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Wang Y, Huang XM, Zhang Y, Li J, Li J, Ye Z, Peng Y, Zhang XJ, Tang N, Qiu WW, Xu L. Comparison of ultrasound features and lesion sites in dysfunctional arteriovenous fistula. Ren Fail 2024; 46:2294148. [PMID: 38186351 PMCID: PMC10776081 DOI: 10.1080/0886022x.2023.2294148] [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] [Received: 04/17/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
This study aimed to investigate ultrasound features of arteriovenous fistula stenosis and their relationship with primary patency after percutaneous transluminal angioplasty (post-intervention primary patency) and compare this classification with that using lesion location. Hemodialysis patients who underwent ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis from July 2020 to December 2021 were retrospectively evaluated. Lesions (excluding inflow arteries) were categorized into five groups based on ultrasound features, and the clinical characteristics and risk factors affecting the post-intervention primary patency of the arteriovenous fistula were analyzed. Among 185 patients, 100 (54.05%), 36 (19.46%), 22 (11.89%), 11 (5.95%), and 16 (8.65%) were classified into the intima-dominant, non-intima-dominant, valve obstruction, vascular calcification, and mixed groups, respectively. The dialysis duration and arteriovenous fistula use time were the highest in the vascular calcification group at 86 (interquartile range: 49-140) and 77 (interquartile range: 49-110) months, respectively. Diabetes mellitus was most common in the intima-dominant group (42.0%). In Kaplan-Meier and univariate Cox analysis, type III lesion location (stenosis in the venous confluence site) was associated with the lower post-intervention primary patency. In the multivariate Cox analysis, percutaneous transluminal angioplasty times (the number of times patients were treated with percutaneous transluminal angioplasty for arteriovenous fistula stenosis dysfunction), vascular calcification, calcification at the lesion site requiring percutaneous transluminal angioplasty, and serum parathyroid hormone levels were independent risk factors for post-intervention primary patency. Ultrasound features showed that calcification of the arteriovenous fistula was detrimental to the post-intervention primary patency of arteriovenous fistula.
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Affiliation(s)
- Yin Wang
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-mei Huang
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Zhang
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Li
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Li
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Ye
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Peng
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian-jin Zhang
- Department of Nephrology, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, China
| | - Na Tang
- Department of Nephrology, Union Jiangbei Hospital of Huazhong University of Science and Technology, Wuhan Caidian District People’s Hospital, Wuhan, China
| | - Wen-wen Qiu
- Department of Nephrology, Wuhan Huangpi District People’s Hospital, Wuhan, China
| | - Li Xu
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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2
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An R, Li J, Zhu T, Zhang Y, Li Y, Li L, Gao R, Liu X, Cao P. Traumatic Iliac Arteriovenous Fistula Treated With the Amplatzer Vascular Plug II: A Case Report and Literature Review. Vasc Endovascular Surg 2024; 58:535-539. [PMID: 38158764 DOI: 10.1177/15385744231225375] [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: 01/03/2024]
Abstract
Traumatic iliac arteriovenous fistula is a rare complication of vascular injury. Open surgical repair has an incidence of postoperative complications. In recent years, endovascular treatment has shown better efficacy. We report a 62-year-old female AVF patient with a stab injury history of more than 16 years. Computed tomography angiography (CTA) revealed a large arteriovenous fistula between the right internal iliac artery and the common iliac vein. After considering the patient's relevant conditions, an endovascular approach was satisfactorily performed with the implantation of an Amplatzer Vascular Plug II to interrupt the abnormal vascular communication and maintain arterial and venous patency. The final control images showed closure of the arteriovenous communication.
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Affiliation(s)
- Rui An
- Department of Vascular Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiatao Li
- Department of Vascular Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tianyi Zhu
- Department of Laboratory, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanrong Zhang
- Department of Vascular Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunsong Li
- Department of Vascular Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liang Li
- Department of Vascular Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruijiao Gao
- Department of Vascular Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiangdong Liu
- Department of Vascular Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pengkai Cao
- Department of Vascular Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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3
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Palić B, Mandić A, Prskalo Z, Fazlibegović E. 32-year-old Traumatic Arteriovenous Fistula Presenting With Leg Ulcer and High-output Heart Failure. Vasc Endovascular Surg 2024; 58:544-547. [PMID: 38158801 DOI: 10.1177/15385744231225886] [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: 01/03/2024]
Abstract
Traumatic arteriovenous fistula (AVF) is not a common disorder, and dermatological signs and heart failure caused by AVF are rarely reported. We present the case of a 55-year-old woman who was referred for congestive heart failure symptoms. Echocardiography revealed preserved left ventricular ejection fraction. Due to edema of the right leg with a long-standing leg ulcer and palpable femoral thrill, duplex ultrasonography was performed. It showed an AVF between the right superficial femoral artery (SFA) and the right femoral vein (FV). The patient recalled a 32-year-old gunshot injury that was not medically treated. After the diagnosis of AVF she was referred to a surgeon for an AVF ligation, with subsequent resolution of her symptoms. The differential diagnosis of leg ulcer with leg edema should include the possibility of AVF as a cause.
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Affiliation(s)
- Benjamin Palić
- Department of Internal Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
- Department of Pathophysiology, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Ante Mandić
- Department of Internal Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
- Department of Pathophysiology, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Zrinko Prskalo
- Department of Internal Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Emir Fazlibegović
- Department of Medical Sciences, International Academy of Science and Arts in Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
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4
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Yu J. Endovascular treatment of traumatic anterior communicating artery-cavernous sinus fistula. Neuroradiol J 2024; 37:372-375. [PMID: 37579065 DOI: 10.1177/19714009231196469] [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: 08/16/2023] Open
Abstract
Traumatic anterior communicating artery (AcomA)-cavernous sinus (CS) fistula is rare. Flow diverter (FD) deployment associated with coiling may be an alternative but has never been reported. We reported such a case. A 61-year-old man who was involved in a traffic accident presented with progressive exophthalmos for 2 weeks. Digital subtraction angiography showed a fistula between the AcomA and CS. First, the fistula was coiled. Then, the FD was deployed to cover the rupture point of the AcomA. The fistula was obliterated. Postoperatively, the patient recovered well, and his eye symptoms disappeared. Follow-up angiography showed no recurrence of the fistula. Therefore, for traumatic AcomA-CS fistula, FD deployment associated with coiling may be a feasible alternative.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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5
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Chen KS, Williams DD, Iacobas I, McClugage SG, Gadgil N, Kan P. Spontaneous thrombosis of high flow pediatric arteriovenous fistulae: Case series of two patients and a comprehensive literature review. Childs Nerv Syst 2024; 40:1405-1414. [PMID: 38085366 DOI: 10.1007/s00381-023-06241-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 04/19/2024]
Abstract
Pediatric pial arteriovenous shunts in the brain and spine are challenging to understand because of low incidence, variable presentation, and associations with genetic syndromes. What is known about their natural history comes from reviews of small series. To better understand the natural history and role for intervention, two cases are presented followed by a review of the literature. In the first case, an infant with a prior history of intracranial hemorrhage from a ruptured pial fistula returns for elective embolization for a second pial fistula which was found to be spontaneously thrombosed 2 weeks later. In the second case, a 5-year-old with a vertebro-vertebral fistula, identified on work up for a heart murmur and documented with diagnostic angiography, is brought for elective embolization 6 weeks later where spontaneous thrombosis is identified. In reviewing the literature on pediatric single-hole fistulae of the brain and spine, the authors offer some morphologic considerations for identifying which high-flow fistulae may undergo spontaneous thrombosis to decrease the potentially unnecessary risk associated with interventions in small children.
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Affiliation(s)
- Karen S Chen
- Edward B. Singleton Department of Radiology and Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 470, Houston, TX, 77030, USA.
| | - Daniel Davila Williams
- Department of Neurology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - Ionela Iacobas
- Department of Pediatrics, Baylor College of Medicine, Vascular Anomalies Center at Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, 6701 Fannin St, Suite 1510, Houston, TX, 77030, USA
| | - Samuel G McClugage
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1230, Houston, TX, 77030, USA
| | - Nisha Gadgil
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1230, Houston, TX, 77030, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, 1005 Harborside Dr, 5th floor, Galveston, TX, 77555, USA
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Tay TKC, Rehena G, Zhuang KD, Irani FG, Gogna A, Too CW, Chong TT, Tan BS, Tan CS, Tay KH. Comparison of pharmacological thrombolysis with mechanical thrombectomy in thrombosed arteriovenous fistulas and grafts: a systemic review and meta-analysis. Clin Radiol 2024; 79:e624-e633. [PMID: 38320944 DOI: 10.1016/j.crad.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/09/2023] [Accepted: 12/12/2023] [Indexed: 02/08/2024]
Abstract
AIM To compare the effectiveness and safety of pharmacological thrombolysis and mechanical thrombectomy. MATERIAL AND METHODS This review was conducted in accordance with the PRISMA guidelines. Pooled proportions and subgroup analysis were calculated for primary and secondary patency rates, technical success, clinical success, major and minor complications rates. RESULTS This systematic review identified a total of 6,492 studies of which 17 studies were included for analysis. A total of 1,089 patients comprising 451 (41.4 %) and 638 (58.6 %) patients who underwent thrombolysis and mechanical thrombectomy procedures, respectively, were analysed. No significant differences were observed between thrombolysis and mechanical thrombectomy procedures in terms of technical success, clinical success, major and minor complications rates, primary and secondary patency rates; however, subgroup analysis of overall arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) demonstrated a significantly higher rate of major complications within the AVF group (p=0.0248). CONCLUSION The present meta-analysis suggests that pharmacological thrombolysis and mechanical thrombectomy procedures are similarly effective and safe; however, AVFs are subject to higher major complications compared to AVGs.
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Affiliation(s)
| | - G Rehena
- Duke-NUS Medical School, Singapore
| | - K D Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - F G Irani
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - A Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - C W Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - T T Chong
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - B S Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - C S Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - K H Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore.
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7
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Béland MA, Bergeron NAD, Béland M, Haydock L, Isenring P. An unusual complication of arteriovenous fistula. Kidney Int 2024; 105:893. [PMID: 38519243 DOI: 10.1016/j.kint.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/27/2023] [Accepted: 09/05/2023] [Indexed: 03/24/2024]
Affiliation(s)
- Marc-Antoine Béland
- Nephrology Service & Research Group, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Nicolas A D Bergeron
- Nephrology Service & Research Group, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Mathieu Béland
- Department of Radiology, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Ludwig Haydock
- Nephrology Service & Research Group, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Paul Isenring
- Nephrology Service & Research Group, CHU de Québec-Université Laval, Québec City, Québec, Canada.
