1
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Abdelsalam A, Saini V, Eatz T, Silva MA, Luther EM, Bandes M, Thompson JW, Ramsay IA, Burks JD, Fountain HB, Starke RM. Balloon-mounted covered stent as endovascular management of a traumatic cervical internal carotid artery pseudoaneurysm in a 23-year-old: a case report. AME Case Rep 2023; 8:17. [PMID: 38234343 PMCID: PMC10789901 DOI: 10.21037/acr-23-56] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/22/2023] [Indexed: 01/19/2024]
Abstract
Background Distal cervical internal carotid artery (cICA) pseudoaneurysms are uncommon. They may lead to thromboembolic or hemorrhagic complications, especially in young adults. We report one of the first cases in the literature regarding the management via PK Papyrus (Biotronik, Lake Oswego, Oregon, USA) balloon-mounted covered stent of a 23-year-old male with an enlarging cervical carotid artery pseudoaneurysm and progressive internal carotid artery stenosis. Case Description We report the management of a 23-year-old male with an enlarging cervical carotid artery pseudoaneurysm and progressive internal carotid artery stenosis. Based on clinical judgment and imaging analysis, the best option to seal the aneurysm was a PK Papyrus 5×26 balloon-mounted covered stent. A follow-up angiogram showed no residual filling of the pseudoaneurysm, but there was some contrast stagnation just proximal to the stent, which is consistent with a residual dissection flap. We then deployed another PK Papyrus 5×26 balloon-mounted covered stent, providing some overlap at the proximal end of the stent. An angiogram following this subsequent deployment demonstrated complete reconstruction of the cICA with no residual evidence of pseudoaneurysm or dissection flap. There were no residual in-stent stenosis or vessel stenosis. The patient was discharged the day after the procedure with no complications. Conclusions These positive outcomes support the use of a balloon-mounted covered stent as a safe and feasible modality with high technical success for endovascular management of pseudoaneurysm.
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Affiliation(s)
- Ahmed Abdelsalam
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vasu Saini
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Michael A. Silva
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Evan M. Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Miguel Bandes
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John W. Thompson
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ian A. Ramsay
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua D. Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hayes B. Fountain
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert M. Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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2
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Cizman Z, Saad W. Transplant Hepatic Artery Complications. Tech Vasc Interv Radiol 2023; 26:100923. [PMID: 38123292 DOI: 10.1016/j.tvir.2023.100923] [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: 12/23/2023]
Abstract
Hepatic artery complications can be divided into 2 different categories, nonocclusive and steno-occlusive disease. Steno-occlusive disease is a collective term that encompasses hepatic artery thrombosis, hepatic artery stenosis, and hepatic arterial kinks, while nonocclusive arterial disease encompasses less than 5% of complications and is a collective term used to describe arteriovenous fistulae, pseudoaneurysms, arterial rupture and nonocclusive hepatic artery hypoperfusion syndrome. This article details the angiographic techniques and definitions needed to accurately diagnose arterial transplant complications and describes the technical aspects and results of endoluminal management of these arterial complications. In addition, this article discusses the presentation, etiology and indications for treatment, including surgical management of these various complications.
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Affiliation(s)
- Ziga Cizman
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT.
| | - Wael Saad
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT
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3
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Clarke H, Nefale T, Mngomezulu V. Endovascular management of intracranial aneurysms at Chris Hani Baragwanath Academic Hospital. SA J Radiol 2023; 27:2634. [PMID: 37292418 PMCID: PMC10244967 DOI: 10.4102/sajr.v27i1.2634] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023] Open
Abstract
Background Worldwide, intracranial aneurysms are associated with a high mortality rate. While endovascular management has proven to be the choice of treatment in selected patients, patient demographics and aneurysm characteristics differ between study populations. Objectives This study aimed to investigate the profile of patients with intracranial aneurysms who underwent endovascular management in the Interventional Neuroradiology Unit at Chris Hani Baragwanath Academic Hospital. Patient demographics, risk factors, indications, aneurysm characteristics and intra-operative complications were studied. Method This was a 3-year retrospective study of all adult patients between 01 January 2018 and 31 January 2021. The Chi-square test was used to compare categorical variables. Results A total of 77 patients were included in this study. The mean age of the patients was 47 ± 11.6 with a male-to-female ratio of 1:1.8. Hypertension was the most reported risk factor in 27% of patients. There was no statistical correlation between the gender groups according to presentation, multiplicity, aneurysmal size dimensions and locations. According to the presentation, there was statistical significance in ruptured intracranial aneurysms (p = 0.020), neck size dimensions less than 4 mm (p = 0.010), and aneurysms located in the internal cerebral artery (ICA) circulation (p = 0.001). Conclusion The study findings support known parameters including females and anterior circulation aneurysm preponderance, and the low complication risk of endovascular management. Interestingly, intracranial aneurysms presented with rupture at smaller size dimensions. Contribution This study provides valuable insights into intracranial aneurysm characteristics and endovascular management efficacy in a resource-limited setting.
