It's not always postdural puncture headache: a case report and note to the astute anesthesiologist

Abstract Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here.

Tratamiento endovascular del aneurisma esplénico incidental y en la urgencia / Endovascular treatment of incidental and emergency splenic aneurysm

Resumen Los aneurismas esplénicos verdaderos son dilataciones saculares que involucran todas las capas de la arteria esplénica. Se presentan más frecuentemente en mujeres, en el embarazo y pacientes con hipertensión portal. Son habitualmente asintomáticos y diagnosticados incidentalmente durante el estudio de otra afección abdominal. Hasta un 10% se puede presentar con ruptura, lo que supone un escenario con una alta morbilidad y mortalidad. El tratamiento de los aneurismas esplénicos es aún un tema de controversia y existen variadas modalidades terapéuticas. Presentamos dos casos de pacientes con aneurismas esplénicos: uno de ellos que se manifestó con rotura y el otro por un diagnóstico incidental. Ambos fueron resueltos mediante embolización endovascular con resultados óptimos. Esta modalidad terapéutica poco difundida para el tratamiento de aneurismas esplénicos gigantes o rotos, nos permitió resolver el cuadro de forma segura y efectiva, con mínima morbilidad y mortalidad.

Abstract True splenic aneurysms are saccular dilations of all the layers of the splenic artery, more common in women, pregnancy and portal hypertension. They are usually asymptomatic and diagnosed incidentally during the study of other abdominal diseases. Up to 10% may present with rupture, which implies a high morbidity and mortality. Treatment of splenic aneurysms is still a subject of controversy and there is a great variety of therapeutic modalities. We present two cases of patients with splenic aneurysms: one who presented with rupture and the other one incidentally diagnosed. Both were treated with endovascular embolization achieving optimal results. Although the utility of this therapy has not been assessed for giant or ruptured aneurysms, it allowed us to solve these scenarios in a secure and effective way, with minimum morbidity and mortality.

Fístulas arteriovenosas pulmonares en un paciente pediátrico: un reporte de caso / Pulmonary arteriovenous fistulas in a pediatric patient: a case report

Las fístulas arteriovenosas pulmonares son malformaciones congénitas dadas por la comunicación directa anómala entre arterias y venas, con una incidencia mundial de 2-3 : 100 000 habitantes. La presentación es, en general, única, asintomática, y aparecen en forma incidental como hallazgo imagenológico en la adultez, y su tratamiento de elección es la embolización endovascular.Se describe la inusual presentación clínica en una paciente de 10 años, que ingresó por disnea, tos, cianosis central y cefalea. Se encontró hipoxemia persistente, hipocratismo digital, nódulos parahiliares pulmonares, gases arteriales con gradiente alvéolo-arterial aumentado. La tomografía axial computarizada de tórax de alta resolución confirmó la presencia de una malformación arteriovenosa pulmonar en la región parahiliar derecha, la cual no se asociaba con la enfermedad de Rendu-Osler-Weber. La paciente fue tratada con embolización endovascular transcutánea. Tras 1,5 años de seguimiento, no hubo recaídas. Son pocos los casos reportados de estas fístulas en la edad pediátrica

Pulmonary arteriovenous fistulas are congenital malformations due to anomalous direct communication between arteries and veins; the incidence is 2-3 : 100,000 inhabitants. This condition is usually asymptomatic and incidentally appearing in adult imaging findings. Transcutaneous endovascular embolization is the technique of choice for treatment. The unusual presentation in a 10-year-old patient is described; she was presented to the Emergency Department with dyspnea, cough, central cyanosis and headache. The examination revealed persistent hypoxemia and digital clubbing; chest X-ray with images suggestive of parahilar nodules, arterial blood gases with increased alveolar arterial gradient. The high resolution computed tomography of the thorax revealed pulmonary arteriovenous malformation in the right parahilar region not associated with Rendu-Osler-Weber disease. The patient was treated with transcutaneous endovascular embolization, and after a year and a half of follow-up there were no relapses. There are few reported cases of pulmonary arteriovenous fistulas in the pediatric age.

Endovascular embolization of an infectious intracranial aneurysm caused by paragonimiasis: A case report / 中国脑血管病杂志

Infectious intracranial aneurysm induced by paragonimiasis is very rare in clinic. Interventional treatment is one of the effective therapies and regular antiparasite therapy is necessary after embolization. This retrospective study summarized one case of intracranial aneurysm caused by paragonimiasis involving the medical history, laboratory examination, imaging findings and treatment strategy, and analyzed the diagnosis and treatment of the disease with literature review.

