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1.
Radiol Case Rep ; 12(4): 780-785, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29484070

ABSTRACT

We present the case of a 54-year-old male patient diagnosed with a right upper lobe lung cancer and was referred for resection. Positron emission tomography-computed tomography scan showed a prominent vascular structure in the right lung, suspicious for vascular malformation. A computed tomography angiography was done, demonstrating an intercostobronchial trunk-pulmonary artery fistula. There was also non-tapering dilated wandering pulmonary artery coursing through the right lower lung without any abnormal connection with pulmonary veins and were supplying normal lung parenchyma. Amplatzer vascular plugs were used for the treatment of the intercostobronchial trunk-pulmonary artery fistula. Our case highlights these very rare vascular anomalies, and their management.

2.
J Radiol Case Rep ; 10(9): 44-51, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27761198

ABSTRACT

We report a case of 59-year-old female with non-alcoholic-steato-hepatitis (NASH) induced cirrhosis, who presented with hematochezia. The patient had a history of bleeding esophageal varices treated with endoscopic variceal ligation (EVL). Colonoscopy showed large rectal varices which were the source of her lower gastrointestinal bleeding (LGIB). Since endoscopic treatment for LGIB are limited, and because the patient had portal vein thrombosis which contraindicated transjugular intrahepatic portosystemic shunt (TIPS), we performed percutaneous transhepatic embolization of her rectal varices using a new mixture of embolic and sclerotic agents, followed by Amplatzer plug 2 (AVP 2). To our knowledge, the use of this new mixture with the AVP 2 in the rectal varices treatment has not been previously published in literature. Our case provides an alternative treatment modality that can be used for rectal varices treatment, when TIPS and endoscopic management fails or is contraindicated.


Subject(s)
Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/therapy , Rectal Diseases/diagnostic imaging , Rectal Diseases/therapy , Rectum/blood supply , Septal Occluder Device , Varicose Veins/diagnostic imaging , Varicose Veins/therapy , Contrast Media , Female , Humans , Middle Aged , Sclerosing Solutions
3.
Diagn Interv Radiol ; 22(4): 358-64, 2016.
Article in English | MEDLINE | ID: mdl-27244759

ABSTRACT

PURPOSE: We aimed to evaluate the frequency of persistence and complication rates of pulmonary arteriovenous malformations (PAVMs) treated with Amplatzer vascular plug (AVP) or Amplatzer vascular plug type 2 (AVP2). METHODS: We retrospectively reviewed a total of 22 patients with 54 PAVMs between June 2004 and June 2014. We included 12 patients with 35 PAVMs who received percutaneous embolization using AVP or AVP2 only without the use of any other embolic devices. The mean follow-up was 54±24.3 months (range, 31-97 months). The primary end-points of the study were the efficacy of embolotherapy, the increase in oxygen saturation, and the persistence of PAVM on follow-up. Secondary end point was the incidence of complications. RESULTS: The study included 10 female and two male patients with a mean age of 50.2±13.7 years (range, 21-66 years). All PAVMs had a simple angioarchitecture. The technical success of the procedure for PAVM occlusion was 100%. There was a significant increase in the oxygen saturation following embolotherapy (P < 0.0001). Follow-up computed tomography angiography revealed successful treatment in 34 PAVMs (97%) and failed treatment in one PAVM (3%). Twenty-three aneurysmal sacs (67%) showed complete disappearance. The failed treatment was due to persistence of PAVM caused by subsequent development of systemic reperfusion, which did not require further intervention. There were two minor complications but no major complications were encountered. CONCLUSION: Embolotherapy of PAVMs using AVP or AVP2 devices is safe and effective, with high technical success rate, low persistence and complication rates, and with excellent long-term results.


