred. Conclusion An interdisciplinary treatment approach combining neuroradiological interventions with surgical resection appears to be an effective treatment with an acceptable complication rate. Patients treated according to our protocol showed a high satisfaction rate, regardless of the radiographic outcome. Standardized follow-up allows for early detection of recurrences and helps with subjective patient satisfaction.
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Affiliation(s)
- Daniel Lilje
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Dimah Hasan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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64
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Pr S, K M, Iyer RS. Brainstem Arteriovenous Malformation and Symptomatic Excessive Daytime Somnolence. J Assoc Physicians India 2022; 70:11-12. [PMID: 36082897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Mugundhan K
- Professor and HOD, Department of Neurology, Stanley Medical College, Chennai
| | - Rajesh Shankar Iyer
- Senior Consultant Neurologist, Department of Neurology KG Hospital, Coimbatore, Tamil Nadu, India
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Schmidt VF, Masthoff M, Brill R, Sporns PB, Köhler M, Schulze-Zachau V, Takes M, Ehrl D, Puhr-Westerheide D, Kunz WG, Shemwetta MD, Mbuguje EM, Naif AA, Sarkar A, Ricke J, Seidensticker M, Wohlgemuth WA, Wildgruber M. Image-Guided Embolotherapy of Arteriovenous Malformations of the Face. Cardiovasc Intervent Radiol 2022; 45:992-1000. [PMID: 35655034 PMCID: PMC9226106 DOI: 10.1007/s00270-022-03169-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/05/2022] [Indexed: 12/16/2022]
Abstract
Purpose To evaluate the safety and outcome of image-guided embolotherapy of extracranial arteriovenous malformations (AVMs) primarily affecting the face. Materials and Methods A multicenter cohort of 28 patients presenting with AVMs primarily affecting the face was retrospectively investigated. Fifty image-guided embolotherapies were performed, mostly using ethylene–vinyl alcohol copolymer-based embolic agents. Clinical and imaging findings were assessed to evaluate response during follow-up (symptom-free, partial relief of symptoms, no improvement, and progression despite embolization), lesion devascularization (total, 100%; substantial, 76–99%; partial, 51–75%; failure, < 50%; and progression), and complication rates (classified according to the CIRSE guidelines). Sub-analyses regarding clinical outcome (n = 24) were performed comparing patients with (n = 12) or without (n = 12) subsequent surgical resection after embolotherapy. Results The median number of embolotherapy sessions was 2.0 (range, 1–4). Clinical outcome after a mean follow-up of 12.4 months (± 13.3; n = 24) revealed a therapy response in 21/24 patients (87.5%). Imaging showed total devascularization in 14/24 patients (58.3%), including the 12 patients with subsequent surgery and 2 additional patients with embolotherapy only. Substantial devascularization (76–99%) was assessed in 7/24 patients (29.2%), and partial devascularization (51–75%) in 3/24 patients (12.5%). Complications occurred during/after 12/50 procedures (24.0%), including 18.0% major complications. Patients with subsequent surgical resections were more often symptom-free at the last follow-up compared to the group having undergone embolotherapy only (p = 0.006). Conclusion Image-guided embolotherapy is safe and effective for treating extracranial AVMs of the face. Subsequent surgical resections after embolization may substantially improve patients’ clinical outcome, emphasizing the need for multimodal therapeutic concepts. Level of Evidence Level 4, Retrospective study. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03169-0.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Peter B Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Köhler
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Victor Schulze-Zachau
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Takes
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Denis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Mwivano Dunstan Shemwetta
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eric M Mbuguje
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Azza A Naif
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Abizer Sarkar
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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66
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Brix ATH, Tørring PM, Kjeldsen AD, Bygum A, Schuster A, Nielsen TH. [Cutaneous capillary malformations with cerebral implementation]. Ugeskr Laeger 2022; 184:V03210220. [PMID: 35593371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Capillary malformations - arteriovenous malformation, hereditary hemorrhagic telangiectasia and Sturge-Weber syndrome - are rare diseases in which cutaneous capillary malformations (CM) may be associated with cerebral vascular malformations. The clinical presentation of each disease is described with focus on how to distinguish them in the clinic and differential diagnoses are listed. This review finds that upon thorough and careful examination of patients, cutaneous CM might be a diagnostic hallmark for underlying disease and therefore a significant clinical observation.
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Affiliation(s)
| | | | | | - Anette Bygum
- Klinisk Institut, Syddansk Universitet
- Klinisk Genetisk Afdeling, Odense Universitetshospital
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67
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Egashira Y, Azama S, Nojiri J, Takeshita G, Irie H. Embolization of renal arteriovenous malformation using double-balloon catheter. J Vasc Interv Radiol 2022; 33:1006-1008. [PMID: 35490931 DOI: 10.1016/j.jvir.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yoshiaki Egashira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Shinya Azama
- Department of Radiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Junichi Nojiri
- Department of Radiology, Medical Corporation Kouhoukai, Takagi Hospital, Fukuoka, Japan
| | - Go Takeshita
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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68
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Dash S, Singh A, Dawar R, Singhal M. Atypical case of arteriovenous malformation invading into a pedicled medial arm flap. BMJ Case Rep 2022; 15:e245545. [PMID: 35444019 PMCID: PMC9021813 DOI: 10.1136/bcr-2021-245545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/03/2022] Open
Abstract
A 54-year-old woman who had previously undergone total excision of an arteriovenous malformation (AVM) of lower lip and chin along with pedicled medial arm flap reconstruction, presented with recurrence of swelling in the same region. The patient reported progressive difficulty in feeding, talking and constant aching pain besides aesthetic concerns. On evaluation, recurrence of AVM with invasion into the flap substance was identified. We performed debulking surgery, which resulted in a considerable reduction in pain and improved lower lip functioning and aesthetic appeal of the face. This case is unique due to the rare presentation of an AVM invading the normal flap tissue. Such a finding has never been reported before for a pedicled flap, along with details of the histopathology and imaging description. There are lacunae in the understanding of the progression of vascular malformations and this additional information will add to the existing literature on AVM.