The clinical value of endovascular embolization in treating severe acute pancreatitis associated with hemorrhage / 介入放射学杂志

Objective To investigate the clinical value of endovascular embolization in treating severe acute pancreatitis (SAP) associated with hemorrhage. Methods The clinical data of 71 patients with SAP, who were admitted to authors' hospital during the period from 2010 to 2016, were collected. DSA was performed in all patients. Of the 71 patients, 27 (38.0％) received endovascular embolization treatment. The angiographic findings and the endovascular embolization results of the 27 patients were analyzed. Results Angiography demonstrated that 20 patients (28.2％, 20/71) had hemorrhage due to arterial rupture and 7 patients (9.9％, 7/71) had pseudoaneurysm formation. A total of 32 responsible arteries were detected, and the spleen artery was the main bleeding artery (34.4％, 11/32) . A total of 32 endovascular embolization procedures were carried out, the technical success rate was 93.8％ (30/32) . Post-embolization complication was seen in 4 patients, including infarction of spleen (n =2), which was improved after symptomatic treatment, liver abscess (n=1) and splenic abscess (n=1), which were improved after anti-infection therapy and tube drainage. Three patients died of hemorrhagic shock (n=2) or brain stem infarction (n=1), the causes of death were not related to the intervention operation. Five patients developed recurrent hemorrhage, in 4 of them the new bleeding point was different from the primary bleeding point, and successful hemostasis was achieved after second embolization treatment. Conclusion In treating SAP associated with hemorrhage, angiography together with endovascular embolization can quickly detect the hemorrhagic responsible arteries, thus, rapid hemostasis can be reliably achieved.

Combined approach to management of periocular arteriovenous malformation by interventional radiology and surgical excision

Periorbital arteriovenous malformations (AVMs) are congenital lesions that may cause significant morbidity such as amblyopia, cosmetic disfigurement, or chronic pain. Due to the rarity of these lesions, they are frequently misdiagnosed and treated inappropriately. We managed a 6-year-old girl with preseptal AVM by endovascular embolization followed by complete surgical excision after 2 days. She was previously diagnosed as capillary hemangioma and was being treated with intralesional steroid injections and oral propranolol. Neuroimaging revealed an AVM fed by the branches of both external and internal carotid arteries and drained by the superior ophthalmic vein. Endovascular embolization with glue followed by complete surgical excision of the lesion was done. The resultant cosmetic and functional outcome was gratifying. Diagnosis and management of periorbital AVM remain a challenge requiring a multidisciplinary approach involving interventional radiologist and trained oculoplastic surgeons. Combined endovascular embolization followed by surgical excision proved safe and effective.

The clinical efficacy of ultraselective intravascular embolization combined with local sclerotherapy in the treatment of large hemangioma in children / 实用放射学杂志

Objective To study the clinical efficacy and complications of ultraselective endovascular embolization combined with local sclerotherapy in the treatment of large hemangioma in children,to provide a better choice for the treatment.Methods 85 cases of large hemangioma in our department in the last three years were analyzed retrospectively.Patients were divided into two groups according to the treatment:the simple treatment group (33 cases),ultraselective endovascular embolization,and the combination treatment group (52 cases),ultraselective endovascular embolization combined with local sclerotherapy or local sclerotherapy after endovascular embolization.The total effective rate and the incidence of complications between two groups were compared,and the patients were followed up for 3 months to 1.5 years.Results 85 cases of large hemangioma were successfully treated by simple ultraselective endovascular embolization or combined treatment.A total of 75 cases were treated effectively (complete cure,partial cure,condition improved)and 10 cases were ineffective and no recurrence or tumor enlargement in the follow-up .In the total effective rate,the combination treatment group [96.2% (50/52)]was superior to the simple treatment group [75.8% (25/33)](χ2=6.245,P=0.012 ).There was no significant difference in the complete cure rate between the two groups (χ2=1.561,P=0.212 ).The complication rate in the simple treatment group was slightly higher than that in the combined treatment group:36.4% (12/33)vs 32.7% (17/52)(χ2=0.064,P=0.996).Conclusion The total effective rate of ultraselective endovascular embolization combined with local sclerotherapy in the treatment of large hemangioma in children is better than simple endovascular embolization,and less complications,safely treatment and less trauma.It can be used as the first choice for treatment of large hemangioma.

