Late Coil Migration after Embolization of Cerebral Aneurysms ­ Case Series

Background Coil migration after cerebral aneurysm embolization is a very rare complication. It can take place early or late in the postoperative period, evolving asymptomatic and causing severe neurological deficits. Ruptured aneurysms of anterior communicant artery were the most frequent reported examples in the literature. Case Report We report three cases of patients with unruptured aneurysms treated with coils and remodeling balloon technique. The first case was that of a left posterior communicating artery aneurysm with coil migration to a distal cortical branch of ipsilateral middle cerebral artery (MCA). The patient had mild paresthesia in the arm for a few days. The second one was a fenestrated basilar artery aneurysm with coil migration to the P2 segment of the left posterior cerebral artery. The patient was fully asymptomatic. The third case was a MCA aneurysm with coil migration to the M3 segment. There were no ischemic complications, and all patients underwent a new endovascular procedure. Conclusions Coil migration is a rare but not always severe complication. Antiplatelet agents are recommended even if the coil migration is asymptomatic.

Introdução A migração de coil após embolização de aneurisma cerebral é uma complicação muito rara. Ela pode ocorrer no período pós-operatório tanto precoce quanto tardio, evoluindo assintomático ou causando graves déficits neurológicos. Aneurismas rotos da artéria comunicador anterior foram os exemplos mais frequentes relatados na literatura. Relato de Caso Relatamos três casos de pacientes com aneurismas não rotos tratados com coils e técnica de remodelagem com balão. O primeiro caso foi de um aneurisma de artéria comunicante posterior com migração do coil para um ramo cortical distal da artéria cerebral média (ACM) ipsilateral. A paciente apresentou parestesia leve no braço por alguns dias. O segundo foi um aneurisma de artéria basilar fenestrada com migração de coil para o segmento P2 da artéria cerebral posterior esquerda. O paciente ficou totalmente assintomático. O terceiro caso foi de um aneurisma de ACM com migração do coil para o segmento M3. Não houve complicações isquêmicas, e todos os pacientes foram submetidos a novo procedimento endovascular. Conclusões Migração de coil é uma complicação rara, mas nem sempre grave. Antiagregantes plaquetários são recomendados mesmo se a migração do coil for assintomática.

Deep vein thrombosis caused by malignant afferent loop obstruction / 영남의대학술지

Afferent loop obstruction following gastrectomy is a rare but fatal complication. Clinical features of afferent loop obstruction are mainly gastrointestinal symptoms. A 56-year-old female underwent radical total gastrectomy with Roux-en-Y esophagojejunostomy for treatment of advanced gastric cancer. After fourteen months postoperatively, she showed gradual development of edema of both legs. Computed tomography (CT) scan showed disease progression at the jejunojejunostomy site and consequent dilated afferent loop, which resulted in inferior vena cava (IVC) compression. A drainage catheter was placed percutaneously into the afferent loop through the intrahepatic duct and an IVC filter was placed at the suprarenal IVC, and selfexpanding metal stents were inserted into bilateral common iliac veins. With these procedures, sympotms related with afferent loop obstruction and deep vein thrombosis were improved dramatically. The follow-up abdominal CT scan was taken 3 weeks later and revealed the completely decompressed afferent loop and improved IVC patency. Surgical treatment should be considered as the first choice for afferent loop obstruction; however, because it is more immediate and less invasive, non-surgical modalities, such as percutaneous catheter drainage or stent placement, can be effective alternatives for inoperable cases or risky patients who have severe medical comorbidities.

Evaluation of the reliability of measurements in cephalograms generated from cone beam computed tomography

OBJECTIVE: The purpose was to compare angular and linear measurements generated in digital cephalometric radiographs and cephalograms synthesized from three-dimensional images. METHODS: Twenty-six individuals (12 men and 14 women) with mean age of 26.3 years were selected. Digital cephalometric radiographs and CBCTs were taken on the same day. The images were imported and analyzed on Dolphin Imaging V.10.5 software, which synthesized cephalograms in perspective projection and magnification of 9.7%. A single observer marked the points and repeated the procedure with an interval of time of ten days to evaluate intraexaminer error. In the statistical analysis paired Student's t test was used to establish the correlation between the measurements. RESULTS: The angular measurements GoGn.SN and IMPA, which involved the Gonial point (Go) and the linear measurements that involved the lips presented significant difference (p < 0.05). The other measurements presented good correlation. CONCLUSION: The measurements in the synthesized cephalograms proved to be reliable.

