Color doppler ultrasound study of the embolism and sclerotherapy of fibrin glue combined with bleomycin for the treatment of cervicofacial vascular malformations / 实用口腔医学杂志

Objective:To explore the mechanism of the embolism and sclerotherapy of fibrin glue combined with bleomycin (FG/BLM) for the treatment of cervicofacial vascular malformations by color doppler ultrasound.Methods:10 patients with venous malformation(VM) and 10 patients with arterio-venous malformation(AVM) were included.All patients underwent embolism and sclerotherapy of FG/BLM guided by ultrasound.Color doppler ultrasound was used to record the real-time two-dimensional ultrasonography and color doppler image.The flow and distribution of FG/BLM after injection into the lesions were observed.Results:Two-dimensional ultrasonography showed clumps or flake strong echo after immediate injection of FG/BLM into the cavity of VMs,then floated in the abnormal venous lumen and diffused throughout the cavity.At the later stage the lesions were filled by a large number of flocculent and netted low echo,and patchy strong echo.The volume of VMs cavity expanded dramaticlly,and the blood flow signal was significantly decreased.After injection of FG/BLM into the lumen of AVMs,clumps or flake strong echo were observed,then most of the snowflake strong echo rapidly filled or scattered along with blood stream to the distal part of the vessels.The color doppler showed significantly decrease of blood flow signal.Conclusion:FG/BLM injection can embolize and block the draining vein of VM,and play a role on the storage of sclerozing agent.FG/BLM injection can embolize both the dilated blood vessels and capillary network of AVM.

Renal Arteriovenous Malformation with Multiple Renal Artery Aneurysms Treated by Control of the Arterial Inflow Alone / 日本心臓血管外科学会雑誌

<p>Endovascular treatment is a first-line treatment for renal arteriovenous malformations (AVMs). Endovascular treatment might be effective in patients with aneurysmal-type renal AVMs, which involve one feeding artery and one drainage vein, because control of the feeding artery, rather than the aneurysm itself, could have a therapeutic effect. Herein, we describe two cases of patients with renal AVM with multiple renal artery aneurysms, who were treated by controlling the arterial inflow alone. In Case 1, the patient was a 76-year-old woman with renal AVM discovered during examination for another medical condition. A computed tomography scan revealed four renal aneurysms (φ38/44/24/35 mm) ranging from an intimal defect in the right renal artery to the drainage vein running into the inferior vena cava (IVC). Although we had planned to use a covered stent in the right renal artery to cover the intimal defect without embolization of the aneurysms, a minor artery proximal to the aneurysm was found near the orifice of the right renal artery. Therefore, we used a covered stent in the right renal artery after embolization of the most proximal aneurysm was performed. In Case 2, a 78-year-old man was referred to our facility because a renal AVM was found during examination for lower back pain. The distal posterior branch of the right renal artery attached to the multiple aneurysms and directly drained into the IVC, which was diagnosed as an aneurysmal-type renal AVM. Because there were no arteries arising from the aneurysms in the right renal artery, which fed the renal parenchyma, embolization of only the inflow artery was performed. For both patients, renal blood flow was maintained without any decrease of the renal function. In these patients, although renin-angiotensin system activity was within the normal range, and blood pressure became better controlled postoperatively. In addition, there was significant improvement in the brain natriuretic peptide (BNP) levels postoperatively. Thus, we believe that unstable hypertension and/or high-output heart failure as well as the aneurysmal size should be assessed in the management of renal AVMs.</p>

Resección quirúrgica de malformación arteriovenosa de alto flujo en ángulo nasogeniano con embolización preoperatoria: reporte de un caso / Surgical resection of high-flow arteriovenous malformation of the nasogenian sulcus with preoperatory embolization: a case report

El 50% de las malformaciones arteriovenosas (MAVs) de alto flujo se ubican en la región craneofacial y pueden producir sangrado con riesgo vital sin diagnóstico y tratamiento adecuado. La resonancia magnética (RM) es útil en el diagnóstico diferencial de las lesiones vasculares, siendo el gold standard la angiografía selectiva. Dado que las MAVs de alto flujo no involucionan espontáneamente, el tratamiento usualmente consiste en embolización con posterior resección quirúrgica. Se presenta un paciente de sexo masculino de 20 años que consulta por aumento de volumen nasogeniano derecho, progresivo, violáceo, blando y pulsátil. Se objetiva mediante RM una zona de vasos serpentiginosos, que se extiende desde el subcutáneo hasta la pared anterior del maxilar. La angiografía cerebral confirma MAV de alto flujo e informa mapeo vascular. Se decide embolización prequirúrgica superselectiva con posterior resección tumoral mediante acceso transvestibular.

The 50 % of arteriovenous malformations (AVMs) of high flow are located in the craniofacial region and can cause life-threatening bleeding without a diagnosis and appropriate treatment. Magnetic resonance imaging is useful in the differential diagnosis of vascular lesions, being the gold standard selective angiography. Since high-flowA VMs do not regress spontaneously, treatment usually involves surgical resection with subsequent embolization. We present a 20 years male patient consulting with a purple, progressive, soft, pulsating enlargement of right-side nasogenian region. Magnetic resonance imaging shows serpiginous vessels, extending from the subcutaneous to the anterior wall of the maxillary. Cerebral angiography confirms high flowAVM and shows vascular mapping. It was decided superselective preoperative embolization with subsequent tumor by transvestibular access.