Efficacy of ultra-early endovascular embolization for ruptured intracranial aneurysms:a Meta-analysis / 中国脑血管病杂志

Objective To compare the effectiveness and safety of ultra-early (< 24 h)and delayed (≥ 24 h ) endovascular embolization of ruptured intracranial aneurysms with systematic review. Methods PubMed,Embase,the Cochrane Library,VIP,Wanfang Data,and China National Knowledge Internet (CNKI)were retrieved according to inclusion,exclusion criteria and retrieval strategies,and the clinical literature of ultra-early and delayed endovascular embolization for the treatment of ruptured intracranial aneurysms were obtained. The Review Manager 5. 3 software was used to conduct Meta-analysis for good prognosis rate,postoperative mortality,and postoperative rebleeding rate. Results A total of 10 articles were included,9 of them were retrospective control studies and 1 was prospective control study. A total of 2 021 patients were enrolled,including 970 patients treated with ultra-early treatment;1 051 patients treated with delayed treatment. There was significant difference in the good prognosis rate (OR,2. 67,95% CI 2. 07 -3. 44,P < 0. 01)and the postoperative rebleeding rate (OR,0. 23,95% CI 0. 11 -0. 47)between the ultra - early embolization group and the delayed embolization group (all P < 0. 01). There were no significant difference in the mortality between the two groups (OR,0. 76,95% CI 0. 51 -1. 13,P = 0. 17). The subgroup analysis showed that there were significant differences in the good prognosis rate in the ultra-early group compared with the early group (< 3 d,OR,1. 98,95% CI 1. 33 -2. 95)and the middle and late group (≥3 d,OR,4. 66,95% CI 2. 21 -9. 81,all P < 0. 01). Conclusion Compared with the delayed group, ultra-early embolization of ruptured intracranial aneurysms may improve the good prognosis rate,reduce the rebleeding rate,and not increase the mortality after procedure at the same time. However,more high quality and large sample randomized controlled trials are needed to confirm them.

Application of magnetic resonance angiography in the follow-up of patients after embolization of intracranial aneurysms with stent-assisted coils / 中国脑血管病杂志

Objective To evaluate the application of 3.0 T magnetic resonance angiography (MRA) in follow-up after embolization of intracranial aneurysms with stent-assisted coils.Methods From June 2013 to June 2015,32 consecutive patients with subarachnoid hemorrhage due to ruptured intracranial aneurysms underwent stent-assisted coil embolization at the Department of Neurosurgery,the Sixth People′s Hospital of Shenzhen were enrolled retrospectively,including 12 males and 20 female,their mean age was 56±10 years.All patients were confirmed to be solitary intracranial aneurysms by digital subtraction angiography (DSA) before embolization.They were followed up with 3.0 T time of flight MRA (TOF-MRA) and contrast enhanced MRA (CE-MRA) at 1 to 2 years after embolization.DSA findings were served as the golden standard.The effect of aneurysm embolization (stabilization,further embolization,recanalization/recurrence) and patency of the parent arteries (without stenosis/mild stenosis,moderate to severe stenosis and occlusion) were compared.Results (1) The comparisons of evaluating the aneurysmal effects and consistencies of DSA among TOF-MRA,CE-MRA and TOF-MRA+source images after stent-assisted coil embolization were poor (Kappa=0.039,P=0.002),medium (Kappa=0.582,P<0.01),and higher (Kappa=0.615,P<0.01),respectively.(2) The comparison of the consistencies in the patency of the parent artery after stent-assisted coil embolization between TOF-MRA,CE-MRA and DSA were poor (Kappa=0.171,P=0.211;Kappa=0.376,P=0.010).(3) With the DSA findings as reference,the accuracy rates of TOF-MRA,TOF-MRA+source images and CE-MRA for interpretation of aneurysm embolization were 37.5% (12/32),75.0% (24/32),and 71.9% (23/32),respectively.TOF-MRA compared with TOF-MRA+source images and CE-MRA respectively,there were significant differences in the accuracy rates (χ2=9.04,P=0.003;χ2=7.63,P=0.006);there were no significant differences in the accuracy rates between TOF-MRA+source images and CE-MRA (χ2=0.08,P=0.777).(4) With the DSA findings as reference,the accuracy rates of TOF-MRA and CE-MRA for interpretation of the patency of the parent artery were 37.5% (12/32) and 62.5% (20/32) respectively.There was no significant difference in the accuracy rate (χ2=4.67,P=0.097).Conclusions The accuracy rate of 3.0 T CE-MRA for evaluating the embolization effect of intracranial aneurysms after stent-assisted coil embolization was superior to that of TOF-MRA.It can be used as a preferred non-invasive examination during the follow-up.TOF-MRA+source images are equivalent to CE-MRA,however,TOF-MRA and CE-MRA for the evaluation of the accuracy of patency of the parent arteries are low.For positive or indeterminate results of MRA examinations,the individualized analysis should be performed,if necessary,perform DSA examination.

