Frozen Shoulder.

Adhesive capsulitis (AC) develops spontaneously without a known cause and is a common cause of painful shoulder. The natural history of AC can last until 36 months and it is classically considered a self-limiting entity, however there is a high rate of refractory cases to conventional treatment with residual deficits during years. There is no consensus on the therapeutic guidelines to be followed in patients with AC. Several authors have pointed out the relevance of hypervascularization of the capsule in the pathophysiology of AC, that is why the objective of transarterial embolization (TAE) is to decrease the abnormal vascularization responsible for the inflammatory-fibrotic state that occurs in AC. TAE has now emerged as a therapeutic option in refractory patients. We describe the most important technical aspects of TAE and review the current literature on arterial embolization as a treatment for AC.

Different clinical presentations of dural arteriovenous fistulae of the hypoglossal canal: Report on three cases and discussion of the treatment approach / Diferentes presentaciones clínicas de fístulas arteriovenosas durales del canal del hipogloso: reporte de tres casos y discusión de su abordaje terapéutico

We report three cases of dural arteriovenous fistulae of the hypoglossal canal (HCDAVF) with different clinical and angiographic presentations and their treatment approach (AU)

Reportamos tres casos de fístulas arteriovenosas durales del canal hipogloso con diferentes presentaciones clínicas y angiográficas, así como sus abordajes terapéuticos (AU)

Clinical Outcomes of Transcatheter Arterial Embolization for Secondary Stiff Shoulder.

PURPOSE: To assess the clinical outcomes of transcatheter arterial embolization (TAE) for secondary stiff shoulder (SSS). MATERIALS AND METHODS: This is a retrospective analysis of prospectively collected data performed between January 2017 and December 2019. This study comprised 25 patients (20 women and 5 men; median age, 49 years; range 27-59) with SSS resistant to conservative management during at least 3 months. The median time of stiffness was 12 months. The etiology of SSS was postoperative in 14 patients (56%) and posttraumatic in the remaining 11 patients (44%). Periods of immobilization in all patients were associated. TAE was performed, and technical aspects, adverse events, changes for pain, and physical examination before and 6 months after TAE were assessed. RESULTS: Abnormal vessels were observed in 20 of 25 (80%) of the procedures. Transitory cutaneous erythema was noted in 4 patients treated after TAE. Significant differences were observed in the median pain visual analog scale reduction between before and 6 months after TAE (8 vs 2, P < .001). Shoulder mobility significantly improved in both flexion and abduction degrees between before and at 6 months after TAE in (70° vs 150°; P < .001). No symptoms of recurrence appeared. CONCLUSIONS: TAE can result in pain reduction and mobility improvement in patients with SSS refractory to conservative therapy.

Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment.

PURPOSE: To evaluate the mid-term clinical outcomes of transcatheter arterial embolization (TAE) for adhesive capsulitis (AC) resistant to medical treatments. MATERIALS AND METHODS: This is a prospective analysis performed between February 2016 and February 2020. Inclusion criteria for TAE were shoulder pain, restriction of movement and no response to conservative treatment for at least 3 months. Demographic variables, risk factors, technical aspects, adverse events, changes by visual analogue scale (VAS) for pain and physical examination before and after TAE were assessed. RESULTS: This study included 40 patients with AC (35 women and 5 men; mean age 50 ± 9 years old). Abnormal vessels were observed in 31/40 (77.5%) procedures. As embolic agent, imipenem/cilastatin was used. The mean follow-up was 21.2 ± 10.5 months. Significant differences were obtained in terms of pain reduction before and 6 months after TAE with the median visual analogue scale (VAS) of 8 vs. 0.5, P = 0.0001. Substantial differences were found regarding mobility in flexion and abduction before and 6 months after embolization, respectively (79.5° ± 18.5° vs. 133° ± 24.5°, P = 0.0001; 72.4° ± 18.8° vs. 129.7° ± 27.9°, P = 0.0001). No complications occurred. Complete recovery was obtained in 37/40 (92.5%) patients and partial recovery in 2/40 (5%). No clinical recurrence appeared. CONCLUSIONS: Clinical results of transcatheter arterial embolization with imipenem/cilastatin are effective and stable in the mid-term follow-up for patients presenting with AC resistant to conservative treatments.

Different clinical presentations of dural arteriovenous fistulae of the hypoglossal canal: Report on three cases and discussion of the treatment approach.

We report three cases of dural arteriovenous fistulae of the hypoglossal canal (HCDAVF) with different clinical and angiographic presentations and their treatment approach.

