ABSTRACT
BACKGROUND: Proximal splenic artery embolisation (PSAE) can be performed in stable patients with Association for the Surgery of Trauma (AAST) grade III-V splenic injury. PSAE reduces splenic perfusion but maintains viability of the spleen and pancreas via the collateral circulation. The hypothesized ideal location is between the dorsal pancreatic artery (DPA) and great pancreatic artery (GPA). This study compares the outcomes resulting from PSAE embolisation in different locations along the splenic artery. MATERIALS AND METHODS: Retrospective review was performed of PSAE for blunt splenic trauma (2015-2020). Embolisation locations were divided into: Type I, proximal to DPA; Type II, DPA-GPA; Type III, distal to GPA. Fifty-eight patients underwent 59 PSAE: Type I (7); Type II (27); Type III (25). Data was collected on technical and clinical success, post-embolisation pancreatitis and splenic perfusion. Statistical significance was assessed using a chi-squared test. RESULTS: Technical success was achieved in 100% of cases. Clinical success was 100% for Type I/II embolisation and 88% for Type III: one patient underwent reintervention and two had splenectomies for ongoing instability. Clinical success was significantly higher in Type II embolisation compared to Type III (p = 0.02). No episodes of pancreatitis occurred post-embolisation. Where post-procedural imaging was obtained, splenic perfusion remained 100% in Type I and II embolisation and 94% in Type III. Splenic perfusion was significantly higher in the theorized ideal Type II group compared to Type I and III combined (p = 0.01). CONCLUSION: The results support the proposed optimal embolisation location as being between the DPA and GPA.
ABSTRACT
The Nellix endovascular aneurysm sealing system is a novel alternative to conventional endovascular aneurysm repair for aortic aneurysm management using paired balloon-expandable endografts supported by polymer-filled endobags to achieve sealing and anatomic fixation. Part of the promise of endovascular aneurysm sealing is increased resistance to lateral and longitudinal forces and a potential for reduced rates of device-related failures, particularly endoleaks. Initial efficacy data on this device are encouraging, but our knowledge of its associated complications and their management is limited. Reported adverse events include Type I and II endoleaks, graft stenosis, and occlusion. The aim of this article was to review the early experience of endovascular aneurysm sealing, focusing on the incidence, significance, and management of device-related complications.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Embolization, Therapeutic , Endoleak/therapy , Endovascular Procedures/instrumentation , Foreign-Body Migration/therapy , Stents , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortography/methods , Blood Vessel Prosthesis Implantation/adverse effects , Computed Tomography Angiography , Endoleak/diagnostic imaging , Endoleak/etiology , Endovascular Procedures/adverse effects , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/etiology , Humans , Prosthesis Design , Prosthesis Failure , Retreatment , Risk Factors , Treatment OutcomeABSTRACT
Selective transarterial catheterisation and translumbar sac puncture are well established techniques for the management of significant type 2 endoleaks. We report an additional technique for endovascular access to the endoleak sac through the space between the iliac endograft and artery wall.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Embolization, Therapeutic/methods , Endoleak/diagnosis , Endoleak/therapy , Aged, 80 and over , Angiography , Blood Vessel Prosthesis , Humans , Iliac Artery , Male , Retreatment , Stents , Tomography, X-Ray Computed , Ultrasonography, Doppler, DuplexABSTRACT
AIM: To evaluate the technical success and mid-term outcomes following transcatheter embolisation of type 1a endoleak after Nellix endovascular aneurysm sealing (EVAS). MATERIALS AND METHODS: Seven patients (5 men; mean age 83; range 79-90) underwent transcatheter embolisation between July 2013 and August 2014. The average time from EVAS to embolisation was 136 days (range 6-301) and from endoleak diagnosis to embolisation was 20 days (range 2-50). Embolisation was performed with coils and Onyx in six cases and Onyx only in one case. Technical success, imaging and clinical outcomes of embolisation were reviewed. Technical success was defined as elimination of the endoleak on completion angiography and first imaging follow-up. Clinical success was defined as unchanged or decreased aneurysm sac size on subsequent follow-up (average 8 months; range 103-471 days). RESULTS: All cases were technically successful. One patient required a second endovascular procedure following Onyx reflux into the Nellix endograft and another patient required surgical closure of a brachial puncture site. All patients are endoleak free with stable sac size on the latest available follow-up imaging. CONCLUSION: If a type 1 endoleak occurs after EVAS, embolisation using Onyx with or without coils is feasible and effective with high technical success and freedom from endoleak recurrence at mid-term follow-up.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Embolization, Therapeutic/statistics & numerical data , Endoleak/therapy , Endovascular Procedures/instrumentation , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/complications , Dimethyl Sulfoxide/therapeutic use , Embolization, Therapeutic/methods , Endoleak/complications , Endovascular Procedures/methods , Female , Follow-Up Studies , Humans , Male , Polyvinyls/therapeutic use , Treatment OutcomeABSTRACT
We report the first case of intervention for a proximal type 1 endoleak following Nellix endovascular aneurysm sealing repair of an aortic aneurysm. This was complicated by migration of Onyx into one of the Nellix graft limbs causing significant stenosis. Subsequent placement of a covered stent to affix the Onyx between the stent and the wall of the Nellix endograft successfully restored stent patency.
Subject(s)
Aortic Aneurysm/surgery , Embolization, Therapeutic , Endoleak/therapy , Endovascular Procedures , Polyvinyls/therapeutic use , Postoperative Complications/therapy , Aged, 80 and over , Aortography , Endoleak/diagnostic imaging , Humans , Male , Postoperative Complications/diagnostic imaging , Stents , Tomography, X-Ray ComputedABSTRACT
Renal transplantation, first performed successfully in the 1950s, is the treatment of choice for most patients with end-stage renal failure. It confers longer term survival and a better quality of life than do both haemodialysis and peritoneal dialysis. The success of renal transplantation is dependent on the preservation of renal graft function and despite the many advances in surgical techniques, immunosuppressive regimens and supportive therapies, many challenges remain including post-operative ureteral obstruction. This complication can pose a risk to graft, and, occasionally, to patient survival. In this pictorial review, we describe the causes of ureteral obstruction following renal transplantation and illustrate the pivotal role of radiology in both diagnosing and managing these complications.