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Affiliation(s)
- Suvashis Dash
- Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amiteshwar Singh
- Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Dawar
- Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Maneesh Singhal
- Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
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69
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Franzetti G, Bonfanti M, Tanade C, Lim CS, Tsui J, Hamilton G, Díaz-Zuccarini V, Balabani S. A Computational Framework for Pre-Interventional Planning of Peripheral Arteriovenous Malformations. Cardiovasc Eng Technol 2022; 13:234-246. [PMID: 34611845 PMCID: PMC9114032 DOI: 10.1007/s13239-021-00572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/26/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Peripheral arteriovenous malformations (pAVMs) are congenital lesions characterised by abnormal high-flow, low-resistance vascular connections-the so-called nidus-between arteries and veins. The mainstay treatment typically involves the embolisation of the nidus, however the complexity of pAVMs often leads to uncertain outcomes. This study aims at developing a simple, yet effective computational framework to aid the clinical decision making around the treatment of pAVMs using routinely acquired clinical data. METHODS A computational model was developed to simulate the pre-, intra-, and post-intervention haemodynamics of a patient-specific pAVM. A porous medium of varying permeability was employed to simulate the sclerosant effect on the nidus haemodynamics. Results were compared against clinical data (digital subtraction angiography, DSA, images) and experimental flow-visualization results in a 3D-printed phantom of the same pAVM. RESULTS The computational model allowed the simulation of the pAVM haemodynamics and the sclerotherapy-induced changes at different interventional stages. The predicted inlet flow rates closely matched the DSA-derived data, although the post-intervention one was overestimated, probably due to vascular system adaptations not accounted for numerically. The nidus embolization was successfully captured by varying the nidus permeability and increasing its hydraulic resistance from 0.330 to 3970 mmHg s ml-1. The nidus flow rate decreased from 71% of the inlet flow rate pre-intervention to 1%: the flow completely bypassed the nidus post-intervention confirming the success of the procedure. CONCLUSION The study demonstrates that the haemodynamic effects of the embolisation procedure can be simulated from routinely acquired clinical data via a porous medium with varying permeability as evidenced by the good qualitative agreement between numerical predictions and both in vivo and in vitro data. It provides a fundamental building block towards a computational treatment-planning framework for AVM embolisation.
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Affiliation(s)
- Gaia Franzetti
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Mirko Bonfanti
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, 43-45 Foley Street, London, W1W 7TS, UK
| | - Cyrus Tanade
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Chung Sim Lim
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Division of Surgery & Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK
| | - Janice Tsui
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Division of Surgery & Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK
| | - George Hamilton
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Division of Surgery & Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK
| | - Vanessa Díaz-Zuccarini
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, 43-45 Foley Street, London, W1W 7TS, UK.
| | - Stavroula Balabani
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, 43-45 Foley Street, London, W1W 7TS, UK.
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Javed T, Kazmi Z, Butt A, Rahim W, Khan MA. Post-traumatic Renal Arteriovenous Malformation Discovered after 2 Years of Blunt Trauma: Diagnosis and Management. J Coll Physicians Surg Pak 2022; 32:S82-S84. [PMID: 35633022 DOI: 10.29271/jcpsp.2022.supp1.s82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/21/2021] [Indexed: 06/15/2023]
Abstract
Blunt trauma to the kidney is usually minor and self-limiting. In some cases, the patient may present with intractable hematuria or persistent flank pain and discomfort, which necessitates aggressive management. It is very rare and unusual to find a renal arterio-venous malformation following blunt trauma. This unusual presentation should be kept in mind when a patient presents with hematuria and history of blunt abdominal trauma. We report the case of a young male who suffered blunt abdominal trauma two years back, and continued to have on-and-off hematuria. After extensive work up, a diagnosis of renal arterio-venous malformation was made. His case was managed promptly with renal angio-embolization. Key Words: Blunt trauma, Arterio-venous malformation (AVM), Angio-embolisation, kidney.
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Affiliation(s)
- Tariq Javed
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Zehra Kazmi
- Department of Urology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Amna Butt
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Waqas Rahim
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Mohammad Ayaz Khan
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
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71
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Kota PB, Kota AA, Agarwal S, Keshava SN. De novo arteriovenous malformations in post-thrombotic limbs. BMJ Case Rep 2022; 15:e244576. [PMID: 35331999 PMCID: PMC8948383 DOI: 10.1136/bcr-2021-244576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 06/14/2023] Open
Abstract
A 50-year-old woman presented with progressive, painful and disabling swelling of the left lower limb following a left ovarian cyst excision 2 years ago. She had gross oedema of the left lower limb with multiple pubic varices. Contrast-enhanced CT and digital subtraction imaging revealed diffuse arteriovenous malformation (AVM) with feeders from the left internal iliac artery and a short segment significant stenosis of the proximal left common iliac vein. She underwent angioplasty and stenting of the left iliac vein. Her symptoms dramatically improved following the procedure and her limb swelling regressed within 6 months. The occurrence of post-thrombotic AVMs has been long established in the dural and portal systems. This report deals with an analogous phenomenon following iatrogenic deep venous thrombosis of the left lower limb, its pathogenesis, natural history and a review of treatment options.