Stent-assisted coil embolization versus simple coil embolization for large and giant intracranial aneurysms: comparison of postoperative recurrence rate / 介入放射学杂志

Objective To compare the recurrence rate and long-term follow-up angiographic findings between stent-assisted coil embolization and simple coil embolization in treating large and giant intracranial aneurysms.Methods The clinical data and imaging materials of a total of 90 patients with large and giant intracranial aneurysms (＞10 mm,91 aneurysms in total),who were admitted to authors' hospital during the period from January 2004 to January 2016 to receive interventional embolization therapy,were retrospectively analyzed.Of the 90 patients,52 patients (52 lesions in total) received simple coil embolization (SCE group)and 38 patients (39 lesions in total) received stent-assisted coil embolization (SACE group).Postoperative recurrence rates of aneurysm were compared between the two groups,and recurrence risk factors were analyzed.Results The whole postoperative recurrence rate of aneurysm and re-treatment rate were 38.5％(35/91) and 20.9％(19/91) respectively;the recurrence rate and re-treatment rate of SACE group were 35.9％ (14/39) and 17.9％ (7/39) respectively,while those of SCE group were 40.4％ (21/52) and 23.1％ (12/52) respectively;the differences between the two groups were not statistically significant (P＞0.05).Multivariate logistic regression indicated that the recurrence risk factors of large or giant intracranial aneurysms included rupture of aneurysm (OR=0.284,95％CI=0.083-0.978,P=0.046),simple coil embolization (OR=5.03,95％ CI=1.04-24.44,P=0.045),concurrent hypertension (OR =0.13,95％ CI=0.036-0.51,P=0.003)and long time after operation (OR=1.002,95％CI=1.001-1.003,P=0.002).Conclusion Compared with simple coil embolization,stent-assisted coil embolization can reduce the recurrence rate of aneurysm.Rupture of aneurysm,simple coil embolization,long time after operation and concurrent hypertension are independent risk factors for recurrence of aneurysm after transcatheter arterial embolization.

Idiopathic Internal Thoracic Artery (ITA) Pseudoaneurysm treated with endovascular embolization

A 44-year-old female was diagnosed with an ITA pseudoaneurysm in the right supraclavicular fossa. She was successfully treated with endovascular embolization. The challenges of diagnosis and treatment are discussed.

Application of 3.0T TOF-MRA in the Follow-up of Coiled Intracranial Aneurysm / 医学研究杂志

Objective To evaluate the application of 3.0T TOF magnetic resonance angiography (MRA) in intracranial aneurysm coiling follow-up retrospectively.Methods In our hospital,48 patients who underwent intracranial aneurysm coiling were followed up for one to two years with radiologic examination,which inclouded 3.0T TOF-MRA and Digital subtraction angiography(DSA) examination.DSA served as the golden standard.The MRA image quality and the results were compared.Results 3.0T TOF-MRA to determine aneurysm recurrence sensitivity was 85.7％,specificity was 95.7％,total accuracy rate was 93.8％,and the accuracy of the patency of the parent arterial was 93.8％.There was no significant difference between the 3.0T TOF-MRA and DSA (P ＞ 0.05).Conclusion In the patients after coiling,3.0T TOF-MRA in the judgment of the aneurysm embolization results and the patency of the parent artery had a high degree of consistency compare with DSA.We can use 3.0T TOF-MRA as a routine means in the follow-up.We should analysis individually for positive results and uncertainties.By optimizing imaging and scanning parameters might obtain better images.Perform DSA if necessary,when MRA was positive or uncertainty.

