Endovascular Embolization versus Observation of Congenital Renal Arteriovenous Malformations: A Retrospective Study

This study retrospectively compared outcomes associated with endovascular embolization to those with observation in patients with congenital renal arteriovenous malformations (AVMs). Chart and imaging review of patients at a single center with congenital renal AVM was performed. Patient demographics, Yakes classification, renal vessel size, and presenting symptoms were recorded. Procedural imaging and follow-up data were analyzed to identify adverse events, complications, and potential advantages of embolization over observation. Eighteen patients had congenital renal AVM, 11 were observed and 7 underwent transarterial embolization. There was a significantly greater number of patients with complications related to AVM in the observation group compared with patients with adverse events in the embolization group (P = .015). This included 2 observed patients with AVM rupture requiring nephrectomy, both of whom had Type I AVM. Endovascular embolization should be considered for all patients with congenital renal AVM. Specifically, Yakes Type I AVM may deserve special consideration for intervention.

Multimodal Ultrasound Diagnosis of Congenital Renal Arteriovenous Malformation: A Case Report

Traditionally, computed tomography angiography has been considered the gold standard for diagnosing renal arteriovenous malformation (AVM). Despite the sensitivity of ultrasound in detecting AVM through Doppler techniques, it often lacks the ability to provide detailed insights into the lesion. In this narrative, we present a case of unexplained hematuria accompanied by flank pain, which was conclusively diagnosed as congenital renal AVM via multimodal ultrasound. The pivotal contributions of color Doppler ultrasound and contrast-enhanced ultrasound are that they are instrumental in enabling an early and markedly precise diagnostic pathway.

An unsuspected case of uterine arteriovenous malformation with nidus aneurysm following vaginal delivery: Diagnostic challenges and management

Uterine arteriovenous malformations (AVMs) are rare but potentially life-threatening cause of postpartum hemorrhage (PPH). Accurate differentiation from other PPH causes, such as retained products of conception (RPOC) and gestational trophoblastic disease (GTD), is imperative, as inadvertent improper management such as uterine curettage may cause catastrophic bleeding with high mortality rates. We present the case of 35-year-old woman who presented with excessive vaginal bleeding 2 months postnormal vaginal delivery. Initial ultrasound findings raised suspicion of uterine AVM with a differential diagnosis of type 3 RPOC. Further imaging with computed tomography angiography (CTA) and digital subtraction angiography (DSA) confirmed an underlying uterine AVM with a nidus aneurysm. The patient subsequently was treated with successful embolization and was discharged in stable condition.

Imaging in Acute Obstetric Conditions: A Pictorial Essay

Acute abdominopelvic pain during pregnancy and the postpartum period is a diagnostic challenge owing to the overlapping symptoms of obstetric, gastrointestinal, and urinary conditions coupled with pregnancy-induced physiological changes. This pictorial essay reviews critical obstetric emergencies and categorizes cases into two phases: the first covers the preconception-to-pregnancy period, while the second focuses on the postpartum period. This essay covers key obstetric emergencies, such as ovarian hyperstimulation syndrome, hyperreactio luteinalis, ectopic pregnancy, red degeneration of fibroids, placenta accreta spectrum disorders, placental abruption, uterine rupture, retained products of conception, and uterine arteriovenous malformations, with an emphasis on their clinical and imaging characteristics. While ultrasound remains the first-line modality, MRI offers superior soft tissue contrast for more complex cases, and CT is reserved for critical scenarios in which the radiation risk is outweighed by diagnostic necessity. Timely and accurate imaging is essential for differentiating these conditions, guiding interventions, such as uterine arterial embolization and surgery, and minimizing maternal and fetal morbidity. This work aims to enhance the diagnostic precision and multidisciplinary management of obstetric emergencies, ensuring optimal clinical outcomes.

Uterine Arteriovenous Malformation: A Rare Cause of Postpartum Hemorrhage

Uterine arteriovenous malformation (AVM) is a rare but serious cause of secondary postpartum hemorrhage (PPH). Although its overall prevalence in the general population remains uncertain, uterine AVM is recognized as an underdiagnosed condition due to its nonspecific symptoms and variable presentation. It poses significant diagnostic and therapeutic challenges, especially when presenting in the delayed postpartum period. Uterine AVM can be acquired following uterine instrumentation or trauma, leading to abnormal vascular connections within the uterine wall. This study describes a unique instance of uterine AVM identified after a cesarean section in a patient with an in vitro fertilization (IVF)-conceived pregnancy, highlighting the potential implications of assisted reproductive techniques on uterine vascular remodeling. Early recognition and multidisciplinary management ensured successful treatment, preserving the patient's fertility and preventing severe complications.

Multimodal approach in distinguishing and managing uterine arteriovenous malformation: A case report

Arteriovenous malformations (AVMs) are abnormal vascular connections bypassing the capillary system, categorized as acquired or congenital. Acquired uterine AVMs, often resulting from uterine trauma due to procedures like dilatation and curettage, can be life threatening, necessitating prompt diagnosis and management. Here we present a 34-year-old woman with a history of missed abortion and dilatation and curettage presenting with abnormal uterine bleeding 2 months postprocedure. Although initial transvaginal ultrasound suggested retained products of conception, several modalities were required to accurately diagnose uterine AVM with invasive angiography revealing the culprit vessel. Multimodal imaging approaches are crucial for accurate diagnosis and treatment. This case highlights the importance of prompt and precise management to prevent severe outcomes and maintain fertility, emphasizing the need for continued research to improve treatment strategies.