Tratamiento endovascular de la estenosis de los senos venosos intracraneales en la hipertensión intracraneal: descripción de tres casos y discusión de la bibliografía / Endovascular treatment of intracranial venous sinus stenosis in intracranial hypertension: three case reports and a discussion of the literature

INTRODUCCIÓN: La hipertensión intracraneal idiopática es una entidad con una incidencia anual aproximada de 1,2 por cada 100.000 habitantes. Afecta en mayor proporción a mujeres obesas y en edad fértil. La cefalea es el síntoma más característico, seguido de las alteraciones visuales. En los últimos años, se ha incrementado el diagnóstico de la estenosis de los senos durales en los casos de hipertensión intracraneal resistentes al tratamiento convencional. Por ello, se encuentra en auge el desarrollo de la terapia endovascular como opción terapéutica en pacientes seleccionados. Casos clínicos. Se presentan tres casos de hipertensión intracraneal secundaria a estenosis de los senos durales, diagnosticados y tratados en nuestro hospital. A pesar de la instauración del adecuado tratamiento diurético y de la realización de procedimientos invasivos de derivación del líquido cefalorraquídeo, persistían la clínica neurológica y el déficit visual. Tras comprobar que cumplían los requisitos descritos en la bibliografía, se sometieron a la implantación de stent intracraneal (stenting), con resultado satisfactorio en todos ellos, logrando la desaparición de la cefalea y la recuperación de la agudeza visual. CONCLUSIÓN: El stenting de la estenosis de los senos durales como causa de hipertensión intracraneal es una técnica cada vez más utilizada que ha presentado resultados favorables. Es necesaria la realización de estudios para conocer su impacto a largo plazo

INTRODUCTION: Idiopathic intracranial hypertension is an entity with an incidence of approximately 1.2: 100,000 inhabitants/year. It affects in a greater proportion obese women and women of childbearing age. Headache is the most characteristic symptom, followed by visual disturbances. In recent years, the diagnosis of dural sinus stenosis has increased in cases of intracranial hypertension resistant to conventional treatment. For this reason, the development of endovascular therapy as a therapeutic option in selected patients is booming. Case reports. We present three cases of intracranial hypertension secondary to dural sinus stenosis, diagnosed and treated in our hospital. Despite the establishment of adequate diuretic treatment and the performance of invasive procedures to bypass the cerebrospinal fluid, they persisted with neurological symptoms and visual deficits. After verifying that they fulfilled the requirements described in the literature, they underwent intracranial stenting, with satisfactory results in all of them, achieving the disappearance of the headache and recovery of visual acuity. CONCLUSION: Stenting of dural sinus stenosis as a cause of intracranial hypertension is an increasingly used technique, which has presented favorable results. Studies are necessary to know its long-term impact

Embolización parcial del bazo en el síndrome de Felty: intervencionismo para un síndrome clínico / Partial splenic embolization in felty´s syndrome: interventionism in a clinic syndrome

El síndrome de Felty comprende la asociación de artritis reumatoidea crónica, neutropenia y esplenomegalia. Esta última, cuando se asocia a hiperesplenismo, se caracteriza por el desarrollo de trombocitopenia, leucopenia, anemia o de todas. La embolización parcial endovascular del bazo puede ser una opción válida para el tratamiento del hiperesplenismo, pero no está exenta de riesgos. Presentamos el caso de un paciente joven, con artritis reumatoidea, síndrome de Felty e hiperesplenismo, a quien se realizó embolización parcial endovascular del bazo.

Felty's syndrome is a rare association of rheumatoid arthritis, neutropeniaand splenomegaly. When associated with hypersplenism ischaracterized by increased pooling or destruction of the corpuscularelements of the blood by the spleen and thrombocytopenia, leukopenia,or anemia may be present.Partial splenic embolization has shown to be effective. However, theprocedure may increase the risk of complications.We described a case of a young patient with Felty's syndrome, rheumatoidarthritis and hypersplenism who underwent partial splenicendovascular embolization.

[Hemodynamic depression in carotid artery stent without angioplasty]. / Incidencia de la depresion hemodinamica en el implante de endoprotesis en la arteria carotida sin dilatacion.