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Affiliation(s)
- Herchel Clarke
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Trevor Nefale
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Mngomezulu
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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4
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Tu T, Song Z, Ma Y, Yang C, Su X, He C, Li G, Hong T, Sun L, Hu P, Zhang P, Ye M, Zhang H. Adult dural arteriovenous fistulas in Galen region: More to be rediscovered. Front Neurol 2022; 13:957713. [PMID: 36388187 PMCID: PMC9650976 DOI: 10.3389/fneur.2022.957713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/26/2022] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) in the Galen region are the most deeply located and most complex type of dural arteriovenous fistulas. However, cases of DAVFs in this region have not been well described. Thus, we aimed to summarize the characteristics of Galenic DAVFs involving clinical symptoms, anatomical architecture, and drainage patterns, providing experientially therapeutic strategies for these lesions based on our 20 years of clinical experience. METHODS We retrospectively examined 31 patients with Galenic DAVFs between January 2000 and June 2021. A comprehensive analysis was carried out based on the symptoms, imaging features, feeding arteries, draining veins, number and location of the fistulas, choice of treatment methods, and prognosis assessment. RESULTS Twenty-nine patients received endovascular embolization, and no perioperative deaths occurred. A transarterial approach was performed in 27 patients, and a combined transarterial and transvenous approach in one. And in one case, access was established by surgical drilling and embolization was done via the venous route. Twenty-four cases were completely obliterated after first embolization, and another five cases received a second period treatment. Only one patient developed cognitive dysfunction after embolization, and the outcomes of the remaining patients were improved at long-term follow-up. CONCLUSION The understanding of symptoms of non-hemorrhagic neurological deficits in DAVF needs to be further clarified. Lesions with pial feeders may be considered first when determining surgical orders. Multi-approach and multi-stage embolization would be safe and effective. Excessive embolization and deep-vein system obstruction should be avoided. Approach creation by surgery would be an innovative interventional therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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5
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Gómez-Galán S, Velandia-Sánchez A, Sanabria-Arévalo LM, Polania-Sandoval CA, Gallo-Bernal S, Cabrales-Arévalo J, Camacho-Mackenzie J, Barrera-Carvajal JG. Endovascular Repair of a Spontaneous Popliteal Arteriovenous Fistula Associated With a Venous Aneurysm. Vasc Endovascular Surg 2022; 56:501-504. [PMID: 35651321 DOI: 10.1177/15385744221077557] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Popliteal arteriovenous fistulae (PAF) are anomalous communications between the arterial and venous systems of the lower extremity. They are usually secondary to trauma and are rarely associated with additional vascular defects. The coexistence of a PAF and a venous aneurysm is rare and usually occurs in patients with connective tissue disorders. Evidence regarding the management of this type of anomaly is scarce. However, both open and endovascular approaches seem feasible alternatives for treating this condition. Here, we describe a spontaneous popliteal arteriovenous fistula associated with a venous aneurysm in a 42-year-old male patient who presented with a popliteal mass. Satisfactory endovascular closure of the fistula and exclusion of the venous aneurysm were achieved using an Amplatzer™ Vascular Plug II.
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Affiliation(s)
- Sebastián Gómez-Galán
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Alejandro Velandia-Sánchez
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Lina María Sanabria-Arévalo
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Camilo Andrés Polania-Sandoval
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Division of Radiology, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Sebastian Gallo-Bernal
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Division of Radiology, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Jaime Cabrales-Arévalo
- Interventional Cardiology, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Jaime Camacho-Mackenzie
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Juan Guillermo Barrera-Carvajal
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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6
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Singh SP, Pandey NN, Raju SN, Shaw M, Malhi AS, Jagia P. Extreme Penetration of Long-Dwelling Retrievable Inferior Vena Cava Filter. Vasc Endovascular Surg 2021; 56:229-230. [PMID: 34654346 DOI: 10.1177/15385744211045152] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Surya Pratap Singh
- Department of Cardiovascular Radiology & Endovascular Interventions, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sreenivasa N Raju
- Department of Cardiovascular Radiology & Endovascular Interventions, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Department of Cardiovascular Radiology & Endovascular Interventions, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder Singh Malhi
- Department of Cardiovascular Radiology & Endovascular Interventions, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, 28730All India Institute of Medical Sciences, New Delhi, India
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7
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Hinojosa-Gonzalez DE, Salgado-Garza G, Torres-Martinez M, Villegas-De Leon SU, Bueno-Gutierrez LC, Herrera-Carrillo FE, Gonzalez-Urquijo M, Segura Ibarra V, Fabiani MA, Flores-Villalba E. Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis. J Endovasc Ther 2021; 29:294-306. [PMID: 34399594 DOI: 10.1177/15266028211038593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. METHODS A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. RESULTS Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17-1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40-0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29-14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29-1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41-251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14-0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75-1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. CONCLUSION The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.
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Affiliation(s)
| | - Gustavo Salgado-Garza
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, NL, Mexico
| | | | | | | | | | | | - Victor Segura Ibarra
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, NL, Mexico.,Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Monterrey, NL, Mexico
| | | | - Eduardo Flores-Villalba
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, NL, Mexico.,Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Monterrey, NL, Mexico
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8
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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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9
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Gautier S, Monakhov A, Tsiroulnikova O, Mironkov B, Voskanov M, Dzhanbekov T, Azoev E, Khizroev K, Dzhiner D, Pashkova I. Time is of the essence: A single-center experience of hepatic arterial supply impairment management in pediatric liver transplant recipients. Pediatr Transplant 2021; 25:e13934. [PMID: 33314615 DOI: 10.1111/petr.13934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Impairment of hepatic arterial flow including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), and splenic artery steal syndrome (SASS) is potentially life-threatening complications. The proposed early diagnosis and urgent treatment strategy of graft arterial flow reduction aim to decrease morbidity and mortality. METHODS Pediatric patients with known hepatic arterial flow impairment were retrospectively reviewed. Patients were grouped by occlusive (HAT) and non-occlusive (HAS/SASS) arterial flow reduction. Patients with HAT were further divided in two groups based on the estimated maximal hepatic artery occlusion time ≤8 and >8 hours. RESULTS Impairment of hepatic arterial flow developed in 32 of 416 pediatric liver transplant recipients. HAT, HAS, and SASS incidences were 4.1% (n = 17), 2.2% (n = 9), and 1.4% (n = 6), respectively. Neither graft loss nor death occurred in the non-occlusive group. The probabilities of sepsis (OR, 1.7; 95% CI, 1.14-2.53; P=.008) and graft loss or death (OR, 1.42; 95% CI, 1.04-1.92; P=.046) were higher in the occlusive group. Patients with estimated maximal duration of hepatic artery occlusion ≤ 8 hours (n = 7; 41.2%) did not have ischemic-type biliary lesions and sepsis (P=.044 and 0.010, respectively) but had excellent 3-year graft survival compared with > 8 hours group (100% vs 40%; P=.037). Multivariate analysis revealed HAT manifestation by fever was associated with increased chances of graft loss or death. CONCLUSION Occlusive arterial complications impose higher risks of graft loss and death. Thorough arterial supply monitoring by Doppler ultrasonography and urgent endovascular arterial flow restoration may salvage both graft and the recipient.