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Affiliation(s)
- Prajna Bhargavi Kota
- Department of Vascular Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Albert Abhinay Kota
- Department of Vascular Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Sunil Agarwal
- Department of Vascular Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Shyamkumar N Keshava
- Department of Interventional Radiology, Christian Medical College and Hospital Vellore, Vellore, India
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72
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Zainudin Z, Azlisham N, Koh GT, Ooi YK, Nunis MA. Pulmonary arteriovenous malformations: A case of missed diagnosis in a neonate. Med J Malaysia 2022; 77:274-276. [PMID: 35338645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pulmonary arteriovenous malformation (PAVM) is a congenital vascular abnormality that can cause persistent cyanosis in children. PAVMs can go undetected till adulthood; however, there have been several neonatal cases reported over the years. This case report describes a classical manifestation of a child with isolated PAVM whose diagnosis was likely missed during the neonatal period. A high level of clinical awareness of this condition is crucial as early diagnosis and appropriate treatment can prevent lifethreatening complications and mortality. Diagnosis was confirmed by computed tomography pulmonary angiography and percutaneous transcatheter embolotherapy resulted in complete resolution of symptoms.
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Affiliation(s)
- Z Zainudin
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Paediatrics, Serdang, Selangor, Malaysia
| | - N Azlisham
- Hospital Pakar Sultanah Fatimah, Department of Paediatrics, Malaysia
| | - G T Koh
- Hospital Serdang, Department of Paediatrics, Malaysia
| | - Y K Ooi
- Hospital Serdang, Department of Paediatrics, Malaysia
| | - M A Nunis
- Hospital Serdang, Department of Paediatrics, Malaysia.
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73
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Prasad SN, Barman B, Singh V, Das KK. Combined endovascular and surgical management of a case of Cobb syndrome. BMJ Case Rep 2022; 15:e246821. [PMID: 35228229 PMCID: PMC8886381 DOI: 10.1136/bcr-2021-246821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
Cobb syndrome is a rare neurocutaneous disorder characterised by spinal and cutaneous vascular malformations in a metameric distribution. Managing such cases is a challenge for the interventionists and neurosurgeons as the results are often suboptimal. We describe a case of Cobb syndrome in a young male child who presented clinically with acute paraparesis and lower backache. On radiological workup, an intradural perimedullary complex spinal arteriovenous fistula was seen with presence of subarachnoid haemorrhage in the spinal canal and compressive myelopathy. There was a haemangioma in paraspinal muscles and a maculopapular cutaneous lesion in the lower back. He was treated with combined endovascular embolisation and surgical intervention and showed significant clinical improvement on follow-up.
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Affiliation(s)
- Surya Nandan Prasad
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Bapi Barman
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vivek Singh
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Goto C, Yatsu S, Wada H, Suwa S. Venous thrombosis via pulmonary arteriovenous malformation causing acute myocardial infarction in a relatively young female patient. BMJ Case Rep 2022; 15:15/2/e247846. [PMID: 35228242 PMCID: PMC8886400 DOI: 10.1136/bcr-2021-247846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pulmonary arteriovenous malformation (PAVM) is a probable cause of thromboembolic diseases such as acute myocardial infarction (MI); however, few cases have been reported. A woman in her early 40s developed acute-onset chest pain; an ECG showed ST-elevated MI. Emergency catheter angiography showed that the culprit lesion was a thrombus that was treated successfully with aspiration. She had a history of deep venous thrombosis and CT revealed PAVM. It was likely that the venous thrombus had moved into the coronary artery through the PAVM. Catheter embolisation of the PAVM was performed and she did not experience any other cardiac event until 6 months after embolisation.
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Affiliation(s)
- China Goto
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
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Ciftci E, Cakir O, Yucel Cicek OS, Cam I. Selective Arterial Embolisation of Uterine Arteriovenous Malformation in an Infertile Patient, subsequent Term Pregnancy and Postpartum Recurrence. J Coll Physicians Surg Pak 2022; 32:239-241. [PMID: 35108800 DOI: 10.29271/jcpsp.2022.02.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/09/2020] [Indexed: 06/14/2023]
Abstract
Uterine arteriovenous malformation (AVM) is a rare entity. This report describes selective catheterisation and embolisation of a uterine AVM in an infertile woman, subsequent spontaneous pregnancy and postpartum recurrence of the AVM treated with a second embolisation procedure. A 22-year woman presented with menometrorrhagia and failure to conceive. Pelvic magnetic resonance imaging showed a large uterine AVM. Selective catheterisation and embolisation of the AVM was performed. The patient conceived spontaneously two months later and delivered vaginally. A second embolisation was performed due to recurrence of uterine AVM at six months postpartum. This is the first case reporting postpartum recurrence of a pre-conceptionally treated uterine AVM. Selective catheterisation and embolisation is a minimally-invasive, fertility-preserving procedure that successfully treats uterine AVM and should be the treatment of choice when the patient desires pregnancy. Successful pregnancy and vaginal delivery following embolisation is possible; however, an increased awareness of postpartum AVM recurrence is required. Key Words: Fertility, Pregnancy, Therapeutic embolisation, Uterus, Arteriovenous malformation.