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8
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Wang Y, Zhang X, Li D. Successful Endovascular Salvage of Viabahn Stent Release Malfunction Using a Cutting Balloon: A Case Report. Vasc Endovascular Surg 2024; 58:443-447. [PMID: 37975272 DOI: 10.1177/15385744231216040] [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: 11/19/2023]
Abstract
In the past two decades, the method of endovascular therapy, particularly utilizing covered stents, has been widely employed to treat arteriovenous fistulas (AVF) following traumatic injury. In this report, we present a case study of a patient with post-traumatic femoral arteriovenous fistula treated using a Viabahn endoprosthesis, during which a rare occurrence of stent deployment obstruction was overcome via successful endovascular intervention. Leveraging the unique release line-based deployment mechanism of the Viabahn stent, we were able to adroitly respond to this emergency situation by adopting a suitable approach via minimally invasive endovascular means, and ultimately resolving the impasse. This approach averted the significant trauma associated with open surgical procedures.
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Affiliation(s)
- Yusheng Wang
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaosong Zhang
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Da Li
- Department of Vascular Surgery, The First People's Hospital of Lianyungang, Lianyungang, China
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9
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Kawahara Y, Inomata JI, Ogasawara A, Hashimoto Y. Superior Mesenteric Arteriovenous Fistula Presenting as Portal Hypertension. Intern Med 2024; 63:753-754. [PMID: 37407454 PMCID: PMC10982024 DOI: 10.2169/internalmedicine.2214-23] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
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10
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Latif MA, Bailey C, Weiss CR. Persistence After Treatment of Pulmonary Arteriovenous Malformations in Children. Cardiovasc Intervent Radiol 2024; 47:394-396. [PMID: 38062174 DOI: 10.1007/s00270-023-03625-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/14/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Muhammad A Latif
- Russell H. Morgan Department of Radiology and Radiological Science, Interventional Radiology Center, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher Bailey
- Russell H. Morgan Department of Radiology and Radiological Science, Interventional Radiology Center, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, Interventional Radiology Center, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA.
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11
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Gong AJ, Bosworth EC, Garg T, Weiss CR. Prospective Study of Polytetrafluoroethylene-Covered Microplugs and Detachable Coils for Embolization of Pulmonary Arteriovenous Malformations: Technical Results, Procedure Times, and Costs. J Vasc Interv Radiol 2024; 35:362-369. [PMID: 38123126 DOI: 10.1016/j.jvir.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/17/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To determine time to occlusion and procedure costs of embolization of pulmonary arteriovenous malformations (PAVMs) using a polytetrafluoroethylene-covered microplug compared with embolization using detachable coils. MATERIALS AND METHODS In this prospective study, 37 patients (mean age, 39.1 years [SD ± 17.6]) with 82 PAVMs underwent embolization with microplug or detachable coils between April 2019 and January 2023. Technical success, procedure time intervals, and costs were analyzed. RESULTS In 37 patients, 82 PAVMs and 101 feeding arteries were successfully treated (microplug, 64; microplug + another device, 5; detachable coils alone, 32). Time from embolic device inserted into the catheter to device deployed and time to occlusion differed significantly between microplug and detachable coil cohorts (P < .0001 for both). Embolization with ≥1 microplug had a significantly shorter occlusion time than embolization with detachable coils (median, 10.0 minutes saved per feeding artery) (P < .0001). Compared with detachable coil embolization, microplug embolization saved a median of 9.0 minutes per feeding artery (P < .0001) and reduced room cost by a median of $429 per feeding artery (P < .0001). Device costs per feeding artery did not differ significantly between microplug ($2,790) and detachable coil embolization ($3,147) (P = .87). CONCLUSIONS Compared with coils, microplugs had an equally high technical success rate but significant time to occlusion and room costs savings per feeding artery. Total room cost and device cost together did not differ significantly between microplugs and coils. Microplugs may be considered technically effective and at least cost-neutral for PAVM embolization where clinically appropriate.
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Affiliation(s)
- Anna J Gong
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eugene C Bosworth
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tushar Garg
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland.
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El Naamani K, Mouchtouris N, Majmundar S, Sah E, Kaul A, Sizdahkhani S, Momin AA, Ghanem M, Al Saiegh F, Gooch MR, Herial NA, Rosenwasser RH, Tjoumakaris SI, Bilyk JR, Jabbour P. Comparison of the transarterial, transvenous, and superior ophthalmic vein approaches in the treatment of indirect carotid-cavernous fistulas. Neurosurg Focus 2024; 56:E7. [PMID: 38427999 DOI: 10.3171/2023.12.focus23776] [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] [Received: 10/30/2023] [Accepted: 12/27/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Indirect carotid-cavernous fistulas (CCFs) are abnormal arteriovenous shunting lesions with a highly variable clinical presentation that depends on the drainage pattern. Based on venous drainage, treatment can be either transarterial (TA) or transvenous (TV). The aim of this study was to compare the outcomes of indirect CCF embolization via the TA, TV, and direct superior ophthalmic vein (SOV) approaches. METHODS The authors conducted a retrospective analysis of 74 patients admitted to their institution from 2010 to 2023 with the diagnosis of 77 indirect CCFs as confirmed on digital subtraction angiography. RESULTS A total of 74 patients with 77 indirect CCFs were included in this study. Embolization was performed via the TA approach in 4 cases, the TV approach in 50 cases, and the SOV in 23 cases. At the end of the procedure, complete occlusion was achieved in 76 (98.7%) cases. The rate of complete occlusion at the end of the procedure and at last radiological follow-up was significantly higher in the SOV and TV cohorts than in the TA cohort. The rate of recurrence was highest in the TA cohort (25% for TA vs 5.3% for TV vs 0% for SOV, p = 0.68). CONCLUSIONS The rate of immediate complete occlusion was higher in the TV and SOV cohorts than in the TA cohort while the rate of complete occlusion at final follow-up was highest in the SOV cohort. The SOV approach was significantly associated with higher rates of postoperative complications. Indirect CCFs require careful examination of the fistulous point and the venous drainage to provide the most effective patient-tailored approach.
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Affiliation(s)
- Kareem El Naamani
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nikolaos Mouchtouris
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Shyam Majmundar
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Eric Sah
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Anand Kaul
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Saman Sizdahkhani
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Arbaz A Momin
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Marc Ghanem
- 2School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Fadi Al Saiegh
- 3Department of Neurosurgery, UT Health San Antonio, Texas; and
| | - M Reid Gooch
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nabeel A Herial
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Robert H Rosenwasser
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stavropoula I Tjoumakaris
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jurij R Bilyk
- 4Department of Oculoplastic and Orbital Surgery, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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13
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Tanaka K, Osuga K, Nagai K, Satomura H, Tomotake K, Koretsune Y, Kimura Y, Ono Y, Higashihara H, Tomiyama N. Four Cases of Delayed Pneumonia Around Coils After Embolization of Pulmonary Arteriovenous Malformations. Cardiovasc Intervent Radiol 2024; 47:397-400. [PMID: 38087054 DOI: 10.1007/s00270-023-03588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/05/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Kaishu Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.
| | - Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, Japan
| | - Keisuke Nagai
- Department of Radiology, Toyonaka Municipal Hospital, 1-14-4 Shibahara-Cho, Toyonaka, Osaka, Japan
| | - Hiroki Satomura
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kosuke Tomotake
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yuji Koretsune
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yasushi Kimura
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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14
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Xie Y, Wang J, Zou Y. Pulmonary arteriovenous fistula. J Vasc Surg Venous Lymphat Disord 2024; 12:101717. [PMID: 37972756 DOI: 10.1016/j.jvsv.2023.101717] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Yong Xie
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Jian Wang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
| | - Yinghua Zou
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
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15
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Botsford A, Tradi F, Loubet A, Tantawi S, Soulez G, Giroux MF, Faughnan ME, Gauthier A, Perreault P, Bouchard L, Holderbaum do Amaral R, Chartrand-Lefebvre C, Therasse E. Transarterial Embolization of Simple Pulmonary Arteriovenous Malformations: Long-Term Outcomes of 0.018-Inch Coils versus Vascular Plugs. J Vasc Interv Radiol 2024; 35:349-360. [PMID: 38013007 DOI: 10.1016/j.jvir.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/24/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To compare the safety, effectiveness, and persistence rates of 0.018-inch coils with those of Amplatzer vascular plugs (AVPs; Abbott Vascular, Abbott Park, Illinois) for the treatment of pulmonary arteriovenous malformations (PAVMs) in response to a growing concern that 0.018-inch coil embolization would increase the long-term persistence rate. MATERIALS AND METHODS This is a retrospective, single-center study of a database (2002-2020) of 633 PAVM embolizations. Complex PAVMs and those not embolized with 0.018-inch coils or plugs were excluded. PAVM embolization material was classified into 4 groups: (a) 0.018-inch nonfibered coils (NFCs), (b) 0.018-inch fibered coils (FCs), (c) NFCs and FCs, or (d) plugs. Persistence was defined as flow through the PAVM on digital subtraction angiography (DSA) or as <30% diameter reduction of the aneurysmal sac on unenhanced computed tomography (CT). Kaplan-Meier analysis and Cox regression were used to assess PAVM's persistence-free survival. RESULTS A total of 312 PAVM embolizations with NFCs (43 PAVMs), FCs (127 PAVMs), NFCs and FCs (12 PAVMs), or plugs (130 PAVMs) in 109 patients (28% men; mean age = 49 years) were included. All PAVM embolizations were technically successful without any major adverse events. PAVM persistence-free survival rates at 10 years' follow-up were 40.8% versus 44.7% in the NFC and FC groups (P = .22) and 47.3% versus 81.0% in the 0.018-inch coil (NFC or FC) and plug groups (P < .0001), respectively. There were 0.43 (79/182) and 0.08 (10/130) re-embolization procedures per PAVM in the 0.018-inch coil and plug groups, respectively (P < .001). CONCLUSIONS PAVM embolization with 0.018-inch coils was safe, but persistence rate with PAVM embolization was significantly higher than that with plugs, with no significant differences between FCs and NFCs.
