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Ghahremani JS, Chapek MA, Singh Rana SS, Lee J, Safran BA, Lau DL, Brewer MB. Endovascular Embolization of Aneurysmal Renal Arteriovenous Malformation. Vasc Endovascular Surg 2024:15385744241286675. [PMID: 39302121 DOI: 10.1177/15385744241286675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Renal arteriovenous malformations (AVM) represent an uncommon vascular condition characterized by an abnormal direct communication between an intrarenal artery and vein. Though asymptomatic in many individuals, treatment is often indicated if the AVM causes flank pain, hematuria, or medically refractory hypertension, or if there is an associated renal artery aneurysm. We present a case of a large right renal AVM with associated renal artery aneurysm and large varix which was incidentally found on magnetic resonance imaging of the spine. Endovascular and open surgical options were considered, including ex-vivo renal vascular reconstruction and nephrectomy. The patient was successfully treated with endovascular embolization of the AVM with coil packing of the arterial aneurysm and inflow artery. The patient recovered uneventfully with well-maintained renal function and blood pressure control. We review and discuss the literature on the etiology and treatment options for renal AVM.
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Affiliation(s)
- Jacob S Ghahremani
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Michael A Chapek
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | | | - John Lee
- Department of Radiology, Interventional Radiology, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| | - Brent A Safran
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Department of Surgery, Vascular and Endovascular Surgery, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| | - David L Lau
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Department of Surgery, Vascular and Endovascular Surgery, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| | - Michael B Brewer
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Department of Surgery, Vascular and Endovascular Surgery, Kaiser Permanente Downey Medical Center, Downey, CA, USA
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Bronchoscopy-guided removal of intrabronchial coil migration after coil embolization of pulmonary arteriovenous malformation. Radiol Case Rep 2022; 17:3410-3414. [PMID: 35899085 PMCID: PMC9309579 DOI: 10.1016/j.radcr.2022.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Abstract
Pulmonary arteriovenous malformations develop in approximately 50% of hereditary hemorrhagic telangiectasia patients. Pulmonary arteriovenous malformations are often treated with coil embolization therapy. We report a case of a 45-year-old female with multiple pulmonary arteriovenous malformations due to underlying hereditary hemorrhagic telangiectasia who had undergone 14 coil embolization procedures over 16 years. She presented with sudden onset severe, unremitting, nonproductive cough from a foreign body sensation in the airway. Computed tomography of the chest demonstrated a metallic foreign body extending from the left lower lobe of the lung into the left mainstem bronchus and trachea. Bronchoscopy-guided removal of the foreign body revealed an intact embolization coil placed 8 years prior to presentation had partially migrated through the vessel and airway walls into the airway lumen, extending from the left lower lobe bronchus to the left mainstem bronchus. Coil migration is a rare, but potentially dangerous, complication of coil embolization therapy.
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Hewgley WP, Webb DL, Garrett HE. Migrated embolization coil causes intestinal obstruction. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2017; 4:8-11. [PMID: 29725660 PMCID: PMC5928003 DOI: 10.1016/j.jvscit.2017.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/01/2017] [Indexed: 01/17/2023]
Abstract
Visceral artery pseudoaneurysm is a rare, potentially fatal entity, but proper identification and management with coil embolization can lead to good outcomes. Embolization coils can migrate to various destinations, causing delayed complications in several case reports. A case of small bowel obstruction due to migrated embolization coils from a gastroduodenal pseudoaneurysm 6 years after initial treatment is presented.
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Affiliation(s)
- W Preston Hewgley
- Division of Vascular Surgery, University of Tennessee, Memphis, Tenn
| | - David L Webb
- Division of Vascular Surgery, University of Tennessee, Memphis, Tenn
| | - H Edward Garrett
- Division of Vascular Surgery, University of Tennessee, Memphis, Tenn
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Trocciola SM, Chaer RA, Lin SC, Dayal R, Scherer M, Garner M, Coll D, Kent KC, Faries PL. Embolization of Renal Artery Aneurysm and Arteriovenous Fistula. Vasc Endovascular Surg 2016; 39:525-9. [PMID: 16382274 DOI: 10.1177/153857440503900610] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A renal artery aneurysm with an associated arteriovenous fistula in a native kidney has been reported infrequently in the literature. Management depends on size, location, and the patient's physiological condition. We describe a case in which endovascular therapy was used to successfully exclude both aneurysm and fistula. This report describes a 13-centimeter renal artery aneurysm with arteriovenous fistula originating from an isolated branch of the renal artery. Coil-embolization resulted in thrombosis of the aneurysm and fistula while preserving parenchymal perfusion. Coil embolization is an alternative to surgery for coexistent renal artery aneurysm and arteriovenous fistula arising from a branch of adequate length for placement of embolic coils. Successful treatment is not limited by aneurysm size or presence of arteriovenous connection.