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Affiliation(s)
- Ercument Ciftci
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Cakir
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozge Senem Yucel Cicek
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Isa Cam
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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76
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Gao F, Ma X, Xu Y, Fu L, Guo X. Management of acquired uterine arteriovenous malformation associated with retained products of conception. J Vasc Interv Radiol 2022; 33:547-553. [PMID: 35093540 DOI: 10.1016/j.jvir.2022.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/09/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of different treatments for acquired uterine arteriovenous malformation associated with retained products of conception (UAVM-RPOC) and investigate the role of uterine artery embolization (UAE) in acquired UAVM-RPOC. MATERIALS AND METHODS This was a retrospective study of consecutive patients who presented with UAVM by ultrasound after recent termination pregnancy. 48 patients were included in this study, divided into two groups (massive and minor bleeding groups) according to vaginal bleeding. The treatments were analyzed between groups. Technical and clinical success of UAE was analyzed. RESULTS Of the 48 patients, 11 patients were in the massive bleeding group, and 37 were in the minor bleeding group. 5 patients were referred for UAE in each group, and UAE was a priority for patients with unstable hemodynamics (chi-square value=5.524, p=0.022). Conservative management, dilation and curettage (D&C), operative hysteroscopy, and UAE were performed in 16 (33%), 18 (38%), 7 (15%) and 13 (27%) patients, respectively. Two patients following ectopic pregnancy suffered uncontrollable bleeding during D&C and required UAE. Three patients underwent UAE before surgery to prevent hemorrhage. The technical and clinical success rate of UAE was 100%. No complications or recurrence occurred. CONCLUSION UAE is a safe and effective treatment for UAVM-RPOC and a priority for patients with unstable hemodynamics. Conservative management, D&C and hysteroscopy are safe and effective for UAVM-RPOC patients with stable hemodynamics. However, UAVM-RPOC following ectopic pregnancy may have high risks of massive hemorrhage during procedures.
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Affiliation(s)
- Feng Gao
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinwen Ma
- Department of Oncology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yali Xu
- Department of Radiology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Le Fu
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoqing Guo
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
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77
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Wu W, An FD, Piao CL, Tan MK, Si ZD, Xin L, Zhao N, Leng JJ. Management of pancreatic arteriovenous malformation: Case report and literature review. Medicine (Baltimore) 2021; 100:e27983. [PMID: 34941037 PMCID: PMC8702121 DOI: 10.1097/md.0000000000027983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pancreatic arteriovenous malformation (P-AVM) is a rare vascular malformation. Fewer than 200 cases have been reported. The clinical manifestations lack specificity. Common symptoms include abdominal pain, gastrointestinal hemorrhage, and jaundice, which is easily confused with other disorders. PATIENT CONCERNS A 42-year-old man received TAE due to abdominal pain caused by P-AVM in a local hospital, melena and abdominal pain occurred in a short time after TAE. DIAGNOSIS The patient was diagnosed as P-AVM which was confirmed by computed tomography and digital subtraction angiography. INTERVENTIONS A pylorus-preserving pancreatoduodenectomy was successfully performed after diagnosis was made. OUTCOMES The patient recovered with no complications two weeks after surgery, and no sign of recurrence was found during the 4-mo follow-up period. CONCLUSION In our experience, TAE may have limitations in the treatment of P-AVM and surgical resection should be considered as the treatment of choice.
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78
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Maruyama T, Kariya S, Nakatani M, Ono Y, Ueno Y, Komemushi A, Tanigawa N. Congenital pulmonary varix: Two case reports. Medicine (Baltimore) 2021; 100:e28340. [PMID: 34941138 PMCID: PMC8702259 DOI: 10.1097/md.0000000000028340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/01/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Patients with congenital pulmonary varix are asymptomatic and require no treatment, but the radiological characteristics of a pulmonary varix are similar to those of a pulmonary arteriovenous malformation, which requires treatment. Pulmonary angiography is useful for obtaining information about the dynamics of pulmonary blood flow to differentiate a pulmonary varix from a pulmonary arteriovenous malformation for the purpose of treatment planning. Two cases of congenital pulmonary varices that were differentiated from pulmonary arteriovenous malformations based on pulmonary angiography findings are presented. PATIENT CONCERNS AND DIAGNOSIS The first patient was an asymptomatic 39-year-old man. Non-contrast-enhanced computed tomography performed as part of the treatment course for pneumonia showed pulmonary arteriovenous malformation in the right lung. Pulmonary angiography was performed and showed that it was a pulmonary varix. The second patient was an asymptomatic 23-year-old woman. As part of her regular health check-up, she underwent plain chest X-ray examination, which showed an abnormal shadow. Non-contrast-enhanced computed tomography was performed, and pulmonary arteriovenous malformation was suspected. However, contrast-enhanced computed tomography findings suggested that the patient had a congenital pulmonary varix rather than a pulmonary arteriovenous malformation. Pulmonary angiography was subsequently performed for diagnosis, and a pulmonary varix was confirmed. INTERVENTIONS AND OUTCOMES No treatment was administered to either patient. The first patient was followed up for four years, and the second patient for two years. Both patients had no symptoms or complications during the follow-up period. LESSONS Two cases of congenital pulmonary varices were reported. Information about the dynamics of pulmonary blood flow obtained by performing pulmonary angiography was effective in distinguishing between pulmonary arteriovenous malformation and congenital pulmonary varix.