OBJETIVO: comparar medidas angulares e lineares geradas em radiografias cefalométricas digitais e cefalogramas sintetizados a partir de imagens tridimensionais. MÉTODOS: selecionou-se 26 indivíduos (12 do sexo masculino e 14 do feminino), com média de idade de 26,3 anos, que realizaram no mesmo dia as radiografias cefalométricas digitais e tomografia computadorizada de feixe cônico. As imagens foram importadas e analisadas no software Dolphin Imaging V.10.5, que sintetizou cefalogramas com projeção perspectiva e magnificação de 9,7%. As marcações dos pontos foram realizadas por um único observador e repetidas com um intervalo de tempo de 10 dias para avaliação do erro intraexaminador. Para a análise estatística, utilizou-se o teste t de Student pareado para estabelecer a correlação entre as medidas. RESULTADOS: as medidas angulares GoGn.SN e IMPA, que envolviam o ponto Gônio (Go), e as medidas lineares que envolviam os lábios, apresentaram diferença significativa (p < 0,05). As outras medidas apresentaram boa correlação. CONCLUSÃO: as medições nos cefalogramas sintetizados mostraram-se confiáveis.

Interventional radiography in management of high-flow arteriovenous malformation of maxilla: report of a case

Arteriovenous malformations are extremely rare conditions in that can result from abnormalities in the structure of blood vessels, which may be potentially fatal. A 30-year-old female patient visited our hospital with a complaint of swelling on the right maxillary posterior gingiva along with the large port-wine stain on right side of face. On clinical examination, the swelling was compressible and pulsatile. Radiographic examination revealed a lytic lesion of maxilla. Diagnostic angiography revealed a high-flow arteriovenous malformation of maxilla which was treated by selective transarterial embolization of maxillary artery using polyvinyl alcohol particles.

Radiation exposure and its reduction in the fluoroscopic examination and fluoroscopy-guided interventional radiology

Radiation exposure during fluoroscopy has been of consistent interest because fluoroscopy is used not only for diagnostic purposes such as upper gastrointestinal series but for many minimally-invasive treatments in various clinical fields. In 2000, the International Commission on Radiological Protection published the important report about the avoidance of radiation injuries from medical interventional procedures, and this report defined harm during fluoroscopic-guided interventional procedure and how to reduce the radiation dose of patients and staff. Two aspects of fluoroscopy exposure differ from other types of medical radiation exposure, including computed tomography. One is that the entrance surface dose during an interventional procedure may be very high, so the deterministic effects of radiation such as skin or corneal injury should be emphasized more than stochastic effects such as cancer risk. The other is that the variation in radiation exposure is great for the same kind of procedure, so it is very difficult to generate a reference level for the radiation dose. Therefore, it is necessary to develop a guideline for the use of fluoroscopy through a nationwide survey about irradiation during fluoroscopic examinations and fluoroscopy-guided intervention procedures. In conclusion, radiation exposure by fluoroscopic guided intervention is not negligible, and the practitioner should always aim to reduce radiation exposure during interventional procedures.

