Endovascular therapy of arteriovenous malformation in a male patient with severe post-coital pelvic pain

Purpose: Congenital pelvic arteriovenous malformations (AVMs) are high-flow vascular lesions consisting of abnormal shunts between arteries and veins within a nidus. The rare presentation and extensive network of vasculature contributes to the difficulty in effective treatment. Optimal therapeutic options are determined based on the clinical presentation, the location of the lesion, and possible complications. Case report: A 24-year-old male patient with a history of recurrent pain following sexual intercourse presented with complaints of intense pelvic pain radiating to the perineal area. Computed tomography angiography (CTA) revealed a large venous aneurysm as an outflow vein of a right-sided pelvic AVM. Embolisation of the outflow veins was established along with direct percutaneous delivery of fibre coils and thrombin to the venous aneurysm of the AVM. With recurring symptoms and AVM recanalisation on angiography, another direct puncture and placement of pushable coils was made. Total AVM occlusion was achieved with no recanalisation on follow-up digital subtraction angiography (DSA), and the patient remained asymptomatic. Conclusions: Endovascular embolisation of the nidus area may result in a complete occlusion of an AVM. Therefore, a thorough understanding of the vascular anatomy of the AVM is essential in choosing an effective embolisation strategy and to minimise the risk of possible complications

Central venous access ports in the interventional radiology suite : one-centre experience

Purpose: Central venous access ports (CVAP) are widely used to provide long-term vascular access for the delivery of chemotherapeutic medications. The aim of this study was to evaluate the clinical outcomes and complications following CVAP implantation in the interventional radiology suite. Material and methods: A retrospective analysis was conducted on 937 oncology patients who underwent CVAP implantation between January 2009 and June 2017. Information regarding patient characteristics, operative data, and procedural outcomes was collected and analysed. Results: A total of 937 patients scheduled for CVAP were included in the final analysis. Initial success was achieved in 930 patients (99.3%), and overall completion was achieved in 933 patients (99.6%). There were 63 complications overall. Among these, 19 (2.0%) occurred during the intra- and perioperative period and 44 were late complications (4.7%). No CVAP-related mortalities were observed. Conclusions: The analysis in the present study revealed that the CVAP is a safe and effective route for long-term administration of chemotherapy with an overall complication rate of 6.7% throughout the entire device duration. The CVAP implantation procedure carried out in the interventional radiology suite provides an advantage in the management of procedural, vascular and catheter-related complications

Endovascular management of pancreatitis-related pseudoaneurysms: A review of techniques

<div><p>Objectives</p><p>To present the various techniques used in the management of pancreatitis-related pseudoaneurysms of visceral vessels.</p><p>Methods</p><p>The retrospective clinical study was carried out at the Department of Diagnostic and Interventional Radiology at Poznan University of Medical Sciences from 2011 to 2016. The fifteen patients included in the study were diagnosed with pseudoaneurysms of visceral arteries, as a complication of chronic pancreatitis. The diagnosis was made using contrast-enhanced computed tomography, followed by angiography. On admission, all patients were symptomatic, with varying degrees of abdominal pain. One patient was haemodynamically unstable. Treatments with endovascular techniques were analysed, along with their efficacy and outcomes. Coil embolisation was performed in 5 patients. Stent graft was used in 1 patient. Liquid embolic agents were used in 7 cases, of which 5 patients were treated with thrombin injection and 2 with Squid. A combination of techniques was used in 2 patients.</p><p>Results</p><p>The most common artery affected by pseudoaneurysm formation was the splenic artery (7/15; 46.7%), and the size of the pseudoaneurysms ranged from 27 mm to 85 mm. Primary technical success was achieved in 14 out of 15 patients (93.3%). One patient required reintervention. Two patients required splenectomy after embolisation due to splenic ischemia. No recanalisation was present at the follow-up computed tomography performed after 1 to 3 weeks, and no mortality was observed within 30 days.</p><p>Conclusion</p><p>Vascular complications of pancreatitis require accurate diagnosis and immediate treatment. Endovascular intervention is highly effective and is the preferred treatment option. The technique used is determined based on vascular anatomy and the patient’s haemodynamic status.</p></div

Pseudoaneurysm of the gastroduodenal artery pre- and post-coil embolization.

<p>(A) Pseudoaneurysm of the gastroduodenal artery visible on the contrast-enhanced CT (arrow). (B) Digital Subtraction Angiography (DSA) image showing vasospasm and thrombosis of the gastroduodenal artery with no active bleeding (arrow). (C) Post-embolisation DSA image showing successful coil embolisation of the gastroduodenal artery (arrow).</p

Superior mesenteric artery pseudoaneurysm treated with stent graft implantation.

<p>(A) Contrast-enhanced CT scan showing the pseudoaneurysm arising from the SMA (arrow). (B) DSA showing pseudoaneurysm. (C) Final selective DSA confirming the exclusion of the pseudoaneurysm following stent graft implantation and post-dilation.</p

Pseudoaneursym of the common hepatic artery treated with coil and thrombin embolization.

<p>(A) Contrast-enhanced CT scan and (B) DSA image showing the pseudoaneursym arising from the distal common hepatic artery (arrow). (C) DSA image showing initial thrombin injection. (D) Persistent perfusion despite additional placement of coils. (E) Final DSA depicting procedural success after the deployment of an additional coil and thrombin.</p

Arterial site of involvement, size of pseudoaneurysms, and treatment administered.

<p>Arterial site of involvement, size of pseudoaneurysms, and treatment administered.</p

Pseudoaneurysm of the common hepatic artery variant treated initially with coil embolisation followed by vascular plugs placement.

<p>(A) 3D Volume Rendering CT image showing a pseudoaneurysm (arrow) arising from the common hepatic artery (CHA). This anatomical variant shows the right hepatic artery (RHA) arising from the superior mesenteric artery (SMA). The common hepatic artery branches into the gastroduodenal artery (GDA) and left hepatic artery (LHA). Patent pancreaticoduodenal branches (PDB) are present connecting the SMA and the GDA. (B) DSA image showing ineffective coil embolisation of the pseudoaneurysm. (C) Final DSA depicting procedural success after the placement of two vascular plugs.</p

Endovascular treatment of late thoracic aortic aneurysms after surgical repair of congenital aortic coarctation in childhood.

BACKGROUND: In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1) to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2) to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs) and (3) to assess outcomes after intravascular treatment for TAAs. METHODS: This study involved 37 asymptomatic patients (26 female and 11 male) who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair. RESULTS: Follow-up studies revealed TAA in seven cases (19%) (including six with the gothic type of the aortic arch) and mild recoarctation in other six (16%). Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA), in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure. CONCLUSIONS: The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch) that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary

Pseudoaneursym of the common hepatic artery treated with coil and thrombin embolization.

<p>(A) Contrast-enhanced CT scan and (B) DSA image showing the pseudoaneursym arising from the distal common hepatic artery (arrow). (C) DSA image showing initial thrombin injection. (D) Persistent perfusion despite additional placement of coils. (E) Final DSA depicting procedural success after the deployment of an additional coil and thrombin.</p