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79
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Choi SK, Min GE, Lee DG. Congenital Renal Arteriovenous Malformation: Diagnostic Clues and Methods. Medicina (B Aires) 2021; 57:medicina57121304. [PMID: 34946250 PMCID: PMC8706812 DOI: 10.3390/medicina57121304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background and objectives: Renal arteriovenous malformation (AVM) is a rare disease and is difficult to be diagnosed by conventional methods because of its rarity. In this study, we investigated the diagnostic clues, and made an algorithm for the better diagnosis of renal AVM. Materials and Methods: We reviewed 13 patients who were diagnosed with AVM by using renal angiography from 1986 to 2020 at our institutes. We evaluated clinical features, diagnostic tools, treatment modalities, and outcomes after the treatment of patients. Results: All patients were female, and the mean age was 36.9 years (range 19 to 54 years). Twelve (92.3%) patients complained of gross hematuria. Four (30.8%) patients showed symptoms in relation with pregnancy and delivery. Angiographic findings demonstrated cirsoid type in 10 patients and aneurysmal type in 3 patients. Among the 11 patients who underwent computed tomography, AVMs were detected in 3 (27.3%) patients. Renal duplex Doppler was performed in 6 patients, and all of these patients were diagnosed with AVM, demonstrating a vascular turbulence or blood-rich area. Twelve patients were initially treated with transarterial embolization. Nephrectomy was performed in two patients due to persistent bleeding with hypovolemic shock. Conclusions: We should consider possible AVMs in patients who were not detected by conventional work up for hematuria, especially in mid-aged, pregnant, or recently delivered women. Renal duplex Doppler might be the optimal diagnostic modality in these patients. Our diagnostic algorithm could be aid to diagnosis and treatment for renal AVM patients.
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Affiliation(s)
- Seung-Kwon Choi
- Department of Urology, Seoul Medical Center, Seoul 02053, Korea;
| | - Gyeong Eun Min
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 05278, Korea;
| | - Dong-Gi Lee
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 05278, Korea;
- Correspondence: ; Tel.: +82-2-440-7735; Fax: +82-2-440-7744
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80
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Kosseifi F, Brenier M, Boulay I, Durand X. Renal arteriovenous malformation and venous thrombosis: a tumour-like presentation. BMJ Case Rep 2021; 14:e245602. [PMID: 34785518 PMCID: PMC8596025 DOI: 10.1136/bcr-2021-245602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/04/2022] Open
Abstract
Renal arteriovenous malformation is a primarily congenital renal vascular abnormality. It is usually diagnosed incidentally on imaging, and the most common subtype is 'cirsoid', consisting of multiple, enlarged arterial feeders interconnecting with draining veins. We present a 74-year-old woman with an incidental finding of what was at first considered a hypervascularised kidney tumour but turned out to be a left intrarenal arteriovenous malformation associated with a left renal vein thrombosis. Selective endovascular embolisation was performed. The cause-consequence relationship between the arteriovenous malformation and the thrombosis is unique. To our knowledge, no such case has ever been reported.
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Affiliation(s)
- Fares Kosseifi
- Department of Urology, Paris Saint Joseph Hospital Group, Paris, France
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Martin Brenier
- Department of Urology, Paris Saint Joseph Hospital Group, Paris, France
| | - Isabelle Boulay
- Department of Radiology, Paris Saint Joseph Hospital Group, Paris, France
| | - Xavier Durand
- Department of Urology, Paris Saint Joseph Hospital Group, Paris, France
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81
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Chen CJ, Sheehan JP. Arteriovenous Malformation-A Real Can of Worms. Int J Radiat Oncol Biol Phys 2021; 111:854-855. [PMID: 34655560 DOI: 10.1016/j.ijrobp.2021.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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82
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Naito K. [Key of Classification and Diagnosis of Spinal Arteriovenous Malformation]. No Shinkei Geka 2021; 49:1346-1352. [PMID: 34879352 DOI: 10.11477/mf.1436204519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Spinal arteriovenous malformation(AVM)is a rare disease in which blood is received from the spinal feeding arteries. Owing to its rarity, there is limited experience regarding its diagnosis and treatment. In addition, the various classifications that have been proposed historically make it more difficult for the young neurosurgeons to understand this disease. Because delayed initial diagnosis leads to irreversible damage of the spinal cord, neurosurgeons should always consider spinal AVM as one of the differential diagnoses. In order to understand the pathological condition of spinal AVM, it is important to learn basic classification. Spinal AVM is classified as intradural, dural, and epidural. Spinal digital subtraction angiography(DSA)is the gold-standard for the diagnosis of spinal AVM and is indispensable toolfor treatment planning. The purpose of this paper is to summarize a basic classification and diagnosis of spinal AVM.
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83
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Cvetković D, Schiffmann Maag A, Bischof P, Fischer T, Fischer M, Minotti B. Construction Worker with Painful Swelling on the Hand. Ann Emerg Med 2021; 78:686-696. [PMID: 34688439 DOI: 10.1016/j.annemergmed.2021.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Dragan Cvetković
- Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | | | - Paul Bischof
- Department of Family Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Tim Fischer
- Division of Radiology and Nuclear Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Moritz Fischer
- Hand Surgery Department, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Bruno Minotti
- Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
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84
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Wu KH, Chang CP, Chang CC, Wu YF. A Man With Acute Back Pain. Ann Emerg Med 2021; 78:604-618. [PMID: 34688437 DOI: 10.1016/j.annemergmed.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Kai-Hsiang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Chia-Peng Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Che-Chia Chang
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan
| | - Yi-Fang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan
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85
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Schultz K, Divanovic A, Towe C, Miethke A, Wusik K, Hammill A, Brunner H. Clinicopathologic Conference: A Four-Year-Old Child With Digital Clubbing. Arthritis Care Res (Hoboken) 2021; 73:1379-1386. [PMID: 32813330 PMCID: PMC8518841 DOI: 10.1002/acr.24428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 07/23/2020] [Accepted: 08/13/2020] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Katie Wusik
- Cincinnati Children’s Hospital Medical CenterCincinnatiOhio
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86
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Abstract
Pulmonary arteriovenous malformation (PAVM) is well recognised as a cause of paradoxical brain embolism. The authors report the case of an older woman with a medical history of arterial hypertension who was found unconscious and was discovered to have pulmonary thromboembolism and ischaemic stroke related to a PAVM.