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Affiliation(s)
- Sergey Gautier
- Surgical Department #2 (Liver Transplantation), National Medical Research Center of Transplantology and Artificial Organs named after V.I. Shumakov, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Artem Monakhov
- Surgical Department #2 (Liver Transplantation), National Medical Research Center of Transplantology and Artificial Organs named after V.I. Shumakov, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Olga Tsiroulnikova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Boris Mironkov
- Department of Interventional Radiology, National Medical Research Center of Transplantology and Artificial Organs named after V.I. Shumakov, Moscow, Russia
| | - Mikhail Voskanov
- Surgical Department #2 (Liver Transplantation), National Medical Research Center of Transplantology and Artificial Organs named after V.I. Shumakov, Moscow, Russia
| | - Timur Dzhanbekov
- Surgical Department #2 (Liver Transplantation), National Medical Research Center of Transplantology and Artificial Organs named after V.I. Shumakov, Moscow, Russia
| | - Elkhan Azoev
- Department of Interventional Radiology, National Medical Research Center of Transplantology and Artificial Organs named after V.I. Shumakov, Moscow, Russia
| | - Khizri Khizroev
- Surgical Department #2 (Liver Transplantation), National Medical Research Center of Transplantology and Artificial Organs named after V.I. Shumakov, Moscow, Russia
| | - Deniz Dzhiner
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Irina Pashkova
- Department of Pediatrics, National Medical Research Center of Transplantology and Artificial Organs named after V.I. Shumakov, Moscow, Russia
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10
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Abdelaziz O, Osman AMA, Hosny KA, Emad-Eldin S, Serour DK, Mostafa M. Management of early hepatic artery thrombosis following living-donor liver transplantation: feasibility, efficacy and potential risks of endovascular therapy in the first 48 hours post-transplant-a retrospective cohort study. Transpl Int 2021; 34:1134-1149. [PMID: 33539596 DOI: 10.1111/tri.13839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/02/2020] [Accepted: 01/21/2021] [Indexed: 12/01/2022]
Abstract
This retrospective cohort study aims to review our 18-year experience with early hepatic artery thrombosis (e-HAT) following living-donor liver transplantation (LDLT), as well as to assess the feasibility, efficacy and potential risks of endovascular management of e-HAT in the first 48 hours (hrs) post-LDLT. Medical records of 730 patients who underwent LDLT were retrospectively reviewed. In all cases who had developed e-HAT, treatment modalities employed and their outcomes were evaluated. Thirty-one patients developed e-HAT(4.2%). Definite technical success and 1-year survival rates of surgical revascularization[11/31 cases(35.5%)] were 72.7% & 72.7%, whereas those of endovascular therapy[27/31 cases(87.1%)] were 70.4% & 59.3%, respectively. Endovascular therapy was carried out in the first 48hrs post-transplant in 9/31 cases(29%) [definite technical success:88.9%, 1-year survival:55.6%]. Four procedure-related complications were reported in 3 of those 9 cases(33.3%). In conclusion, post-LDLT e-HAT can be treated by surgical revascularization or endovascular therapy, with comparable results. Endovascular management of e-HAT in the first 48hrs post-LDLT appears to be feasible and effective, but is associated with a relatively higher risk of procedure-related complications, compared to surgical revascularization. Hence, it can be reserved as a second-line therapeutic option in certain situations where surgical revascularization is considered futile, potentially too complex, or potentially more risky.
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Affiliation(s)
- Omar Abdelaziz
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman M A Osman
- Department of General Surgery, Unit of Hepatobiliary Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karim A Hosny
- Department of General Surgery, Unit of Vascular Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sally Emad-Eldin
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia K Serour
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Mostafa
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
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11
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Gao Y, Miserlis D, Longo GM, Garg N. Renal salvage using stent graft placement after acute renal artery occlusion with prolonged ischemic time. JRSM Cardiovasc Dis 2020; 9:2048004020940520. [PMID: 32922767 PMCID: PMC7448260 DOI: 10.1177/2048004020940520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To describe a patient with acute renal artery occlusion who underwent successful revascularization procedure after experiencing a protracted ischemic period, which resulted in successful retrieval of renal function. Case report A 58-year-old male with a history of left renal artery stenosis and stent graft placement presented with symptoms of chest pain, shortness of breath, and flank pain. The patient was admitted to the Intensive Care Unit with the diagnosis of multiorgan failure and subsequent anuria that led to the initiation of hemodialysis. Computed tomography angiography demonstrated an aortic occlusion along with bilateral proximal renal artery occlusion with reconstitution of the mid to distal renal arteries via collateralization. The patient underwent angioplasty with bilateral renal artery stent-graft placement and successful revascularization of proximal renal arteries. Post-operatively, his renal function and urine output improved, and the patient was able to be weaned off hemodialysis along with the benefit of concurrent amelioration of his renovascular hypertension. Conclusion For select patients with renal artery occlusion, revascularization of the renal arteries may result in dialysis independence and stabilization of renovascular hypertension, despite prolonged time of ischemia.