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Affiliation(s)
- Alexander Botsford
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Department of Radiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Farouk Tradi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Assistance publique-hôpitaux de Marseille, Hôpital de la Timone, Service d'imagerie diagnostic et interventionnelle, Marseille, France; Laboratoire d'imagerie interventionnelle expérimentale (LIIE), Faculté de Médecine, CERIMED, Université Aix-Marseille Marseille, France
| | - Antoine Loubet
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Department of Radiology, Université de Montpellier, France
| | - Suhad Tantawi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Centre de recherche du CHUM (CRCHUM), Pavillon R, Montréal Quebec, Canada
| | - Marie-France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Marie E Faughnan
- Montreal HHT Centre, Division of Pneumology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital and Li Ka Shing Knowledge Institute Toronto, Ontario, Canada
| | - Andréanne Gauthier
- Montreal HHT Centre, Division of Pneumology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada
| | - Pierre Perreault
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Louis Bouchard
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | | | - Carl Chartrand-Lefebvre
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Centre de recherche du CHUM (CRCHUM), Pavillon R, Montréal Quebec, Canada.
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16
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Charan BD, Shah SA, Jain S, Sebastian LJD. Cortical malformation adjacent to a large pial arteriovenous fistula. BMJ Case Rep 2024; 17:e258820. [PMID: 38423569 PMCID: PMC10910652 DOI: 10.1136/bcr-2023-258820] [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: 03/02/2024] Open
Abstract
The coexistence of an arteriovenous fistula (AVF) and neuronal migration abnormalities is a rare phenomenon. The underlying pathophysiology responsible for these anomalies remains elusive. Neuronal architectural irregularities arise from complex neuronal formation, migration and organisation dysfunctions. Isolated cases of these associations are rarely described in the literature. Here, we present an unusual case involving the coexistence of a pial AVF and a pachygyria-polymicrogyria complex in an early childhood boy. We have provided a detailed description of the neuroimaging characteristics and the therapeutic embolisation in this case, along with follow-up. Additionally, we conduct a comprehensive review of potential hypotheses about the association, referencing prior case reports. The presence of an aberrant blood supply or deviant venous drainage from the developing cortex may contribute to a variety of neuronal migration anomalies.
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17
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Ting M, Chang PY, Chan CY. Addressing unmet needs for evidence-based and protocol-driven upper limb exercise programs to improve hemodialysis fistula maturation. J Formos Med Assoc 2024; 123:147-148. [PMID: 37743128 DOI: 10.1016/j.jfma.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Mao Ting
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Po-Ya Chang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yang Chan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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18
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Schlager O, Wolf F, Mueller M, Gschwandtner ME, Loewe C, Koppensteiner R, Beitzke D, Willfort-Ehringer A. Closure of Post-thrombotic Iliac Arteriovenous Fistulas by Iliac Vein Recanalization. J Endovasc Ther 2024; 31:157-163. [PMID: 35980088 PMCID: PMC10773157 DOI: 10.1177/15266028221113745] [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: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to report the closure of iliac arteriovenous fistulas associated with a post-thrombotic iliac vein occlusion by iliac venous stent recanalization. CASE REPORT An 80-year-old woman presented with a worsening painful swelling of her left leg after an iliofemoral deep vein thrombosis 6 months ago. Duplex ultrasound and magnetic resonance venography revealed a post-thrombotic obstruction of her iliac veins as well as several arteriovenous fistulas between branches of her left external and internal iliac arteries and adjacent diseased venous segments. In a first attempt, coil embolization did not sustainably close these iliac arteriovenous fistulas. Direct stent recanalization of the chronically diseased iliofemoral venous segment, however, resulted in an immediate closure of arteriovenous shunt flow and subsequent improvement of clinical symptoms. Six months after iliac vein stent recanalization, still no fistulas could be detected any more, venous stents were fully patent, and the patient was free of symptoms. CONCLUSION Post-thrombotic iliofemoral obstructions might be associated with the development of arteriovenous fistulas. Direct stent recanalization of the chronically occluded veins results in closure of related arteriovenous fistulas. CLINICAL IMPACT This case suggests that the combined occurrence of post-thrombotic venous obstructions with arteriovenous fistulas, which are related to aforementioned venous lesions, should be evaluated for primary venous stent recanalization rather than fistula embolization.
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Affiliation(s)
- Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Florian Wolf
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Mueller
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael E. Gschwandtner
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Takai K, Endo T, Fujimoto S. Angiographic challenges of spinal dural and epidural arteriovenous fistulas: report on 45 cases. Neuroradiology 2024; 66:279-286. [PMID: 37792087 DOI: 10.1007/s00234-023-03227-5] [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] [Received: 06/19/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The localization of the fistula level in spinal dural arteriovenous fistulas (dAVFs) and epidural arteriovenous fistulas (edAVFs) remains a diagnostic challenge. METHODS Consecutive patients with spinal dAVFs and edAVFs in the thoracic, lumbar, and sacral regions were included. The primary endpoint was to describe the characteristics of patients who required angiography with multiple catheterizations of segmental arteries (10 or more). RESULTS Forty-five patients (median age 69 years; male 89%; dAVFs, n = 31; edAVFs, n = 14) were included. Spinal dAVFs commonly developed in the thoracic region and edAVFs in the lumbosacral region. Fistulas were predicted at the correct level or plus/minus 2 level in less invasive examinations using multi-detector CT angiography (n = 28/36, 78%) and/or contrast-enhanced MR angiography (n = 9/14, 64%). We encountered diagnostic challenges in the localization of fistulas in 6 patients. They underwent angiography a median of 2 times. In each patient, spinal levels were examined at a median of 25 levels with a median radiation exposure of 3971 mGy and 257 ml of contrast. Fistulas were finally localized at the high thoracic region (T4-6) in 3 patients, the sacral region (S1-2) in 2, and the lumbar region (L3) in 1. Four patients were diagnosed with edAVFs and 2 with dAVFs. The correlation coefficient between the fistula level and the rostral end of the intramedullary T2 high-signal intensity on MRI was interpreted as none. CONCLUSION In patients in whom less invasive examinations failed for fistula localization, high thoracic or sacral AVFs need to be considered.
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Affiliation(s)
- Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan.
| | - Takeaki Endo
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - So Fujimoto
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan
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20
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Pang S, Chang T, Chang M, Huang X, Wang X, Song M, Wang Z, Zhang S. Efficacy of cutting balloon angioplasty versus high-pressure balloon angioplasty for the treatment of arteriovenous fistula stenoses in patients undergoing hemodialysis: Systematic review and meta-analysis. PLoS One 2024; 19:e0296191. [PMID: 38271445 PMCID: PMC10810470 DOI: 10.1371/journal.pone.0296191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
This systematic review and meta-analysis aimed to assess and compare the therapeutic outcomes of cutting balloon angioplasty and high-pressure balloon angioplasty for arteriovenous fistula stenosis in hemodialysis patients. All studies indexed in PubMed, Embase, and Cochrane Library Web of Science were retrieved. The retrieval deadline was July 15, 2023. Risk of bias 2.0 was used to evaluate the quality of the included studies. Revman 5.4 software was used for data analysis. This review included three studies and 180 patients, with 90 patients in the cutting balloon angioplasty group and 90 patients in the high-pressure balloon angioplasty group. The results of the meta-analysis suggested that compared with high-pressure balloon angioplasty, cutting balloon angioplasty can improve primary lesion patency rates of internal arteriovenous fistulas at 6 months (relative risk, 1.45; 95% confidence interval, 1.08-1.96; P = 0.01). However, there were no significant differences between the technical success rate (relative risk, 0.99; 95% confidence interval, 0.93-1.05; P = 0.72) and clinical success rate (relative risk, 1.01; 95% confidence interval, 0.95-1.07; P = 0.73). Therefore, cutting balloon angioplasty is likely to increase primary lesion patency rates at 6 months. However, more high-quality, large-sample, multicenter, randomized controlled trials are needed for further validation due to the limited number of included studies.
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Affiliation(s)
- Shuyue Pang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun Jilin, China
| | - Tianying Chang
- EBM Office, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun Jilin, China
| | - Mingxin Chang
- Nephrology Department, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun Jilin, China
| | - Xu Huang
- Nephrology Department, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun Jilin, China
| | - Xiaodan Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun Jilin, China
| | - Meijin Song
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun Jilin, China
| | - Zhongtian Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun Jilin, China
| | - Shoulin Zhang
- Nephrology Department, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun Jilin, China
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21
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Saliou G, Deiva K, Möhlenbruch MA, Lubicz B. Anticoagulation helps shrink giant venous lakes and arteriovenous fistulas in dural sinus malformation. J Neurointerv Surg 2024; 16:183-186. [PMID: 36804768 DOI: 10.1136/jnis-2022-019923] [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] [Received: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Dural sinus malformations (DSMs) associated with high flow arteriovenous shunts are a challenging disease in babies that can lead to severe neurological damage or death. We report our treatment strategy in seven consecutive DSMs. METHODS We performed a retrospective analysis of seven consecutive patients from four centres, treated with transarterial embolization and anticoagulants. RESULTS Mean clinical and imaging follow-up was 2.8 years (IQR1-3 1.8-5.3). At baseline, the median size of the dilated venous pouch (giant lake) was 35 mm (IQR1-3 24-41) that decreased to a normal or near normal venous collector diameter of median size 11.5 mm (IQR1-3 8.5-13.8). This was achieved after a median of two embolization sessions targeted on dural feeders (IQR1-3 1.5-2.5), leaving associated pial feeders untreated. There were no cerebral hemorrhagic complications during the anticoagulation treatment. Median percentage of shunt remaining after embolization was 30% (IQR1-3 12-30), which spontaneously decreased with anticoagulation and even after discontinuation of anticoagulation, in parallel with the reduction in diameter of the dilated sinus, up to healing (or near healing). At the last clinical assessment, the modified Rankin Scale score was 0 in four patients, 1 in one patient, and 3 in two patients. CONCLUSIONS Anticoagulants may help to potentiate transarterial embolization in DSMs in babies by decreasing venous dilatation and reducing the remaining arteriovenous shunt, particularly the pial feeders. We did not observe recurrence of arteriovenous shunts after treatment, especially during anticoagulation treatment. Further studies are needed to support our findings.
