Successful endovascular treatment of intralobar pulmonary sequestration : an effective alternative to surgery

Introduction: Pulmonary sequestration is a rare congenital malformation characterised by the presence of non-functional and dysplastic pulmonary tissue that lacks communication with the tracheobronchial tree and has an aberrant non-pulmonary blood supply. Depending on its location, presence of the pleura covering, and venous drainage, 2 forms of pulmonary sequestration have been described: intra- and extralobar. Traditionally, surgical resection was performed; however, a growing number of cases have been treated with endovascular intervention. Case report: A 38-year-old female patient was admitted to the hospital with severe haemoptysis for several hours. Examination at admission revealed tachycardia and tachypnoea. Computed tomography-examination disclosed the presence of an area of consolidation in the left lower lobe with a tortuous feeding artery arising from the descending aorta. Visible ground glass opacification indicated diffuse alveolar haemorrhage. Based on these findings, a diagnosis of intralobar sequestration of the left lung was made. The patient was consulted by a cardiothoracic surgeon and an interventional radiologist and qualified for endovascular treatment. In local anaesthesia femoral access was obtained and selective angiography of the common trunk of both bronchial arteries was performed. It depicted a dilated left bronchial artery supplying the sequestration and visible contrast extravasation. Embolisation of the vessel was performed with Glubran (n-butyl-cyanoacrylate). Control contrast injection showed complete elimination of the sequestration’s blood supply with no residual capillary blush. Clinical improvement was observed. No complications were encountered, and the patient was discharged 7 days after the procedure. Conclusions: Arterial embolisation is a promising alternative to surgery in the treatment of symptomatic pulmonary sequestration

Acute renal artery stenting recovered renal function after spontaneous rupture of renal artery aneurysm : case report

Purpose: Renal artery aneurysms (RAAs) are a rare vascular pathology with an estimated prevalence of 0.1% to 2.5%. Rupture of RAA is an extremely unusual cause of acute flank pain and haemodynamic instability with acute kidney failure and high mortality rate (20%). Case report: A 37-year-old male with no relevant history presented to the Emergency Room with acute right flank pain. Initial examination revealed BP 90/60 mm Hg and tachycardia. Initial blood testing was unremarkable, with a haemoglobin level of 9.4 g/dl. Urinalysis revealed moderate blood. Ultrasound (US) examination depicted aneurysm of the right renal artery 6 x 6 cm, with signs of blood extravasation visible in colour and power Doppler. The patient was referred for urgent computed tomography angiography, which revealed active bleeding from the ruptured aneurysm with haematoma spreading into the right retroperitoneum. He was subjected to emergency endovascular treatment. The patient was treated by successful implantation of a Viabahn stent (GORE, Daleware, USA). Selective nephrography revealed lack of flow through one of the segmental arteries resulting from vasospasm due to the placement of the guiding wire necessary for safe stent implantation. Conclusions: The authors present a rare case of spontaneous RAA rupture in a young male successfully treated with endovascular methods. Stent implantation required selective catheterisation of segmental arteries of the kidney, which resulted in the loss of one of them. However, control Doppler US disclosed no ischaemia and successful exclusion of the aneurysm

Ocena skuteczności wewnątrznaczyniowej metody embolizacji w leczeniu zespołu przekrwienia biernego miednicy - badania wstępne

Objectives: The Aim: The aim of the study was to evaluate the effectiveness, safety and clinical outcomes of endovascular embolisation of pelvic congestion syndrome (PCS). Material and methods: This prospective, observational study carried out between January and May of 2014 encompassed 24 female patients aged 22-44 years (average - 31 years) diagnosed with PCS. Diagnosis of PCS was established by medical history, physical examination, transvaginal Doppler ultrasound examination and confirmed by MRI. The patients were qualified for phlebography and ovarian vein embolization with 0.035” detachable coils and/or microcoils. Pelvic pain scores were assessed before and 3 months after the procedure with the visual analog scale (VAS; 0 – no pain, 10 – unbearable pain). Results: Embolisation procedures were performed in 23 out of 24 patients. Nineteen patients underwent unilateral and 4 patients bilateral embolisation of the ovarian vein. In one case, safe and selective vessel catheterization was not possible due to the anatomical variant of venous flow. Nineteen patients underwent unilateral embolisation of the left ovarian vein. Four patients had the left and right ovarian veins embolized; in one of them, the internal iliac vein was additionally closed (the two-stage procedure). The technical success rate was 96%. Procedures lasted 23-78 minutes (32 minutes on average). An average of 40 ml of contrast was administered during the procedures. The total mean radiation dose at the reference point was 389 mGy (from 127 mGy to 1112 mGy). A decrease in pelvic pain intensity according to VAS was considered a clinical success. The median VAS pelvic pain score before the procedure was 8. Three months after the procedure median pelvic pain score decreased to 1 (p < 0.001). In two cases, the ovarian vein was injured and the contrast medium extravasated, which was clinically insignificant. In one case, a small injection site haematoma developed. Conclusion: Embolisation is a minimally invasive, effective and safe method of treatment for PCS. The cooperation between gynaecologists and interventional radiologists is essential for successful outcomes.Cel pracy: Celem badania była ocena skuteczności, bezpieczeństwa i wyniku klinicznego przeznaczyniowej embolizacji zespołu przekrwienia biernego miednicy. Materiał i metody: W prospektywnym, obserwacyjnym badaniu od stycznia do maja 2014 do zabiegu embolizacji PCS zakwalifikowano 24 chore, w wieku od 22 do 44 lat (średnio 31). Diagnozę postawiono na podstawie objawów klinicznych, badania fizykalnego, przezpochwowego USG Doppler i/lub MRI. Pacjentki zakwalifikowano do badania czynnościowego układu żylnego, flebografii i ewentualnej embolizacji żył jajnikowych przy użyciu spiral. Ocenianio średnie nasilenie dolegliwości bólowych miednicy w wizualnej skali analogowej VAS przed i 3 miesiące po zabiegu embolizacji. Wyniki: Zabieg wykonano u 23 z 24 chorych. U 19 chorych wykonano jednostronną embolizację lewej żyły jajnikowej. U 4 pacjentek wykonano embolizację lewej i prawej żyły jajnikowej. Sukces techniczny wyniósł 96 %. Procedury trwały od 23 do 78 min (średnio 32 minuty). W czasie zabiegu podano średnio 40 ml kontrastu. Łączna średnia dawka promieniowania w punkcie referencyjnym wyniosła 389 mGy. Za sukces kliniczny uznano zmniejszenie stopnia natężenia bólu w miednicy mierzonej w skali VAS. Średni ból miednicy w skali VAS przed zabiegiem wynosił 8 pkt. Trzy miesiące po zabiegu ból miednicy w skali VAS zmniejszył się do 1 (p < 0.001). W dwóch przypadkach doszło do wynaczynienia środka cieniującego bez znaczenia klinicznego. Wnioski: Embolizacja w leczeniu PCS jest małoinwazyjną, skuteczną i bezpieczną metodą leczenia. Współpraca ginekologa i radiologia zabiegowego odgrywa tutaj kluczową rolę