Subject(s)
Arteriovenous Malformations/therapy , Embolization, Therapeutic/instrumentation , Pulmonary Artery/abnormalities , Adult , Aged , Computed Tomography Angiography/methods , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young Adult
4.
Vasc Endovascular Surg ; 48(7-8): 516-21, 2014.
Article in English | MEDLINE | ID: mdl-25487250

ABSTRACT

Although renal arteriovenous fistula (AVF) is an uncommon condition, it may lead to high cardiac output heart failure and renal insufficiency. Recently, percutaneous transcatheter embolization has replaced traditional surgery as the first line of treatment. We report a case of a 68-year-old male who presented with a renal AVF and was treated by percutaneous transcatheter embolization using the Amplatzer Vascular Plug 2 (AVP 2; St Jude Medical, Plymouth, Minnesota) through an arterial access. To our knowledge, the use of AVP 2 device in the treatment of renal AVF as a single embolotherapy device through the transarterial route has not been previously reported in the literature. Our technique demonstrates the feasibility and safety of AVP 2 device in the treatment of renal AVF.


Subject(s)
Aneurysm, False/therapy , Arteriovenous Fistula/therapy , Embolization, Therapeutic/instrumentation , Nephrectomy/adverse effects , Renal Artery , Renal Veins , Aged , Aneurysm, False/diagnosis , Aneurysm, False/etiology , Aneurysm, False/physiopathology , Arteriovenous Fistula/diagnosis , Arteriovenous Fistula/etiology , Arteriovenous Fistula/physiopathology , Equipment Design , Humans , Male , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Renal Veins/diagnostic imaging , Renal Veins/physiopathology , Tomography, X-Ray Computed , Treatment Outcome
5.
Vasc Endovascular Surg ; 48(7-8): 460-5, 2014.
Article in English | MEDLINE | ID: mdl-25255909

ABSTRACT

We report a case of extensive acute portal vein thrombosis (PVT) presenting with severe diffuse abdominal pain and impending small bowel infarction. The patient was successfully treated with ultrasound-accelerated catheter-directed thrombolysis (EKOS endowave system; Covidien, Mansfield, Massachusetts), which resulted in prompt recanalization of his portal vein (PV) and its tributaries. The patient eventually had ischemic stricture that necessitated bowel resection. However, we believe that our technique was successful in rapidly restoring the patency of the PV and its tributaries, and therefore, avoiding a life-threatening complication of more extensive bowel infarction. To our knowledge, the use of ultrasound-accelerated thrombolysis in treatment of PVT has not been previously described in the literature.


Subject(s)
Catheterization, Peripheral , Endovascular Procedures , Fibrinolytic Agents/administration & dosage , Portal Vein/drug effects , Thrombolytic Therapy , Ultrasonography, Interventional , Venous Thrombosis/drug therapy , Abdominal Pain/etiology , Acute Disease , Humans , Male , Middle Aged , Phlebography/methods , Portal Vein/diagnostic imaging , Portal Vein/physiopathology , Tomography, X-Ray Computed , Treatment Outcome , Vascular Patency/drug effects , Venous Thrombosis/complications , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/physiopathology
6.
Vasc Endovascular Surg ; 48(2): 180-5, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24327739

ABSTRACT

We report a case of a 68-year-old female patient presenting with portal hypertension and variceal bleeding in the absence of any liver disease. After performing a computed tomography angiogram, the cause of her condition was identified to be a splenic arteriovenous fistula (SAVF). After confirming the findings with angiography, we opted to treat the condition with coil embolization as an alternative to a more invasive surgical treatment. Coil embolization of the SAVF was performed successfully resulting in the improvement of the patient's variceal congestion. Our case highlights the importance of identifying SAVF as a potentially curable cause of variceal bleeding in the absence of liver disease. Seeking this diagnosis is of utmost importance since it completely changes the endovascular approach and management of these patients with variceal bleeding. We describe a minimally invasive endovascular technique for treatment of these critically ill patients.


Subject(s)
Arteriovenous Fistula/therapy , Endovascular Procedures , Esophageal and Gastric Varices/etiology , Gastrointestinal Hemorrhage/etiology , Hypertension, Portal/etiology , Splenic Artery/injuries , Splenic Vein/injuries , Vascular System Injuries/therapy , Aged , Arteriovenous Fistula/diagnosis , Arteriovenous Fistula/etiology , Embolization, Therapeutic , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/physiopathology , Female , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/physiopathology , Humans , Hypertension, Portal/diagnosis , Hypertension, Portal/physiopathology , Portal Pressure , Predictive Value of Tests , Risk Factors , Splenic Artery/diagnostic imaging , Splenic Vein/diagnostic imaging , Tomography, X-Ray Computed , Vascular System Injuries/diagnosis , Vascular System Injuries/etiology
7.
Cardiovasc Intervent Radiol ; 37(3): 819-24, 2014 Jun.
Article in English | MEDLINE | ID: mdl-23839006