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Affiliation(s)
- Yue Gao
- Division of Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Dimitrios Miserlis
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - G Matthew Longo
- Division of Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nitin Garg
- Division of Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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12
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Xu Y, Li X, Shang D, Liu J, Jin B, Chen W, Gao J. Mid-term outcomes of symptomatic isolated superior mesenteric artery dissection with endovascular management. Vascular 2020; 29:301-310. [PMID: 32819204 DOI: 10.1177/1708538120950110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The clinical outcomes, safety, and efficacy of endovascular management are explored for symptomatic isolated superior mesenteric artery dissection (ISMAD). METHODS In this retrospective study, 51 consecutive patients with symptomatic ISMAD received endovascular management from three institutions between January 2011 and December 2019.These patients were categorized into group A (endovascular treatment was used as the first-line therapy) and group B(endovascular treatment was used as the second-line therapy). The general epidemiological data, clinical manifestations, first-episode symptoms, treatment process, imaging findings, follow-up outcomes were analyzed from the medical records. RESULTS A total of 51 patients with endovascular management were collected in this study. Significant differences were observed between the two groups with respect to the course (150 h vs. 57 h; p < 0.001), intestinal ischemia (26.32% vs. 6,25%; p = 0.04) and dissection length (45.26 ± 13.78 mm vs. 63.37 ± 12.73 mm; p < 0.001). Technical success rate was 90.2% (46/51). There was significant difference in the MOD (42.27 ± 23.41 min vs. 76.63 ± 28.62 min p < 0.001), MPSRT (4.67 ± 2.65 h vs. 7.32 ± 2.49 h, p = 0.02), LOS (9.52 ± 3.72 days vs. 11.86 ± 4.13 days; p = 0.01) between the two groups. The bleeding complication rate was 7.84% (one patient in group A and three patients in group B). A total of 48 (94.12%, 48/51) patients were followed up for a median of 36.51 months (range, 4-87 months). Positive events of the SMA were achieved in 81.25% (39/48), and negative events of the SMA were achieved in 18.75% (8/48) based on the follow-up contrast-enhanced CT scan. CONCLUSIONS Endovascular management of symptomatic ISMAD has a high technical success rate and efficient at controlling symptoms. Furthermore, as more positive events occur, endovascular management should be encouraged early when pain persists after conservative management or there are signs of disease progression.
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Affiliation(s)
- Yingjiang Xu
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, PR China.,Key Laboratory of Metabolism and Molecular Medicine, The Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai, PR China
| | - Xuexin Li
- Department of Neurosurgery, Binzhou Medical University Hospital, 661 Huanghe Second Road, Binzhou, PR China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Jianyong Liu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Bi Jin
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Wei Chen
- Department of Interventional Vascular, Shengli Oilfield Central Hospital, Dongying, PR China
| | - Jianwei Gao
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, PR China
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13
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Phuoc LV, Tuan NHN, Khoa LV, Bao NVT, Tu PD, Hoan DD, Thao PTN, Khoi NV. Initial Results of Management for Acute Ischemic Stroke due to Large Vessel Occlusion by a Direct Aspiration First Pass Technique at a Vietnamese Hospital. Asian J Neurosurg 2020; 15:65-69. [PMID: 32181175 PMCID: PMC7057864 DOI: 10.4103/ajns.ajns_258_19] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/14/2019] [Indexed: 01/01/2023] Open
Abstract
Background: The development of novel revascularization devices has improved procedural and clinical outcomes in acute ischemic stroke (AIS). A direct aspiration first pass technique (ADAPT) has been introduced as a rapid simple method for achieving good recanalization and clinical outcomes using large bore aspiration catheters in the treatment of AIS due to large vessel occlusion (LVO). Objectives: The aim of this study was to assess the safety and efficacy of ADAPT in the treatment of AIS due to LVO in the Vietnamese patient population. Materials and Methods: A retrospective analysis of a hospital database was conducted on all patients undergoing stroke therapy with the ADAPT technique at the institution from January 2017 to December 2017. Efficacy and safety were evaluated by the variables: revascularization rates (thrombolysis in cerebral infarction [TICI] score), time to revascularization, procedural complications, and clinical outcomes (modified Rankin scale [mRS] score) at the 90-day follow-up visit. Results: From the database review, 37 AIS patients treated with ADAPT were identified. The mean NIHSS score at presentation was 17.3 and improved to 8.9 at discharged. The average time arterial puncture to revascularization was 32.5 min. TICI 2b/3 revascularization was achieved in 30/37 (81.1%) patients, good clinical outcomes were achieved (mRS 0–2) in 21/37 (56.7%) patients, and mortality rate was 6/37 (16.2%) during follow-up. Conclusions: ADAPT utilizing large bore aspiration catheters appears to be a fast, simple, safe, and effective method for the management of AIS in the Vietnamese patient population.
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Affiliation(s)
- Le Van Phuoc
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | | | - Le Van Khoa
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | | | - Pham Dang Tu
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | - Duong Dinh Hoan
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | | | - Nguyen Van Khoi
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh, Vietnam
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14
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Abstract
Despite several effective strategies of stroke prevention, the stroke epidemic still constitutes the leading cause of permanent disability. The recent series of well-designed, convincingly-positive randomized controlled trials of endovascular thrombectomy in stroke patients with large vessel occlusion launched a paradigm shift and a new era in acute stroke management. The present review provides an overview of the technical aspects of the procedure, discusses patient selection criteria, summarizes the current evidence from randomized trials about its efficacy and safety, and explores its implications in the organization of acute stroke care.
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Affiliation(s)
- Panagiotis Papanagiotou
- From the Clinic for Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.); Saarland University, Germany (P.P.); and Department of Medicine, University of Thessaly, Larissa, Greece (G.N.).
| | - George Ntaios
- From the Clinic for Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.); Saarland University, Germany (P.P.); and Department of Medicine, University of Thessaly, Larissa, Greece (G.N.)
