Spontaneous occlusion of cerebral arteriovenous malformation accompanied by distal flow-related aneurysm after partial embolisation : a case report

We report the case of a 48-year-old woman with right occipito-temporal AVM associated with two flow-related aneurysms. One of the aneurysms was located on the junction of P1/P2 segments of the right posterior cerebral artery (PCA), the second one- on the right carotid internal artery (ICA). The patient suffered from migraine headache, epilepsy (resistant to treatment) and left hemiparesis. The decision to treat the AVM and the aneurysms with endovascular embolisation was made. The purpose of the treatment was to occlude the flow-related aneurysm which was located on the main access route to the AVM first, and then to carry out the embolisation of the latter. An attempt of aneurysm embolisation failed due to its large neck as well as high, turbulent flow inside the sac which prevented from anchoring any coil. An embolisation of an AVM via right ICA and posterior communicating artery was undertaken and resulted in 80% reduction of the AVM nidus volume. Control angiogram after 2 months showed complete occlusion of the AVM and lack of filling of the right P1/P2 junction aneurysm

Ultrasound-guided compression repair of iatrogenic femoral artery pseudoaneurysms after endovascular procedures

Wstęp. Praca dotyczy jatrogennych pseudotętniaków tętnic udowych występujących u chorych leczonych w ośrodku lubelskim. W artykule omówiono wstępne wyniki leczenia pseudotętniaków uciskiem sondą ultrasonograficzną pod kontrolą obrazów uzyskanych metodą kolorowego Dopplera. Materiał i metody. Spośród 18 000 chorych poddanych zabiegom wewnątrznaczyniowym z nakłucia tętnicy udowej u 194 pacjentów wykonano badanie dopplerowskie, podejrzewając przetrwałe uszkodzenia tętnicy. Badano obrazy B-mode oraz zapis dopplerowski uzyskany metodą kodowania kolorem oraz techniką power doppler. Podczas badań dokonywano pomiarów przepływu krwi w odcinkach tętnic udowych wspólnych, powierzchownych i głębokich powyżej i poniżej typowego miejsca nakłucia. U chorych, u których rozpoznano pseudotętniaki, wykonywano próbę uciskową sondą ultrasonograficzną pod kontrolą obrazu dopplerowskiego metodą znakowania kolorem. W przypadku skutecznej próby uciskowej, ucisk kontynuowano przez następne 30-60 minut, aż do uzyskania obrazu bez sygnału przepływu krwi w pseudotętniaku. W przypadku nieskuteczności próby uciskowej lub gdy za pomocą kontrolnego badania dopplerowskiego wykazano przepływ krwi w obrębie pseudotetniaka, chorych kierowano do leczenia chirurgicznego. Wyniki. Pseudotętniaki stwierdzono u 42 osób - 0,23% wszystkich chorych po zabiegach cewnikowania tętnic i 21,6% pacjentów z podejrzeniem przetrwałego uszkodzenia tętnic udowych. U 144 osób nie odnotowano uszkodzenia tętnic, a u 7 chorych rozpoznano przetokę tętniczo-żylną. U jednego pacjenta badanie ujawniło współistnienie pseudotętniaka i przetoki tętniczo-żylnej. U żadnego chorego nie stwierdzono zaburzeń drożności tętnic podziału udowego. U 39 osób wykonano próbę uciskową za pomocą sondy ultrasonograficznej. Leczenie uciskiem było skuteczne u 17 chorych (40,5%) z rozpoznanymi pseudotętniakami. Pozostałych pacjentów z pseudotętnikami i przetokami tętniczo-żylnymi poddano leczeniu chirurgicznemu. Wnioski. Leczenie jatrogennych pseudotętniaków tętnic udowych metodą ucisku sondą pod kontrolą dopplerowską z kolorowym odwzorowaniem przepływu jest metodą bezpieczną i należy ją stosować jako wstępną formę terapii. Osiągnięcie dobrych wyników wymaga właściwej kwalifikacji i dużego doświadczenia. Leczenie uciskiem jest korzystne dla chorych - skraca czas pobytu w szpitalu i zmniejsza koszty leczenia.Background. The paper discusses the issue of iatrogenic femoral artery pseudoaneurysm treatement and initial results of color Doppler ultrasound-guided compression repair of pseudoaneurysms. Material and methods. In the group of 18,000 patients subjected to femoral endovascular procedures, the Doppler examinations were performed in 194 individuals suspected of persistent arterial damage. The B-mode, Color and Power Doppler images were assessed. On examination, the blood flows in the common, superficial and deep femoral arteries above and below the typical site of puncture were measured. In the patients with the diagnosis of pseudoaneurysms, the color Doppler ultrasound-guided compression tests were performed. When the compression test was effective, compression was continued for 30-60 minutes until the image without the signal of blood flow in the pseudoaneurysm was obtained. When the compression test was ineffective or the control Doppler examination revealed the blood flow within the pseudoaneurysm, the patients were sent for surgical treatment. Results. Pseudoaneurysms were found in 42 patients, i.e. 0.23% of all the patients subjected to artery catheterization procedures and 21.6% of those suspected of persistent femoral artery damage. No artery damage was detected in 144 patients, in 7 cases the arteriovenous fistulas were diagnosed. In one patient, the examination revealed concurrent pseudoaneurysm and arteriovenous fistula. None of the patients showed the disorders of the femoral artery patency. The ultrasound-guided compression tests were performed in 39 patients. Compression repair was successful in 17 patients (40.5%) with diagnosed pseudoaneurysms. The remaining patients with pseudoaneurysms and arteriovenous fistulas were treated surgically. Conclusions. Color Doppler ultrasound-guided compression repair of iatrogenic femoral artery pseudoaneurysms is a safe method and should be used as an initial stage of treatment. Proper qualifications and experience are required to obtain good results. Successful compression repair is beneficial to patients, shortens the hospital stay and reduces the cost of treatment

