Endovascular treatment of acute type B dissection complicating graft-bypass repair for aortic coarctation

AbstractObjectivesThe early dissection of the descending aorta after the repair of aortic coarctation is very rare. Herein, we present a special endovascular technique used for acute type B dissection complicating graft bypass for aortic coarctation.MethodsThe 48 year-old male patient with the diagnosis of adult type aortic coarctation had bypass procedure between the aortic arch and the descending aorta. Six weeks after the first operation, the patient was readmitted with severe back pain and had the diagnosis of acute type B dissection which involved the descending aorta at the distal part of the graft anastomosis.ResultsTwo separate stent-grafts were deployed respectively 31 × 150 mm and 34 × 200 mm (C-TAG™ WL Gore&Asc., Flagstaff, AZ, USA). The previous Dacron bypass graft was used as a proximal landing zone for the first stent-graft. The distal landing zone for the second stent was the area between the celiac trunk and superior mesenteric artery. Therefore, the covered stent-graft was implanted to the celiac trunk (Viabahn™ 7 × 50 mm WL Gore&Asc, AZ, USA) to maintain its patency before the deployment of the second graft. The segment of coarctation was closed with a vascular plug (Amplatzer™ vascular plug II) to prevent persistent perfusion of aneurysmal false lumen.ConclusionThe endovascular approach offers multiple less invasive options based on a patient-specific problem

Effects of percutaneous transhepatic biliary drainage on renal function in patients with obstructive jaundice

WOS: 000287226600011PubMed ID: 20690079PURPOSE We assessed the effects of percutaneous transhepatic biliary drainage on renal function in patients with obstructive jaundice using the estimated glomerular filtration rate (eGFR) and evaluated the factors associated with renal dysfunction. MATERIALS AND METHODS Between July 2007 and September 2009, 108 consecutive patients (69 men 39 women; median age, 59 years; range, 29-87 years) with obstructive jaundice (20 benign, 88 malignant) that were unsuitable for endoscopic retrograde cholangiopancreticography were evaluated at admission and at follow-up exams five and thirty days after percutaneous transhepatic biliary drainage. Two patients with suspected contrast-induced nephropathy were excluded. Renal function was assessed by measuring levels of urea, creatinine and electrolytes and evaluating the modification of diet in the renal disease formula for eGFR. RESULTS eGFR was <60 mL/min/1.73 m(2) before percutaneous transhepatic biliary drainage in 27 patients (25%) and increased significantly 30 days after percutaneous transhepatic biliary drainage (P = 0.008). In the malignant external drainage subgroup, there was a significant increase in eGFR on the fifth day after percutaneous transhepatic biliary drainage (P = 0.038). The procedure-related mortality rate was zero. Nine malignant patients (8.49%) died within thirty days due to underlying diseases. On the fifth day, eGFR was significantly lower in these patients than in surviving patients (P = 0.049), and bilirubin levels were significantly higher before the intervention than in surviving patients (P = 0.04). Multiple logistic regression analysis showed that serum direct bilirubin is a significant predictor of renal function (P. 0.049). CONCLUSION Obstructive jaundice is associated with renal dysfunction, and serum direct bilirubin is a significant predictor of renal function. Percutaneous transhepatic biliary drainage improves renal function and is crucial for prognosis of obstructive jaundice

Chimney technique for solitary pelvic kidney

BOZKAYA, HALIL/0000-0002-5012-6635WOS:000593040200029PubMed: 32888009The combination of solitary pelvic kidney and abdominal aortic aneurysm is extremely rare. in this report, we present chimney graft implantation in a patient with solitary pelvic kidney. A 63-year-old man had the diagnosis of infrarenal abdominal aortic aneurysm made incidentally. Preoperative computed tomography illustrated a fusiform abdominal aortic aneurysm accompanying a solitary ectopic kidney in the pelvis with aberrant renal artery. A bifurcated endograft was implanted, and a covered stent graft was placed into the renal artery by use of the chimney technique. Good patency of the chimney graft was documented with early postoperative and first month scans. To the best of our knowledge, this is the first report of the chimney technique used in a solitary pelvic kidney

Partial removal of endovascular stent grafts: technical considerations in three cases

WOS: 000326410100039The endovascular repair of an abdominal aortic aneurysm has become increasingly common during the past decade. However, the endoleak, a complication of endovascular repair, is also on the rise. Most of the endoleaks can be managed with endovascular techniques. In some cases, conversion to open surgery for total or partial removal of the stent-graft may be required. In this article, we report three patients who underwent partial removal of the stent-graft in the light of technical feasibility and possible complications of the procedure

Radiological Findings and Endovascular Management of Three Cases with Segmental Arterial Mediolysis