INTRODUCTION: Hemodynamic depression is a frequent complication related to carotid artery stenting with angioplasty. The aim of this study was to assess our results regarding hemodynamic depression, in patients who underwent carotid artery stenting without angioplasty. PATIENTS AND METHODS: Between October 2002 and April 2010, 261 carotid stenosis (in 242 patients) were treated with the use of self-expanding stents without angioplasty. Inclusion criteria were symptomatic carotid stenosis > 50%, asymptomatic carotid stenosis > 70%, and stenosis ranging between 50-70% with evidence of high risk plaque morphology or micro-embolism. Outcomes during hospitalization and 30 days after procedure were registered. Hemodynamic depression was defined as hypotension (systolic blood pressure < 90 mm Hg) or bradycardia (heart rate < 60 beats/min). RESULTS: During the procedure 7 (2.9%) patients presented bradycardia and 3 (1.2%) hypotension. No patient required vasopressor drugs or ICU for hemodynamic monitoring. No patient developed asystole or other types of arrhythmia. During hospitalization, hemodynamic depression was not observed in any patients. During the first 30 days post-procedure, there were 11 TIAs (4.5%), 1 disabling stroke (0.4%), 1 non disabling stroke (0.4%), and 1 death (0.4%) (1 stent thrombosis at 11 days). CONCLUSION: The incidence of hemodynamic depression is low when carotid stenting procedure is performed without balloon angioplasty. The incidence of neurological complications post procedure was also low. This report highlights the need for performing randomized trials comparing both techniques.

Incidencia de la depresión hemodinámica en el implante de endoprótesis en la arteria carótida sin dilatación / Hemodynamic depression in carotid artery stent without angioplasty

Introducción. La depresión hemodinámica es una complicación frecuente tras el implante de una endoprótesis carotídea con angioplastia. El objetivo del estudio es evaluar la incidencia de depresión hemodinámica en pacientes sometidos al implante de endoprótesis carotídea sin angioplastia. Pacientes y métodos. Entre octubre de 2002 y abril de 2010, se trataron 261 estenosis carotídeas (242 pacientes) con endoprótesis autoexpandibles sin angioplastia. Los criterios de inclusión fueron estenosis carotídea sintomática > 50%, estenosis carotídea asintomática > 70%, estenosis entre el 50-70% y evidencia de alto riesgo de microembolismo por la morfología de la placa de ateroma. Se evaluó a los pacientes al ingreso y 30 días después del procedimiento. La depresión hemodinámica se definió como hipotensión (presión arterial sistólica < 90 mmHg) o bradicardia (pulso < 60 lpm). Resultados. Durante el procedimiento, siete pacientes (2,9%) presentaron bradicardia y tres (1,2%), hipotensión. Ninguno de ellos necesitó medicación o monitorización. No se observó asistolia u otro tipo de arritmia en ningún paciente. Durante la hospitalización, no se observó depresión hemodinámica en ningún paciente. En los 30 primeros días después del procedimiento se produjeron 11 ataques isquémicos transitorios (4,5%), un ictus incapacitante (0,4%), un ictus no incapacitante (0,4%) y un fallecimiento (0,4%) (por trombosis de la endoprótesis a los 11 días). Conclusiones. La incidencia de depresión hemodinámica y de complicaciones neurológicas es baja en pacientes sometidos a implante de endoprótesis en la arteria carótida sin angioplastia con balón. Este estudio subraya la necesidad de realizar ensayos aleatorios que comparen ambas técnicas con y sin angioplastia(AU)

Introduction. Hemodynamic depression is a frequent complication related to carotid artery stenting with angioplasty. The aim of this study was to assess our results regarding hemodynamic depression, in patients who underwent carotid artery stenting without angioplasty. Patients and methods. Between October 2002 and April 2010, 261 carotid stenosis (in 242 patients) were treated with the use of self-expanding stents without angioplasty. Inclusion criteria were symptomatic carotid stenosis > 50%, asymptomatic carotid stenosis > 70%, and stenosis ranging between 50-70% with evidence of high risk plaque morphology or microembolism. Outcomes during hospitalization and 30 days after procedure were registered. Hemodynamic depression was defined as hypotension (systolic blood pressure < 90 mm Hg) or bradycardia (heart rate < 60 beats/min). Results. During the procedure 7 (2.9%) patients presented bradycardia and 3 (1.2%) hypotension. No patient required vasopressor drugs or ICU for hemodynamic monitoring. No patient developed asystole or other types of arrhythmia. During hospitalization, hemodynamic depression was not observed in any patients. During the first 30 days post-procedure, there were 11 TIAs (4.5%), 1 disabling stroke (0.4%), 1 non disabling stroke (0.4%), and 1 death (0.4%) (1 stent thrombosis at 11 days). Conclusion. The incidence of hemodynamic depression is low when carotid stenting procedure is performed without balloon angioplasty. The incidence of neurological complications post procedure was also low. This report highlights the need for performing randomized trials comparing both techniques(AU)

Bifurcated endograft in aortoiliac type C and D lesions: long-term results.