Flank pain, hypertension, and hematuria: CT and 3D cinematic rendering in the evaluation of renal artery emergencies-a pictorial essay

Non-traumatic acute renal artery emergencies encompass a spectrum of etiologies, including renal artery stenosis, arteriovenous malformations, aneurysms and pseudoaneurysms, dissections, thrombosis, and vasculitis. Prompt and accurate diagnosis in the emergency setting is crucial due to the potential for significant morbidity and mortality. Computed tomography (CT) and CT angiography (CTA) are the mainstay imaging modalities, offering rapid acquisition and high diagnostic accuracy. The integration of 3D postprocessing techniques, such as 3D cinematic rendering (CR), improves the diagnostic workflow by providing photorealistic and anatomically accurate visualizations. This pictorial essay illustrates the diagnostic utility of CT and CTA, supplemented by 3D CR, through a series of 10 cases of non-traumatic renal artery emergencies. The added value of 3D CR in improving diagnostic confidence, surgical planning, and understanding of complex vascular anatomy is emphasized.

A case of coexistence of multiple vascular anomalies including the absence of a left internal carotid artery, a left vertebral artery arising from the subclavian artery in a high cervical location, and a bovine arch associated with vertebral fusion

We report a rare 16-year-old male case of Klippel-Feil anomaly associated with fetal alcohol syndrome exhibiting complex congenital vascular anomalies. The congenital vascular anomalies observed were the absence of a left internal carotid artery, a left vertebral artery arising from the subclavian artery in a very high cervical location and a bovine arch. The vascular and vertebral anomalies were evaluated using CT and MRI before cervical surgery.

A comprehensive diagnostic approach to differentiate intrauterine arteriovenous malformation in cases of enhanced myometrial vascularity

PURPOSE

The differentiation between conditions such as uterine arteriovenous malformation, pseudoaneurysm, gestational trophoblastic disease, and retained trophoblastic tissue can be challenging. Ultrasound imaging and Doppler interrogation are the primary diagnostic tools to assess cases of enhanced myometrial vascularity and differentiate intrauterine vascular anomalies. However, some cases remain of difficult differentiation. This study aims to analyze suspected cases and describe their diagnostic management and outcomes.

METHODS

We reviewed post-abortion cases that underwent pelvic transvaginal U/S imaging and Doppler examinations due to suspected uterine vascular anomalies. CT scans were performed in cases in which ultrasound did not reach a diagnosis. Simple follow-up, medical or surgical therapy, or embolization of uterine arteries were performed according to the final diagnosis.

RESULTS

From 2015 to 2022, we retrieved from electronic ultrasound records 22 cases of suspected vascular malformations. In eight cases, first-line U/S at admission excluded the suspected anomaly. In Five of the remaining 14 patients, uterine vascular anomalies were excluded upon a second-level  U/S based on angio-Doppler imaging and Doppler peak velocity interrogation. Nine cases underwent CT scan, and a digital angiography and embolization were performed in eight of these cases, of whom only two had a documented uterine arteriovenous malformation.

CONCLUSION

Our triage proved that only two out of 22 suspected cases had a uterine arteriovenous malformation. This diagnosis is frequently misused in clinical practice. Our data confirm that enhanced myometrial vascularity should be used to encompass the spectrum of possible differential diagnosis. A precise step-by-step diagnostic method is of paramount importance to prevent unnecessary interventions.

The rise of the machines: are robots the future of renal artery aneurysm repair? A systematic review

Renal artery aneurysms (RAAs) are a rare vascular condition. Robot-assisted surgery offers a minimally invasive approach for RAA repair, potentially improving surgical outcomes. This review investigates the current evidence on the effectiveness and limitations of this technique. A systematic search following PRISMA guidelines identified relevant studies across five electronic databases. Studies investigating the use of robot-assisted surgery for RAA repair were included. The review identified 11 studies encompassing a total of 23 patients. Procedures included aneurysmectomy, end-to-end anastomosis, prosthetic graft repair, and even coil embolization. All surgeries were successful, with only minor complications reported in four cases. Robot-assisted RAA repair shows promise as a minimally invasive approach with encouraging preliminary outcomes. However, the limited data come from small studies. Future advancements in robotic technology hold the potential to optimize this approach for improved patient care.

Rare Incidental Finding of Multiple Pseudoaneurysms After Imaging-Guided Kidney Biopsy in a Patient With Lupus Nephritis: A Case Report and Literature Review

Renal pseudoaneurysms are serious and rare vascular lesions. They can be seen in vasculitis or, more commonly, after renal biopsy, percutaneous renal surgery, penetrating trauma, and less frequently due to blunt renal trauma. We present the case of a 28-year-old woman with lupus nephritis accompanied by the incidental finding of renal pseudoaneurysms in both kidneys after an elective percutaneous renal biopsy of the left kidney. An abdominal CT scan showed a subcapsular hematoma and likely intraparenchymal lower pole hematoma. Two days after the procedure, angiography showed multiple pseudoaneurysms in the left kidney as well as a pseudoaneurysm in the upper pole of the right kidney.

A Huge High-Flow Aneurysmal Renal Arteriovenous Malformation Treated With Endovascular Transcatheter Embolization

Renal arteriovenous anomalies are uncommon. They are characterized by an abnormal vascular connection that usually bypasses the capillary bed. Most are acquired arteriovenous fistulas (AVF) while the rest are congenital or idiopathic arteriovenous malformations (AVM). AVF are usually caused by renal interventions, trauma, or neoplastic processes. They can lead to hypertension, heart failure, hematuria, and renal insufficiency. A 69-year-old woman presented with arrhythmia, tachycardia, mild ankle edema, and increasing fatigue. Right kidney color Doppler ultrasound confirmed the presence of a huge AVM with a blood flow of 9 L/minute and a dilated, 35 mm in diameter, right renal vein. Two months later, an attempt to embolize the AVM failed as the Amplatzer™ Vascular Plug II (Abbott Laboratories, Chicago, Illinois, United States) migrated to the pulmonary circulation and was later removed. Complete embolization was achieved by implanting two Amplatzer Vascular Plug IIs, various embolization coils, histoacryl glue, and lipiodol. Control angiography revealed significant stenosis in the right subclavian artery endovascular access, which was managed with BeGraft (Bentley InnoMed GmbH, Hechingen, Germany) and Zilver (Cook Group Incorporated, Bloomington, Indiana, United States) stents. The patient was discharged on the third postoperative day, all her symptoms resolved, and she reported eventual recovery. Three months later, the patient was operated on due to a 40x58 mm pseudoaneurysm at the right femoral access site. Thus, renal AVMs should be included as a potential alternative diagnosis for various symptoms such as hematuria and hypertension resistant to medication. Endovascular embolization is a less-invasive, safer, and more effective option than open surgery but has a risk of complications. Success requires fully occluding the shunted vessel, preventing embolic material migration, and preserving normal arterial branches. It depends on selecting adequate techniques and embolic materials individually, based on etiology and precise vascular anatomy assessment.