ABSTRACT

We report a case of simultaneous pancreas-kidney transplant, referred to us with an arteriovenous fistula (AVF) in the transplanted pancreas. The AVF was manifested by compromised functions of the transplanted pancreas. The patient was successfully treated with percutaneous transcatheter embolotherapy using Amplatzer Vascular Plug 2 (St. Jude Medical, Plymouth, MA), after the adequacy of the pancreatic transplant perfusion was ensured to avoid the risk of postembolization pancreatic infarction. There were no complications related to the procedure and the patient pancreatic functions and clinical status returned to baseline. Our case highlights a rare vascular complication related to pancreatic transplant that was managed by minimally invasive endovascular treatment. To our knowledge, the technique used in treatment of this case was not previously described in literature.


Subject(s)
Arteriovenous Fistula/therapy , Embolization, Therapeutic/instrumentation , Kidney Transplantation , Pancreas Transplantation , Postoperative Complications/therapy , Septal Occluder Device , Adult , Allografts , Arteriovenous Fistula/diagnosis , Diagnostic Imaging , Female , Humans , Postoperative Complications/diagnosis
8.
Eur J Gastroenterol Hepatol ; 25(7): 755-63, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23492985

ABSTRACT

Upper gastrointestinal bleeding (UGIB) remains a frequent presentation in the emergency department. There are several causes of UGIB, which can be generally classified into variceal and nonvariceal bleeding. Although most cases of nonvariceal UGIB spontaneously resolve or respond to medical management and/or endoscopic treatment, transcatheter arterial embolization (TAE) remains an important available tool in the emergency evaluation and management of nonvariceal UGIB. In this article, we will discuss the current strategies for rendering a specific diagnosis of nonvariceal UGIB, and we will focus on the various TAE techniques for its management. We will also provide an algorithm for the diagnostic work-up of these patients. The majority of patients with nonvariceal UGIB that is refractory to endoscopic treatment is successfully treated with minimally invasive TAE and can avoid undergoing surgery.


Subject(s)
Embolization, Therapeutic , Endovascular Procedures , Gastrointestinal Hemorrhage/therapy , Algorithms , Critical Pathways , Diagnostic Imaging/methods , Embolization, Therapeutic/adverse effects , Endovascular Procedures/adverse effects , Gastrointestinal Hemorrhage/diagnosis , Humans , Patient Selection , Predictive Value of Tests , Treatment Outcome
9.
Vasc Endovascular Surg ; 47(2): 115-23, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23275482

ABSTRACT

Entrapment of a central venous catheter (CVC) guide wire in an inferior vena cava (IVC) filter is a rare, but reported complication during CVC placement. With the increasing use of IVC filters, this number will most likely continue to grow. The consequences of this complication can be serious, as continued traction upon the guide wire may result in filter dislodgement and migration, filter fracture, or injury to the IVC. In this article, we review the various preferred techniques reported in the literature for removal of the entrapped guide wire in particular situations, along with their indications, advantages, and disadvantages. We present simple useful recommendations to prevent this complication.


Subject(s)
Catheterization, Central Venous/adverse effects , Central Venous Catheters/adverse effects , Device Removal/methods , Vena Cava Filters/adverse effects , Catheterization, Central Venous/instrumentation , Equipment Failure , Humans , Practice Guidelines as Topic , Treatment Outcome
10.
Cardiovasc Intervent Radiol ; 36(2): 558-60, 2013 Apr.
Article in English | MEDLINE | ID: mdl-22526100

ABSTRACT

Entrapment of a central venous catheter (CVC) guide wire in an inferior vena cava (IVC) filter is a rare, but reported complication during CVC placement. With the increasing use of vena cava filters (VCFs), this number will most likely continue to grow. The consequences of this complication can be serious, as continued traction upon the guide wire may result in filter dislodgement and migration, filter fracture, or injury to the IVC. We describe a case in which a J-tipped guide wire introduced through a left subclavian access without fluoroscopic guidance during CVC placement was entrapped at the apex of an IVC filter. We describe a technique that we used successfully in removing the entrapped wire through the left subclavian access site. We also present simple useful recommendations to prevent this complication.