PURPOSE: To report long-term outcome when using a bifurcated aortic endograft for treatment of aortoiliac occlusive disease (AIOD) in Trans Atlantic Inter Society Consensus (TASC) classification C and D patients. MATERIALS AND METHODS: Between May 2001 and May 2009, 14 patients (11 men, 3 women) with aortoiliac TASC C and D type lesions and a mean age of 59 years ± 10 (range 41-73 years) were treated using a bifurcated aortic endograft. Although these patients were young, all were considered at high surgical risk. Patients were followed up clinically and by computed tomography (CT) every 3 months for 1 year and yearly thereafter. RESULTS: Endoprosthesis placement was performed in all patients with a technical success rate of 100%. There were no amputations or deaths at 30 days after the procedure. The mean follow-up was 62 months (range 11-96 months). One patient was lost during follow-up at 11 months, and another patient died of a nonrelated cause after 49 months. A single limb occlusion of the prosthesis was seen in two patients at 2 months and 7 months; both were successfully treated by intraarterial fibrinolysis. At a mean follow-up of 62 months, primary patency was 85.7%, and secondary patency was 100%. CONCLUSIONS: This series shows promising long-term results following the use of a bifurcated aortic endograft for treatment of AIOD TASC C and D type lesions. Bifurcated aortic endograft is a good minimally invasive alternative to open surgery in high surgical risk patients.

Endovascular treatment of the nutcracker syndrome: report of two cases.

The nutcracker syndrome (NS) is a rare condition characterized by the entrapment of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta. Clinically, it presents with flank pain, hematuria, and symptoms of pelvic venous congestion. Several surgical techniques have been described including left renal vein (LRV) transposition, autotransplantation, LRV bypass, superior mesenteric artery (SMA) transposition, gonadocaval bypass and nephrectomy. More recently, endovascular stenting of the renal vein has been proposed. We present two patients with NS who were successfully managed endovascularly, providing satisfactory mid-term clinical and imaging results.

Stent-assisted coil embolization of a mycotic renal artery aneurysm by use of a self-expanding neurointerventional stent.

Mycotic aneurysms are uncommon, especially those located in visceral arteries. We present a case of a patient with two visceral mycotic aneurysms due to bacterial endocarditis, one located in right upper pole renal artery and the second in the splenic artery. Both aneurysms were treated as endovascular embolization using microcoils. In the aneurysm located at the renal artery, the technique of stent-assisted coils embolization was preferred to avoid coils migration due to its wide neck. The stent used was the Solitaire AB, which was designed for the treatment of intracranial aneurysms and was used recently in acute stroke as a mechanical thrombectomy device. Complete embolization of the aneurysm was achieved, preserving all the arterial branches without nephrogram defects in the final angiogram.

Successful occlusion of a ruptured aortic aneurysm using the Amplatzer Vascular Plug: a technical note.

Ruptured abdominal aortic aneurysm is related with a 100% mortality rate if left untreated. Even with surgical intervention or endovascular repair, mortality is still extremely high. However, there are conditions in which neither open surgical aneurysm repair nor endovascular aneurysm repair can be considered a viable therapeutic option because of comorbidities or anatomic reasons. We report a case of successful endovascular treatment in a patient with ruptured abdominal aortic aneurysm by occluding the abdominal aneurysm using the Amplatzer Vascular Plug (AVP II).

Is endovascular revascularisation worthwhile in diabetic patients with critical limb ischemia who also have end-stage renal disease?

To present the outcomes of endovascular treatment of diabetics patients with critical limb ischemia who have end-stage renal disease. Limb-salvage was achieved in 58.6% of the limbs during a mean follow-up period of 12.4 months. No major amputations were required on patients with rest pain or with grade 1 lesions.

Non-protected carotid artery stent without angioplasty in high-risk patients with carotid and coronary artery disease undergoing cardiac surgery.

Hemodynamic depression (HD) is a frequent complication related to carotid endartherectomy or carotid artery stenting (CAS), often not well tolerated in patients with coronary artery disease. The purpose of this study is to assess whether CAS without angioplasty is beneficial in patients with severe carotid artery disease before coronary revascularization surgery (CABG) regarding the occurrence of HD. Between October 2002 and August 2006, 39 CAS were performed in 35 patients before cardiac surgery. Outcome measures, including periprocedural and 30-day post stenting and cardiac surgery complications, were assessed. Twenty-seven patients underwent CABG and eight combined CABG and valve replacement. During or immediately after CAS there was no episode of bradycardia or hypotension necessitating medical treatment. In the period between CAS-CABG, there was no case of HD. We also found no myocardial infarction. There were five neurological complications, two of them in the period between CAS-CABG (one transitory ischemic attack (TIA) and one minor stroke) and three after CABG (one TIA and two strokes). Three of them were discharged symptom-free. CAS without angioplasty can be a safe alternative to treat patients with coexistence of carotid and cardiac disease, since does not produce hemodynamic depression, therefore diminishing the cardiac complications.