Minimally Invasive Endovascular Management of Uterine Arteriovenous Malformations: A Single Center Experience and Case Series

Uterine arteriovenous malformations (UAVMs) are rare and abnormal entanglements of uterine arteries and veins that are potentially fatal, requiring blood transfusions in about a third of cases. Although the optimal management of the condition is not well established in the literature, surgical hysterectomy is believed to be the only definitive treatment for arteriovenous malformations. We present three cases of UAVMs treated by a minimally invasive endovascular approach. Chief complaints were heavy menstrual bleeding and sudden onset heavy bleeding. The diagnosis was confirmed by computed tomography imaging and angiography of the pelvic vessels. Uterine artery embolization (UAE) was performed in all patients. The follow-up period was uneventful. In our experience, the UAE provides satisfactory results in terms of success rates, complications, and short hospital stays.

A tumor-like renal arteriovenous malformation on 18F-PSMA-1007 PET/CT: a case report

Background

Renal arteriovenous malformations (rAVMs) are congenital abnormal pathways between renal arteries and veins that are rare in the general population. It is often misdiagnosed as malignant renal tumors with abundant blood supply, and the definitive diagnosis primarily relies on angiography. Multimodality imaging, including contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT plays an important role in the differential diagnosis of renal space-occupying lesions.

Case presentation

A 56-year-old man presented with abdominal distension, loss of appetite, and back pain without obvious cause 2 years ago, without nausea vomiting, or frequent urination. Gastroscopy and colonoscopy showed multiple polyps in the duodenum and colon. Abdomen contrast-enhanced CT revealed a mass of 1.6 × 1.4 cm in the left kidney, which was considered to be a malignant tumor. PET/CT was performed for further diagnosis; the 18F-fluorodesoxyglucose (18F-FDG) PET/CT scan showed mild uptake in the left renal mass, while no uptake of 18F- prostate-specific membrane antigen (PSMA) was observed. Following a multidisciplinary discussion, the possibility of renal AVMs was considered and subsequently confirmed by renal angiography as the diagnosis. Then, selective segmental renal artery embolization was performed for treatment.

Conclusion

Renal AVMs are extremely rare in clinical practice. Due to limited research on the application of 18F-FDG and 18F-PSMA PET/CT to renal AVMs, its role remains largely unexplored. With the increasing popularity of PET/CT imaging, comprehensive imaging of the disease has become indispensable. We report the first case of PSMA PET/CT imaging in renal AVMs, and when PSMA expression is absent in a renal mass, the possibility of renal AVMs should be considered.

Uterine Arteriovenous Malformation: Diagnostic and Therapeutic Challenges

Uterine arteriovenous malformations are a rare cause of puerperal haemorrhage, but their incidence is increasing due to both improved diagnosis and the more frequent use of uterine surgery in recent years. The use of ultrasound, both B-mode and Doppler, is recommended for diagnosis and follow-up, as it has been shown to be the simplest and most cost-effective method. Endometrial thickening associated with an anechoic and vascular intramiometrial structure is very useful for diagnosis and can help to exclude other causes of dysfunctional bleeding. Pulsed Doppler shows low-resistance vessels and high pulsatility indices with a high peak systolic velocity (PSV). In a healthy myometrium, the vessels have a peak systolic velocity of 9-40 cm/s and a resistance index between 0.6 and 0.8, whereas in the case of AVMs, the systolic and diastolic velocities are 4-6 times higher (PSV 25-110 cm/s with a mean of 60 cm/s and a resistance index of 0.27-0.75 with a mean of 0.41). For treatment, we must individualise each case, taking into account haemodynamic stability, the patient's reproductive wishes, and the severity of the AVM as assessed by its size and PSV.

Post-traumatic renal arteriovenous malformation failed endovascular embolization

Renal arteriovenous malformations (AVMs) are abnormal connections between the renal arteries and venous system. Arteriovenous fistulas account for 70%-80% of renal arteriovenous abnormalities, often resulting from iatrogenic injuries. While most renal AVMs are asymptomatic, hematuria is a common symptom caused by AVM rupture into the renal calyces. Angiography is the gold standard for diagnosis, but noninvasive imaging techniques like ultrasound, computed tomography, or magnetic resonance imaging are commonly used for initial evaluation. Most renal AVMs are managed conservatively. Symptomatic patients typically undergo endovascular embolization, the preferred treatment, while surgery is reserved for unstable patients or those with complex vascular anatomy. We present a case of a 32-year-old man with renal AVMs following a motor vehicle accident. The patient initially received unsuccessful endovascular embolization but achieved successful treatment through open fistula ligation. This case highlights the challenges in managing renal AVMs and the importance of considering alternative interventions when initial treatments prove ineffective.

