Recurrent Scrotal Arteriovenous Malformation as a Slowly Increasing Left Testicular Swelling: A case report

Arteriovenous malformations (AVMs) are benign vascular lesions. Although, the majority of AVMs occur in the central nervous system, there are published reports of AVMs involving all systems including the scrotum, kidney, and uterus. We report a 37-year-old male patient who presented to the urology clinic of a tertiary care hospital in Riyadh, Saudi Arabia, in 2021 with recurrent gradual scrotal swelling for four years attributed to scrotal AVM. Embolisation was performed; however, one year later his symptoms reoccurred. As a result, left partial scrotal wall excision was carried out without complications.

Gastroesophageal Stents for the Management of Post Sleeve Gastrectomy Leakage: Interventional Radiology Experience

Objective The aim of this study was to assess the efficacy and safety of retrievable, self-expandable gastroesophageal stents to manage gastric leaks post sleeve gastrectomy by interventional radiology (IR).

Methods This is a retrospective study of patients with gastric leaks post sleeve gastrectomy who were managed with gastroesophageal stent placement. The diameters of the stents ranged from 23 to 30 mm and the lengths 12.5 to 24 cm.

Results Thirty-one patients (mean age, 32.4 ± 7.97 years) were included in the study, and 46 stents were placed. The total average stenting time was 59.1 ± 35.5 days. Leakage resolved in 93.5% of the patients. Thirty-eight (82.6%) of the stents were retrieved by IR, and the remaining stents were retrieved under endoscopic visualization. Stricture occurred as a complication in four patients: three of which were treated with stenting (one by IR and two by endoscopy) and one required esophagoplasty. Six patients experienced stent migration, three of which underwent stent adjustment, while the remaining three underwent stent reinsertion

Conclusion Gastroesophageal stent placement by IR for gastric leaks post sleeve gastrectomy is safe and effective in our study.

Can the Body Mass Index Predict Varicocele Recurrence Post-Intervention?

Purpose

In this study, we investigated the association between the body mass index (BMI) and varicocele recurrence post-intervention in our local Saudi population. We also explored the association between recurrence and other predictors such as age, laterality, indication for surgery, type of intervention, clinical grade, testicular delivery, and method of ligation.

Methods

We conducted a retrospective cohort study, including all patients who had microscopic varicocelectomy surgery or radiographic embolization for varicoceles over a five-year period. The data included demographic information and intervention-related variables. Descriptive and analytical statistics were used to analyze the data.

Results

We included 147 patients who had microscopic varicocelectomy surgery or radiographic embolization. We categorized the patients according to their BMI as underweight, normal, overweight, and obese. We found no statistical association between any BMI group and the recurrence of varicocele (P>0.05). However, there was a significant association between the clinical grade and recurrence (P<0.05).

Conclusion

This study did not show any significant correlation between height, weight, BMI, and varicocele recurrence after an intervention. The only predictor of varicocele recurrence was the clinical grade.

Interventional Radiology Awareness among the Final‑Year Medical Students in Riyadh

Objective: Interventional radiology (IR) is experiencing massive growth in the medical scene as new interventions are being introduced continuously to contribute to patient care. However, IR does not go without its fair share of challenges. Personnel shortages, turf wars, and a vague understanding of the role of IR in the hospital setting by medical students are a few. The latter could negatively impact the recruitment of young prospects and contribute to further personnel shortage. To combat this, we aimed to assess the final-year medical students' awareness of IR. Methods: This was a cross-sectional, self-administered questionnaire study. Our target population was all final-year medical students at university-based medical schools. Surveys were sent to 822 students, and a total of 719 final-year medical students responded (87.5%). The survey was distributed anonymously during November and December 2018. The survey consists of 21-closed and open-ended questions. Results: The vast majority of the respondents felt that their knowledge of IR was poor (83%), while a few reported that they had a good grasp of IR (16%). Half of the respondents believe that an Interventional Radiologist (IRs) must complete training in radiology. However, 42% thought that radiology and surgery was the correct route of training for IRs. Seventy-one percent and 73% of the final-year medical students correctly identified that IRs perform uterine artery embolization and lower limb angioplasty, respectively. A majority (68%) of the respondents believe that IRs perform cardiac angioplasty and stenting, whereas 57% believe that they perform femoral-popliteal bypass. Conclusion: Our data suggest that knowledge, awareness, and exposure of the final-year medical students to IR are overwhelmingly poor in the region. This can be ameliorated through a number of means, such as directly involving IRs in the medical student curriculum, IR awareness campaigns, and IR symposiums.