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15
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Mukendi AM, Rauf A, Doherty S, Mahlobo F, Afolayan P, Dawadi S. Renal arteriovenous malformation: An unusual pathology. SA J Radiol 2019; 23:1704. [PMID: 31754531 PMCID: PMC6837781 DOI: 10.4102/sajr.v23i1.1704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/10/2019] [Indexed: 11/10/2022] Open
Abstract
Renal arteriovenous malformations are rare renal vascular abnormalities. More commonly, the term refers to the congenital type of malformation. Only a few cases have ever been presented and reported in the literature, mostly with a nidus. We present the clinical, ultrasound and computed tomography findings and discuss the management related to a 63-year-old male with a right congenital renal arteriovenous malformation without a nidus that was successfully managed with coil embolisation. Relevant literature is hereby reviewed to highlight characteristic imaging and appropriate treatment.
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Affiliation(s)
- Alain M Mukendi
- Department of Urology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Amer Rauf
- Department of Radiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sean Doherty
- Department of Urology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Florence Mahlobo
- Department of Radiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Afolayan
- Department of Urology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabina Dawadi
- Department of Radiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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16
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Wang Y, Xin H, Tan H, Wang H. Endovascular stent graft repair of complete persistent sciatic artery aneurysm with lower limb ischemia: A case report and review of the literature. SAGE Open Med Case Rep 2019; 7:2050313X19841462. [PMID: 31007917 PMCID: PMC6457022 DOI: 10.1177/2050313x19841462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/11/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Persistent sciatic artery is a rare embryological vascular anomaly, with an
incidence of 0.01%–0.05%. Up to 60% of persistent sciatic artery patients
will develop aneurysms that can subsequently lead to distal embolization and
a high risk of limb loss. Method: Here we report a case with acute limb ischemia caused by thrombus in a right
persistent sciatic artery aneurysm. The patient underwent endovascular
treatment by deploying a 10 × 150 mm stent graft (Viabahn) in the persistent
sciatic artery and two self-expanding bare stents (10 × 40 mm, 10 × 60 mm,
SMART) in the stent graft to reinforce the radial resistive force. In
addition, we conducted a literature review of articles published in PubMed
from 2001 to 2018 regarding stent graft repair of complete persistent
sciatic artery aneurysms. A total of 13 articles reported 13 patients with
complete persistent sciatic artery aneurysms who underwent endovascular
stent graft repair. Result: A favorable result was obtained for this patient, and computed tomographic
angiography at 6 months of follow-up revealed patent stent graft. Most
articles reported favorable results. Conclusion: Favorable results can be achieved with endovascular stent graft repair and
anticoagulation therapy for complete persistent sciatic artery
aneurysms.
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Affiliation(s)
- Yuewei Wang
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hai Xin
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haofei Tan
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haofu Wang
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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17
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Mazurek A, Partyka L, Trystula M, Jakala J, Proniewska K, Borratynska A, Tomaszewski T, Slezak M, Malinowski KP, Drazkiewicz T, Podolec P, Rosenfiled K, Musialek P. Highly-calcific carotid lesions endovascular management in symptomatic and increased-stroke-risk asymptomatic patients using the CGuard™ dual-layer carotid stent system: Analysis from the PARADIGM study. Catheter Cardiovasc Interv 2019; 94:149-156. [PMID: 30945420 DOI: 10.1002/ccd.28219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/13/2019] [Accepted: 03/23/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess feasibility, safety, angiographic, and clinical outcome of highly-calcific carotid stenosis (HCCS) endovascular management using CGuard™ dual-layer carotid stents. BACKGROUND HCCS has been a challenge to carotid artery stenting (CAS) using conventional stents. CGuard combines a high-radial-force open-cell frame conformability with MicroNet sealing properties. METHODS The PARADIGM study is prospectively assessing routine CGuard use in all-comer carotid revascularization patients; the focus of the present analysis is HCCS versus non-HCCS lesions. Angiographic HCCS (core laboratory evaluation) required calcific segment length to lesion length ≥2/3, minimal calcification thickness ≥3 mm, circularity (≥3 quadrants), and calcification severity grade ≥3 (carotid calcification severity scoring system [CCSS]; G0-G4). RESULTS One hundred and one consecutive patients (51-86 years, 54.4% symptomatic; 106 lesions) received CAS (16 HCCS and 90 non-HCCS); eight others (two HCCS) were treated surgically. CCSS evaluation was reproducible, with weighted kappa (95% CI) of 0.73 (0.58-0.88) and 0.83 (0.71-0.94) for inter- and intra-observer reproducibility respectively. HCCS postdilatation pressures were higher than those in non-HCCS; 22 (20-24) versus 20 (18-24) atm, p = .028; median (Q1-Q3). Angiography-optimized HCCS-CAS was feasible and free of contrast extravasation or clinical complications. Overall residual diameter stenosis was single-digit but it was higher in HCCS; 9 (4-17) versus 3 (1-7) %, p = .002. At 30 days and 12 months HCCS in-stent velocities were normal and there were no adverse clinical events. CONCLUSION CGuard HCCS endovascular management was feasible and safe. A novel algorithm to grade carotid artery calcification severity was reproducible and applicable in clinical study setting. Larger HCCS series and longer-term follow-up are warranted.
