Blunt injury of the infrarenal inferior vena cava - imaging and conservative management : trauma

Isolated rupture of the infrarenal segment of the inferior vena cava due to blunt trauma is relatively rare. It may be missed clinically and even diagnostic peritoneal lavage may prove negative. The mainstay of diagnosis remains a high degree of clinical suspicion together with sectional imaging. If the patient is haemodynamically stable after initial resuscitation and there is no other indication for exploratory surgery; these lesions can be managed conservatively with good outcome as shown in the case described in this report

Initial experience with intracranial stent-graft use. Technical notes.

SUMMARY: We describe our initial experience with the placement of two premounted balloon expandable intracranial Jostent stent-grafts within the intracavernous internal carotid artery for the treatment of a symptomatic large intracavernous aneurysm in one case and a post-traumatic caroticocavernous fistula in the second. Among the initial technical complications we encountered were stent-graft migration and rapidly progressive intragraft thrombosis, with delayed sealing of the stent-graft coverings and exclusion of the pathologies relating to the use of abciximab in both cases. Despite these initial problems both cases had excellent short-term clinical outcomes with angiographic exclusion of both lesions by day three and good clinical and angiographic outcomes at one and two months respectively.

Cerebral vasospasm and intracerebral haemorrhage in a case of pregnancy-related thrombotic thrombocytopoenic purpura/haemolytic uraemic syndrome.

SUMMARY: We report a case of a woman with pregnancyrelated thrombotic thrombocytopoenic purpura/haemolytic uraemic syndrome (TTP/HUS) who developed cerebral vasospasm similar to that seen in the other pregnancy-related thrombotic microangiopathic syndromes of eclampsia and HELLP syndrome. A further complication in this case was the development of a focal intracerebral haemorrhage necessitating surgical removal. Despite a successful evacuation of the haematoma and several plasma exchange treatments she developed recurrent haemolysis and thrombocytopoenia with an eventual fatal outcome due to severe pulmonary and gastrointestinal haemorrhage.

Endovascular treatment of intractable epistaxis--results of a 4-year local audit.

OBJECTIVE: Transcatheter embolisation is an accepted and effective treatment for intractable epistaxis. We analysed our success and complication rates and compared these with results from other published series. DESIGN: Retrospective review. SETTING: Unitas Interventional Unit, Centurion. METHODS: Case record review (57 procedures) and telephonic interviews (36 traceable respondents). OUTCOME MEASURES: A numerical audit of the success and complication rates for embolisation procedures performed during the 4-year period between July 1999 and June 2003. RESULTS: A total of 57 endovascular embolisation procedures were performed for intractable epistaxis in 51 patients during this period. Eight patients (15.7%) developed a re-bleed between 1 and 33 days after embolisation, of whom 5 were reembolised, giving a primary short-term success rate of 86.3% and secondary assisted success rate of 94.1%. Thirty-five of 36 respondents (97.2%) reported no further epistaxis during the long-term follow-up period of 1-47 months. The mortality rate was 0%, the major morbidity rate was 2% (1 stroke) and the minor morbidity rate was 25%. CONCLUSION: Our success and complication rates are acceptable and compare favourably with those reported in other large series.

Distal embolization and local vessel wall ulceration after gastric variceal obliteration with N-butyl-2-cyanoacrylate: a case report and review of the literature.

Repeated endoscopic injections of N-butyl-2-cyanoacrylate mixtures into large gastric varices in a single patient led to two complications: initially, pulmonary embolism, and later local ulceration of the wall of a varix. The latter resulted in massive uncontrollable hemorrhage that ultimately led to a fatal outcome. This case report also analyzes complications reported in the literature during similar endoscopic procedures for gastric varices.

Acute severe epistaxis due to iatrogenic maxillary pseudoaneurysm. Emergency control of haemorrhage by carotid compression and early recurrence after coil embolization.

SUMMARY: Internal maxillary arterial or branch transection is a potential complication of maxillofacial surgery. We describe one such patient who developed acute massive nasal haemorrhage, an episode of which was controlled clinically just prior to performing endovascular embolization by employing the simple but effective clinical manoeuvre of manual carotid arterial compression. Six weeks later the haemorrhage recurred despite a seemingly adequate embolization of the affected arteries with microcoils and Spongistan due to re-establishment of flow through the coils.

Immediate endovascular stent-graft repair of an acute traumatic rupture of the thoracic aorta : case report

We describe a case of emergency endovascular stentgraft placement for acute traumatic rupture of the thoracic aorta in a patient with an associated unstable type II odontoid fracture. The stent-graft placement procedure was performed within 4 hours of admission under sedation and local anaesthesia while the neck remained externally splinted. After exclusion of the rupture the patient could then undergo treatment of the associated cervical fracture and other injuries

Non-aneurysmal perimesencephalic subarachnoid haemorrhage with associated pontine haemorrhagic infarction. A case report and subject review.

SUMMARY: Non-aneurysmal perimesencephalic subarachnoid saemorrhage is characterized by an accumulation of blood in the perimesencephalic and prepontine cisterns identified on sectional imaging together with persistently negative cerebral angiography. Magnetic resonance imaging usually contributes no further information on the possible cause of the bleed but may occasionally show further features including associated parenchymal infarcts such as the pontine haemorrhagic infarct seen in the case described here.

Type D Traumatic Carotido-cavernous Fistula due to Selective Transection of the Inferolateral Trunk(ILT). Diagnosis and Endovascular Treatment.

SUMMARY: A minority of traumatic carotido-cavernous fistulas (CCF) are of the indirect variety, and then usually supplied only by meningeal branches of the ipsilateral external carotid artery (Type C).We describe a case of a Type D CCF due to traumatic injury of the inferolateral trunk (ILT), and describe its angiographic features and endovascular management through both the external and internal carotid arteries following a failed transvenous approach.

Accessory meningeal arterial supply to the posterior nasal cavity: another reason for failed endovascular treatment of epistaxis.

A patient with intractable posterior epistaxis was treated with embolization of the ipsilateral sphenopalatine and facial arteries and contralateral sphenopalatine artery. She continued to bleed despite a seemingly adequate embolization procedure. A second angiogram revealed a significant collateral blood supply to the posterior nasal cavity from the accessory meningeal artery not identified during the first procedure. This was then embolized with no further epistaxis encountered. This case demonstrates yet another collateral arterial pathway that might account for a failed embolization.

Catheter-Directed Intra-Arterial Abciximab Administration for Acute Thrombotic Occlusions during Neurointerventional Procedures.

SUMMARY: Abciximab is one of a new class of platelet aggregation inhibitors that has to date been used mainly in the management of acute coronary ischaemic syndromes or during cardiac intervention for the prevention and treatment of acute vessel occlusion during and after angioplasty or stent placement. More recently, it has begun to play a similar role in neurointerventional work. Its administration during acute stent or vessel occlusions has usually been via systemic intravenous infusion.We describe five cases of acute vessel occlusion during neurointerventional procedures where the abciximab bolus was administered intra-arterially at or close to the site of the occlusion, with rapid complete visual dissolution of the thrombus in four cases and partial dissolution in one, resulting in two patients with no neurological deficits, one with no further neurological deterioration, one with a mild residual thumb paresis and one with a severe neurological deficit.