The Management of Uterine Arteriovenous Malformations in Obstetrics

Uterine arteriovenous malformation (AVM) is a rare but serious condition that can cause heavy uterine bleeding. It occurs when abnormal connections form between the arteries and veins in the uterus, leading to significant health complications. Accurate identification and diagnosis are crucial because overlooking or mishandling them can lead to severe, life-threatening bleeding. We present the case of a 30-year-old patient presenting with abnormal uterine bleeding 15 days after she gave birth to her second child. The ultrasound examination showed images suggestive of retained ovuloplacental remnants, so a uterine aspiration was performed, but the patient presented severe vaginal bleeding. Subsequently, magnetic resonance imaging (MRI) was performed, demonstrating the presence of a prominent lesion in the posterior wall of the uterine body with multiple serpentine-like pathways and a signal void suggestive of aberrant vessels corresponding to AVMs. Ergotrate and misoprostol were administered to control the bleeding, and a Bakri balloon was inserted and maintained until the bleeding stopped. We are highlighting this case to emphasize the importance of considering uterine AVM (UAVM) when dealing with abnormal uterine bleeding, even in the postpartum period. Due to its rarity, there is a lack of substantial evidence to guide clinicians in managing this condition.

Imaging of Visceral Vessels

The visceral vasculature is inextricably intertwined with abdominopelvic disease staging, spread, and management in routine and emergent cases. Comprehensive evaluation requires specialized imaging techniques for abnormality detection and characterization. Vascular pathology is often encountered on nondedicated routine imaging examinations, which may obscure, mimic, or confound many vascular diagnoses. This review highlights normal arterial, portal venous, and systemic venous anatomy and clinically relevant variants; diagnostic pitfalls related to image-acquisition technique and disease mimics; and characteristics of common and rare vascular diseases to empower radiologists to confidently interpret the vascular findings and avoid misdiagnosis.

Acute Abdominal Pain Without Gross Hematuria as an Atypical Initial Presentation of Renal Arteriovenous Malformation

Congenital renal arteriovenous malformations (AVMs) occasionally manifest with recurrent gross hematuria, typically in young populations. Acute abdominal pain without previous episodes of gross hematuria in young women is frequently considered a diagnosis related to obstetric and gynecological conditions or acute appendicitis, excluding the possibility of clot retention, which is more commonly associated with the elderly. A 36-year-old woman with no history of gross hematuria presented with acute lower abdominal pain. Adnexal torsion was initially considered based on her symptoms and ultrasonography findings. However, contrast-enhanced computed tomography (CT) revealed clot retention and delayed contrast excretion in the right kidney. After bladder irrigation, she returned complaining of right flank pain. Subsequent plain CT revealed contrast pooling in the right kidney and hydronephrosis. In addition to these findings, small vessels in the right renal hilum were found to be prominent in the arterial phase on the first contrast-enhanced CT. Finally, angiography of renal arteries confirmed the diagnosis of a congenital cirsoid-type renal AVM, which was successfully treated with ethanol embolization. This case highlights the importance of understanding an atypical presentation of renal AVMs, which is acute abdominal pain, even in the absence of prior gross hematuria and the characteristic CT findings. Early diagnosis of renal AVMs is crucial for preventing potentially serious complications, including repeated clot retention and life-threatening rupture. The diverse clinical manifestations and images of renal AVMs should be recognized to facilitate prompt and accurate diagnosis.

Successful coiling embolization of an intraparenchymal renal pseudoaneurysm: Case reports

INTRODUCTION AND IMPORTANCE

Intraparenchymal renal artery aneurysms are a really rare condition that represents <10 % of all renal artery aneurysms. They are more often caused by trauma or iatrogenic injury and their rupture can lead to life-threatening hemorrhage.

CASE PRESENTATION

We report the case of a 25-year-old male with history of back stab wound three months before being admitted to our unity. The patient presented a macroscopic hematuria three days after the injury. An abdominal CT angiography revealed an intraparenchymal renal artery aneurysm, and it was successfully treated with super selective endovascular coil embolization, achieving both pseudoaneurysm exclusion and renal preservation.

CLINICAL DISCUSSION

Intraparenchymal renal artery aneurysms are rare. They are more often caused by trauma or iatrogenic injury. Renal artery pseudoaneurysms are mainly asymptomatic. Renal pseudoaneurysms can be diagnosed through contrast enhanced CT, renal Doppler ultrasound, or MRI. Super selective embolization of the feeding artery of the pseudoaneurysm using endovascular techniques is the treatment of choice.

CONCLUSION

The management of patients with renal pseudo aneurysms should allow to achieve two main goals: Preserving Renal function, and excluding the pseudoaneurysm.

Surveillance of a Transplant Kidney Harboring a Stable Renal Artery Aneurysm: A Case Report

Renal artery aneurysms (RAAs) may occur in patients with transplanted kidneys, either through de novo development or as a preexisting feature of the donor kidney. How this vascular condition progresses in patients on immunosuppressive therapy after transplantation is poorly understood, and to our knowledge, consensus guidelines for treating transplant patients with RAA have not been developed. We present the case of a kidney allograft recipient on triple immunosuppressive therapy in whom postoperative imaging revealed a 13-mm renal artery aneurysm in the renal hilum not amenable to endovascular intervention. We review systemic influences on aneurysm formation and how matrix metalloproteinases may interact with immunosuppressive medications. Surveillance imaging over 5 years has shown a stable aneurysm, and the patient has maintained stable renal function with adequate creatinine levels and no adverse symptoms.

Renal artery pseudoaneurysm formation and rupture induced by renal abscess: A case report

Severe consequences can ensue from the rupture and hemorrhage of a renal artery pseudoaneurysm, necessitating immediate intervention upon detection. To date, no reports exist on the development of renal artery pseudoaneurysms as a result of renal abscesses. This document introduces the first reported case of this occurrence.