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Affiliation(s)
- Adam Mazurek
- Department of Cardiac & Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Lukasz Partyka
- KCRI Angiographic Core Laboratory and Data Management Division, Krakow, Poland
| | - Mariusz Trystula
- Department of Vascular Surgery, John Paul II Hospital, Krakow, Poland
| | - Jacek Jakala
- KCRI Angiographic Core Laboratory and Data Management Division, Krakow, Poland
| | - Klaudia Proniewska
- KCRI Angiographic Core Laboratory and Data Management Division, Krakow, Poland
| | - Anna Borratynska
- Neurology Inpatient and Outpatient Department, John Paul II Hospital, Krakow, Poland
| | - Tomasz Tomaszewski
- Neurology Inpatient and Outpatient Department, John Paul II Hospital, Krakow, Poland
| | - Magdalena Slezak
- Department of Vascular Surgery, John Paul II Hospital, Krakow, Poland
| | - Krzysztof P Malinowski
- Department of Vascular Surgery, John Paul II Hospital, Krakow, Poland.,Institute of Public Health, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Drazkiewicz
- KCRI Angiographic Core Laboratory and Data Management Division, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac & Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Kenneth Rosenfiled
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Piotr Musialek
- Department of Cardiac & Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
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18
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Chen X, Sun Z, Shi L, Xu L, Yu J, Fang B, Zheng J, Xu J, Zhang J. Endovascular management of ruptured distal posterior inferior cerebellar artery aneurysms: A retrospective cohort study. Medicine (Baltimore) 2018; 97:e13300. [PMID: 30544389 PMCID: PMC6310559 DOI: 10.1097/md.0000000000013300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/27/2022] Open
Abstract
Distal posterior inferior cerebellar artery (PICA) aneurysm is a kind of rare intracranial aneurysm with controversial evidence in managements. The main purposes of this research are to study the safety and effectiveness of parent artery occlusion (PAO) compared with selective aneurysm coiling (SAC) as well as figure out factors that affect the outcomes.All characteristics of patients that diagnosed with ruptured distal PICA aneurysm and treated with endovascular management in our hospital from July 2009 to February 2016 were retrospectively collected. Details include complete occlusion rate, procedure-related complications and Modified Rankin Scale (mRS) of 31 months (mean) follow-up.Total 36 patients finally met the criterions and were included in the present study. New imaging infarction was observed in 12 (33.33%) patients. And 10 of them showed no apparent neurological dysfunctions after 34 months (mean) follow-up; 1 remained coma status since the symptom onset; and 1 patient died. 27 (75%) patients got a mRS ≤ 2 at the discharge while 20 (86.96%) patients with 3-year follow-up after the operation. There is no significant difference between patients treated with SAC and PAO in both complications and functional recovery in 3-years follow-up period. Hunt&Hess classification (H&H), age, and hydrocephalus are risk factors for functional recovery at discharge.PAO is safe and efficient in the management of distal PICA aneurysms while complications and outcomes are similar with SAC. H&H, age, and hydrocephalus are predicting factors for the mRS at discharge. Further prospective study is still needed to confirm the results of present study.
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Affiliation(s)
- Xianyi Chen
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine
| | - Zeyu Sun
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine
| | - Ligen Shi
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine
| | - Liang Xu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine
| | - Jun Yu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine
| | - Bing Fang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine
| | - Jingwei Zheng
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine
| | - Jing Xu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine
- Brain Research Institute
- Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China
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19
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Abstract
To evaluate the outcomes and prognostic factors of endovascular management in immature arteriovenous fistula (AVF) for hemodialysis.From April 2007 to September 2017, 54 patients (male:female = 31:23, mean age 65.63 years, range 33-90 years) who underwent endovascular management for the salvage of immature AVF were retrospectively reviewed. Clinical data, procedural details, and results were evaluated. Primary and secondary patency rates and factors influencing the patency were also analyzed.Technical and clinical success rates were 88.9% (48/54) and 85.2% (46/54), respectively. Mean primary and secondary patency was 42.10 (±8.85) and 91.5 (±14.77) months, respectively. Primary and secondary patency rates were 66% and 89% in 1 year, 66% and 78% in 2 years, and 51% and 78% in 3 years. In multivariate analysis, only brachiocephalic AVF and antegrade access procedures showed significantly shorter primary patency (HR 5.196; 95% CI (1.04-25.77); P = .044, HR 8.096; 95% CI (1.36-48.00); P = .021). There was no statistically significant factor associated with secondary patency in the multivariate study.Endovascular management in immature AVF is safe and effective to make the AVF available. Brachiocephalic AVF and antegrade access procedures are the factors influencing the patency in multivariate analysis.
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Affiliation(s)
- Shin Jae Lee
- Department of Diagnostic Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Yatap-ro beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do
| | - Gyeong Sik Jeon
- Department of Diagnostic Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Yatap-ro beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do
| | - Byungmo Lee
- Department of Surgery, Seoul Paik Hospital, College of Medicine, Inje University, Mareunnae-ro, Jung-gu, Seoul, Republic of Korea
| | - Gun Lee
- Department of Thoracic and Cardiovascular Surgery
| | - Jung Jun Lee
- Department of Surgery, CHA Bundang Medical Center, College of Medicine, CHA University, Yatap-ro beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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20
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Ghonem ME, Yuan X, Mitsis A, Nienaber CA. Interventional repair of a vascular aneurysm in a patient with Marfan syndrome. SAGE Open Med Case Rep 2018; 6:2050313X18788448. [PMID: 30046448 PMCID: PMC6056777 DOI: 10.1177/2050313x18788448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/11/2018] [Indexed: 11/16/2022] Open
Abstract
Marfan syndrome is a heritable connective tissue disorder affecting skeletal, ocular and cardiovascular systems. Cardiovascular manifestations comprise aneurysmal dilatation of aortic root, aortic dissection and rupture; peripheral arterial aneurysms have been reported in femoral, iliac and subclavian arteries with surgical reconstruction as the first-line therapeutic option. We report a Marfan patient with a symptomatic aneurysm of left subclavian artery in the intrathoracic retro-clavicular space; instead of open surgical resection, an endovascular solution was successfully applied by use of a flexible self-expanding stent-graft (W.L Gore® Viabahn® Endoprosthesis 9 × 100 mm) to exclude the aneurysm. This case exemplifies a modern option to manage vascular pathology even in patients with Marfan syndrome. Follow-up over 1 year proved very reassuring with complete remodelling and resolution of the aneurysm; long-term follow-up is certainly warranted, considering the potential of recurrence or initial reactive hyperplasia.
