Tine after tine: a varied approach to the removal of a long-standing IVC filter.

Inferior vena cava filters are important tools used to help prevent life-threatening pulmonary embolisms in hospitalized patients with contraindications to pharmacological prophylactic anticoagulation. This is a case report of a patient who had an inferior vena cava filter placed after a traumatic subdural hematoma. He made a complete recovery but was lost to follow-up until he presented 1825 days after filter deployment with abdominal pain discovered to be from penetration of the filter tines outside the lumen and into adjacent structures. We describe a case complicated by fibrotic tine entrapment with penetration to surrounding structures and discuss the technical approach used to free and eventually remove the long-standing filter.

Transarterial embolization of renal tumors improves surgical outcomes: A case series.

INTRODUCTION: Operative treatment of renal tumors can be associated with a high rate of perioperative morbidity related to hemorrhage and injury to adjacent anatomical structures. This morbidity of solid organ surgery is especially prevalent when the lesion involves chronic inflammation or a desmoplastic reaction from a rapidly growing tumor. No consensus on the use of transarterial embolization has been fashioned as the number of prospective studies is small. This study proposes to examine the beneficial effects of selective transarterial embolization of the kidney prior to surgical resection. PRESENTATION OF CASE: A retrospective case matched review was performed of consecutive nephroureterectomies evaluating outcomes of patients receiving transarterial embolization versus those patients who received no embolization. The records were obtained from University Medical Center of El Paso for the time period of 05/2011-12/2014. Data examined included patient demographics, operative blood loss, operative time, transfusion requirements, and pathology. Previous studies have shown that preoperative embolization of renal tumors resulted in a decreased need for blood transfusion. CONCLUSION: Our review showed transarterial embolization had a decrease in blood loss and required no transfusions. It also facilitated a larger and more advanced tumor resection. Our series of patients tolerated transarterial embolization well and had good surgical outcomes. Transarterial embolization of kidneys prior to radical nephroureterectomy results in a safe and uncomplicated operative course with less perioperative morbidity when compared to resection alone.

Hepatic "BOLSA" a novel method of perihepatic wrapping for hepatic hemorrhage "BOLSA".

INTRODUCTION: Severe traumatic liver hemorrhage quickly leads to exsanguination. Perihepatic packing is frequently used in damage control surgery. This method can be unsuccessful and accompanied by complications. Vicryl mesh wraps have been described in the treatment of liver hemorrhage. In this report, we describe an enhanced technique of hepatic wrapping in a case of hepatic bleeding after liver biopsy in a coagulopathic patient. The technique is called the hepatic "BOLSA" (Bag on Liver Supporting Anti-Hemorrhage). PRESENTATION OF CASE: A 59 year old male presented in the recovery room after liver biopsy of a mass, followed by angio-embolization of the hepatic mass 9h earlier. The patient was acidotic, coagulopathic, and demonstrated intra-abdominal hypertension. Computed tomography demonstrated perihepatic fluid. The patient continued hemorrhaging despite attempts to correct coagulopathy by transfusion. Multiple operating room visits were required where a combination of packing and hemostatic agents could not stop hepatic venous parenchymal hemorrhage. Mesh wrap consisting of Vicryl and PDS suture were used to create the "BOLSA" to achieve hemostasis. DISCUSSION: Perihepatic packing compromises pulmonary excursion, elevates intra-abdominal pressure, is a risk factor for sepsis, and requires an additional trip to the operating room for removal. The use of Vicryl mesh wrap obviates these complications. Previously described mesh wraps require anchoring. The self-supporting structure of the BOLSA simplifies construction and application. CONCLUSION: The BOLSA is an effective tool in treatment of severe liver hemorrhage in coagulopathic patients. It is the modern simplification of hepatic wrapping and the solution to the side effects of perihepatic packing.

Use of three-dimensional power Doppler sonography in the diagnosis of uterine arteriovenous malformation and follow-up after uterine artery embolization: Case report and brief review of literature.

Arteriovenous malformations (AVM) of the uterus can cause life-threatening hemorrhage. Unexplained, heavy vaginal bleeding in a reproductive age woman should raise suspicion for an AVM. Here a 37-year-old woman had increasingly severe vaginal bleeding for 15 days. Serum ß-hCG was elevated. Two-dimensional transvaginal ultrasound suggested retained products of conception. Before dilation and curettage (D&C), color Doppler and three-dimensional (3D) power Doppler demonstrated findings indicative of uterine AVM. A bilateral uterine artery embolization was performed without complications. Three months after uterine artery embolization, 3D power Doppler ultrasonography found complete resolution of the AVM. This case illustrates the importance of assessing both gray-scale and 3D power Doppler, and the ability of postprocedure Doppler to assess resolution.