A case of hemosuccus pancreaticus in arteriovenous malformation / 대한내과학회지

Hemosuccus pancreaticus describes the syndrome of gastrointestinal bleeding into the pancreatic duct, manifested by blood loss through the ampulla of Vater. Pancreatic arteriovenous malformation (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. Endoscopy is essential to rule out other causes of upper gastrointestinal bleeding. In rare cases, active bleeding is seen from the duodenal ampulla. Selective celiac angiography is the only diagnostic test. Angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage. We experienced a patient with upper gastrointestinal bleeding in which the diagnosis of hemosuccus pancreaticus secondary to a AVM in chronic pancreatitis was diagnosed preoperatively. We report our experience with a review of literatures.

Thrombosed Cerebral Arteriovenous Malformation (AVM): Operative Case Report / 대한뇌혈관학회지

Spontaneously thrombosed cerebral arteriovenous malformations (AVM) are infrequently reported. Its pathophysiology, and natural course, however, are still not clarified yet. Authors report a case of symptomatic, spontaneously thrombosed cerebral AVM in a 34-year-old male with a follow-up of 16-year duration, which was surgically extirpated due to repeated bleeding and intractable seizure disorder, and histopathologically confirmed. Relevant literatures are reviewed and discussed.

Cerebral Arteriovenous Malformation Associated with Intracranial Meningioma and Aneurysm: Case Report

The cerebral arteriovenous malformation(AVM) rarely coexists with primary intracranial tumor. The authors experienced a patient with intracerebral hematoma due to AVM rupture in whom intracranial meningioma and intracranial aneurysms coexisted. The meningioma was located at convexity of right frontal lobe, and arteriovenous malformation at temporo-occipital lobe of same hemisphere with feeding from right middle cerebral artery, and three intracranial aneurysms exist at the cavernous portion of right internal carotid artery, AVM feeding artery, and intranidal of the AVM. The authors report a rare case of coexisted intracranial AVM, meningioma and aneurysms with review of literatures.

A Case of Endoscopic Band Ligation Therapy in Gastric Arteriovenous Malformation / 대한소화기내시경학회지

Although various endoscopic treatments, such as laser photocoagulation, electrocoagulation, heater probe, injection have been used for treatment of arteriovenous malformation (AVM), associated complications also have been reported. In order to avoid the complications, elastic band ligation has recently been used as an alternative method for endoscopic treatment of gastric AVM. A 58-year-old man was admitted due to hematemesis and melena. A gastroscopy revealed AVM with vessel exposure and active bleeding at the greater curvature of fundus, and we performed arteriography for emergency embolization, but, we do not find the bleeding vessel. Endoscopic band ligation therapy was performed as an alternative method for control of bleeding. 2 months later, follow-up endoscopy showed disappearance of AVM and no evidence of hemorrhage.

Surgery of Cerebrovascular Lesions Causing Intractable Epilepsy

OBJECTIVE: Traditionally, the main indications for surgery in vascular-related lesion were based upon reduction or control of seizures, reversal of symptoms of deficits related to mass effect, and prevention of hemorrhage or recurrent hemorrhage. However, the results of surgical treatment for seizure control are disappointing in some reports. Here we describe surgical strategies and our experience in treating patients with intractable seizures associated with vascular-related lesions according to sophisticated presurgical and intraoperative evaluation. METHODS: Twelve(4.5%) patients were selected for this study out of total 264 patients with resective epilepsy surgery at our epilepsy center during four years since 1992. All were treated with anticonvulsant agents but became refractory. These patients operated on under local or general anesthesia for resection surgery, underwent presurgical and intraoperative evaluation for identification of adjacent, beyond or remote epileptogenic area and the eloquent area. RESULTS: Of these 12 patients, vascular malformations(AVM, cavernous angioma) were 7, overt hemorrhage due to vascular lesion were 2 and intractable ongoing seizure after vascular surgery were 3. Other vascular lesion including occlusive disease, moyamoya disease or previous hemorrhage were excluded in this study. The location of the lesion was mainly temporal and peri-Rolandic areas, and dual pathology was verified in 2 cases of 6 temporal lesion. The surgical outcome(class I;7, II;3, III;1, IV;1) was excellent by Engel's classification. CONCLUSION: Control of seizures related to vascular lesions remains strong indication for surgical resection. For this reason, careful presurgical evaluations are essential to evaluate the remote epileptogenic area, especially in temporal lesion. Intraoperative acute recording(ECoG) and functional mapping by electrical stimulation or SSEP are important for maximal resection of epileptogenic area with minimal sequellae.

Brain Abscess Associated with Pulmonary Arteriovenous Malformation: Case Report

The authors report a case of brain abscess associated with pulmonary arteriovenous malformation(AVM). As right to left shunt in systemic circulation can precipitate brain abscess in congenital cyanotic heart disease, arteriovenous fistula in pulmonary AVM is an etiologic factor of brain abscess. Brain abscess associated with pulmonary AVM is very rare and has so far been lacking in previous report in Korea. The pertinent literatures of brain abscess associated with pulmonary AVM are also reviewed.

DISCUSSION ON PRIMARY SUBARACHNOID HEMORRHAGE:REPORT OFSEVEN AUTOPSY CASES / 中国法医学杂志

Prim ary subarachnoid hemorrhage(SAH)is not uncommon in forensic autopsy.This paper reported 7 cases of primary SAH.Disputes about the cause of death arose because death occured after minor head injuries.Through thorough histopathological examination,causesof primary SAH in these 7 ca- ses were determined:arteriovenous malformation of the brain in 5 cases; aneurysm in 1 case;giant cell arteritis in 1 case.Causes of SAH were undeter- mined macroscopically in all these cases.The misdiagnosis of traumatic SAH were made in 4 reappraisal cases.Facts indicated the importance of thorough histopathological examination tor determining real causes of SAH. The literature was reviewed and the methods of histopathological exa- mination,as well as the attention it must paid were discussed.