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Affiliation(s)
- Mohammed E Ghonem
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
| | - Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
| | - Andreas Mitsis
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Trust and Imperial College, London, UK
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21
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Abstract
Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.
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Affiliation(s)
- Jong Woo Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jonathan K Park
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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22
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Ramírez-Senent B, Abadal JM, Vázquez E, Lago I, Gálvez E, Araujo MA, de la Quintana MI. Endovascular Management of a Giant High-Flow Lower Limb Arteriovenous Malformation. Vasc Endovascular Surg 2017; 51:572-576. [PMID: 28954598 DOI: 10.1177/1538574417731206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE High-flow arteriovenous malformations (AVMs) may pose a challenge for endovascular treatment due to high-flow rates. Incomplete treatment, recurrence, or even worsening can occur if a proper management is not performed. We report a case successfully treated with endovascular therapy. CASE REPORT A 37-year-old male was referred to our hospital with a soft tumor in the left thigh, limb asymmetry and associated pain. Doppler ultrasound and magnetic resonance imaging showed an extensive high-flow AVM with a venous aneurysm of 40 mm diameter. Diagnostic angiography identified multiple feeding vessels from the profunda femoris and superficial femoral arteries. Two endovascular interventions were performed within 1 month, combining afferent vessel embolization and percutaneous thrombin injection into the nidus, to exclude the AVM. Two-year imaging follow-up revealed thrombosis of the malformation. The patient remained asymptomatic with normal thigh diameter. No complications were documented in any of the sessions. CONCLUSION Endovascular therapy could be a safe and effective option for AVM as long as it includes not only feeding vessels embolization but also complete occlusion of the nidus.
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Affiliation(s)
| | - José M Abadal
- 2 Hospital Universitario Severo Ochoa, Leganes, Madrid, Spain
| | - Esther Vázquez
- 2 Hospital Universitario Severo Ochoa, Leganes, Madrid, Spain
| | - Isabel Lago
- 2 Hospital Universitario Severo Ochoa, Leganes, Madrid, Spain
| | - Esther Gálvez
- 2 Hospital Universitario Severo Ochoa, Leganes, Madrid, Spain
| | - Miguel A Araujo
- 2 Hospital Universitario Severo Ochoa, Leganes, Madrid, Spain
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23
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Abstract
Atherosclerotic axillary artery aneurysms are rare. We report a case of a ninety six year old female who presented with a pulsatile left breast mass causing her intractable pain. She was diagnosed with a massive axillary artery aneurysm which was treated with and endovascular aneurysm repair for palliation of her symptoms.
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24
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Lahiri S, Schlick K, Kavi T, Song S, Moheet AM, Yusufali T, Rosengart A, Alexander MJ, Lyden PD. Optimizing Outcomes for Mechanically Ventilated Patients in an Era of Endovascular Acute Ischemic Stroke Therapy. J Intensive Care Med 2016; 32:467-472. [PMID: 27543141 DOI: 10.1177/0885066616663168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Endovascular mechanical thrombectomy is a new standard of care for acute ischemic stroke (AIS). The majority of these patients receive mechanical ventilation (MV), which has been associated with poor outcomes. The implication of this is significant, as most neurointerventionalists prefer general compared to local anesthesia during the procedure. Consequences of hemodynamic and respiratory perturbations during general anesthesia and MV are thought to contribute significantly to the poor outcomes that are encountered. In this review, we first describe the unique risks associated with MV in the specific context of AIS and then discuss evidence of brain goal-directed approaches that may mitigate these risks. These strategies include an individualized approach to hemodynamic parameters (eg, adherence to a minimum blood pressure goal and adequate volume resuscitation), respiratory parameters (eg, arterial carbon dioxide optimization), and the use of ventilator settings that optimize neurological outcomes (eg, arterial oxygen optimization).
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Affiliation(s)
- Shouri Lahiri
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Konrad Schlick
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tapan Kavi
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shlee Song
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Asma M Moheet
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Taizoon Yusufali
- 3 Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Axel Rosengart
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael J Alexander
- 2 Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Patrick D Lyden
- 1 Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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25
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Abstract
OBJECTIVE To evaluate the effectiveness of endovascular management in iatrogenic renal injuries with regard to clinical status on follow-up and requirements for repeat angiography and embolization. MATERIALS AND METHODS This retrospective study included patients who were referred for endovascular management of significant hemorrhage following an iatrogenic injury. Data was recorded from the Picture Archiving and Communication system (PACS) and electronic medical records. The site and type of iatrogenic injury, imaging findings, treatment, angiography findings, embolization performed, clinical status on follow-up, and requirement for repeat embolization were recorded. The outcomes were clinical resolution, nephrectomy, or death. Clinical findings were recorded on follow-up visits to the clinic. Statistical analysis was performed using descriptive statistics. RESULTS Seventy patients were included in this study between January 2000 and June 2012. A bleeding lesion (a pseudoaneurysm or arteriovenous fistula) was detected during the first angiogram in 55 patients (78.6%) and was selectively embolized. Fifteen required a second angiography as there was no clinical improvement and five required a third angiography. Overall, 66 patients (94.3%) showed complete resolution and 4 patients (5.7%) died. Three patients (4.3%) underwent nephrectomy for clinical stabilization even after embolization. There were no major complications. The two minor complications resolved spontaneously. CONCLUSIONS Angiography and embolization is the treatment of choice in iatrogenic renal hemorrhage. Upto 20% of initial angiograms may not reveal the bleed and repeat angiography is required to identify a recurrent or unidentified bleed. The presence of multiple punctate bleeders on angiography suggests an enlarging subcapsular hematoma and requires preoperative embolization and nephrectomy.