Comparison of Long-term Complication of Malignant Biliary Obstruction after Percutaneous Transhepatic Biliary Drainage Versus Metallic Biliary Drainage / 고신대학교의과대학학술지

OBJECTIVES: Several advances in the diagnosis, therapy and palliation of patients affected by malignant biliary obstruction have occurred during the last decades. Unresectable malignant biliary obstruction has usually been treated by percutaneous transhepatic biliary drainage (PTBD) versus metallic biliary drainage (MBD). The optimal management of complications after biliary drainage is still an unresolved problem. To compare the complications of malignant biliary obstruction after PTBD and MBD. METHODS: We enrolled 51 patients of malignant biliary obstruction after biliary drainage. The clinical characteristics and complications of each groups were assessed and compared. RESULTS: The complications after biliary drainage of MBD are lower than those of PTBD (59.1% vs 82.8%, P = 0.06, respectively). Patients with PTBD tended to have a shorter event of complication time compared to MBD patients (2.9 months vs 7.1 months, P < 0.01). Patients with older age in PTBD tended to have a longer event of complication time compared to younger patients (4.6 months vs 2.3 months, P < 0.01). CONCLUSIONS: The method of biliary drainage in malignant biliary obstruction have statistically significant impact on the complication time. The clinical efficacy of metallic stent in patients with malignant biliary obstruction is better than that of PTBD.

Tratamento endovascular de ruptura traumática da aorta torácica descendente / Endovascular treatment of traumatic descending thoracic aortic rupture

Paciente do sexo feminino, 55 anos de idade, vítima de atropelamento, foi admitida em unidade de emergência, onde se realizou o diagnóstico clínico, radiológico e tomográfico de ruptura traumática da aorta torácica descendente. Diante do achado, a paciente foi encaminhada para tratamento endovascular com colocação de endoprótese auto-expansível (stent) pela artéria femoral. O tratamento obteve sucesso, evidenciado pela exclusão da lesão localizada previamente no istmo aórtico. O tratamento endovascular tem sido indicado nas afecções de aorta torácica descendente com bons resultados iniciais. Na ruptura traumática de aorta, a terapêutica endovascular representa uma alternativa aceitável, especialmente devido aos riscos do tratamento operatório convencional.

A 55-year-old, female patient who was run over by a motor vehicle was admitted at an emergency room. Clinical, radiological and tomographic diagnosis of traumatic descending aortic thoracic rupture was performed. The patient was referred for endovascular treatment with placement of a self-expandable stent through the femoral artery. Treatment was successful, with exclusion of the lesion previously located in the aortic isthmus. Endovascular treatment has been indicated in the treatment of descending thoracic aortic diseases, with good initial results. In case of traumatic aortic rupture, endovascular treatment is a feasible alternative, especially due to risks offered by the conventional surgical treatment.

Comparison study between transcatheter closure and surgical repair in over 50-year old patients with secundum atrial septal defect / 中华胸心血管外科杂志

Objective: The aim of this study is to compare the clinical data and result between transcatheter closure and surgical repair for the treatments of secundum ASD in patients above 50 years old, and explore the indications for these two methods. Methods: From January 1998 to December 2003, 53 patients with surgical repair and 42 patients with transcatheter closure were enlisted according to the diagnosis of ASD. The ages of all of cases were above 50 years old. The interventional approach was administrated with Amplatzer device. The surgical approach mended the defect directly or with autologous pericardium. These patients were followed up by echocardiography (Echo). The clinical data including the diameter of the right ventricle (RVD), the pulmonic flow velocity, the pulmonary pressure and the tricuspid valve regurgitation. Results: In surgery group, surgical mortality was 1 9% (1/53). Cerebral embolism occurred in 4 (7 5%) patients. Pericardial effusion and other complications occurred in 24.5%. All 42 patients with ASD were effectively closed with Amplatzer occlude. One occluder displaced and moved into pulmonary artery on the fourth day after the treatment. The short term effective rate was 97 6% in transcatheter closure group. The diameter of ASD showed by Echo was significantly less in patients treated with transcatheter closure than that in surgical repair group. The hospitalization time was significantly less in patients treated with transcatheter closure. The follow up data recorded decreased load of right ventricle, the decreased diameter of right ventricle as well as the relief of pulmonary artery hypertension. Conclusion: The data suggested that of surgical approach of ASD has a wider indication for patients in different stages of the disease, whereas surgical morbidity may increase in elderly patients due to their pre existed diseases. However, the transcatheter closure for ASD is feasible for patients with smaller defects.