Subject(s)
Catheterization, Central Venous/adverse effects , Device Removal , Vena Cava Filters , Accidents, Traffic , Aged , Humans , Male , Prosthesis Failure , Radiography , Vena Cava, Inferior/diagnostic imaging , Venous Thrombosis/etiology
11.
J Radiol Case Rep ; 6(8): 8-16, 2012 Aug.
Article in English | MEDLINE | ID: mdl-23365712

ABSTRACT

We report a case of a large, heterogeneously enhancing, pathologically proven, supratentorial subependymoma in a 31-year-old male patient presenting with headache, nausea and vomiting as well as gait disturbances. Although most supratentorial subependymomas have distinctive MR features, our case demonstrated imaging findings that made it indistinguishable from other more aggressive malignant supratentorial intraventricular lesions. It is of paramount importance to consider supratentorial subependymomas in the differential diagnosis of supratentorial lesions, even if their radiological features were atypical.


Subject(s)
Cerebral Ventricle Neoplasms/diagnosis , Gait Disorders, Neurologic/diagnosis , Glioma, Subependymal/diagnosis , Headache/diagnosis , Supratentorial Neoplasms/diagnosis , Vomiting/diagnosis , Adult , Cerebral Ventricle Neoplasms/complications , Cerebral Ventricle Neoplasms/pathology , Diagnosis, Differential , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/pathology , Glioma, Subependymal/complications , Glioma, Subependymal/pathology , Headache/etiology , Headache/pathology , Humans , Magnetic Resonance Imaging , Male , Supratentorial Neoplasms/complications , Supratentorial Neoplasms/pathology , Vomiting/etiology , Vomiting/pathology
12.
Vasc Endovascular Surg ; 46(1): 70-4, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22156151

ABSTRACT

We describe a technique that allows repositioning of malfunctioning peritoneovenous shunt (PVS) catheters. We report a 67-year-old female with refractory ascites, who presented with malfunctioning PVS. The catheter tip was outside the superior vena cava (SVC), possibly in a small mediastinal vein, which makes its tip inaccessible to regular snares and retrieval devices. We used "in situ" loop snare technique to reposition the tip of the catheter into the inferior vena cava (IVC). In situ loop snare technique can be used to reposition malfunctioning PVS catheters caused by a kink or by malposition of its tip. The technique avoids surgical or interventional replacement of these catheters. This technique can be also used for retrieval of foreign body fragments that have no free ends and, therefore, cannot be captured by a snare or other retrieval devices.


Subject(s)
Ascites/therapy , Catheterization, Central Venous/instrumentation , Catheters, Indwelling , Peritoneovenous Shunt/instrumentation , Vena Cava, Superior , Aged , Catheterization, Central Venous/adverse effects , Equipment Design , Equipment Failure , Female , Humans , Peritoneovenous Shunt/adverse effects , Phlebography , Radiography, Interventional , Treatment Outcome , Vena Cava, Superior/diagnostic imaging
13.
J Endovasc Ther ; 18(5): 739-43, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21992648

ABSTRACT

PURPOSE: To present a new endovascular technique for treating acute large thrombus burden in the iliocaval venous system. TECHNIQUE: This method is demonstrated in a 62-year-old man with end-stage renal disease on hemodialysis who had a nonfunctioning right femoral dialysis catheter that was placed 3 month earlier. After catheter removal, venography demonstrated significant thrombus in the inferior vena cava (IVC) and both iliac veins. The patient was treated successfully using two simultaneously operating Trellis-8 thrombolysis catheters placed side-by-side in the IVC and both iliac veins in a "kissing" configuration. CONCLUSION: This technique was able to effectively debulk acute large thrombus burden in the iliocaval system in a single session and preserve the patient's available hemodialysis access. The technique has the potential to minimize morbidity, duration of hospital stay, and overall cost of treatment.