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Affiliation(s)
- Helena Luís
- Internal Medicine, SESARAM, Funchal, Portugal
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87
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Goda M, Suzuki T, Adachi H. Placental polyp with arteriovenous malformation treated with a gonadotoropin-releasing hormone antagonist. BMJ Case Rep 2021; 14:14/9/e244664. [PMID: 34497058 PMCID: PMC8438750 DOI: 10.1136/bcr-2021-244664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 35-year-old woman (gravida 1, para 0) underwent termination of pregnancy (ToP) at 12 weeks of gestation. One month after ToP, she experienced significant vaginal bleeding and the mass with blood flow was identified on imaging. The presence of a placental polyp with arteriovenous malformation (AVM) was suspected on transvaginal sonography and MRI. Since the bleeding had ceased when she visited our hospital, we decided to treat the placental polyp with AVM with gonadotropin-releasing hormone (GnRH) antagonist therapy instead of surgery. Two months after GnRH antagonist treatment, the mass and blood flow in the uterus disappeared. Menstruation resumed 1 month after the completion of treatment. In our case, we were able to successfully treat placental polyps with AVM using GnRH antagonist therapy.
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Affiliation(s)
- Mayuko Goda
- Obstetrics and gynaecology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Takashi Suzuki
- Obstetrics and gynaecology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Hiroshi Adachi
- Obstetrics and gynaecology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
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88
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Mi J, Dong H, Wan L, Zou D, Li Z, Tian Z, Wang Z, Liu N, Chen Y. Diagnosis of Vascular Rupture Due to Arteriovenous Malformation Using Postmortem Angiography and 3-Dimensonal Printing: A Case Report. Am J Forensic Med Pathol 2021; 42:258-262. [PMID: 34397510 DOI: 10.1097/paf.0000000000000658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Postmortem computed tomography (PMCT), PMCT angiography, and 3-dimensonal (3D) printing technology are increasingly applied to forensic practice. Although their effectiveness is undeniably confirmed, their potential role in practice still needs to be further explored. Here, we report a typical case in which such 4 technologies were applied to a woman found dead with stomach content beneath the head on the pillow in her residence. At first, the cause of death was simply considered as hypertensive cerebral hemorrhage after preliminary examination. However, the initial judgment was questioned by her family for her devoid of hypertension history. As indicated by the targeted PMCT with cerebral angiography, the woman died of pathological cerebral hemorrhage due to arteriovenous malformation, which was still unconvincing enough for the family because in violent death, some cerebral hemorrhage could also be located in the same position. Finally, the family came to be convinced when the close connection between the deformed blood vessels and hematoma was perfectly demonstrated by the application of 3D printing technology. This study proved that it can be an efficient tool for identifying the cause of death when the integration is made of 3D printing technology and PMCT angiography, as a more intuitive evidence of forensic science.
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Affiliation(s)
| | - Hewen Dong
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Lei Wan
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Donghua Zou
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Zhengdong Li
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Zhiling Tian
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Zhuoqun Wang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Ningguo Liu
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
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89
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Nilesh K, Shah S, Gautam A, Thorat S. Uncontrolled bleeding during tooth extraction from an undiagnosed arteriovenous malformation. BMJ Case Rep 2021; 14:e236983. [PMID: 34446508 PMCID: PMC8395353 DOI: 10.1136/bcr-2020-236983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/04/2022] Open
Abstract
Arteriovenous malformations (AVMs) are rare congenital disorders of vascular morphogenesis. These lesions are characterised by high vascular flow with risk of severe bleeding from accidental trauma or surgical manipulation. Although infrequent, potentially life-threatening and fatal oral bleeding has been reported during extraction of tooth associated with AVM. This paper presents a case of uncontrolled bleeding in an adult female patient undergoing mandibular anterior tooth extraction. The bleeding was related to undiagnosed soft tissue AVM in gingivobuccal space. Management of the case with review of previously reported similar cases is presented.
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Affiliation(s)
- Kumar Nilesh
- Oral and Maxillofacial Surgery, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - Swenil Shah
- Department of Radiology, RCSM Government Medical College, Kolhapur, India
| | - Amol Gautam
- Department of Radiodiagnosis, Krishna Institute of Medical Sciences Deemed University, Karad, India
| | - Sagar Thorat
- Department of Oral and Maxillofacial Surgery, Krishna Deemed University, Karad, India
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90
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Schimmel K, Ali MK, Tan SY, Teng J, Do HM, Steinberg GK, Stevenson DA, Spiekerkoetter E. Arteriovenous Malformations-Current Understanding of the Pathogenesis with Implications for Treatment. Int J Mol Sci 2021; 22:ijms22169037. [PMID: 34445743 PMCID: PMC8396465 DOI: 10.3390/ijms22169037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022] Open
Abstract
Arteriovenous malformations are a vascular anomaly typically present at birth, characterized by an abnormal connection between an artery and a vein (bypassing the capillaries). These high flow lesions can vary in size and location. Therapeutic approaches are limited, and AVMs can cause significant morbidity and mortality. Here, we describe our current understanding of the pathogenesis of arteriovenous malformations based on preclinical and clinical findings. We discuss past and present accomplishments and challenges in the field and identify research gaps that need to be filled for the successful development of therapeutic strategies in the future.