Budd-Chiari Syndrome-A Single Center Experience From the United Kingdom

Pediatric Budd-Chiari syndrome (BCS) is a rare cause of portal hypertension and liver disease in Europe and North America. In order to understand the long-term effect of radiological intervention on BCS we performed a single center retrospective review. Fourteen cases were identified; 6 of 14 (43%) had a congenital thrombophilia with many having multiple prothrombotic mutations. Two were managed with medical anticoagulation alone and two required super-urgent transplant for acute liver failure. The remaining 10 of 14 (71%) underwent radiological intervention: 1 of 14 thrombolysis, 5 of 14 angioplasty, and 4 of 14 transjugular intrahepatic portosystemic shunt (TIPS). Six of 14 (43%) patients required repeat radiological intervention (1 angioplasty, 5 TIPS) but none required surgical shunts or liver transplantation for chronic liver disease. The time between diagnosis and treatment did not predict the need for repeat radiological intervention. These data show that radiological intervention can be highly effective, and reduces the need for surgery, though it requires specialist multidisciplinary teams for monitoring.

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part I: Obstetric (Non-Fetal) Complications

Acute abdominopelvic pain in pregnant and postpartum patients presents clinical and therapeutic challenges, often requiring quick and accurate imaging diagnosis. Ultrasound remains the primary imaging investigation. Magnetic resonance imaging (MRI) has been shown to be a powerful diagnostic tool in the setting of acute abdominal pain during pregnancy and puerperium. MRI overcomes some drawbacks of US, avoiding the ionizing radiation exposure of a computed tomography (CT) scan. Although CT is not usually appropriate in pregnant patients, it is crucial in the emergency evaluation of postpartum complications. The aim of this article is to provide radiologists with a thorough familiarity with the common and uncommon pregnancy and puerperium abdominal emergencies by illustrating their imaging appearances. The present first section will review and discuss the imaging findings for acute abdominopelvic pain of obstetric (non-fetal) etiology.

Long-term results of large common iliac artery aneurysms caused by Kawasaki disease in four patients

Among Kawasaki disease patients with systemic artery aneurysms, the brachial and internal iliac arteries are the most commonly affected, and occlusions of both arteries are often found. However, the long-term fate of large common iliac artery aneurysms remains unknown, because their prevalence is very low. The long-term outcomes of common iliac artery aneurysms caused by Kawasaki disease in four patients (three females, one male) were investigated retrospectively based on their medical records and angiograms. Their ages ranged from 30 to 36 years-old. The onset age of Kawasaki disease ranged from 4 to 8 months, and the interval from the onset of Kawasaki disease to the latest angiogram ranged from 17 to 21 years. All patients had bilateral large coronary aneurysms and common iliac artery aneurysms with maximal diameters greater than 10 mm. Although all patients had multi-vessel coronary artery stenotic lesions and systemic artery aneurysms, they were asymptomatic. The three female patients underwent coronary artery bypass grafting, and the male patient underwent replacement of artificial vessels for large bilateral common iliac artery aneurysms at 3 years old of age. Over the long-term, common iliac artery aneurysms greater than 10 mm persisted as calcified aneurysms. However, they had no symptoms due to their common iliac artery aneurysms, and their ankle brachial pressure index was preserved, even if the stenosis of the common iliac artery developed as a late outcome, because the collateral arteries were well developed. The progression of stenosis of the common iliac artery after Kawasaki disease was slower.

Uterine venous malformations in the puerperium: 2 Atypical cases and literature review

Uterine arteriovenous malformations (AVMs) is a rare but high-risk cause of uterine bleeding. The clinical management of this condition is challenging, as the ultrasound picture can sometimes be unambiguously interpreted. Moreover, in the puerperium in which acquired AVMs are most frequently formed, it is necessary to discuss the correct management in a multidisciplinary and personalized manner. We present two cases of AVMs developing in the puerperium, both with a vaginal delivery and spontaneous and complete secondment. The symptom of onset was an episode of bright red blood loss in the puerperium, on the 14th and 21st postpartum days, respectively. Transvaginal ultrasound showed a hypervascularized lesion in the myometrium with turbulent vascular flow, confirmed by transabdominal ultrasound and angiography. To date, there are no guidelines on the management of MAVs. In our cases we opted for a conservative approach, in order to preserve the fertility of the patient. These experiences reported have the purpose of enriching a literature still sparse on the subject and in the future to be able to represent a fulcrum for official recommendations.

Pelvic arteriovenous malformation (AVM) with recurrent hematuria: A case report

INTRODUCTION

Arteriovenous malformation (AVM) leads to a direct connection between arterial and venous networks, in which capillary branches are not involved. Pelvic AVM is a benign and rare condition causing severe pain, hematuria, and rectal or vaginal bleeding.

CASE PRESENTATION

A 36-year-old woman presented with five months history of hematuria. Her medical history was unremarkable, and laboratory findings were all within normal ranges. Abdominopelvic computed tomography (CT) scan revealed a vascular mass in the left lateral pelvis that extended to the bladder neck and was suggestive of an AVM. The patient underwent a laparotomy for the resection of AVM. The first angiography revealed an AVM in the left internal iliac artery. The patient underwent embolization with coil and gel foam. The second angiography revealed complete obstruction of the left internal iliac artery due to multiple coils and AVM of the right internal iliac artery (RIIA), embolized with glue and lipiodol. A week later, venography revealed another left iliac vein malformation embolized with foam sclerotherapy. Forty days later, the third angiography revealed another AVM in the right iliac artery, embolized with three vials of polyvinyl alcohol (PVA). Following two months of follow-up, the symptoms did not return.

DISCUSSION

The present study reported a rare case of recurrent pelvic AVM causing painless hematuria in a female patient. The lesion was treated with several angioembolization sessions.

CONCLUSION

Angioembolization is one of the main therapeutic options for AVM. Appropriate material should be precisely chosen for AVM embolization regarding the AVM's location, size, and condition.

Hybrid surgery of arteriovenous malformation and aneurysm of the sole

The study describes the successful treatment of a rare type of arteriovenous malformation (AVM) in the sole using hybrid surgery, which consists of open resection and embolization. Moreover, the possibility of utilizing ultrasound during examination in addition to angiography for the diagnosing of AVM of the sole is proposed.