Artificial intelligence in radiology: does it impact medical students preference for radiology as their future career?

Objective

To test medical students' perceptions of the impact of artificial intelligence (AI) on radiology and the influence of these perceptions on their choice of radiology as a lifetime career.

Methods

A cross-sectional multicenter survey of medical students in Saudi Arabia was conducted in April 2019.

Results

Of the 476 respondents, 34 considered radiology their first specialty choice, 26 considered it their second choice, and 65 considered it their third choice. Only 31% believed that AI would replace radiologists in their lifetime, while 44.8% believed that AI would minimize the number of radiologists needed in the future. Approximately 50% believed they had a good understanding of AI; however, when knowledge of AI was tested using five questions, on average, only 22% of the questions were answered correctly. Among the respondents who ranked radiology as their first choice, 58.8% were anxious about the uncertain impact of AI on radiology. The number of respondents who ranked radiology as one of their top three choices increased by 14 when AI was not a consideration. Radiology conferences and the opinions of radiologists had the most influence on the respondents' preferences for radiology.

Conclusion

The worry that AI might displace radiologists in the future had a negative influence on medical students' consideration of radiology as a career. Academic radiologists are encouraged to educate their students about AI and its potential impact when students are considering radiology as a lifetime career choice.

Advances in knowledge

Rapid advances of AI in radiology will certainly impact the specialty, the concern of AI impact on radiology had negative influence in our participants and investing in AI education and is highly recommended.

Transcatheter Unilateral Renal Artery Embolization for Managing Refractory Hypertension Prior to Renal Transplant

We report a case of unilateral renal artery embolization as a management of refractory hypertension that precluded renal transplantation in a patient with end-stage renal disease and not a candidate for nephrectomy. Over the subsequent few months, the targeted blood pressure was achieved followed by noncomplicated renal transplantation.

Arab's Research Productivity and Contribution to Vascular and Interventional Radiology Literature

Objective: Vascular and interventional radiology (VIR) is one of the most rapidly growing fields of medicine. In this report, we evaluate the contribution of Arab countries to VIR publications and literature. Materials and Methods: Using PubMed database, we reviewed the total number of VIR publications from all Arab countries. In addition, we evaluated the total number of IR articles from each individual country, number of publications in VIR specialty journals and the type of manuscripts. Results: Seventy-four articles from different Arab countries were published in different journals from 1988 to 2016. Only 11 (14.9') articles were published in interventional radiology journals. The majority of these publications were from Kingdom of Saudi Arabia 31 (41.9') articles, followed by 20 (27.02') articles from Egypt, 7 articles (9.5') from Jordan, 6 articles (8.1) from Kuwait, and 4 articles (5.4') from Morocco. There was one article (1.4') from Lebanon, United Arab Emirates, Oman, Tunis, and Qatar. Nine (12.2') articles from different Arab countries were published in the two highest impact specialty journals in VIR. Conclusion: This review demonstrated the limited number of publications and poor contribution of Arab countries to VIR literature. Collaborative efforts of researchers, governments, and funding bodies are needed to improve research output in this important field of medicine.

Median sacral artery injury following a bone marrow biopsy successfully treated with selective trans-arterial embolization: a case report

Background

Iatrogenic arterial injury during bone marrow biopsy is an extremely rare complication. We present unreported complication of median sacral artery injury that was managed successfully with endovascular treatment.

Case presentation

A 22-year-old Caucasian man known to have end-stage renal disease secondary to Senior-Loken syndrome presented with anemia. He underwent an investigation with bone marrow biopsy that was complicated by hypotension and a further significant drop in his hemoglobin level. Cross-sectional imaging with computed tomography demonstrated a large abdominopelvic retroperitoneal hematoma and active bleeding of the median sacral artery. A successful lifesaving endovascular trans-arterial embolization was performed on an emergency basis and our patient was discharged in a stable condition a few days later.

Conclusion

Iatrogenic arterial injury after a bone marrow biopsy is extremely rare. To the best of our knowledge, a median sacral artery injury has not been previously reported. Endovascular trans-arterial embolization is a safe, effective, and minimally invasive therapeutic option.