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Affiliation(s)
- Katharina Schimmel
- Division Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA; (K.S.); (M.K.A.)
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA 94305, USA
| | - Md Khadem Ali
- Division Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA; (K.S.); (M.K.A.)
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA 94305, USA
| | - Serena Y. Tan
- Department of Pathology, Stanford University, Stanford, CA 94305, USA;
| | - Joyce Teng
- Department of Dermatology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA 94305, USA;
| | - Huy M. Do
- Department of Radiology (Neuroimaging and Neurointervention), Stanford University, Stanford, CA 94305, USA;
- Department of Neurosurgery and Stanford Stroke Center, Stanford University, Stanford, CA 94305, USA;
| | - Gary K. Steinberg
- Department of Neurosurgery and Stanford Stroke Center, Stanford University, Stanford, CA 94305, USA;
| | - David A. Stevenson
- Department of Pediatrics, Division of Medical Genetics, Stanford University, Stanford, CA 94305, USA;
| | - Edda Spiekerkoetter
- Division Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA; (K.S.); (M.K.A.)
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-(650)-739-5031
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91
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Ota T. Letter to the Editor Regarding "Cerebellar Arteriovenous Malformation with Coexistent Hemangioblastoma". World Neurosurg 2021; 150:213. [PMID: 34098634 DOI: 10.1016/j.wneu.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
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92
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Funaki B, Zangan S. Pulmonary Arteriovenous Malformation Embolization: So Much Left to Learn. J Vasc Interv Radiol 2021; 32:1009-1010. [PMID: 34210474 DOI: 10.1016/j.jvir.2021.03.543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Brian Funaki
- Department of Vascular and Interventional Radiology, University of Chicago Medicine, 5840 S. Maryland Ave., MC 2026, Chicago, IL 60546.
| | - Steven Zangan
- Department of Vascular and Interventional Radiology, University of Chicago Medicine, 5840 S. Maryland Ave., MC 2026, Chicago, IL 60546
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93
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He C, Li J. Arteriovenous Malformations in the Setting of Giant Elephantiasis Neuromatosa. Mayo Clin Proc 2021; 96:1710-1711. [PMID: 34218851 DOI: 10.1016/j.mayocp.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Chunni He
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China.
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94
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Yamada M, Iwamoto H, Konno O, Kihara Y, Akashi I, Okihara M, Oda T. Pelvic arteriovenous malformation in a kidney transplant recipient. Kidney Int 2021; 100:246. [PMID: 34154715 DOI: 10.1016/j.kint.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Muneharu Yamada
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan.
| | - Hitoshi Iwamoto
- Kidney Disease Center, Department of Kidney Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Osamu Konno
- Kidney Disease Center, Department of Kidney Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Yu Kihara
- Kidney Disease Center, Department of Kidney Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Isao Akashi
- Kidney Disease Center, Department of Kidney Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Masaaki Okihara
- Kidney Disease Center, Department of Kidney Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Takashi Oda
- Kidney Disease Center, Department of Nephrology and Blood Purification, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
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95
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Campos CI, Kujundzic W, Vergara-Galliadi LM, Ávila F, Nieto-Calvache AJ. Diffuse Uterine Arteriovenous Malformations as an Unusual Cause of Secondary Postpartum Hemorrhage. Journal of Obstetrics and Gynaecology Canada 2021; 45:177-178. [PMID: 35589526 DOI: 10.1016/j.jogc.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Clara Ivette Campos
- Fundación Valle del Lili, Pathology and Blood Bank Department, Cali, Colombia 760032
| | - Winy Kujundzic
- Universidad Icesi, Medicine Program, Cali, Colombia, 760032
| | | | - Fernando Ávila
- Fundación Valle del Lili, Tertiary Obstetric Care Unit, Cali, Colombia, 760032
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Kitagawa S, Ishikawa S, Misawa H. Extraluminal Duodenal Gastrointestinal Stromal Tumor with Arteriovenous Malformation. Intern Med 2021; 60:1789-1790. [PMID: 33328408 PMCID: PMC8222139 DOI: 10.2169/internalmedicine.6318-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sho Kitagawa
- Department of Gastroenterology, Sapporo Kosei General Hospital, Japan
| | - Shori Ishikawa
- Department of Gastroenterology, Sapporo Kosei General Hospital, Japan
| | - Hiraku Misawa
- Department of Gastroenterology, Sapporo Kosei General Hospital, Japan
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Abstract
Renal arteriovenous malformations (AVMs) are infrequent vascular morphological anomalies. About 20% of AVMs are congenital renal AVMs (CRAVMs). A 53-year-old female patient presented with a 5-day history of gross hematuria and right flank pain. The patient underwent the selective renal arteriography and embolization under local anesthesia. Renal computed tomography angiography (CTA) and digital subtraction angiography (DSA) results showed bleeding of the right renal arteriovenous malformation, both nidus and aneurysm, which indicated that the patient had both cirsoid and cavernosal types of CRAVM. Endovascular management was chosen to treat the patient. The patient was cured and discharged, then followed-up for 3 months. These results show that early identification using radiologic tests is important for diagnosis and treatment of CRAVM.