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Affiliation(s)
- Guillaume Saliou
- Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- UNIL, Lausanne, Switzerland
| | - Kumaran Deiva
- Service de Neuropédiatrie, Hôpital Bicêtre Service de Neuropédiatrie, Le Kremlin-Bicetre, France
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Lubicz
- Diagnostic and Interventional Neuroradiology, Hôpital Universitaire Erasme, Bruxelles, Belgium
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22
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Tian Y, Shi K, Zhang Y, Cao Y, Zhou Y. Logistic regression analysis of risk factors for hematoma after autologous arteriovenous fistula in hemodialysis patients. Medicine (Baltimore) 2024; 103:e36890. [PMID: 38215112 PMCID: PMC10783359 DOI: 10.1097/md.0000000000036890] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
To determine the risk factors and nursing countermeasures for post-operative hematoma in hemodialysis patients with autogenous arteriovenous fistula by logistic regression analysis. A retrospective analysis of 240 chronic hemodialysis patients admitted to our hospital from January 2019 to October 2022 was performed. Physical and vascular examinations of the patients were performed by surgeons. Continuous care measures were implemented for all patients. The patient serum creatinine (Scr) and blood urea nitrogen (BUN) were measured on the day of inclusion and after the implementation of care measures. Self-management scales were used to analyze patients' self-management. Fatigue symptoms were assessed using the Fatigue Scale 14. The WHO Quality of Life Scale (WHOQOL-BREF score) was used to assess patients' quality of life. Self-Rating Depression Scale and Self-Rating Anxiety Scale (SAS) were used to assess negative affect. Treatment compliance was assessed according to 3 levels: complete compliance, compliance, and noncompliance. In all, 240 patients underwent 240 initial and 48 repeat procedures; 18 of the 240 patients experienced fistula failure, with an overall success rate of 92.5% (222/240). There were no significant differences in renal function, self-management, General Self-Efficacy Scale, fatigue symptom scores, and WHOQOL-BREF scores between the postoperative hematoma group and no-hematoma group before the continuous care. After continuous care, renal function, self-management, General Self-Efficacy Scale, fatigue symptom scores, and WHOQOL-BREF scores were better in the postoperative no-hematoma group than in the hematoma group, and the difference was statistically significant (P < .05). Logistic regression analysis of risk factors for postoperative hematoma showed that elevated Scr and BUN levels, decreased self-management and SAS scores and poor treatment compliance were independent risk factors for postoperative hematoma in hemodialysis patients with autologous arteriovenous fistulas (P < .05). Elevated Scr levels, elevated BUN levels, decreased self-management scores, decreased SAS scores, and poor treatment compliance were independent risk factors for postoperative hematoma in hemodialysis patients with autogenous arteriovenous fistulas. By providing continuous care to hemodialysis patients based on timing theory, the negative emotions can be alleviated and the self-efficacy, quality of life, and treatment compliance of the patients can be improved.
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Affiliation(s)
- Yuanru Tian
- Department of Blood Purification Room, Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Lianyungang, Jiangsu, China
| | - Kuanfan Shi
- Department of Blood Purification Room, Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Lianyungang, Jiangsu, China
| | - Yan Zhang
- Department of Operating Room, The Second People’s Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Yan Cao
- Department of Operating Room, The Second People’s Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Yuping Zhou
- Department of Operating Room, The Second People’s Hospital of Lianyungang, Lianyungang, Jiangsu, China
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Schultz H, Bacorn C, Cristiano BC, Carey AR, Carper MG, Gailloud P, Miller NR, Campbell AA. Bilateral Dilated Superior Ophthalmic Veins in a Patient With an Arteriovenous Dialysis Fistula. Ophthalmic Plast Reconstr Surg 2024; 40:e19-e23. [PMID: 37721308 DOI: 10.1097/iop.0000000000002524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
A 64-year-old man presented with 4 months of diplopia. He had end-stage renal disease requiring a cephalic transposition brachiocephalic fistula that was no longer in use following successful renal transplantation. On presentation, he had bilateral proptosis, extraocular movement restriction, chemosis, tortuous episcleral vessels, and caruncular injection. Non-contrast CT of the orbits demonstrated dilation of both superior ophthalmic veins, and CT angiography showed asymmetric enlargement of both cavernous sinuses and superior ophthalmic veins. A carotid-cavernous fistula was suspected, but cerebral angiography revealed shunting from the old fistula with intracranial drainage and cerebral venous hypertension. Aberrant retrograde drainage resulted from anatomical compression of the left brachiocephalic vein. The fistula was ligated, and at 1-week follow-up, the patient had marked improvement in extraocular movements and orbital congestion with near complete resolution of diplopia. Postoperative CT angiography obtained 2 months later demonstrated decreased size of both superior ophthalmic veins, consistent with improvement of venous hypertension.
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Affiliation(s)
- Hannah Schultz
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Colin Bacorn
- Division of Oculoplastic Surgery, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Brian C Cristiano
- Department of Interventional Neuroradiology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Andrew R Carey
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Michael G Carper
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Philippe Gailloud
- Department of Interventional Neuroradiology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Neil R Miller
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Ashley A Campbell
- Division of Oculoplastic Surgery, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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24
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Maleknia PD, Hale AT, Savage C, Blount JP, Rocque BG, Rozzelle CJ, Johnston JM, Jones JGA. Characteristics and outcomes of pediatric dural arteriovenous fistulas: a systematic review. Childs Nerv Syst 2024; 40:197-204. [PMID: 37864710 DOI: 10.1007/s00381-023-06156-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/09/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Dural arteriovenous fistulas (dAVF) are arteriovenous shunts in communication with the dural vasculature in the brain or spine. Apart from single-center series, risk factors and treatment outcomes for pediatric dAVFs are largely undescribed. METHODS We performed a systematic literature review of pediatric (< 18 years at diagnosis) intracranial and spinal dAVF according to PRISMA guidelines. We queried PubMed, CINAHL, SCOPUS, and Embase databases without time/date restriction. Search strings included a variety of MeSH keywords relating to dural AV fistulas in combination with MeSH keywords related to pediatric cases (see Appendix). Manuscripts describing patients diagnosed with dural sinus malformations or pial AVF were excluded. RESULTS We identified 61 studies describing 69 individual patients. Overall, dAVF were more common in males (55.1%) with a mean age of diagnosis (5.17 ± 4.42 years). Approximately 20.2% of patients presented with cardiovascular disease (CVD), and 31.9% were discovered incidentally on neuroimaging studies. Transverse-sigmoid junction was the most common location (17.3%). Ninety-three percent (64 patients) were treated, most commonly using endovascular embolization (68.1%) followed by surgery (8.7%) and radiosurgery (2.9%). Almost half (43.8%) of dAVFs were completely obliterated. Of the 64 procedures, there were 19 neurological complications (29.7%) of varying severity where 12.5% were considered transient (i.e., pseudomeningocele) and 17.2% permanent (i.e., mortality secondary to acute sinus thrombosis, etc.). CONCLUSION There is a paucity of information on pediatric dAVFs. This systematic review summarizes the published cases of dAVFs in the pediatric population. While the rate of missing data is high, there is publication bias, and precise details regarding complications are difficult to ascertain, this review serves as a descriptive summary of pediatric dAVFs.
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Affiliation(s)
- Pedram D Maleknia
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew T Hale
- Department of Neurosurgery, University of Alabama at Birmingham, FOT Suite 1060, 1720 2nd Ave S, Birmingham, AL, 35294, USA.
| | - Cody Savage
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandon G Rocque
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Curtis J Rozzelle
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Johnston
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse G A Jones
- Department of Neurosurgery, University of Alabama at Birmingham, FOT Suite 1060, 1720 2nd Ave S, Birmingham, AL, 35294, USA
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Diagnostic Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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25
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Yu Q, Zangan S, Funaki B. Preliminary Experience with a Low-Profile High-Density Braid Occluder for Transcatheter Embolization of Pulmonary Arteriovenous Malformations. J Vasc Interv Radiol 2024; 35:32-35.e2. [PMID: 37748577 DOI: 10.1016/j.jvir.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
This brief report describes safety, technical feasibility, and early treatment effectiveness of the low-profile braided occluder (LOBO; Okami Medical, San Diego, Caliornia) for embolization of 9 pulmonary arteriovenous malformations (PAVMs) in 4 patients (3 female and 1 male; age range: 33 to 63 years; 3 patients showed positive results for hereditary hemorrhagic telangiectasia genes). A total of 10 occluders were deployed in 10 vessels (median treated vessel diameters, 3 and 4 mm for LOBO-3 and LOBO-5 groups, respectively). All devices were successfully deployed into the feeder pulmonary arteries, achieving complete cessation of flow. There were no severe adverse events or device migrations. Available short-term follow-up computed tomography (6 PAVMs: median, 7 months; range, 1.5-7 months) demonstrated complete occlusion without persistence or recanalization. The early experience of embolization of PAVMs using a low-profile braided occluder showed it to be safe and effective. Further studies with larger cohorts and longer follow-up periods are warranted.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
| | - Steven Zangan
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Brian Funaki
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
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26
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Noufal M, Liang C, Chhabra V. Percutaneous transosseous embolization of a diploic vein arteriovenous fistula with intracranial and extracranial shunting. Interv Neuroradiol 2023; 29:773-777. [PMID: 35505599 PMCID: PMC10680960 DOI: 10.1177/15910199221096009] [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] [Received: 02/02/2022] [Accepted: 03/26/2022] [Indexed: 11/15/2022] Open
Abstract
EDUCATIONAL MESSAGE Transosseous embolization of diploic vein arteriovenous fistula is feasible when necessary in select cases.