Endovascular embolization and prognosis of middle cerebral artery aneurysms / 中国脑血管病杂志

Objective To investigate the effectiveness and safety of endovascular embolization for the treatment of middle cerebral artery aneurysms. Methods From March 2007 to May 2015,the clinical data of 170 patients with 173 middle cerebral artery aneurysms treated with endovascular embolization at the Department of Neurosurgery,Nanjing Jinling Hospital were analyzed retrospectively,including 120 (69.4%)ruptured aneurysms and 53 (30. 6%)unruptured aneurysms. The incidence of complications and prognosis were compared between the 2 groups. Results (1)A total of 170 patients who could perform endovascular embolization after preoperative evaluation successfully completed the interventional procedure. None of the patients died. (2)18 patients (10. 6%)had intraoperative and postoperative complications,including 4 (7. 5%,4/53)in the unruptured aneurysm group and 14 (11. 7%,14/120)in the ruptured aneurysm group. There was no significant difference in the incidence of complications between the two groups. (3)101 patients were followed up for 3-48 months. No new nervous system symptoms and reruptured aneurysm were observed. One patient had recurrence in the unruptured aneurysm group and 4 had recurrence in the ruptured aneurysm group. Conclusion Endovascular treatment of middle cerebral artery aneurysms is a safe,effective,and feasible technique.

Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials

Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.

Risk factors of intracranial hemorrhage after endovascular therapy of cerebral arteriovenous malformation embolization / 中国基层医药

Objective To study the risk factors of intracranial hemorrhage after endovascular therapy of cere-bral arteriovenous malformations embolization.Methods the clinical records and images of 230 patients with cAVMs were retrospectively reviewed.Patients with intracranial hemorrhage after endovascular therapy in 3 days were recorded and the risk factors of hemorrthage by using multivariate logistic regression for guiding the treatment strategy were studied.Results There were 15 patients occurred intracerebral hemorrhages.After treatment the area of cAVMs was significantly smaller than that before treatment[(2.18 ±0.91)cm vs (6.67 ±1.56)cm],the difference lvas a statis-tically significant (t =9.627,P <0.05).A partial AVM reduction of ≥36.5%(P =0.031)and hypertension(P =0.025)were considered as risk factors for hemorrhage after endovascular therapy of cAVWs.Conclusion Patients receives a partial AVMreduction of ≥36.5% or with hypertension history have a tendancy of increasing hemorrhage after endovascular therapy of cAVMs.It's helpful for preventing intracerebral hemorrhage if the arterial blood pressure maintains after endovascular therapy.

Endovascular embolization with detachable balloon for traumatic carotid-cavernous fistulae：clinical experience in 188 cases / 介入放射学杂志

Objective To evaluate the clinical efficacy of endovascular embolization with detachable balloon, based on the characteristics of traumatic carotid-cavernous fistulae (TCCF), in treating TCCF. Methods The clinical data of 188 patients with TCCF, who had received endovascular embolization with detachable balloon via femoral artery access, were retrospectively analyzed. The risk factors for recurrence were statistically analyzed. Results Of the total 188 patients, complete cure after the first balloon embolization was obtained in 160, certain improvement of clinical symptoms was achieved in 22, and balloon embolization failed in 6, for whom other surgical options had to be carried out. Complications occurred in three patients. Recurrence was seen in 23 patients within the period from one day to 5 years after the treatment, and the recurrent lesion was successfully cured in all patients. Univariate analysis and chi square test or correction chi square test indicated that factors affecting postoperative recurrence were the use of multiple balloons for embolization and the presence of residual fistula after operation (P0.05). Multivariate logistic regression analysis revealed that the independent factors affecting recurrence included the number of used balloon≥2 (OR=7.80, 95%CI:2.28-26.73,P=0.001) and postoperative residual fistula that was observed immediately after the embolization (OR=10.46, 95%CI:2.99-36.50,P=0.000). Conclusion For the treatment of TCCF, transcatheter embolization with detachable balloon is minimally-invasive, safe and reliable with fewer complications, therefore, this technique should be regarded as the therapy of first choice. The use of multiple balloons and the presence of residual fistula observed immediately after the embolization procedure are the risk factors for recurrence. Other possible risk factors are still to be furtherstudied.

