Missile embolism--pulmonary vein to systemic bullet embolism: a case report and review of the literature.

Missile embolism occurs very rarely. It was first reported by Thomas Davis in 1834, and only 153 cases had been reported up to 1988. Rich et al. reported a 0.3% incidence in 7 500 cases of vascular injury in the Vietnam conflict. To our knowledge, this is the first reported case of pulmonary vein entry and internal carotid artery embolisation.

Direct percutaneous intratumoral bleomycin injection for palliative treatment of impending quadriplegia.

We describe a case of midcervical angiosarcoma causing compression of the cervical spinal cord, producing rapidly progressive neurologic deficits. The tumor had recurred despite previous resection and was refractory to radiation and chemotherapy. Shrinkage of the tumor by percutaneous embolization was not considered feasible. A single direct percutaneous intratumoral injection of 15 U of bleomycin produced sufficient tumor shrinkage to relieve the pressure on the spinal cord and thereby reverse some of the neurologic deficits and give adequate palliation against recurrence of this problem for the remainder of the patient's life. Direct percutaneous intratumoral injection of bleomycin may thus be considered for palliation when other treatment methods have failed to elicit a suitable clinical response.

Percutaneous management of concomitant post-traumatic high vertebrovertebral and caroticojugular fistulas using balloons, coils, and a covered stent.

PURPOSE: To describe the endovascular management of vertebrovertebral and caroticojugular fistulas in the same patient using a combination of endovascular techniques including covered stent placement in the high extracranial internal carotid artery. CASE REPORT: A 22-year-old man presented with ipsilateral vertebrovertebral and caroticojugular fistulas at the C1 level several weeks after sustaining a solitary penetrating knife injury below the right ear. The right vertebral artery was sacrificed after a failed endovascular attempt to close the vertebrovertebral fistula. The caroticojugular fistula was treated with a self-expanding covered stent (Wallgraft) with exclusion of the fistula and preservation of flow through the carotid artery. CONCLUSIONS: Preservation of the extracranial arteries should be the preferred goal of treatment in traumatic extracranial arteriovenous fistulas. The use of covered stents in the extracranial vessels can accomplish this goal.

Circumferential flow reduction during percutaneous embolotherapy of extracranial vascular malformations: the "cookie-cutter" technique.

We describe a simple, inexpensive, and very effective method of achieving circumferential flow reduction during direct percutaneous cyanoacrylate embolization of a high-flow vascular malformation of the scalp. By using a plastic "cookie cutter" placed over the lesion and applying various degrees of pressure, both venous outflow from and arterial inflow into the lesion were limited. This flow reduction technique improved both the efficacy and safety of the procedure.