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Affiliation(s)
- Mazen Noufal
- Department of Neurosurgery, Kaiser Permanente, Southern California, Fontana, CA, USA
| | - Conrad Liang
- Department of Neurosurgery, Kaiser Permanente, Southern California, Fontana, CA, USA
| | - Vaninder Chhabra
- Department of Neurosurgery, Kaiser Permanente, Southern California, Fontana, CA, USA
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Hoang TT, Do HD, Do HT, Nguyen CN, Alward WLM. Bilateral Blood Reflux Into Schlemm Canals Caused by a Unilateral Dural Sinus Arteriovenous Fistula in a Patient With Cerebral Venous Thrombosis. J Neuroophthalmol 2023; 43:e288-e290. [PMID: 34924532 DOI: 10.1097/wno.0000000000001419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tung Thanh Hoang
- Department of Ophthalmology (TTH, HDD), Hanoi Medical University, Hanoi, Vietnam; Ophthalmology Unit (TTH, HDD, HTD), Hanoi Medical University Hospital, Hanoi, Vietnam; Save Sight Institute (TTH), The University of Sydney School of Medicine, Sydney, Australia ; Radiology Center (CNN), Hanoi Medical University Hospital, Hanoi,Vietnam; and Department of Ophthalmology and Visual Sciences (WLMA), University of Iowa Carver College of Medicine, Iowa City, Iowa
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28
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Beigh A, Mazumder MA. Successful treatment of a brachial artery pseudoaneurysm in a brachiobasilic arteriovenous fistula using ultrasound-guided manual compression. J Ultrasound 2023; 26:955-957. [PMID: 36260216 PMCID: PMC10632190 DOI: 10.1007/s40477-022-00701-3] [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] [Received: 02/21/2022] [Accepted: 06/16/2022] [Indexed: 10/24/2022] Open
Abstract
Pseudoaneurysm is a well-recognized complication seen in arteriovenous fistula (AVF) which usually involves the venous segments. Ultrasound-guided manual compression (UGMC) is a non-invasive and effective treatment for the management of pseudoaneurysms involving the venous segment. Pseudoaneurysm of the arterial segment of AVF is rare complication which usually needs surgical intervention. We report the first successful treatment case of a brachial artery pseudoaneurysm in a brachiobasilic arteriovenous fistula using ultrasound-guided manual compression. The patient presented with a 30 × 30 mm pulsatile swelling below the cubital fossa after second session of hemodialysis using an AVF created 8 weeks earlier. Ultrasound doppler demonstrated a brachial artery pseudoaneurysm in the non-transposed brachiobasilic fistula. Complete occlusion of the cavity with thrombus formation was accomplished after 55 min of compression and the psuedoaneurysm did not recur. UGMC can be an alternative treatment option for select cases of arterial segment pseudoaneurysm in AVF.
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Affiliation(s)
- Aadil Beigh
- Khyber Medical Institute, Khayam Chowk, Srinagar, Jammu and Kashmir, India
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29
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Lu W, Dang X, Liu C, Wang Z, Lv J, Yang S, Li H. Factors Associated with Dialysis Initiation in Patients with Predialysis Arteriovenous Fistula. Blood Purif 2023; 53:210-218. [PMID: 37967549 DOI: 10.1159/000535251] [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] [Received: 05/04/2023] [Accepted: 11/12/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION A large proportion of patients initiated hemodialysis with a central vein catheter rather than a permanent vascular access which was recommended by guidelines. One major barrier was the paucity of evidence regarding the optimal timing of vascular access creation in predialysis patients. METHODS Our study prospectively enrolled 300 patients undergoing predialysis arteriovenous fistula (AVF) creation in our center from 2015 to 2018. Cox proportional hazard regression was performed to identify which demographic and clinical factors were associated with the initiation of hemodialysis after AVF surgery. A receiver operating characteristic area under the curve (AUC) was used to assess the predictive power of preoperative factors for the likelihood of hemodialysis initiation. RESULTS Overall, 163 (54.3%), 214 (71.3%), and 275 (91.7%) patients initiated hemodialysis within 3 months, 6 months, and 1 year, respectively, after AVF creation. The median time between AVF creation and hemodialysis start was 71.5 days. Using multivariate Cox regression analysis, three factors were associated with hemodialysis initiation within 1 year: serum phosphorus (HR = 1.407, p = 0.021), diabetic kidney disease (DKD) (HR = 1.429, p = 0.039), and cystatin C (HR = 1.179, p = 0.009). Cystatin C alone had a moderate predictive value for dialysis initiation (AUC = 0.746; p < 0.001), whereas the full model had a higher predictive value (AUC = 0.800; p < 0.001). CONCLUSION DKD, serum cystatin C, and phosphorus at access surgery were associated with hemodialysis initiation within 1 year of the predialysis AVF creation. Our findings provide a basis for a more customized approach to planning AVF placement in patients with chronic kidney disease.
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Affiliation(s)
- Wanhong Lu
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiangyun Dang
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chao Liu
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhigang Wang
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Lv
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shifeng Yang
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huixian Li
- Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Ghahvehchian H, Karimi N, Kashkouli MB, Ramadan M, Ghamari K, Aghili S. Endoscopic-assisted Orbitotomy for Obliteration of Orbital Arteriovenous Fistula Refractory to Endovascular Techniques. Ophthalmic Plast Reconstr Surg 2023; 39:e188-e192. [PMID: 37338309 DOI: 10.1097/iop.0000000000002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Orbital arteriovenous fistula is a rare acquired disorder. The coincidence of arteriovenous fistula with lymphaticovenous malformation is even rarer. The optimal treatment, thus, is controversial. Surgical approaches vary widely, with associated pros and cons. The purpose of this case report is to describe an orbital arteriovenous fistula in a 25-year-old man with congenital fronto-orbital lymphaticovenous malformation, refractory to endovascular techniques, which was later successfully ablated by a direct endoscopic-assisted orbital approach.
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Affiliation(s)
- Hossein Ghahvehchian
- Ophthalmology Department, Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nasser Karimi
- Ophthalmology Department, Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahmani Kashkouli
- Ophthalmology Department, Skull Base Research Center, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Ramadan
- Ophthalmology Department, Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Kiandokht Ghamari
- Ophthalmology Department, Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - SeyyedSaeed Aghili
- Ophthalmology Department, Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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31
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Mulryan P, O'Brien C, Mazur M, Power S. Renal artery stenosis stenting with unmasking and embolisation of a renal arteriovenous fistula. BMJ Case Rep 2023; 16:e256560. [PMID: 37844978 PMCID: PMC10583021 DOI: 10.1136/bcr-2023-256560] [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: 10/18/2023] Open
Abstract
A man in his 70s was presented to the emergency department with uncontrollable hypertension and worsening renal function on a background of atherosclerosis-related bilateral renal artery stenosis. Following progressive deterioration in renal function and refractory hypertension, the patient was referred to interventional radiology for consideration of renal artery stenting. Following stenting of the right renal artery, a large renal arteriovenous fistula became apparent, which required emergent embolisation. Both procedures were successful, with excellent clinical and radiological responses.
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Affiliation(s)
- Philip Mulryan
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Claire O'Brien
- Department of Medicine, University Hospital Kerry, Tralee, Kerry, Ireland
| | - Marek Mazur
- Department of Nephrology, Cork University Hospital, Cork, Ireland
| | - Stephen Power
- Department of Radiology, Cork University Hospital, Cork, Ireland
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32
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Yamamoto H, Nanto M, Kishida K, Goto Y, Hashimoto N. Iatrogenic Vertebral Arteriovenous Fistula Involving Brachiocephalic Vein Due to Central Venous Catheterization: A Case Report. J Endovasc Ther 2023; 30:779-783. [PMID: 35735198 DOI: 10.1177/15266028221105181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/17/2022]
Abstract
PURPOSE To report a case of vertebral arteriovenous fistula (VAVF) caused by iatrogenic trauma of central venous catheterization (CVC) involving brachiocephalic vein (BCV). CASE REPORT A 79-year-old female was referred for assessment of a vertebral artery (VA) aneurysm at the V1 segment. The patient had no signs other than a vascular murmur on the right neck and was diagnosed 20 years after undergoing CVC. Right vertebral angiography revealed a high-flow shunt from the V1 segment of the right VA and draining into the right BCV. The fistula had a single communication between a pseudoaneurysm and large varix. We diagnosed the patient with CVCinduced VAVF (CIVAVF) involving BCV and obliterated the shunt by selective transarterial and transvenous embolization of the pseudoaneurysm under flow control using a balloon catheter with no complications. CONCLUSION This case highlights the point that CIVAVF involving BCV is rare but possible. In addition, there is a possibility that CIVAVF involving BCV does not demonstrate the findings of arterial steal or retrograde venous drainage and is undiagnosed for a long term due to lack of neurological manifestation and other subjective symptoms. We also showed that endovascular treatment can be feasible and useful for CIVAVF involving BCV.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masataka Nanto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kengo Kishida
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yudai Goto
- Department of Neurosurgery, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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33
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Delfiner MS, Hoffman M, White A, Forfia PR. Impact of Arteriovenous Fistula Compression on Mitral Regurgitation Severity. Circ Heart Fail 2023; 16:e010733. [PMID: 37435745 DOI: 10.1161/circheartfailure.123.010733] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Matthew S Delfiner
- Department of Internal Medicine, Section of Cardiovascular Medicine (M.S.D., P.R.F.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Matthew Hoffman
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO (M.H.)
| | - Austin White
- Department of Internal Medicine (A.W.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Paul R Forfia
- Department of Internal Medicine, Section of Cardiovascular Medicine (M.S.D., P.R.F.), Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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34
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Yoshida K, Niimi Y, Kamamoto D, Fukumura M, Imai R, Nagoshi N, Akiyama T. Targeted embolisation for coexisting conus medullaris arteriovenous malformation and cauda equina arteriovenous fistulas with a varix on a shared drainer †. Br J Neurosurg 2023; 37:1200-1205. [PMID: 33034527 DOI: 10.1080/02688697.2020.1830948] [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] [Received: 06/18/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The coexistence of vascular malformations in the conus medullaris and cauda equina has been rarely reported, and the complex angioarchitecture in multiple arteriovenous lesions remains poorly understood. CASE DESCRIPTION A 17-year-old woman presented with a sudden-onset, stepwise worsening of weakness and pain in the bilateral legs. Angiography revealed conus medullaris arteriovenous malformation and cauda equina arteriovenous fistulas. One of the drainers was shared between the coexisting lesions and harboured a varix. Targeted embolisation of a fistulous point in the conus lesion was performed with precaution to prevent occluding the common drainage route, which led to symptom improvement with angiographical diminishment of the varix. CONCLUSIONS Recognising that communications between drainers can be observed in multiple spinal arteriovenous lesions is important in facilitating a safe embolisation. Cautious assessment of angiogram with fusion images of cone-beam computed tomography and volumetric T2 magnetic resonance imaging can help in establishing the diagnosis and treatment strategy.
