Efficacy of endoscopic ultrasound-guided hemostatic interventions for resistant nonvariceal bleeding

A subset of patients with nonvariceal gastrointestinal bleeding fail, or are unsuitable candidates for, endoscopic, radiologic, and surgical interventions. Endoscopic ultrasound (EUS)-guided intervention might be effective in these patients. We performed EUS-guided hemostatic interventions for 17 patients with nonvariceal gastrointestinal bleeding from June 2003 through May 2014 who failed, or were unsuitable candidates for, additional therapies. Indications for treatment included gastrointestinal stromal tumors, colorectal vascular malformations, duodenal masses or polyps, Dieulafoy lesions, duodenal ulcers, rectally invasive prostate cancer, pancreatic pseudoaneurysms, ulcerated esophageal cancer, and ulceration after Roux-en-Y gastric bypass. After the procedure, 88% of patients have had no further bleeding related to the treated lesion, over a median follow-up period of 12 months. EUS-guided hemostatic therapy therefore is feasible and useful for select patients with clinically severe, refractory, or recurrent nonvariceal gastrointestinal bleeding.

Coil embolization of intralobar pulmonary sequestration - an alternative to surgery: a case report

BACKGROUND

Pulmonary sequestration is a congenital lung disease characterized by nonfunctioning pulmonary tissue that lacks normal communication with the bronchial tree and is supplied by a nonpulmonary systemic artery. Symptomatic bronchopulmonary sequestration is uncommon, seen more frequently in the pediatric population than in adults. It has traditionally been treated with surgical resection; however, a limited but growing number of cases have been treated with angiographic embolization. Given the inherent risks of cardiothoracic surgery, embolization of the anomalous vessel is an enticing alternative treatment. We present a case of a 56-year-old woman with known, symptomatic, intralobar pulmonary sequestration that was successfully treated with coil embolization.

CASE PRESENTATION

A 56-year-old Pacific Islander woman with a history of chronic myeloid leukemia was admitted to the hospital with an episode of hemoptysis. Computed tomography of the chest demonstrated left lower lobe intralobar pulmonary sequestration fed by a large tortuous vessel branching off of the descending thoracic aorta. Surgical resection of the sequestration is the current standard treatment strategy of symptomatic intralobar pulmonary sequestration. The cardiothoracic surgeon noted that given the size and location of arterial blood supply, intervention would involve thoracotomy and lobectomy. The interventional radiologist offered embolization of the lesion as an alternative to surgery. Multiple coils, 6-13 mm in size, were used to embolize the sequestration. No considerable flow distal to the coils was noted postembolization.

CONCLUSIONS

Intralobar pulmonary sequestration is a rare condition that typically requires surgical management. This case demonstrates the efficacy of coil embolization as an alternative management strategy. To date, limited case reports of adults treated with endovascular embolization exist. Treatment of symptomatic pulmonary sequestration with embolization can be considered as an alternative to surgical resection.

Transvenous coil embolization of hypoglossal canal dural arteriovenous fistula using detachable coils: A case report

The hypoglossal canal (HC) is an unusual location of the posterior fossa dural arteriovenous fistula (AVF), which usually occurs in the transverse or sigmoid sinus. Herein, we report a case of HC dural AVF successfully treated with transvenous coil embolization using detachable coils in a 68-year-old woman who presented with headache and left pulsatile tinnitus for 2 months. Brain magnetic resonance imaging (MRI) and cerebral angiography revealed left HC dural AVF. The pulsatile bruit disappeared immediately after the procedure. Follow-up MRI showed complete disappearance of the fistula. Precise localization of the fistula through careful consideration of the anatomy and transvenous coil embolization using a detachable coil can facilitate the treatment for HC dural AVF.

Meticulous observations essential before and after coil embolization of pulmonary arteriovenous malformation; lessons learned from two case

BACKGROUND

Endovascular coil embolization is an approved treatment for pulmonary arteriovenous malformation (AVM) but it brings high rate of thromboembolic complications with subsequent morbidity and mortality. Hereby, we report two cases of AVM coil embolization and management of their compilations.

CASE REPORT

The first case was a 57-year-old male with five implanted coils in the lower lobe of right lung in which two of them were migrated soon after implantation. On exploration, a large atrial septal defect was detected and then repaired successfully. The next day, he was transferred for fluoroscopy. Two embolized coils were found at the site of the left iliac artery which was extracted via snare through sheath implanted in the left femoral artery. Coil migration to the left atrium and subsequently to the left iliac artery is reported for the first time. The second case was a 45-year-old male with central cyanosis and clubbing of upper and lower extremities from childhood. On computed tomography angiography (CTA), a vascular lesion was found. The patient underwent coil embolization for closure of AVM. The patient was still symptomatic after successful closure of AVM. On CTA, two feeding arteries were detected. He underwent second coil embolization procedure.

CONCLUSION

AVM coil embolization is a temptative procedure, which should be performed on its real indications by an expert centers who can handle complications of this procedure. The performance of CTA seems beneficial in some cases to confirm complete embolization of AVM.

Feasibility of using intravascular ultrasonography for assessment of giant cavernous aneurysm after endovascular treatment: a technical report

INTRODUCTION

Intravascular ultrasonography (IVUS) has been shown as a valuable adjunct imaging tool during endovascular procedures but its value in detection of any recurrence during follow up after endovascular coil embolization of large and giant intracranial aneurysms is not reported.

METHODS

A 41 years old man who had been treated using stent assisted coil embolization for cavernous segment aneurysm of the left internal carotid artery underwent 60 month angiographic follow up. Concurrently, IVUS catheter was advanced under fluoroscopic guidance inside the cavernous portion of the left internal carotid artery. Then IVUS images were used to visualize the stent, coil loops, and aneurysm neck.

RESULTS

The angiographic images were limited because of superimposition of the aneurysm on the parent vessel in all projections. IVUS images demonstrated that the stent was patent along its whole length and there was no sign of stent deformity or in-stent thrombosis. Loops of the coil were visualized as hyperechoic signals inside the aneurysm and there was no sign of herniated loops of coil inside the stent.

CONCLUSION

In this case report, we observed that adjunct use of IVUS can provide valuable information not ascertained by angiography during follow up assessment of coil embolized aneurysm.