TrueSight [portable laser mapping device]

TrueSight, by Absolute Vision Systems, is a real time laser mapping system intended to enhance and supplement human vision in low visibility environments. TrueSight is a helmet-mounted device which grabs IR depth data and projects this information into the user\u27s field of view in real time. Our goal at Absolute Vision Systems is to create a unique visual system which is a robust and simple-to-use solution for emergency response teams. TrueSight improves efficiency for first responders in low visibility environments while simultaneously reducing the risk they take

Management Options for Fetal Bronchopulmonary Sequestration

To evaluate the prenatal course and perinatal outcome of fetuses with bronchopulmonary sequestration (BPS) managed expectantly or using minimally invasive methods. This was a retrospective study of 29 fetuses with suspected BPS managed between 2010 and 2021 in three fetal medicine centers in Poland. Medline was searched to identify cases of BPS managed expectantly or through minimally-invasive methods. In 16 fetuses with BPS, there was no evidence of cardiac compromise. These fetuses were managed expectantly. Thirteen hydropic fetuses with BPS qualified for intrauterine intervention: a thoraco-amniotic shunt (TAS) was inserted in five fetuses, laser coagulation of the feeding vessel was performed in seven cases, and one fetus had combined treatment. In the combined data from the previous and the current study of various percutaneous interventions for BPS associated with hydrops, the survival rate was 91.2% (31/34) for TAS, 98.1% (53/54) for laser coagulation, and 75% (3/4) for intratumor injection of sclerosant. After taking into account cases with available data, the rate of preterm birth before 37 weeks in the group treated with laser coagulation was 14.3% (7/49) compared to 84.6% (22/26) in the group treated with TAS. The need for postnatal sequestrectomy was lower in the group of fetuses treated with laser coagulation 23.5% (12/51) in comparison to fetuses treated with TAS 84% (21/26). In fetuses with BPS without hydrops, progression of the lesion’s volume, leading to cardiac compromise, is unlikely. In hydropic fetuses with BPS, intrauterine therapy using minimally invasive methods prevents fetal demise. Both, the rate of preterm birth and the need for postnatal surgery is significantly lower in the group treated with laser coagulation compared to the group treated with TAS

Comparative Genomic Hybridization to Microarrays in Fetuses with High-Risk Prenatal Indications: Polish Experience with 7400 Pregnancies

The aim of this study was to determine the suitability of the comparative genomic hybridization to microarray (aCGH) technique for prenatal diagnosis, but also to assess the frequency of chromosomal aberrations that may lead to fetal malformations but are not included in the diagnostic report. We present the results of the aCGH in a cohort of 7400 prenatal cases, indicated for invasive testing due to ultrasound abnormalities, high-risk for serum screening, thickened nuchal translucency, family history of genetic abnormalities or congenital abnormalities, and advanced maternal age (AMA). The overall chromosomal aberration detection rate was 27.2% (2010/7400), including 71.2% (1431/2010) of numerical aberrations and 28.8% (579/2010) of structural aberrations. Additionally, the detection rate of clinically significant copy number variants (CNVs) was 6.8% (505/7400) and 0.7% (57/7400) for variants of unknown clinical significance. The detection rate of clinically significant submicroscopic CNVs was 7.9% (334/4204) for fetuses with structural anomalies, 5.4% (18/336) in AMA, 3.1% (22/713) in the group of abnormal serum screening and 6.1% (131/2147) in other indications. Using the aCGH method, it was possible to assess the frequency of pathogenic chromosomal aberrations, of likely pathogenic and of uncertain clinical significance, in the groups of cases with different indications for an invasive test