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Affiliation(s)
- Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Dai Kamamoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Fukumura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryotaro Imai
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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35
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Essibayi MA, Srinivasan VM, Catapano JS, Graffeo CS, Lawton MT. Spinal Dorsal Intradural Arteriovenous Fistulas: Natural History, Imaging, and Management. Neurology 2023; 101:524-535. [PMID: 37185123 PMCID: PMC10516273 DOI: 10.1212/wnl.0000000000207327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/06/2023] [Indexed: 05/17/2023] Open
Abstract
In this review, we describe the pathophysiology, diagnosis, and treatment of spinal dorsal intradural arteriovenous fistulas (DI-AVFs), focusing on novel research areas. DI-AVFs compose the most common subgroup of spinal arteriovenous lesions and most commonly involve the thoracic spine, followed by lumbar and sacral segments. The pathogenesis underlying DI-AVFs is an area of emerging understanding, thought to be attributable to venous congestion and hypertension that precipitate ascending myelopathy. Patients with DI-AVFs typically present with motor, sensory, or urinary dysfunction, although a wide swath of other less common symptoms has been reported. DI-AVFs can be subdivided by spinal region, which in turn is associated with 4 distinct clinical phenotypes: craniocervical junction (CCJ), subaxial cervical, thoracic, and lumbosacral. Patients with CCJ and lumbosacral DI-AVFs have particularly interesting presentations and treatment considerations. High-value diagnostic findings on MRI include flow voids, missing-piece sign, and T2-weighted intramedullary hyperintensity. However, digital subtraction angiography is the gold standard for diagnosis and localization of DI-AVFs and for definitive treatment planning. Surgical disconnection of DI-AVFs is almost universally curative and frontline treatment, especially for CCJ and lumbosacral DI-AVFs. Endovascular techniques evolve in promising ways, such as improved visualization, distal access, and liquid embolic techniques. The pathophysiology of DI-AVFs is better understood using newly identified radiologic diagnostic markers. Despite new techniques and devices introduced in the endovascular field, surgery remains the gold-standard treatment for DI-AVFs.
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Affiliation(s)
- Muhammed Amir Essibayi
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Visish M Srinivasan
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Joshua S Catapano
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Christopher S Graffeo
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Michael T Lawton
- From the Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Da Zhuang K, Irani FG, Gogna A, Too CW, Tan BS, Tay KH. The Role of Drug-Coated Balloon in Haemodialysis Arteriovenous Fistula Stenosis Management. Cardiovasc Intervent Radiol 2023; 46:1144-1153. [PMID: 37414842 DOI: 10.1007/s00270-023-03497-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
Arteriovenous fistula (AVF) stenosis is a common problem leading to dialysis access dysfunction. The conventional balloon (CB) is the most commonly used device during angioplasty but suffers from poor durability of results due to neointimal hyperplasia-mediated recurrence. The drug-coated balloon (DCB) is an adjunct to balloon angioplasty that reduces neointimal hyperplasia, thereby improving post-angioplasty patency. Despite the heterogeneity of DCB clinical trials to date, the evidence suggests that DCBs of different brands are not necessarily equal, and that patient selection, adequate lesion preparation and proper DCB procedural technique are important to realize the benefit of DCB angioplasty.
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Affiliation(s)
- Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Farah Gillan Irani
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Bien Soo Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Kiang Hiong Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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37
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Trivedi SB, Gaba RC. Transplant Renal Biopsy Complicated by Arteriovenous Fistula. J Vasc Interv Radiol 2023; 34:1634-1635. [PMID: 37019428 DOI: 10.1016/j.jvir.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023] Open
Affiliation(s)
- Surbhi B Trivedi
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Ron C Gaba
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois.
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38
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Sanchez S, Raghuram A, Wendt L, Hayakawa M, Chen CJ, Sheehan JP, Kim LJ, Abecassis IJ, Levitt MR, Meyer RM, Guniganti R, Kansagra AP, Lanzino G, Giordan E, Brinjikji W, Bulters DO, Durnford A, Fox WC, Smith J, Polifka AJ, Gross B, Amin-Hanjani S, Alaraj A, Kwasnicki A, Starke RM, Chen SH, van Dijk JMC, Potgieser ARE, Satomi J, Tada Y, Phelps R, Abla A, Winkler E, Du R, Lai PMR, Zipfel GJ, Derdeyn C, Samaniego EA. Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas. J Neurointerv Surg 2023; 15:903-908. [PMID: 35944975 DOI: 10.1136/jnis-2022-019160] [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] [Received: 05/14/2022] [Accepted: 07/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) are aggressive vascular lesions. The pattern of venous drainage is the most important determinant of symptoms. Due to the absence of a venous sinus in the anterior cranial fossa, most ACF-dAVFs have some degree of drainage through small cortical veins. We describe the natural history, angiographic presentation and outcomes of the largest cohort of ACF-dAVFs. METHODS The CONDOR consortium includes data from 12 international centers. Patients included in the study were diagnosed with an arteriovenous fistula between 1990-2017. ACF-dAVFs were selected from a cohort of 1077 arteriovenous fistulas. The presentation, angioarchitecture and treatment outcomes of ACF-dAVF were extracted and analyzed. RESULTS 60 ACF-dAVFs were included in the analysis. Most ACF-dAVFs were symptomatic (38/60, 63%). The most common symptomatic presentation was intracranial hemorrhage (22/38, 57%). Most ACF-dAVFs drained through cortical veins (85%, 51/60), which in most instances drained into the superior sagittal sinus (63%, 32/51). The presence of cortical venous drainage predicted symptomatic presentation (OR 9.4, CI 1.98 to 69.1, p=0.01). Microsurgery was the most effective modality of treatment. 56% (19/34) of symptomatic patients who were treated had complete resolution of symptoms. Improvement of symptoms was not observed in untreated symptomatic ACF-dAVFs. CONCLUSION Most ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation.
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Affiliation(s)
- Sebastian Sanchez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ashrita Raghuram
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Linder Wendt
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA
| | - Minako Hayakawa
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Louis J Kim
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | | | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - R Michael Meyer
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Ridhima Guniganti
- Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Akash P Kansagra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Enrico Giordan
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Diederik O Bulters
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - Andrew Durnford
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - W Christopher Fox
- Department of Neurosurgery, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Jessica Smith
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Bradley Gross
- Department of Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amanda Kwasnicki
- Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA
| | - Stephanie H Chen
- Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, Groningen, Groningen, Netherlands
| | - Adriaan R E Potgieser
- Department of Neurosurgery, University of Groningen, Groningen, Groningen, Netherlands
| | - Junichiro Satomi
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
| | - Yoshiteru Tada
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
| | - Ryan Phelps
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Adib Abla
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Ethan Winkler
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gregory J Zipfel
- Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Colin Derdeyn
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Edgar A Samaniego
- Departments of Neurology, Radiology and Neurosurgery, The University of Iowa, Iowa City, Iowa, USA
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Vihtelič P, Hawlina S, Popovič P. Endovascular treatment of traumatic penile arteriospongious fistula in a patient with erectile dysfunction: a case report and literature review. BMC Urol 2023; 23:134. [PMID: 37558999 PMCID: PMC10413610 DOI: 10.1186/s12894-023-01305-7] [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] [Received: 12/07/2022] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND An arteriovenous fistula is an abnormal communication between an artery and a vein. Traumatic penile arteriospongious fistula is a rare complication and has been described as a cause of erectile dysfunction. Clinical evaluation of patients with erectile dysfunction after penile trauma includes a thorough history, physical examination, vascular assessment, and other complementary exams. Treatment consists of endovascular embolization, surgical ligation, or a combination of both techniques. CASE PRESENTATION A 40-year-old man presented with erectile dysfunction that had persisted since suffering blunt trauma a few months ago. He reported problems with short duration of erection and insufficient penile tumescence. Due to high suspicion of an arteriovenous fistula, he was referred to angiography, which confirmed the diagnosis of an abnormal connection between the pudendal vessels. The patient was treated with the coil embolization technique and the symptoms were successfully resolved after endovascular treatment. CONCLUSIONS The appearance of a post-traumatic arteriospongious fistula is a rare complication with almost non-existent literature reported. Rapid development in endovascular techniques, in which we use embolic agents to block anomalous blood flow, has allowed safe, effective and less invasive alternative to surgery. Our case demonstrates that endovascular approach is a successful treatment for post-traumatic arteriospongious fistula since the symptoms were resolved, and normal erectile function was regained after the intervention.
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Affiliation(s)
- Polona Vihtelič
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška cesta 7, Ljubljana, SI-1000, Slovenia
| | - Simon Hawlina
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, SI-1000, Slovenia
- Department of Urology, University Medical Centre Ljubljana, Zaloška cesta 7, Ljubljana, SI-1000, Slovenia
| | - Peter Popovič
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška cesta 7, Ljubljana, SI-1000, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, SI-1000, Slovenia.
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Li J, Ji Z, Yu J, Ren J, Yang F, Bian L, Zhi X, Li G, Zhang H. Angioarchitecture and prognosis of pediatric intracranial pial arteriovenous fistula. Stroke Vasc Neurol 2023; 8:292-300. [PMID: 36609545 PMCID: PMC10512084 DOI: 10.1136/svn-2022-001979] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/04/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Pial arteriovenous fistulas (PAVFs) are rare and mostly observed in children. However, the overall angioarchitecture, clinical features, treatments and long-term prognosis for pediatric patients remain unclear. METHODS Clinical data of consecutive 42 pediatric PAVFs were documented and analysed. According to the differences of age distribution and clinical features, they were split into a younger group (≤3 years old; 20 cases) and an older group (3-14 years old; 22 cases). RESULTS Their mean age was 4.9±3.9 years, and the mean preoperative modified Rankin Scale (mRS) score was 1.64±1.57. Fourteen patients (33.3%) were asymptomatic, followed by epilepsy (21.4%), intracranial haemorrhage (16.7%), hydrocephalus (9.5%), developmental delay (7.1%), intermittent headache (7.1%) and congestive heart failure (4.8%). Annual bleeding rate and rebleeding rate before treatment reached 3.86% and 3.17%. Poor venous drainage including sinus dynamic obstruction (21 cases, 50.0%) and sinus occlusion (17 cases, 40.48%) were found with high frequency among these patients. Finally, 33 cases were cured (78.57%), and 4 cases faced surgery-related complications (9.52%). During 24-140 months' follow-up, the mean mRS score reduced to 0.57±0.40. However, only 22 cases (52.38%) recovered to absolutely normal, and poor venous drainage was the risk factor for patients' incomplete recovery (p=0.028, Exp(B)=14.692, 95% CI 1.346 to 160.392). Compared with the older group, younger group showed more chronic symptoms, more secondary pathological changes, more times treatment and worse prognosis (p=0.013, 0.002, 0.000 and 0.032, respectively). CONCLUSIONS Pediatric PAVF has different angioarchitectures, clinical features and prognoses in different age groups. Poor venous drainage is an important factor leading to poor prognosis, and it accounts for incomplete recovery in nearly half of patients.
