The Results of Embolization of Dural Arteriovenous Fistula

PURPOSE: To assess the embolization effect of dural arteriovenous fistula(DAVF). MATERIALS AND METHODS: Weevaluated 23 patients with DAVF who were diagnosed using digital subtraction angiography and treated bytransarterial and/or transvenous emobolization. The locations of DAVFs, as seen on angiography were as follows: 16in the cavernous sinus, four in the major dural sinuses, two in the jugular bulb, one in the torcula Herophili,and one in the tentorium cerebelli. On the basis of venous drainage patterns, Cognard's classification of DAVF wasused. Among our 23 patients, 13 underwent transarterial embolization, six underwent transvenous embolization, andfour underwent both. After embolization, three patients underwent other treatment: surgery, one ; gammairradiation, one ; and both. One. Polyvinyl alcohol particles or glue was used in transarterial embolization, andtungsten, platinum, or Guglielmi detachable coils in transvenous embolization. To analyse the residual lesion inDAF, we compared pre- and post-treatment angiograms ; patients were followed up for 2 to 48 months, and theircondition was assessed as cured, improved, not changed, or aggravated. RESULTS: Nine patients were found to beCognard type I, two were IIa, four were IIa+b, and eight were type III. Of our 23 patients, 12 were cured, tenimproved, and one was aggravated ; of the 13 who underwent transarterial embolization, four were cured, eightimproved, and one was aggravated ; of the six who underwent transvenous embolization, five were cured and oneimproved. The condition of a patient with a lesion in the torcular herophili was aggravated despite surgery andgamma irradiation after embolization. CONCLUSION: DAVF can be managed successfully with endovascular treatment.The outcome of the transvenous approach appears to be better than that of the transarterial approach alone. In acase involving a lesion in the torcular herophili, the outcome was poor and more aggressive treatment wasrequired.

Imaging Spectrum of Primary Antiphospholipid Antibody Syndrome

Antiphospholipid antibody syndrome is recognized as one of the most important causes of hypercoagulability. Itcan be clinically diagnosed if patients have experienced unexplained recurrent venous or arterial thrombosis,recurrent fetal loss, or thrombocytopenia in the presence of circulating autoantibodies to phospholipids, such asanticardiolipin antibody or lupus anticoagulant. Approximately half of all patients with this syndrome do not haveassociated systemic disease, and their condition is described as primary antiphospholipid antibody syndrome(PAPS). In the remainder, the syndrome is accompanied by systemic lupus erythematosus or other connective tissuediseases, and is known as secondary antiphospholipid syndrome (1). The purpose of this paper is to illustrate thesystemic manifestations of PAPS, focusing on the radiological findings of CT, MR and angiography in clinicallyproven patients.

Experimental Model of Arteriovenous Fistula in Pigs

PURPOSE: To establish an experimental model of arteriovenous fistula in pigs. MATERIALS AND METHODS: Ten fistulas were created in eight pigs, and angiography was performed 3 to 5 days after surgery. A follow-up angiogram of three fistulas was obtained 2 to 12 weeks later. In one animal, pathologic examination showed occlusion 8 weeks after a successful operation. RESULTS: Eight angiograms of nine fistulas in seven pigs were obtained; one animal died due to cardiac failure. In six pigs, high-flow fistulas were shown to be present, and in two, the fistulas were slow flow; a pseudoaneurysm was seen in one. A follow-up angiogram obtained in three cases showed occlusion of the fistula. Pathologic examination of one animal showed fibrosis in the occluded portion of the fistula. CONCLUSION: An arteriovenous fistula model was surgically established in 80% of cases; during follow-up, three fistulas were seen to be occluded due to fibrosis. This model can therefore be used within one week of surgery.

Esophageal Achalasia: Results of Balloon Dilation

PURPOSE: To evaluate the clinical effectiveness of fluoroscopically guided balloon dilation in the treatment of esophageal achalasia. MATERIALS AND METHODS: Under fluoroscopic guidance, 21 balloon dilation procedures were performed in 14 patients with achalasia. A balloon with a diameter of 20mm was used for the initial attempt. Ifthe patient tolerated this well, the procedure was repeated with a 10-20 mm balloon, placed alongside at the same session. If, however, the patient complained of severe chest pain and/or a postprocedural esophagogram showed an improvement, the additional balloon was not used. For patients whose results were unsatisfactory, the dilation procedure was repeated at sessions three to seven days apart. RESULTS: Succesful dilation was achieved in 13 of 14patients(92.9%), who needed a total of 20 sessions of balloon dilation, ranging from one to three sessions perpatient(mean, 1.54 sessions). Esophageal rupture occured in one of 14 patients(7.1%) ; of the 13 patients who underwent a successful dilation procedure, 12(92.3%) were free of recurrent symptoms during the follow-up periodof 1-56(mean, 18.5) months. The remaning patient(7.7%) had a recurrence seven months after dilation. CONCLUSION: Fluoroscopically guided balloon dilation seems to be safe and effective in the treatment of esophageal achalasia.