ABSTRACT
PURPOSE: To retrospectively analyze the results and complications of the endovascular treatment of 18 renal aneurysms. METHODS: From 2002 to 2011, 15 patients (aged 31-76), with 18 renal aneurysms, were admitted in our institution for treatment by embolization. Except one, all were wide-necked aneurysms. One aneurysm was treated by occluding the parent artery considering its distal location; a small-necked aneurysm was treated by simple coiling, and the remaining 16 were embolized utilizing adjunctive techniques to protect the parent artery. We analyzed the rates of technical success, complication and clinical consequence, post-operative occlusion and recurrence. RESULTS: There was a 100% technical success rate. 15 aneurysms showed a total occlusion on the post-treatment angiogram. 2 aneurysms demonstrated neck remnants, and one had an intrasaccular residual in-flow. Two minor post-operative complications were encountered but resolved over time. No delayed clinical complications were observed and the long-term angiographic follow-up demonstrated stability of the occlusion of the target renal aneurysm with no major recurrence. CONCLUSION: Complications of the embolization of renal aneurysms are rare. Endovascular treatment should therefore be considered at first for the treatment of renal aneurysms.
Subject(s)
Aneurysm/diagnostic imaging , Aneurysm/therapy , Embolization, Therapeutic/methods , Renal Artery/diagnostic imaging , Adult , Aged , Humans , Middle Aged , Radiography , Treatment OutcomeABSTRACT
The indications for treating carotid artery stenosis are related to the symptomatic nature of the lesion and the degree of stenosis. Duplex sonography is adequate for screening. While some groups believe that Duplex US alone or in combination with transcranial Doppler imaging may be sufficient for presurgical evaluation, it often is recommended to complete the evaluation with either MRA or CTA. Both techniques are advantageous since they allow evaluation of the cervical and intracranial arteries as well as cerebral parenchyma hence providing valuable information prior to definitive management. Catheter angiography remains indicated in patients with multi-vessel disease and ischemic cardiomyopathy, when results at non-invasive evaluation are discordant or in an emergency setting. Duplex US is used for routine follow-up of non-surgical lesions and after endarterectomy. Transcranial Doppler as well as advances in MRA and CTA techniques will be reviewed. Even though the treatment of atherosclerotic carotid artery stenoses remains primarily surgical, specific considerations related to angioplasty will be reviewed. Finally, diseases of the intracranial carotid artery and non-atherosclerotic diseases (dissection...) will also be discussed.
Subject(s)
Carotid Artery Diseases/diagnosis , Diagnostic Imaging , Angiography , Humans , Intracranial Arterial Diseases/diagnosis , Magnetic Resonance Angiography , Tomography, X-Ray Computed , Ultrasonography, Doppler, Duplex , Ultrasonography, Doppler, TranscranialABSTRACT
The diagnosis of vascularitis should be proposed when a concentric and regular thickening of the wall of the aorta or one of its branches is observed or when there is late enhancement of the arterial wall, on sites which are usually free from atheromatous lesions and in a young patient. The radiologist must be aware of the associated clinical signs: oral and genital ulcerative lesions in the Behçet syndrome; finger necrosis in a young male smoker in Buerger disease; hip and shoulder arthropathy and headache in a 70 Year old female and Horton disease; pulseless upper limbs and inflammatory syndrome in a young adult for the Takayasu arteritis. The diagnosis of popliteal entrapment or adventitial cyst should be proposed in young patients without atheromatous lesions.
Subject(s)
Diagnostic Imaging , Vascular Diseases/diagnosis , Adult , Age Factors , Aged , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Peripheral Vascular Diseases/diagnosis , Sex Factors , Tomography, X-Ray Computed , Ultrasonography, Doppler , Vasculitis/diagnosisABSTRACT
The present case illustrates the value of multidetector CT scan and cardiac MRI for the diagnosis of a hydatid cyst of the interventricular septum of the heart. These new modalities can help both for surgery planning and follow-up.
Subject(s)
Cardiomyopathies/diagnosis , Echinococcosis/diagnosis , Heart Septum , Magnetic Resonance Imaging, Cine/methods , Tomography, X-Ray Computed/methods , Adult , Aftercare , Cardiomyopathies/epidemiology , Cardiomyopathies/surgery , Diagnosis, Differential , Echinococcosis/epidemiology , Echinococcosis/surgery , Humans , Male , Preoperative CareABSTRACT
Follow-up color duplex sonography after arterial surgery or angioplasty for lower limb arterial disease evaluates the outcome of the procedure and searches for lesions compromising patency. The various types of lesions are described. After surgical bypass, lesions include stenosis, anastomotic abnormality (enlargement, false-aneurysm), arterio-venous fistula, intrinsic bypass abnormalities, and collections. After endoluminal treatment, the main lesions include residual stenosis, restenosis, and in-stent hyperplasia. Local complications related to arterial puncture are described. The frequency and the type of lesions encountered depend on the interval between the date of the revascularization and the follow-up examination.
Subject(s)
Aftercare/methods , Angioplasty/methods , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/surgery , Leg/blood supply , Ultrasonography, Doppler, Duplex/methods , Endarterectomy/methods , Equipment Failure , Humans , Recurrence , Stents/adverse effects , Time Factors , Treatment Outcome , Vascular PatencyABSTRACT
Subintimal angioplasty consists in entering the subintimal space proximal to the occlusion, traversing the occlusion creating by angioplasty a subintimal channel exiting downstream in the natural lumen. Major complications rarely occur but compromising important collaterals or run-off vessels may be very deleterious. Subintimal angioplasty is indicated in patients with critical limb ischemia, unfit for anesthesia or in the absence of a suitable venous conduit. This technique is mainly effective in long and tibioperoneal occlusions, a location in which transluminal angioplasty usually fails. Further studies are required to determine the modalities of associated anti-thrombotic treatment and if subintimal angioplasty can be used as primary treatment in critical leg ischemia.
Subject(s)
Angioplasty/methods , Leg/blood supply , Peripheral Vascular Diseases/surgery , Angioplasty/adverse effects , Humans , Prognosis , Tunica Intima/surgeryABSTRACT
The duodenum is the second most common site, after the colon, for intestinal diverticulae. This condition is most often asymptomatic and is usually an accidental finding. Complications, with variable clinical presentations, may occur in up to 5% of such individuals. We report a retrospective analysis of 5 patients who presented with complicated duodenal diverticular disease. The complications, either isolated or multiple, consisted of bezoar formation (n = 2), diverticulitis (n = 2), extrinsic compression of the common bile duct (n = 3), perforation (n = 1), choledocholithiasis (n = 1), and an abnormality of the bilio-pancreatic ductal convergence (n = 1). The radiological aspects, in particular, the magnetic resonance imaging (MRI) features are reviewed. These are, to our knowledge, the first descriptions of MRI and magnetic resonance cholangiopancreatographic (MRCP) findings in complicated duodenal diverticular disease. MRI facilitates precise delineation of the complicated duodenal diverticulum while MRCP allows assessment of the effects on the biliary and pancreatic ducts.