WOS: 000277594900021PubMed ID: 19629590Segmental arterial mediolysis (SAM) is an uncommon self-limited disorder that can cause abdominal catastrophes through massive bleeding or bowel infarction. The former arise from arterial aneurysms, and the latter from arterial stenosis or occlusions. Although this is an acute self-limiting disease, the catastrophic consequence, originating from intra-abdominal hemorrhage (arterial dilatation, aneurysms, dissecting hematomas) or bowel infarction (arterial stenosis, arterial occlusions), is not rare. The identification of these lesions is very important in the differential diagnosis of suspected patients with complaints of abdominal pain with hemorrhage. We report computerized tomography angiography and digital subtraction angiography findings of three cases with abdominal SAM, who were treated with endovascular management due to abdominal bleeding. Angiography showed arterial dilatations, aneurysms, and occlusions of visceral arteries in all three cases, The string-of-beads appearance was present in only one case. Bleeding stopped immediately after embolization of three cases and follow-up revealed no evidence of recurrences at 23, 18, and 15 months, respectively, Arterial coil embolization is an effective treatment modality for bleeding complications of SAM. Close follow-up is recommended, primarily to ascertain the fate of the nontreated arterial lesions

Solitary osteochondroma causing popliteal pseudoaneurysm that presented as a mass lesion

WOS: 000254343200006PubMed ID: 18092290Osteochondromas are the most frequently occurring bone tumors and can rarely lead to vascular complications. A 14-year-old boy with solitary exostosis of the right femur presented with a mass lesion at the posterior aspect of the thigh. Radiological studies demonstrated a popliteal artery pseudoaneurysm. In this case report, radiological findings of this lesion are reviewed

Evaluation of Treatment Response of Chemoembolization in Hepatocellular Carcinoma with Diffusion-Weighted Imaging on 3.0-T MR Imaging

WOS: 000299656600015PubMed ID: 22019180Purpose: To assess the treatment response of hepatocellular carcinoma (HCC) after transarterial chemoembolization with diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance (MR) imaging with a 3-T system. Materials and Methods: Between February 2010 and November 2010, 74 patients were treated with chemoembolization in our interventional radiology unit. Twenty-two patients (29%) who had liver MR imaging including diffusion and dynamic contrast-enhanced MR imaging on a 3-T system before and after transarterial chemoembolization were evaluated retrospectively. Tumor size, arterial enhancement, venous washout, and apparent diffusion coefficient (ADC) values of lesions, peritumoral parenchyma, normal liver parenchyma, and spleen were recorded before and after treatment. The significance of differences between ADC values of responding and nonresponding lesions was calculated. Results: The study included 77 HCC lesions (mean diameter, 31.4 mm) in 20 patients. There was no significant reduction in mean tumor diameter after treatment. Reduction in tumor enhancement in the arterial phase was statistically significant (P = .01). Tumor ADC value increased from 1.10 x 10(-3) mm(2)/s to 1.27 x 10(-3) mm(2)/s after treatment (P < .01), whereas the ADC values for liver and spleen remained unchanged. ADC values from cellular parts of the tumor and necrotic areas also increased after treatment. However, pretreatment ADC values were not reliable to identify responding lesions according to the results of receiver operating characteristic analysis. Conclusions: After transarterial chemoembolization, responding HCC lesions exhibited decreases in arterial enhancement and increases in ADC values in cellular and necrotic areas. Pretreatment ADC values were not predictive of response to chemoembolization

Prognostic Utility of Serum Neopterin in Obstructive Jaundice Secondary to Malignant Lesions Treated by Percutaneous Transhepatic Biliary Drainage

WOS: 000319956100018PubMed ID: 23707094Purpose: To perform biochemical profiles before and after percutaneous transhepatic biliary drainage (PTBD) and investigate the potential utility of measuring C-reactive protein (CRP); circulating cytokines, and neopterin, a marker Of cell-mediated immunity, to predict outcomes of patients with obstructive jaundice. Materials and Methods: In a prospective study, 47 patients with obstructive jaundice secondary to malignant lesions were evaluated before, at the fifth hour after, and on the fifth day after PTBD for neopterin, nitrate, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, CRP levels, and liver function. Results: Neopterin levels on day 5 after PTBD were significantly higher than the levels before treatment bent and at the fifth hour. However, nitrate, cytokine, white blood cell, albumin, and creatinine levels were not significantly different. On the fifth day after PTBD, CRP levels were significantly higher and total bilirubin, direct bilirubin, alkaline phosphatase, aspartate transaminase, and alanine transaminase values were lower than the before-treatment values. Seven patients (15%) died within 30 days after drainage. On the fifth day after PTBD, neopterin, IL-6, IL-10, and creatinine levels were significantly higher and albumin levels were lower in the early mortality group. The performance characteristics of neopterin and creatinine were statistically significant in predicting mortality. Conclusions: Neopterin levels increased after PTBD, indicating cellular immune activation. The nonsignificant change in cytokine levels may be related to low enduring release in malignancy. The extremely elevated level a of neopterin and creatinine after PTBD might serve as harbingers of early death in patients with cholestasis secondary to malignant lesions.Ege University Scientific Research Projects DirectorshipEge UniversityThis study is supported by Ege University Scientific Research Projects Directorship