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Affiliation(s)
| | | | - Vinu Moses
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kekre
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - V Tamilarasi
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anthony Devasia
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
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26
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Liu P, Lv X, Li Y, Lv M. Endovascular management of intracranial aneurysms during pregnancy in three cases and review of the literature. Interv Neuroradiol 2015; 21:654-8. [PMID: 26472635 PMCID: PMC4757365 DOI: 10.1177/1591019915609134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/14/2015] [Accepted: 07/18/2015] [Indexed: 02/05/2023] Open
Abstract
We present three cases of cerebral aneurysms (1 unruptured; 2 ruptured) treated with endovascular techniques in pregnancies. The first ruptured case is a 28-year-old female on 20th gestational week. After the endovascular coiling, the patient suffered persistent hemiparesis and delivered a healthy baby by cesarean section. The second ruptured case is a 25-year-old female on 36th week of pregnancy. She died of aneurysm re-rupture after delivery of a healthy baby by cesarean section. The third unruptured case is a 31-year-old woman on the 26th gestational week of pregnancy who died of a giant basilar tip aneurysm after stent-assisted coiling. Ruptured aneurysm obliteration should be prioritized followed by vaginal delivery or cesarean section. The decision regarding the treatment of unruptured aneurysms should be carefully considered on a case-by-case basis. Stent-assisted coiling may be applicable to aneurysm during pregnancy.
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Affiliation(s)
- Peng Liu
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| | - Xianli Lv
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| | - Youxiang Li
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| | - Ming Lv
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
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27
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Akkari M, Gascou G, Trévillot V, Bonafé A, Crampette L, Machi P. Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis. Interv Neuroradiol 2015; 21:660-3. [PMID: 26494406 DOI: 10.1177/1591019915609164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/09/2015] [Indexed: 11/17/2022] Open
Abstract
Non-traumatic cavernous internal carotid artery (ICA) aneurysms are rare, and favour the occurrence of massive recurrent epistaxis, which is associated with a high mortality rate. We report the case of a 67-year-old woman presenting a ruptured ICA aneurysm extending into the sphenoid sinus, revealed by epistaxis. Selective coil embolization of the aneurysm was performed. Flow-diverter stents were deployed in order to utterly exclude the aneurysm and prevent revascularization. Anti-platelet treatment was provided to lower the risk of in-stent thrombosis. A left frontal hematoma associated with a subarachnoid haemorrhage occurred at day 2. Outcome was favourable with no neurological sequelae, and no clinical recurrence of epistaxis occurred. A 4 months follow-up digital subtraction angiography showed a complete exclusion of the aneurysm. In addition, a magnetic resonance cerebral angiography at 16 months showed stable results. Thus, this two-stage endovascular procedure has proven its effectiveness in preventing epistaxis recurrence while preserving the ICA patency.
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Affiliation(s)
- Mohamed Akkari
- ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Grégory Gascou
- Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Vincent Trévillot
- ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Alain Bonafé
- Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Louis Crampette
- ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Paolo Machi
- Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France
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28
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Kaya B, Erdi F, Keskin F, Kalkan E, Koç O. Endovascular management of a collateral network aneurysm in a patient with spontaneous internal carotid artery occlusion. Interv Neuroradiol 2015; 21:175-7. [PMID: 25948115 DOI: 10.1177/1591019915582377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous "non-moyamoya" arterial occlusion of the intracranial arteries is very unusual. Progressive occlusion of a major intracranial artery, independently from the etiology, can lead to the development of collateral arterial networks that supply blood flow to distal territories beyond the occlusion. These collateral arteries are typically small and conduct low flows, but the hemodynamic stress within them can lead to aneurysm formation within the collateral network. In this report we present a case of spontaneous internal carotid artery occlusion and collateral network aneurysm for the first time in the literature and discuss the main features of the etiology and endovascular treatment of this rare, challenging aneurysm.
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Affiliation(s)
- Bulent Kaya
- Department of Neurosurgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Fatih Erdi
- Department of Neurosurgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Fatih Keskin
- Department of Neurosurgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Erdal Kalkan
- Department of Neurosurgery, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Osman Koç
- Department of Radiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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29
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Hegde UN, Rajapurkar MM, Gang SD, Lele SS. Percutaneous endovascular management of recurrent aneurysm of transplant renal artery anastomosed to internal iliac artery. Indian J Urol 2011; 24:411-3. [PMID: 19468480 PMCID: PMC2684339 DOI: 10.4103/0970-1591.42629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aneurysm formation constitutes 0.5 to 1% of all vascular complications in transplant patients. Aneurysms may result from infection, injury during procurement or preservation, faulty suture technique or trauma. Transplant renal artery aneurysm presents with hypertension, graft dysfunction and bleeding. We report a case of percutaneous covered stent-graft for recurrent aneurysm with stenosis of transplant renal artery. To our knowledge this is the first report of successful treatment of transplant renal artery aneurysm with covered stent-graft.
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30
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Abstract
Endovascular coil embolisation is increasingly used to treat unruptured intracranial aneurysms (UIA). Endovascular coil embolisation of UIA is associated with a 5-10% risk of morbidity and nearly zero mortality from the procedure. Complete or near complete occlusion is usually achieved in >90% of cases, and endovascular therapy seems to reduce the risk of future rupture significantly. Specific selection criteria for endovascular embolisation and novel approaches to endovascular treatment of aneurysms are discussed. Endovascular therapy appears to be a safe and effective treatment for selected UIA. Treatment failure rates will probably decrease with greater experience and advances in techniques and devices. Further study with long term follow up, however, is still necessary to characterise the efficacy, durability, and cost efficiency of endovascular treatment of UIA.
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Affiliation(s)
- N Pouratian
- University of Virginia, Department of Neurological Surgery, Box 800212, Charlottesville, VA 22903, USA.
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