Successful repair of transplant renal artery aneurysm (TRAA)

BACKGROUND

Transplant renal artery aneurysm (TRAA) is rare. TRAA that develops post transplantation consists of 0.10% of the vascular complications post renal transplant (Transplant Proc 41:1609-1614, 2009; Indian J Urol 29:42-47, 2013).

CASE PRESENTATION

We report a case of TRAA in an asymptomatic young female. CT angiogram with detailed 3D reconstruction showed a 2.6 × 2.2 cm wide neck saccular TRAA arising from the anterior segmental branch of the graft renal artery (Figs. 2 and 3). A multidisciplinary team of interventional radiologists, vascular and urologist was involved for preoperative surgical planning and unique repair methods. Endovascular and percutaneous approaches were deemed not feasible, and an open in vivo approach with a saphenous vein graft was taken.

CONCLUSION

TRAA, albeit rare, is a complication that can occur post renal transplant. In-vivo surgical repair of TRAA is feasible with a multidisciplinary approach and careful preoperative planning. Saphenous vein graft is still a versatile graft and can be used as a conduit successfully.

Current guidelines for diagnosis and management of hepatic involvement in hereditary hemorrhagic teleangiectasia

Hereditary hemorrhagic teleangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is the most common cause of hepatic vascular malformations in adults. Different vascular shunts (arteriovenous, arterioportal or portovenous) lead to different clinical manifestations. Even though no hepatic-related symptoms are reported in the majority of cases, the severity of liver disease could lead to refractory medical conditions, in some cases requiring liver transplantation. The aim of this manuscript is to provide an updated overview of the current evidence regarding the diagnosis and treatment of HHT liver involvement and liver-related complications.

Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings

Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.

Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview

The liver has a complex vascular anatomy with a unique dual blood supply. Clinical conditions of the liver vary widely and include disorders originating in the vascular and biliary systems as well as the parenchyma. In most vascular disorders, the effects on the liver are generally subclinical because of its abundant blood supply. However, early diagnosis of such vascular diseases can significantly reduce patient morbidity and mortality. Because imaging findings of vascular disease are not always readily apparent, diagnosis can be difficult. Computed tomography angiography is an excellent imaging modality for visualizing the vascular anatomy of patients for treatment planning. In this review article, we focus on the vascular anatomy of the liver and the imaging findings in some acute hepatic vascular diseases.

Vascular Contributions to the Neurobiological Effects of Prenatal Alcohol Exposure

Fetal alcohol spectrum disorders (FASD) are often characterized as a cluster of brain-based disabilities. Though cardiovascular effects of prenatal alcohol exposure (PAE) have been documented, the vascular deficits due to PAE are less understood, but may contribute substantially to the severity of neurobehavioral presentation and health outcomes in persons with FASD.

Methods

We conducted a systematic review of research articles curated in PubMed to assess the strength of the research on vascular effects of PAE. 40 pertinent papers were selected, covering studies in both human populations and animal models.

Results

Studies in human populations identified cardiac defects, and defects in vasculature, including increased tortuosity, defects in basement membranes, capillary basal hyperplasia, endarteritis, and disorganized and diminished cerebral vasculature due to PAE. Preclinical studies showed that PAE rapidly and persistently results in vasodilation of large afferent cerebral arteries, but to vasoconstriction of smaller cerebral arteries and microvasculature. Moreover, PAE continues to affect cerebral blood flow into middle-age. Human and animal studies also indicate that ocular vascular parameters may have diagnostic and predictive value. A number of intervening mechanisms were identified, including increased autophagy, inflammation and deficits in mitochondria. Studies in animals identified persistent changes in blood flow and vascular density associated with endocannabinoid, prostacyclin and nitric oxide signaling, as well as calcium mobilization.

Conclusion

Although the brain has been a particular focus of studies on PAE, the cardiovascular system is equally affected. Studies in human populations, though constrained by small sample sizes, did link pathology in major blood vessels and tissue vasculature, including brain vasculature, to PAE. Animal studies highlighted molecular mechanisms that may be useful therapeutic targets. Collectively, these studies suggest that vascular pathology is a possible contributing factor to neurobehavioral and health problems across a lifespan in persons with a diagnosis of FASD. Furthermore, ocular vasculature may serve as a biomarker for neurovascular health in FASD.

Utilizing 3D printing to facilitate surgical in-situ paediatric renal artery aneurysm repair for refractory hypertension

Renal artery aneurysmal (RAA) disease is a rare, but potentially life-threatening cause of renovascular disease presenting with hypertension. Conventional management involves aneurysmal excision followed by renal auto-transplantation. We present the management of a 13-year-old girl with complex multiple saccular aneurysmal disease of the left renal artery with hilar extension and symptomatic hypertension. We used 3D printing to print a patient-specific model that was not implanted in the patient but was used for surgical planning and discussion with the patient and their family. Endovascular options were precluded due to anatomical complexities. Following multi-disciplinary review and patient-specific 3D printing, she underwent successful in-situ RAA repair with intraoperative cooling, without the need for auto-transplantation. 3D printing enabled appreciation of aneurysmal spatial configuration and dimensions that also helped plan the interposition graft length needed following aneurysmal excision. The models provided informed multidisciplinary communications and proved valuable during the consent process with the family for this high-risk procedure. To our knowledge, this is the first reported case utilizing 3D printing to facilitate in-situ complex repair of RAA with intra-hilar extension for paediatric renovascular disease.

Eighteen cases of renal aneurysms: Clinical retrospective analysis and experience of endovascular interventional treatment

Background

Development of endovascular interventional techniques gradually replaced traditional open surgery and has become the preferred treatment for renal aneurysms. This study aimed to analyze the clinical characteristics of renal artery aneurysm (RAA) and the safety and efficacy of intravascular interventional treatment.