Subject(s)
Catheterization, Central Venous/adverse effects , Catheters , Endovascular Procedures/instrumentation , Iliac Vein , Thrombectomy/instrumentation , Thrombolytic Therapy/instrumentation , Vena Cava, Inferior , Venous Thrombosis/therapy , Acute Disease , Equipment Design , Fibrinolytic Agents/administration & dosage , Humans , Iliac Vein/diagnostic imaging , Infusions, Intravenous , Kidney Failure, Chronic/therapy , Male , Middle Aged , Phlebography , Renal Dialysis , Treatment Outcome , Vena Cava, Inferior/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiology
14.
Vasc Endovascular Surg ; 45(3): 307-10, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21478250

ABSTRACT

PURPOSE: To present a case of upper gastrointestinal bleeding (UGIB) that was treated with percutaneous endovascular embolization using Amplatzer vascular plug and hydrogel coils after failed endoscopic treatment. CASE REPORT: A 78-year-old male was referred for endovascular treatment of massive recurrent UGIB from a duodenal ulcer. Attempts at endoscopic treatment were unsuccessful. Based on our knowledge of the site of the bleeder in the duodenum from prior endoscopy, we decided to empirically embolize the gastroduodenal artery (GDA) and the right gastroepiploic artery using a combination of coils (Azur peripheral hydrocoil; Terumo Medical Corporation, Somerset, New Jersey) and Amplatzer vascular plug II (AVP II; AGA Medical, Plymouth, Minnesota). CONCLUSION: We present this case of UGIB where effective, rapid, precise, and controlled embolization of the GDA was achieved using AVP II device in combination with coils. To our knowledge, the use of AVP II in embolization of GDA for treatment of emergent UGIB has not been described in the literature.


Subject(s)
Duodenal Ulcer/complications , Embolization, Therapeutic/instrumentation , Peptic Ulcer Hemorrhage/therapy , Aged , Duodenal Ulcer/drug therapy , Equipment Design , Hemostasis, Endoscopic , Humans , Male , Peptic Ulcer Hemorrhage/diagnostic imaging , Peptic Ulcer Hemorrhage/etiology , Proton Pump Inhibitors/therapeutic use , Radiography, Interventional , Treatment Failure
15.
AJR Am J Roentgenol ; 192(3): 793-9, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19234279

ABSTRACT

OBJECTIVE: The occlusion time, that is, the interval between device deployment and complete occlusion of the vessel, associated with the use of embolic devices influences the risk of embolic complications caused by small clots that can form over the surface of a device and break away. The purpose of our study was to determine the time for an Amplatzer vascular plug to bring about percutaneous transcatheter occlusion of a pulmonary arteriovenous malformation (PAVM). MATERIALS AND METHODS: We retrospectively studied the occlusion times of Amplatzer vascular plugs in the management of 12 PAVMs. We recorded the number, location, type (simple or complex), and diameter and number of feeding arteries of PAVMs; the number and size of devices needed to occlude each PAVM; and the occlusion time for each PAVM. The occlusion time is the time interval from device placement to complete occlusion of the PAVM. Occlusion time was determined by recording the time between acquisition of the first angiographic image after deployment of the device and the angiogram that showed total occlusion of the PAVM. The relevant literature on the subject was reviewed. RESULTS: All PAVMs managed were supplied by a single feeding artery. The average diameter of the feeding arteries was 4.8 mm (range, 3.0-11.2 mm). All PAVMs were occluded by deployment of a single Amplatzer vascular plug. Vascular plug sizes ranged from 4 to 16 mm. The mean occlusion time was 3 minutes 20 seconds (range, 1 minute 49 seconds-5 minutes 16 seconds). There were no immediate complications, including air embolism and thromboembolism. CONCLUSION: The occlusion time determined in our study and the need to place only one Amplatzer vascular plug in each feeding artery to achieve complete occlusion in most cases suggest that the device is safe for management of PAVM with no increased risk of systemic embolization. The use of the Amplatzer vascular plug for PAVM embolization is a relatively recent development. Long-term follow-up studies are needed to assess recanalization rates, radiation exposure rates, and risk of device migration.


Subject(s)
Angiography/methods , Arteriovenous Malformations/therapy , Embolization, Therapeutic/instrumentation , Pulmonary Circulation , Radiography, Interventional , Adult , Contrast Media , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Tomography, X-Ray Computed , Treatment Outcome
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