Infrainguinal revascularization using the Crosser vibrational system.

Revascularization of infrainguinal vessels is still a challenge. Complications such as flow-limiting dissections or perforation are responsible for a limited success rate. Failed revascularization attempt leads to amputation in a significant number of patients and increases mortality. We report the use of a novel percutaneous device using the CROSSER catheter system in two patients with peripheral vascular disease. In case # 1 anterior tibial artery patency was restored in a diabetic foot and in case # 2 a chronic traumatic occlusion of the superficial femoral artery was revascularized. In both cases the lesion was recanalized in a short time without any procedure-related complications. The CROSSER catheter system can overcome technical problems and make reentry devices and retrograde distal accesses less relevant. It opens new horizons for the treatment of complex below-the-knee lesions.

Endovascular management of a spontaneous dissecting aneurysm of the superior mesenteric artery: case report and discussion of treatment options.

Spontaneous dissection of the superior mesenteric artery represents a rare cause of abdominal angina. Conservative or more aggressive treatments such as surgery or endovascular therapy depend on the symptoms. We present a case report of acute mesenteric ischemia due to spontaneous dissection of the superior mesenteric artery successfully treated by endovascular stent placement. In the discussion we review the different alternatives of treatment presented in the literature.

Bifurcated endograft (Excluder) in the treatment of isolated iliac artery aneurysm: preliminary report.

The aim of this study was to evaluate the effectiveness of endovascular repair in the treatment of isolated iliac artery aneurysm (IAA) using Excluder bifurcated endograft. Eight consecutive patients with IAA were treated during a period of 45 months using Excluder bifurcated endograft. Two patients presented with isolated IAA rupture and were treated emergently, whereas the other six patients underwent elective treatment. All aneurysms lacked sufficient proximal necks and therefore were not suitable for tubular-shaped endograft. Follow-up imaging was performed at 1 week, at every 3 months during the first year, semiannually until 2 years, and annually afterward using angio-computed axial tomography and plain films. Technical success was achieved in all patients. No mortality was seen despite two patients having IAA rupture. Follow-up (12 to 60 months) was done in all but one patient. During this period, complications were observed in three patients. One patient developed sexual impotence at 3-month follow up; one patient presented unilateral gluteal claudication after the procedure, which resolved at 3 months; and one patient developed a graft porosity-related endoleak, which was successfully managed with placement of an additional ipsilateral iliac extension. Endovascular treatment of isolated IAA using bifurcated endograft is safe and can be an alternative to surgical treatment. The benefits from decreased morbidity and mortality of endoluminal treatment of isolated IAA using bifurcated endograft outweigh the minor complications associated with this technique, which are mostly related to occlusion of hypogastric arteries.

Clinical follow-up in endovascular treatment for TASC C-D lesions in femoro-popliteal segment.

OBJECTIVE: To demonstrate the technical success and clinical follow-up after endovascular treatment of femoropopliteal segment TASC II C and D lesions. METHODS: From July 2002 to February 2007, 234 limbs in 190 patients with femoropopliteal segment TASC II C (n = 112) and D (n = 122) lesions were treated. Endovascular treatment consisted of PTA, fibrinolysis and PTA, subintimal recanalization and PTA, and finally stent graft. Patients were clinically evaluated at 30 days, 3, 6 month, and at 1 year in the outpatient setting with clinical examination and ankle-brachial indices (ABI). In the case of stent placement, additional ultrasound evaluation was performed at 12, 24, and 48 month. RESULTS: 49.5% of procedures were performed on patients with lifestyle-limiting claudication (IC) and 50.5% were performed for critical limb ischemia (CLI). Technical success, defined as successful recanalization and treatment of the occluded vessel, was achieved in 97% of cases. Periprocedural mortality was 3.15% and all deaths occurred in the CLI group. A follow-up 13 +/- 6 months and was achieved in 76%. During the follow-up, clinical outcome for IC group and clinical CLI group was asymptomatic 72% vs. 29.8%, symptomatic with clinical improvement 22% vs. 33.7%, and major amputation 3% vs. 23.3%. CONCLUSION: The majority of claudicating patients with femoropopliteal TASC II C and D lesions will benefit from the endovascular treatment. Patient presenting CLI have a worse outcome, nevertheless the endovascular treatment can delay amputation, preserving the native vessel and does not impede surgical bypass if needed. For this reason, we consider that endovascular treatment may be the first choice treatment even in femoropopliteal TASC II C and D lesions.