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Affiliation(s)
- Jingwei Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Zhenlong Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Affiliated Hospital of Beihua University, Jilin province, China
| | - Jiaxing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Fan Yang
- Department of Neurosurgery, Beijing United Family Hospital, Beijing, China
| | - Lisong Bian
- Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
| | - Xinglong Zhi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Guilin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- China International Neuroscience Institute, Beijing, China
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Killer-Oberpfalzer M, Chapot R, Orion D, Barr JD, Cabiri O, Berenstein A. Clinical experience with the Bendit steerable microcatheter: a new paradigm for endovascular treatment. J Neurointerv Surg 2023; 15:771-775. [PMID: 35853698 PMCID: PMC10359519 DOI: 10.1136/jnis-2022-019096] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/23/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vessel tortuosity poses a challenge during endovascular treatment of neurovascular lesions. Bendit Technologies (Petah Tikva, Israel) has developed flexible, steerable microcatheters designed with unique bending and torquing capabilities. OBJECTIVE To describe our first-in-human trial of Bendit21. METHODS Bendit21 was used in our exploratory, prospective, multicenter, open-label, single-arm clinical study, and in two compassionate use cases. Procedures were conducted at four centers in Austria, Germany, Israel, and the United States between May 2021 and March 2022, in patients with neurovascular conditions. The primary endpoints were device-related safety events, successful navigation through the neurovasculature, and, when intended, successful delivery of contrast or therapy. RESULTS Two patients with giant aneurysms were treated successfully under compassionate use approval. The clinical study included 25 patients (mean age: 63.4±11.8 years; 32.0% female). Fourteen patients (56.0%) had aneurysms, two had arteriovenous malformations/fistulas (8.0%), one had a stroke (4.0%), four (16.0%) had intracranial stenosis, and four (16.0%) had other conditions. Bendit21 was used without a guidewire in 12/25 (48.0%) procedures. Bendit21 was successfully navigated through the vasculature without delays or spasms in all cases (100%). Contrast was delivered as intended in 7/7 (100%) cases. Therapeutic devices were delivered successfully with Bendit as intended in 14/18 (77.8%) cases; four deficiencies occurred in three patients with aneurysms, in whom delivery of coils, an intrasaccular device, or a flow diverter was attempted. There were no device-related safety events or mortalities. CONCLUSIONS Our initial clinical experience with the Bendit21 microcatheter demonstrates its usefulness in achieving technical success in patients with challenging neurovascular conditions.
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Affiliation(s)
| | - René Chapot
- Department of Interventional Neuroradiology, Alfried Krupp Hospital Ruttenscheid, Essen, Germany
| | - David Orion
- Neuro-Interventional Unit and Stroke Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - John D Barr
- Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Oz Cabiri
- Bendit Techologies, Ltd, Petah Tikva, Israel
| | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zhang Y, Yuan F, Hu X, Wang Q, Zou Z, Li Z. Comparison of drug-coated balloon angioplasty versus common balloon angioplasty for arteriovenous fistula stenosis: A systematic review and meta-analysis. Clin Cardiol 2023; 46:877-885. [PMID: 37417371 PMCID: PMC10436783 DOI: 10.1002/clc.24078] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
Drug-coated balloons (DCBs) have been used in dialysis patients with arteriovenous fistula (AVF) stenosis, but whether DCBs have advantages over ordinary balloons is still controversial. A meta-analysis was designed to investigate the safety and efficacy of DCBs and common balloons (CBs) in the treatment of AVF stenosis. We searched the PubMed, EMBASE, and China National Knowledge Internet (CNKI) databases for randomized controlled trials that evaluated the comparison of DCB angioplasty versus CB angioplasty for AVF stenosis in dialysis patients and reported at least one outcome of interest. The results showed that the DCB group had a higher first-stage patency rate of the target lesion 6 months [odds ratio, OR = 2.31, 95% confidence interval, CI: (1.69, 3.15), p < .01] and 12 months [OR = 2.09, 95% CI: (1.50, 2.91), p < .01] after surgery. There was no statistically significant difference in all-cause mortality between the two groups at 6 months [OR = 0.85, 95% CI: (0.47, 1.52), p = .58] and 12 months [OR = 0.99, 95% CI: (0.60, 1.64), p = .97]. Compared with CB, DCBs as a new endovascular treatment for AVF stenosis have a higher primary patency rate of target lesions and can delay the occurrence of restenosis. There is no evidence that DCB can increase the mortality of patients.
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Affiliation(s)
- Yong Zhang
- Department of NephrologyJianli People's HospitalJingzhouChina
| | - Fan‐Li Yuan
- Department of NephrologyThe First Affiliated Hospital of Yangtze UniversityJingzhouChina
| | - Xiang‐Yang Hu
- Department of EmergencyThe Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Qi‐Bing Wang
- Department of EmergencyThe Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Zhen‐Wu Zou
- Department of General PracticeThe Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Zhen‐Guo Li
- Department of PediatricsJianli People's HospitalJingzhouChina
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Liu J, Zhang H, Luo C, Guo Y, Li Y, Yuan D, Jiang W, Yan J. Haemorrhage risk of brain arteriovenous malformation during pregnancy and puerperium. Stroke Vasc Neurol 2023; 8:307-317. [PMID: 36599484 PMCID: PMC10512072 DOI: 10.1136/svn-2022-001921] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to assess whether pregnancy and puerperium were associated with the risk of brain arteriovenous malformation (bAVM) haemorrhage. METHODS A retrospective review was conducted in Xiangya Hospital, Central South University from January 2012 to December 2021. A case-crossover design was adopted to calculate the incidence density of bAVM-related haemorrhage among female patients in risk (pregnancy and puerperium) and control (non-pregnancy and non-puerperium) periods, according to four scenarios observed in different populations (scenario I: patients with haemorrhagic bAVM of all ages; scenario II: patients with haemorrhagic bAVM of all ages, with at least one previous pregnancy; scenario III: patients with haemorrhagic bAVM who are of reproductive age (15-45 years); scenario IV: patients with haemorrhagic bAVM of reproductive age (15-45 years), with at least one previous pregnancy. Next, a comprehensive literature aggregation (up to April 2022) was performed for evidence synthesis. RESULTS Among the 311 female patients with haemorrhagic bAVM, a significant haemorrhage risk during pregnancy and puerperium was found in Scenarios I (relative risk [RR], 2.08; 95% CI, 1.28 to 3.39), II (RR, 3.21; 95% CI, 1.95 to 5.31) and IV (RR, 2.92; 95% CI, 1.73 to 4.93); however, a suggestive risk was found in scenario III (RR, 1.62; 95% CI, 0.99 to 2.67). Evidence synthesis revealed a consistent haemorrhage risk among patients of all ages (RR, 3.15; 95% CI, 1.93 to 5.15) and those of reproductive age (RR, 1.29; 95% CI, 0.89 to 1.86). CONCLUSION Compared with most previous studies, a higher but relatively moderate risk for bAVM-related haemorrhage was identified during pregnancy and puerperium. Individualised prevention and treatment strategies should be preferred when neurosurgeons make clinical decisions.
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Affiliation(s)
- Junyu Liu
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan, China
- Department of Pharmacology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Honghao Zhang
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Chun Luo
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
| | - Yuxin Guo
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
| | - Yifeng Li
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Dun Yuan
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Weixi Jiang
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Junxia Yan
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University Xiangya School of Public Health, Changsha, Hunan, China
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Chen L, Yang Y, Tang L, Zhou M, He L. Embolic Stroke Associated With a Pulmonary Arteriovenous Fistula: An Unignorable Rare Causes of Stroke. Neurologist 2023; 28:180-183. [PMID: 36125977 DOI: 10.1097/nrl.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Here, we described a patient with ischemic stroke due to embolism, through an isolated pulmonary arteriovenous fistula (PAVF). Our case could be a paradigm of embolic stroke of undetermined source (ESUS) with an uncommon cause, providing an etiologic investigation process in addition to diagnostic pitfalls and pearls, eventually raising neurologists' ability to treat ESUS. CASE REPORT A 37-year-old right-handed woman presented to our emergency department with sudden onset left upper limb and lower limb weakness. She denied a past medical history of hypertension, diabetes, heart diseases, and other cerebrovascular disease risk factors, and she is without a family history of stroke, previous trauma, toxic exposure, or drug use. On admission, her physical and neurological examinations were negative, except for left-sided hemiparesis. Her routine evaluations, serum autoantibody testing, and digital subtraction angiography were negative. Subsequent diffusion-weighted brain magnetic resonance imaging demonstrated acute infarction in the right frontoparietal lobe. To find the etiology of this case, more detailed examinations were performed. Finally, she was diagnosed with ESUS, which was caused by the PAVF. CONCLUSIONS This case raises the awareness of a potential important emboligenic mechanism, the existence of an isolated PAVF as a right-to-left shunt in patients with a stroke of unknown origin should not be overlooked, even if a PAVF is not suggested by the initial physical findings or chest x-ray.
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Affiliation(s)
- Lizhang Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Kathrani NV, Chauhan RS, Ramalingaiah AH, Saini J, Devi BI. Percutaneous Embolization of Spinal Epidural Arteriovenous Fistulae: Report of 2 Cases and Technical Considerations. J Vasc Interv Radiol 2023; 34:498-500.e3. [PMID: 36473613 DOI: 10.1016/j.jvir.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nihar V Kathrani
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Richa S Chauhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Arvinda H Ramalingaiah
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru- 560029, Karnataka, India.