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Affiliation(s)
- Jieru Cai
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; The Institute for Gastroenterology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Li Ding
- Nursing Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yiwen Xie
- Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; The Institute for Gastroenterology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yuyong Wang
- Department of Urology, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Yuyong Wang, No. 261, Huansha Road, Department of Urology, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China. Emails: ;
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98
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Li Z, Ye M, Hu L, Gu C, Zhang N, Wang M, Zhang X, Meng Y, Li L. A Successful Pregnancy after Laparoscopic Surgery: Severe Recurrent Pelvic Arteriovenous Malformation Managed by Laparoscopic Internal Iliac Artery Ligation. J Minim Invasive Gynecol 2021; 28:1568. [PMID: 33894377 DOI: 10.1016/j.jmig.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/31/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To show a case of severe pelvic arteriovenous malformation (AVM) treated by laparoscopic internal iliac artery ligation after 2 uterine artery embolization (UAE) procedures, where successful pregnancy was achieved after surgery. DESIGN Stepwise demonstration of the technique with a video. SETTING Chinese PLA General Hospital. INTERVENTIONS A 36-year-old woman with heavy menstrual bleeding was diagnosed with pelvic AVM by computed tomography scan. Before surgical intervention, she underwent 2 UAE procedures that temporarily reduced menstrual blood loss. Finally, we performed a laparoscopic internal iliac artery ligation on her. After the surgery, she conceived naturally. During the cesarean section, no AVMs were found. CONCLUSION Laparoscopic internal iliac artery ligation can be a choice for patients who still have severe symptoms of AVM after UAE.
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Affiliation(s)
- Zhen Li
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China (all authors)
| | - Mingxia Ye
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China (all authors)
| | - Lingyun Hu
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China (all authors)
| | - Chenglei Gu
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China (all authors)
| | - Nina Zhang
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China (all authors)
| | - Mingyang Wang
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China (all authors)
| | - Xiaoyan Zhang
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China (all authors)
| | - Yuanguang Meng
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China (all authors)
| | - Lian Li
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China (all authors).
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99
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Jubashi A, Yamaguchi D, Nagatsuma G, Inoue S, Tanaka Y, Yoshioka W, Hino N, Morisaki T, Ario K, Fukui K, Ishimaru H, Tsunada S. Successful retrograde transvenous embolization under balloon occlusion for rectal arteriovenous malformation. Clin J Gastroenterol 2021; 14:594-598. [PMID: 33420667 PMCID: PMC8016791 DOI: 10.1007/s12328-020-01335-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/25/2020] [Indexed: 11/29/2022]
Abstract
A 57-year-old man was admitted to our hospital because of frequent hematochezia. Colonoscopy exhibited a submucosal tumor-like lesion in the lower rectum. Abdominal contrast-enhanced computed tomography showed a rectal arteriovenous malformation (AVM) on the right side wall of the lower rectum. The feeder was the superior rectal artery, with early venous return. Embolization of the draining vein and feeding artery of the AVM with N-butyl-2-cyanoacrylate under balloon occlusion was planned. Angiography of the superior rectal artery showed the nidus in the rectum with early venous return of contrast material. The portal vein was punctured percutaneously under ultrasound guidance, and a balloon catheter advanced to the distal part of the superior rectal vein. Venography under balloon occlusion showed the outflow vein and nidus. Transvenous and transarterial nidus embolization with N-butyl-2-cyanoacrylate under balloon occlusion was then performed. Since the embolization, there have been no further episodes of bleeding. There is no established treatment for AVMs. Successful treatment requires targeting and eradication of the nidus. We successfully performed embolization therapy for a rectal AVM via a retrograde transvenous approach. This technique may be suitable for completely eradicating the nidus without the risk of embolism.
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Affiliation(s)
- Amane Jubashi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan.
- Division of Gastroenterology, Department of Internal Medicine, Saga University, Saga, 849-8501, Japan.
| | - Goshi Nagatsuma
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Suma Inoue
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yuichiro Tanaka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Wataru Yoshioka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Naoyuki Hino
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Tomohito Morisaki
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Keisuke Ario
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Kenichiro Fukui
- Department of Radiology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | | | - Seiji Tsunada
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
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Gan F, Vikneswaran V, Yu KK. Uterine arteriovenous malformation - Possible association to uterine fibroids? Med J Malaysia 2021; 76:273-274. [PMID: 33742646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 32-year-old, gravida 2 para 0+1, was managed in Selayang Hospital, Selangor for uterine fibroids in pregnancy and placenta previa major. The lady went into preterm labour at 33 weeks, requiring emergency Caesarean section. Intraoperatively, we found a thinned-out bulge between the intramural uterine fibroids at the posterior uterine wall, which then perforated and was repaired. Persistent bleeding post operatively led to relaparotomy and hysterectomy. Histology of the uterus reported arteriovenous malformation (AVM). We postulate the possibility of these lesions coexisting with uterine fibroids. Screening for uterine AVMs in patients with fibroids may lead to early detection with option of embolization; deferring the need for hysterectomy.
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Affiliation(s)
- F Gan
- Selayang Hospital, Department of Obstetrics and Gynaecology, Selangor, Malaysia.
| | - V Vikneswaran
- Selayang Hospital, Department of Obstetrics and Gynaecology, Selangor, Malaysia
| | - K K Yu
- Selayang Hospital, Department of Obstetrics and Gynaecology, Selangor, Malaysia
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