Materials and Methods

We retrospectively analyzed the clinical characteristics and imaging data of 23 aneurysms in 18 patients with RAA. The technical success rate, complication rate, mortality rate, reintervention rate, and use of embolization materials were evaluated.

Results

In 18 patients with RAA (age, 32-72 years, average age, 52.2 ± 11.2 years), a total of 23 aneurysms were found (diameter 0.5-5.5 cm, average diameter 2.2 ± 1.4 cm). Among them, 11 cases (61.1%) were discovered accidentally, and the remaining patients were diagnosed due to the following major complaints: four cases (22.2%) presented low back pain, two (11.1%) were due to high blood pressure, and one (5.5%) had low back pain with gross hematuria. A total of 14 aneurysms in 13 patients received endovascular interventional therapy. The technical success rate of 13 patients with renal aneurysms was 100%. Three of the 18 patients were lost to follow-up, and the remaining were followed up for 4-89 months. There was no recurrence of the aneurysm or displacement of the stent or coil.

Conclusion

Endovascular treatment for RAA has a high success rate, low complication rate, and low reintervention rate. It has the advantage of less trauma and is flexible and more targeted for different types of renal aneurysms.

Percutaneous intervention for giant renal extrarenal aneurysm and arteriovenous fistula

Arteriovenous fistula is a high-flow vascular malformation characterized by a direct connection between an artery and a vein without the presence of a nidus (a network of arterial and venous channels). Renal artery aneurysm concomitant with a renal arteriovenous fistula (RAVF) is extremely rare. We report the case of a 45-year-old woman with a giant renal artery aneurysm combined with RAVF who presented with gross hematuria. The patient was successfully treated by embolization of a giant extrarenal aneurism and RAVF using coils and a plug device. RAVF can lead to harmful complications, and treatment is necessary upon diagnosis. Endovascular embolization is a feasible, efficient, and safe method able to retain maximal normal renal function.

Case report: Asymptomatic renal arteriovenous fistula requiring endovascular embolization in a living donor transplanted kidney more than 15-years after last protocol biopsy

Here we present the case of an HLA-identical living-donor kidney transplant recipient, who was incidentally found to have a large complex renal arteriovenous fistula (RAVF) in their transplanted kidney that had been present for nearly 6 years but was previously misinterpreted as being part of a collection of cysts. This patient had undergone 7 protocol biopsies of the transplanted kidney, the last of which had been performed approximately 16 years prior, representing the longest interval between most recent biopsy renal allograft to RAVF diagnosis in the literature date. This report reviews the etiology and principles of management for RAVF.

Perioperative Complications and Long-Term Follow-Up of Liver Transplantation in Hemorrhagic Hereditary Telangiectasia: Report of Three Cases and Systematic Review

The aim was to describe three patients with hemorrhagic hereditary telangiectasia (HHT) requiring liver transplantation (LT) and to perform a systematic review focusing on surgical complications and long-term follow-up. Unrestricted searches of the Medline and Embase databases were performed through February 2022. Forty-five studies were selected including 80 patients plus the three new reported patients, 68 (81.9%) were female and mean age was 50 (27–72) years. Main indications for LT were high-output cardiac failure (n = 40; 48.2%), ischemic cholangitis (n = 19; 22.9%), and a combination of both conditions (n = 13;15.6%). Mean cold ischemic time and red blood cell units transfused during LT were 554 (300–941) minutes and 11.4 (0–88) units, respectively. Complications within 30 days were described in 28 (33.7%) patients, mainly bleeding complications in 13 patients, hepatic artery (HA) thrombosis in four and hepatic vein thrombosis in one. Mean follow-up was 76.4 (1–288) months, and during it, four new patients developed thrombotic complications in HA, HA aneurysm, celiac artery, and the portal–splenic–mesenteric vein. HHT relapse in the transplant allograft was detected in 13 (17.1%) patients after 1–19 years (including two fatal recurrences). Overall mortality was 12%. In conclusion, previous assessment of HA anatomy and hyperdynamic circulatory state could reduce LT complications. The risk of relapse in the hepatic graft supports a multidisciplinary follow-up for HHT patients with LT.

Percutaneous Sclerotherapy for Budd-Chiari Syndrome Secondary to Giant Hepatic Venous Malformations (Hemangiomas)

This prospective study evaluated the safety and effectiveness of percutaneous sclerotherapy in the treatment of secondary Budd-Chiari syndrome due to hepatic venous malformations (HVMs). Four patients (mean age, 40 years; 3 women) with 5 HVMs underwent 7 sessions of percutaneous sclerotherapy with a mixture of bleomycin and lipiodol. All patients had chronic Budd-Chiari syndrome, determined based on imaging findings, with the main symptom being abdominal discomfort and distention. On physical examination, 2 patients had ascites and the other 2 had an epigastric mass. The indication for treatment was intractable abdominal symptoms due to hepatic and/or inferior vena cava (IVC) outflow compression. All procedures were technically successful, with no major complications. Three patients underwent a second session because of incomplete IVC decompression. The patients' symptoms completely resolved at 6 and 12 months of follow-up. There was a significant reduction in lesion volume (P = .007) and an increase in IVC luminal area (P = .018) at 12 months of follow-up.

Imaging of renal emergencies: Review of infectious, hemorrhagic, vascular, and traumatic etiologies

Diagnostic imaging allows for accurate and early recognition of acute renal pathologies, thus allowing for appropriate clinical triage, life-saving treatments, and preservation of renal function. In this review, we discuss the clinical presentation and imaging findings of renal emergencies with infectious, hemorrhagic, vascular, and traumatic etiologies.