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru- 560029, Karnataka, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru- 560029, Karnataka, India
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Lim SG, Park SE, Nam IC, Choi HC, Won JH, Jo SH, Baek HJ, Moon JI, Cho E, Jang JY. Large gastroduodenal artery pseudoaneurysm, arterioportal fistula and portal vein stenosis in chronic pancreatitis treated using combined transarterial embolization and transportal stenting: A case report. Medicine (Baltimore) 2022; 101:e32593. [PMID: 36596040 PMCID: PMC9803455 DOI: 10.1097/md.0000000000032593] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Chronic pancreatitis is an ongoing fibroinflammatory disease of the pancreas characterized by irreversible damage to the pancreatic parenchyma and ductal system. Besides, chronic pancreatitis can present with a variety of life-threatening complications. PATIENT CONCERNS The patients visited our hospital due to abdominal pain and anemia, and had chronic pancreatitis as an underlying disease. DIAGNOSES Computed tomography showed a large gastroduodenal artery pseudoaneurysm, arterioportal vein fistula, and portal vein stenosis. INTERVENTIONS We would like to report the successful use of the coils, and N-butyl cyanoacrylate glue for the therapeutic embolization of the pseudoaneurysm and fistula between the gastroduodenal artery and the portal vein, and stenting for portal vein stenosis. OUTCOMES On the day following the endovascular management, the patient reported remission of abdominal pain, and hemoglobin level returned to normal after transfusion. It was confirmed that it was still well maintained in the follow-up examination after 1 month. LESSONS Although chronic pancreatitis causes many vascular complications, simultaneous occurrence of these lesions is extremely rare. Herein, we share our experience with a unique case of an extrahepatic arterioportal fistula induced by the rupture of gastroduodenal artery pseudoaneurysm with concomitant portal vein stenosis. In these complex cases, combined transarterial embolization and transportal stenting can be helpful.
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Affiliation(s)
- Sung Gong Lim
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
- * Correspondence: Sung Eun Park, Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea (e-mail: )
| | - In Chul Nam
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Jung Ho Won
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Sa Hong Jo
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Eun Cho
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Yool Jang
- Department of General Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
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Volders D, Cora EA, Chaalala C, Cartier M, Tanaka M, Farzin B, Berthelet F, Raymond J. Fatal hemorrhagic complication after coil embolization of a petrosal arteriovenous shunt. Interv Neuroradiol 2022; 28:629-633. [PMID: 34775852 PMCID: PMC9706274 DOI: 10.1177/15910199211057705] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/17/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cerebello-pontine AVMs (CPAVMs) and petrous apex dural arteriovenous fistulae (DAVFs) are rare and sometimes difficult to distinguish. We report a fatal hemorrhagic complication after coil embolization of the petrosal vein draining a trigeminal AVM misdiagnosed as a DAVF. CASE PRESENTATION A 73-year-old woman with a petrous apex arteriovenous shunt with dual dural and pial arterial supply presented with posterior fossa hemorrhage. The draining petrosal vein was catheterized and coiled via the superior petrosal sinus. Two episodes of contrast extravasation occurred during coiling, but the lesion was completely occluded at the end of the procedure. The patient developed a fatal posterior fossa hemorrhage in the recovery room. Microscopic pathology revealed numerous dilated vessels within the trigeminal nerve. CONCLUSION CPAVMs and DAVFs with pial drainage should be distinguished pre-operatively. Occlusion of a pial vein (as opposed to a sinus) in the treatment of an arteriovenous shunt carries hemorrhagic risk if a liquid embolic agent is not used to completely occlude all pathological vessels.
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Affiliation(s)
- David Volders
- Department of Radiology, Centre Hospitalier de l’Université de Montréal
(CHUM), Montreal, Quebec, Canada
- Department of Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elena Adela Cora
- Department of Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chiraz Chaalala
- Department of Neurosurgery, Centre Hospitalier de l’Université de Montréal
(CHUM), Montreal, Quebec, Canada
| | - Maxime Cartier
- Department of Radiology, Centre Hospitalier de l’Université de Montréal
(CHUM), Montreal, Quebec, Canada
| | - Michihiro Tanaka
- Department of Neurointervention, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Behzad Farzin
- Department of Radiology, Centre Hospitalier de l’Université de Montréal
(CHUM), Montreal, Quebec, Canada
| | - France Berthelet
- Department of Anatomy and Pathology, Centre Hospitalier de l’Université de Montréal
(CHUM), Montreal, Canada
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier de l’Université de Montréal
(CHUM), Montreal, Quebec, Canada
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Shin YM, Kim Y, Yang J, Yang B, Choi IA, Lee KM. Recurrent pulmonary arteriovenous malformation in a patient with Sjögren syndrome: A case report. Medicine (Baltimore) 2022; 101:e30954. [PMID: 36254021 PMCID: PMC9575738 DOI: 10.1097/md.0000000000030954] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pulmonary manifestations of Sjögren syndrome (SS) are variable and may involve the airway or lung parenchyma and increase the risk of vascular and malignant disease. However, to date, only one case of pulmonary arteriovenous malformation (AVM) has been reported in a patient with SS. Here, we report a rare case of recurrent pulmonary AVMs with aggravating multiple cysts in a patient with SS during a period of 14 years. PATIENT CONCERNS A 45-year-old woman was diagnosed with SS and pulmonary AVM in the right lung. Her AVMs were embolized successfully and she was followed up annually for 14 years. Eleven years after the initial treatment, her chest computed tomography showed new pulmonary AVMs in the left lung with aggravating multiple cysts. DIAGNOSIS We diagnosed her with SS according to the American-European consensus group criteria of 2010. Chest computed tomography and angiographic findings confirmed the recurrence of pulmonary AVMs. INTERVENTIONS The patient's recurrent pulmonary AVMs were successfully treated by embolization. OUTCOMES Although her multiple cystic lung lesions had been aggravating during 14 years, she received embolization for the pulmonary AVMs twice and developed no complication related to these procedures. Currently, the patient is 56 years old and still alive with good performance state. LESSONS To date, only one case of pulmonary AVM has been reported in a patient with SS. The patient died 2.5 years after the diagnosis without recurrence of AVM. Here, we present a rare case of recurrent pulmonary AVMs associated with aggravating multiple cysts in both lungs, which were observed during long-term follow-up, in a patient with SS.
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Affiliation(s)
- Yoon Mi Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Yook Kim
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jiyoul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - In Ah Choi
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki Man Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- * Correspondence: Ki Man Lee, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776 1Sunhwan-ro, Seowon-gu, Cheongju 28644, Republic of Korea (e-mail: )
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Yamada H, Akiyama T, Kamamoto D, Yoshida K, Fukumura M, Toda M. Combined transarterial and transvenous embolization of multi-hole pial arteriovenous fistula with large varix. Neuroradiol J 2022; 35:640-646. [PMID: 35477369 PMCID: PMC9513922 DOI: 10.1177/19714009221096829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/15/2022] Open
Abstract
BACKGROUND Pial arteriovenous fistula (AVF) is a vascular fistulous disease in which the cerebral pial artery and vein are directly connected without the intervening nidus within a sub-pial space. Multi-hole pial AVFs, wherein multiple feeders flow into one drainer, are usually formed with complex angioarchitecture and are difficult to treat. METHODS A rare case of an adult patient with hereditary hemorrhagic telangiectasia and multi-hole pial AVF was described. A 23-year-old woman was referred to our hospital. She was previously diagnosed with left cerebellar pial AVF with multiple feeders (bilateral superior cerebellar artery and common trunk of the left anterior inferior cerebellar artery and posterior inferior cerebellar) and large varix that had been untreated for 9 years. The enlargement of the large varix with the new second varix formation was revealed by angiography. Although asymptomatic, considered to be a risk for future hemorrhage was the continuous high hemodynamic stress. RESULTS Endovascular embolization was performed by securing safe transarterial n-butyl-2-cyanoacrylate injection by transarterial and transvenous coil placement to the shunt points and feeders, resulting in total occlusion of the fistula without any complications. Extensive transvenous coil placement inside the varix allowed safe embolization of the entire fistula with multiple high-flow feeders. Moreover, bidirectional (transarterial and transvenous) retrograde coil embolization enabled firm obliteration of the shunt points. CONCLUSIONS Performing combined transarterial and transvenous embolization in a well-balanced manner was considered to treat multi-hole pial AVF to provide a safe and effective embolization.
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Affiliation(s)
- Hiroki Yamada
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Dai Kamamoto
- Department of Neurosurgery, Tokyo Dental College Ichikawa General
Hospital, Chiba, Japan
| | - Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mariko Fukumura
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Barcena AJR, Perez JVD, Liu O, Mu A, Heralde FM, Huang SY, Melancon MP. Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use. Biomolecules 2022; 12:biom12101367. [PMID: 36291576 PMCID: PMC9599524 DOI: 10.3390/biom12101367] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/23/2022] [Indexed: 01/14/2023] Open
Abstract
An arteriovenous fistula (AVF) is the preferred vascular access for chronic hemodialysis, but high failure rates restrict its use. Optimizing patients' perioperative status and the surgical technique, among other methods for preventing primary AVF failure, continue to fall short in lowering failure rates in clinical practice. One of the predominant causes of AVF failure is neointimal hyperplasia (NIH), a process that results from the synergistic effects of inflammation, hypoxia, and hemodynamic shear stress on vascular tissue. Although several systemic therapies have aimed at suppressing NIH, none has shown a clear benefit towards this goal. Localized therapeutic approaches may improve rates of AVF maturation by providing direct structural and functional support to the maturating fistula, as well as by delivering higher doses of pharmacologic agents while avoiding the adverse effects associated with systemic administration of therapeutic agents. Novel materials-such as polymeric scaffolds and nanoparticles-have enabled the development of different perivascular therapies, such as supportive mechanical devices, targeted drug delivery, and cell-based therapeutics. In this review, we summarize various perivascular therapeutic approaches, available data on their effectiveness, and the outlook for localized therapies targeting NIH in the setting of AVF for hemodialysis use. Highlights: Most systemic therapies do not improve AVF patency outcomes; therefore, localized therapeutic approaches may be beneficial. Locally delivered drugs and medical devices may improve AVF patency outcomes by providing biological and mechanical support. Cell-based therapies have shown promise in suppressing NIH by delivering a more extensive array of bioactive substances in response to the biochemical changes in the AVF microenvironment.
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Affiliation(s)
- Allan John R. Barcena
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Joy Vanessa D. Perez
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Olivia Liu
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Amy Mu
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - Francisco M. Heralde
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Steven Y. Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marites P. Melancon
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Correspondence:
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