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Affiliation(s)
- Susan M Trocciola
- Division of Vascular Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University and College of Physicians and Surgeons of Columbia University, New York, NY 10021, USA
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Congenital and Acquired Renal Arteriovenous Malformations: Curative Embolization with Onyx. IRANIAN JOURNAL OF RADIOLOGY 2016. [DOI: 10.5812/iranjradiol.25672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hamoodi I, Hawthorn R, Moss JG. Can ovarian vein embolization cause more harm than good? J Obstet Gynaecol Res 2015; 41:1995-7. [PMID: 26370930 DOI: 10.1111/jog.12805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
Abstract
Ovarian vein embolization using embolic coils is a recognized treatment for chronic pelvic pain caused by pelvic congestion syndrome (PCS). Although it is considered a non-invasive procedure with a good safety record, there have been reported complications resulting from embolic coil migration. We present a case of embolic coil erosion of the ovarian vein discovered on laparoscopy for chronic pelvic pain.
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Affiliation(s)
| | - Robert Hawthorn
- Department of Obstetrics and Gynaecology, Southern General Hospital, Glasgow, UK
| | - Jonathan G Moss
- Radiology Department, Gartnavel General Hospital, Glasgow, UK
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Hatzidakis A, Rossi M, Mamoulakis C, Kehagias E, Orgera G, Krokidis M, Karantanas A. Management of renal arteriovenous malformations: A pictorial review. Insights Imaging 2014; 5:523-30. [PMID: 24996396 PMCID: PMC4141337 DOI: 10.1007/s13244-014-0342-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 11/29/2022] Open
Abstract
Background Arteriovenous malformations (AVMs) are communications between an artery and a vein outside the capillary level. This pathologic communication may be either a fistula, a simple communication between a single artery and a dilated vein, or a more complex communication, a nidus of tortuous channels between one or more arteries/arterioles and one or more draining veins. The latter type of lesion is most frequently seen in the extremities; in the kidney they tend to appear more rarely. The most common clinical presentation of renal arteriovenous malformations (RAVMs) is haematuria. Percutaneous treatment with selective endovascular techniques offers a minimally invasive, nephron-sparing option in comparison to the more invasive surgical approaches. The purpose of this pictorial review is to highlight the general lines of management and to show the range of imaging findings of the percutaneous treatment of RAVMs. Methods The imaging characteristics of a selection of cases of percutaneously managed congenital RAVMs are presented and the most common lines of approach are discussed. Conclusion The imaging spectrum of diagnosis and percutaneous treatment of RAVMs is presented in order to aid interpretation and endovascular management. Teaching points • Renal arteriovenous malformations are very rare lesions. • Clinical expression is usually haematuria. • Diagnosis is made with CT or MRI but the gold standard is digital subtraction angiography. • Catheter-directed treatment with the use of coils or liquid embolics is minimally invasive, safe and effective.
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Affiliation(s)
- Adam Hatzidakis
- Department of Medical Imaging, University Hospital of Heraklion, Medical School of Crete, 71110, Heraklion, Greece,
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Renoduodenal fistula after transcatheter embolization of renal angiomyolipoma. Cardiovasc Intervent Radiol 2014; 38:232-5. [PMID: 24722895 DOI: 10.1007/s00270-014-0887-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
Abstract
Transcatheter embolization of renal angiomyolipomas is a routinely performed, nephron-sparing procedure with a favorable safety profile. Complications from this procedure are typically minor in severity, with postembolization syndrome the most common minor complication. Abscess formation is a recognized but uncommon major complication of this procedure and is presumably due to superinfection of the infarcted tissue after arterial embolization. In this case report, we describe the formation of a renoduodenal fistula after embolization of an angiomyolipoma, complicated by intracranial abscess formation and requiring multiple percutaneous drainage procedures and eventual partial nephrectomy.