Early endovascular embolization treatment for the ruptured posterior communicating artery aneurysm:analysis of the mid-term and long-term effects / 介入放射学杂志

Objective To evaluate the mid-term and long-term effects of early endovascular emboli-zation in treating ruptured posterior communicating artery aneurysm. Methods Early endovascular embolization therapy was carried out in 36 patients with ruptured posterior communicating artery aneurysm (36 aneurysms in total), and the effects of embolization therapy were evaluated by using Raymond grading method. The unified imaging review program was formulated, and the mid-term and long-term effects were evaluated at half, 1, 2, 3 and 5 years after the treatment. Results The technical success rate was 100% in 36 patients (36 aneurysms in total). Raymond grading evaluation showed that gradeⅠwas seen in 32 patients, gradeⅡ in 2 patients, and grade Ⅲ in 2 patients. Recurrence of aneurysm was found in 5 patients (13.89%) at half (n=1), 2 (n=1), 3 (n=1) and 5 years (n=2) after the treatment. Re-rupture of the recurrent aneurysm was seen in one patient (2.78%). No death occurred during the following-up period. Conclusion Early endovascular embolization for ruptured posterior communicating artery aneurysm can effectively improve the prognosis of subarachnoid hemorrhage, and regular imaging examination can promptly detect the recurrence of aneurysm. Effective interventions are helpful for preventing deterioration and rupture of aneurysm.

Endovascular embolization treatment for the spinal dural arteriovenous fistulae / 介入放射学杂志

Objective To investigate the clinical effect of endovascular embolization in treating spinal dural arteriovenous fistulae, and to discuss its imaging manifestations. Methods A total of 7 patients with spinal dural arteriovenous fistulae were included in this study. Endovascular embolization was carried out in all the 7 patients. The clinical data, including epidemiology, spinal MRI and DSA manifestations, therapeutic method and follow-up findings, were retrospectively analyzed. Results Abnormal MRI manifestations of spinal cord were demonstrated in all 7 patients. After the diagnosis was confirmed by DSA, endovascular embolization was carried out. All patients were followed up for 6 months, and their clinical symptoms were improved in different degrees. N-butyl cyanoacrylate (NBCA) glue was used as embolization agent in 4 cases, and no recurrence was observed in them. Onyx liquid glue was used in 3 patients, and in one of them the arteriovenous fistula recurred. Conclusion For the treatment of spinal dural arteriovenous fistulae, endovascular embolization is effective and safe although further investigation is still needed.

Clinical analysis of endovascular embolization in the treatment of 130 cases of intracranial aneurysms / 重庆医学

Objective To evaluate the efficacy of endovascular embolization in intracranial aneurysm treatment .Methods We retrospectively analyzed 130 patients with different locations and types intracranial aneurysms treated by variety endovascular em‐bolization .The postoperative and long‐term follow up results was examined .Results 124 cases with 139 aneurysms was successful‐ly embolized ,1 case failed but clipping successfully .6 cases suffered from intraoperative bleeding ,3 cases died ,3 cases had a good recovery .The results of Glasgow Outcome Scale after operation:1 score 3 cases ,2 score 0 case ,3 score 1 case ,4 score 3 cases ,5 score 123 cases .119 cases(91% ) were followed up for 3‐48 months with an average of 12 months .33 cases(27% ) achieved long‐term follow‐up(exceeded 6 months) .During follow‐up ,1 case had severe stenosis of the parent artery and received angioplasty .The other cases didn′t see aneurysms in cerebral angiography and showed different degree of neurological function recovery .Conclusion According to the different intracranial aneurysm with endovascular treatment of corresponding intravascular can effectively im‐prove the clinical treatment effect ,reduce the risk of aneurysm rupture ,improve the prognosis of the patients .

Oclusión percutánea de la vena vertical con un Amplatzer® Vascular Plug: Informe de un caso / Endovascular occlusion of the vertical vein with an Amplatzer® Vascular Plug: Case report

El uso del Amplatzer® Vascular Plug (St. Jude Medical-Minnesota, EE. UU.) se ha diversificado y ha sido descrito con éxito en diferentes escenarios clínicos. Se describe otra aplicación para este dispositivo, presentando el caso de una paciente con antecedente de corrección de conexión anómala total de venas pulmonares a quien se le realizó oclusión de una vena vertical permeable con un Amplatzer® Vascular Plug.

The use of the Amplatzer® Vascular Plug has diversified and has been described successfully in different clinical settings. We describe another application for this device, presenting the case of a patient with a history of correction of total anomalous connection of pulmonary veins, who underwent occlusion of the unligated vertical vein with the Amplatzer® Vascular Plug.