Percutaneous transluminal angioplasty for symptomatic hepatic vein-type Budd-Chiari syndrome: feasibility and long-term outcomes

For management of Budd-Chiari syndrome (BCS), a step-wise therapeutic approach starting with medical treatment, followed by endovascular recanalization, transjugular intrahepatic portosystemic shunt, and finally liver transplantation has been adopted. We retrospectively analyzed 51 patients with symptomatic short segment (≤ 30 mm) hepatic vein (HV)-type BCS who underwent percutaneous transluminal balloon angioplasty (PTBA) with/without stenting to determine the feasibility, clinical effectiveness, and long-term outcomes. The intervention was technically successful in 94.1% of cases (48/51)—32 patients underwent PTBA and 16 patients underwent HV stenting. Procedure-related complications occurred in 14 patients (29.1%). The clinical success rate at 4 weeks was 91.7% (44/48). Nine patients underwent reintervention, six patients due to restenosis/occlusion and three patients with clinical failure. The mean primary patency duration was 64.6 ± 19.9 months (CI, 58.5–70.8; range, 1.2–81.7 months). The cumulative 1-, 2-, and 5-year primary patency rates were 85.4, 74.5, and 58.3%, respectively. The cumulative 1-, 2-, and 5-year secondary patency rates were 93.8, 87.2, and 75%, respectively. The cumulative 1-, 2-, and 5-year survival rates were 97.9, 91.5, and 50%, respectively. Percutaneous transluminal angioplasty with and without stenting is effective and achieves excellent long-term patency and survival rates in patients with symptomatic HV-type BCS. With its lower incidence of re-occlusion and higher clinical success rate, HV angioplasty combined with stenting should be the preferred option especially in patients with segmental HV-type BCS.

Acute pelvic pain: A pictorial review with magnetic resonance imaging

Acute uterine emergencies constitute both obstetric and gynecologic conditions. The superior image resolution, superior soft-tissue characterization, and lack of ionizing radiation make magnetic resonance imaging (MRI) preferable over ultrasonography (USG) and computed tomography (CT) in investigating uterine emergencies. Although USG is the first-line imaging modality and is easily accessible, it has limitations. USG is an operator dependent and limited by patient factors such as obesity and muscle atrophy. CT is limited by its risk of teratogenicity in pregnant females, poor tissue differentiation, and radiation effect. The non-specific findings on CT may lead to misinterpretation of the pathology. MRI overcomes all these limitations and is emerging as the most crucial imaging modality in the emergency room (ER). The evolving 3D MR sequences further reduce the acquisition times, expanding its ER role. Although MRI is not the first-line imaging modality, it is a problem-solving tool when the ultrasound and CT are inconclusive. This pictorial review discusses the various MRI techniques used in uterine imaging and the appearances of distinct etiologies of uterine emergencies across different MRI sequences.

Endovascular interventions in main renal artery pathologies: an overview and update

Renal arteries are involved in a wide spectrum of pathologies including atherosclerosis, fibromuscular dysplasia, Takayasu arteritis, aneurysms, and aortic type B dissections extending into main renal arteries. They manifest as renovascular hypertension, renal ischemia, and cardiovascular dysfunction. The location of the renal arteries in relation to the abdominal aortic aneurysm is a critical determinant of interventional options and long-term prognosis. This article provides a comprehensive review of the role of interventional radiologists in transcatheter interventions in various pathologies involving the main renal arteries with analysis of epidemiology, pathophysiology, newer interventional techniques, and management options.

Selective Angioembolisation of Iatrogenic Renal Artery Pseudoaneurysms Following Minimally Invasive Urological Procedures: A Single Centre Case Series

INTRODUCTION

The purpose of this study was to report our centre's experience using selective angioembolisation in the treatment of iatrogenic renal artery pseudoaneurysms (RAP) following minimally invasive urological procedures.

METHODS

Our retrospective analysis included four consecutive patients treated with angioembolisation for iatrogenic RAP between October 2016 and October 2021. Data on demographics, minimally invasive urological intervention, clinical features, imaging findings, embolization procedure and perioperative details were collected. Rates of technical and clinical success, defined as 1. total occlusion of the extravasation site on completion digital subtraction angiography (DSA), and 2. resolution of symptoms, signs, and serum hemoglobin (Hb) derangements secondary to RAP, were analysed. Renal function, measured by serum creatinine (Cr) and estimated glomerular filtration rate (eGFR), was recorded prior to and post - angioembolisation procedure and compared.

RESULTS

Mean time between urological intervention and angioembolisation was 9 days (range, 2-17 days). Rates of technical and clinical success were 100% and 100% respectively. No additional angioembolisation procedures were required, and there were no peri or post-operative complications identified during mean follow-up of 662 days (range, 30-1845 days). Mean serum Cr prior to and post angioembolisation was 83 mmol/L and 79.5 mmol/L. Mean eGFR prior to and post angioembolisation was 73.8 and 77.8 mL/min/1.73 m2. In all patients, no significant difference was observed in serum Cr and eGFR prior to and post angioembolisation.

CONCLUSION

Iatrogenic renal artery pseudoaneurysms can occur following a range of minimally invasive urological procedures. This retrospective review highlights the utility of angioembolisation as a safe and effective treatment with high clinical and technical success rates. Further studies involving larger populations are required to validate its broader application.

Coil embolization of ruptured distal renal artery pseudoaneurysm with gross hematuria and hemorrhagic shock

Renal artery pseudoaneurysms have been infrequently reported in the literature. In the present report, we have described a case of a ruptured renal artery pseudoaneurysm requiring coil embolization. A 49-year-old man had presented to our institution with a hypertensive emergency. Computed tomography revealed a 3.4-cm right renal artery pseudoaneurysm. Nonemergent coil embolization was planned for the following day. However, he became hypotensive, exsanguinating frank blood from the urethra. An arteriogram showed extravasation of contrast into the pseudoaneurysm sac, renal pelvis, and ureter, consistent with intrarenal pseudoaneurysm rupture. We have demonstrated coil embolization as a method of repairing a ruptured renal artery pseudoaneurysm with gross hematuria.