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Tekola BD, Arner DM, Behm BW. Coil migration after transarterial coil embolization of a splenic artery pseudoaneurysm. Case Rep Gastroenterol 2013; 7:487-91. [PMID: 24348322 PMCID: PMC3861862 DOI: 10.1159/000357151] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 48-year-old man with a history of splenic artery pseudoaneurysm requiring transarterial embolization 3 months earlier presented to the emergency department with abdominal pain and fever. Computed tomography showed evidence of embolization coil fragments within the gastrointestinal tract. Upper endoscopy showed a large gastric ulcer with numerous embolization coils extruding into the gastric lumen. The patient underwent partial gastrectomy, distal pancreatectomy and resection of the splenic artery pseudoaneurysm. This case illustrates a rare delayed complication of transarterial embolization of a splenic artery pseudoaneurysm.
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Affiliation(s)
- Bezawit D Tekola
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Va., USA
| | - David M Arner
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Va., USA
| | - Brian W Behm
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Va., USA
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Zhang B, Jiang ZB, Huang MS, Zhu KS, Guan SH, Shan H. The role of transarterial embolization in the management of hematuria secondary to congenital renal arteriovenous malformations. Urol Int 2013; 91:285-90. [PMID: 23548766 DOI: 10.1159/000347025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of transarterial embolization (TAE) in the management of hematuria secondary to congenital renal arteriovenous malformations (AVM). PATIENTS AND METHODS Between May 2007 and February 2012, 6 patients with congenital AVM treated with TAE were analyzed retrospectively, followed by a brief review of TAE in the treatment of congenital AVM. Clinical records with respect to general conditions, location, embolic materials, complications and overall outcome were collected from the original hospital charts and outpatient medical records. RESULTS Three patients with AVM were confirmed by contrast-enhanced CT scans, and the other 3 patients were detected by renal angiography. TAE was performed with steel coils in 2 patients and n-butyl-2-cyanoacrylate (NBCA) in 4 patients. After a mean follow-up of 22 months, no serious adverse effects were observed in all patients. There were no complaints of hematuria at the end of the follow-up period. CONCLUSION For unexplained massive hematuria, congenital renal AVM needs to be considered as a differential diagnosis. Selective renal angiography and embolization should be recommended as the first choice to treat massive hematuria secondary to congenital renal AVM.
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Affiliation(s)
- Bo Zhang
- Department of Radiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
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Phan J, Lall C, Moskowitz R, Clayman R, Landman J. Erosion of embolization coils into the renal collecting system mimicking stone. West J Emerg Med 2012; 13:127-30. [PMID: 22461946 PMCID: PMC3298228 DOI: 10.5811/westjem.2011.7.6784] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/21/2011] [Accepted: 07/19/2011] [Indexed: 11/23/2022] Open
Abstract
Urinary tract interventions can lead to multiple complications in the renal collecting system, including retained foreign bodies from endourologic or percutaneous procedures, such as stents, nephrostomy tubes, and others. We report a case of very delayed erosion of embolization coils migrating into the renal pelvis, acting as a nidus for stone formation, causing mild obstruction and finally leading to gross hematuria roughly 18 years post transarterial embolization. History is significant for a remote unsuccessful endopyelotomy attempt that required an urgent embolization.
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Affiliation(s)
- Jason Phan
- University of California Irvine, Department of Radiology, Orange, California
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Bilbao JI, Martínez-Cuesta A, Urtasun F, Cosín O. Complications of embolization. Semin Intervent Radiol 2011; 23:126-42. [PMID: 21326756 DOI: 10.1055/s-2006-941443] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Embolization is a remarkably versatile procedure used in nearly all vascular and nonvascular systems to treat a wide range of pathology. The published literature is rich with studies demonstrating the enormous therapeutic potential offered by embolization procedures, and the possibilities continue to expand with the advent of new embolization agents and techniques. Unfortunately, with this variety and innovation comes a wide spectrum of potential complications, not always easy to classify and summarize, associated with embolization. This article reviews the procedures and associated complications of arterial and venous embolization procedures, organized by vascular distribution.
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Affiliation(s)
- José I Bilbao
- Department of Radiology, Clínica Universitaria de Navarra, Pamplona, Spain
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Basile A, Marletta G, Tsetis D, Patti MT. The Amplatzer Vascular Plug Also for Ovarian Vein Embolization. Cardiovasc Intervent Radiol 2007; 31:446-7. [DOI: 10.1007/s00270-007-9235-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 10/10/2007] [Indexed: 10/22/2022]
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