Uterine artery embolization using gelatin sponge particles performed due to massive vaginal bleeding caused by ectopic pregnancy within a cesarean scar: a case study

A pregnancy located within a cesarean scar is the rarest form of ectopic pregnancy. We present a case of a 34-year-old woman with a history of one cesarean section (gravida 2, para 1) admitted to the hospital at 9 weeks of gestation due to vaginal bleeding, initially diagnosed as a missed abortion. During the hospitalization spontaneous abortion took place, and the patient was qualified for dilatation and curettage. After the procedure massive vaginal bleeding occurred, a cesarean scar pregnancy was diagnosed, and uterine artery embolization (UAE) using gelatin sponge particles was performed. The treatment was successful. Our case shows that UAE might be a life-saving procedure in cesarean scar pregnancy hemorrhages. Absorbable properties of gelatin sponge particles reduce the risk of adverse effect on fertility

Endovascular embolisation strategies for pulmonary arteriovenous malformations

Purpose: To assess the immediate efficacy of distinct embolisation devices in the endovascular treatment of pulmonary arteriovenous malformations as well as to identify and analyse the possible determinants of the technical success of the procedure. Material and methods: Prospective analysis of 16 consecutive patients was carried out, who underwent transcatheter endovascular embolisation therapy for pulmonary arteriovenous malformations between 2005 and 2017. Pre- and post-procedural angiography studies were implemented to confirm the diagnosis and to evaluate the technical success defined as the complete occlusion of the feeding artery. Embolisation devices - coils, microcoils, occluders, or combination of the above - were used. All the patients were advised to conduct a follow-up computed tomography evaluation 12 months after the procedure. Results: A total of 40 pulmonary arteriovenous malformations (PAVMs) were observed and embolised. The immediate technical success was achieved in all (n = 40; 100%) treated PAVMs, as confirmed by the post-procedural angiographic result. The statistical analysis revealed no significant impact of the number of PAVMs per patient (p > 0.05), their angioarchitecture (p > 0.05), localisation within the lung (p > 0.05) or particular lobe (p > 0.05), and the selection of embolisation device (p > 0.05) on the procedural success rates. The procedure-related complication rate was equal to 6.25%. Conclusions: The immediate success rate of the transcatheter PAVM embolisation reached 100% in this study. The statistical model of logistic regression revealed no significant impact of the number of PAVMs per patient, their angioarchitecture, localisation, and distribution pattern, as well as device selection, on the immediate technical success of the procedure

Uretero-vaginal fistulas — clinical presentation, treatment and literature overview

A uretero-vaginal fistula (UVF) describes an abnormal connection between the ureter and vagina causing urinary incontinence, frequent infection, and discomfort. Although UVF might be diagnosed after vaginal delivery, infertility treatment or pelvic radiation therapy, gynecological operations, especially total abdominal hysterectomy, remain the leading cause of ureteral injury and formation of UVF. Traditional ureteroneocystostomy was usually the treatment of choice in patients with UVF. Nevertheless, it is now frequently replaced by less invasive endoscopic and percutaneous procedures which are also highly effective and feasible. That is why, ureteral stenting became the first-line treatment in uncomplicated UVF. The aim of this review is to present clinical presentation of UVF and to assess the current state of knowledge about the diagnosis and management of uretero-vaginal fistula with special interest on minimally-invasive methods

Third gender — the clinical image of Morris syndrome

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