Recurrent infections related to an extruded ureteral stone in case of spontaneous ureteral rupture.

Spontaneous rupture of the ureter is a rare entity most commonly a result of ureteral stone disease. Despite the overall low prevalence, the diagnosis should be considered so appropriate imaging and management can be performed without delay. Although treatment has shifted towards more minimally invasive intervention and conservative management, open surgical intervention should be considered in certain situations to mitigate the risk of long-term complications. Here we present a unique case of spontaneous ureteral rupture complicated by recurrent infections and fistulous sinus tract formation.

Friction-lowering capabilities and human subject preferences for a hydrophilic surface coating on latex substrates: implications for increasing condom usage.

Personal lubricants can increase user satisfaction with male condoms by reducing friction and yielding a slippery sensation. However, lubricants pose disadvantages of dilution in physiologic fluids and sloughing away over repeated articulations. To address these drawbacks, a latex surface modification, which becomes lubricious in the presence of physiologic fluid, has been developed and evaluated. This study assesses (i) the frictional performance of the lubricious coating compared to non-coated latex and latex lubricated by personal lubricant, (ii) the level of agreement between human-perceived slipperiness and machine-measured friction, and (iii) human preference for a hypothetical male condom containing the lubricious coating. Friction coefficient of the lubricious coating was 53% lower than that of non-coated latex and approximately equal to that afforded by personal lubricant. A touch test and survey of a small population sample (N = 33) revealed a strong correlation (R 2 = 0.83) between human-perceived slipperiness and machine-measured friction. A majority of participants (73%) expressed a preference for a condom containing the lubricious coating, agreeing that an inherently slippery condom that remained slippery for a long duration would increase their condom usage. Such a coating shows potential to be an effective strategy for decreasing friction-associated pain, increasing user satisfaction and increasing condom usage.

Redefining Budd-Chiari syndrome: A systematic review.

AIM: To re-examine whether hepatic vein thrombosis (HVT) (classical Budd-Chiari syndrome) and hepatic vena cava-Budd Chiari syndrome (HVC-BCS) are the same disorder. METHODS: A systematic review of observational studies conducted in adult subjects with primary BCS, hepatic vein outflow tract obstruction, membranous obstruction of the inferior vena cava (IVC), obliterative hepatocavopathy, or HVT during the period of January 2000 until February 2015 was conducted using the following databases: Cochrane Library, CINAHL, MEDLINE, PubMed and Scopus. RESULTS: Of 1299 articles identified, 26 were included in this study. Classical BCS is more common in women with a pure hepatic vein obstruction (49%-74%). HVC-BCS is more common in men with the obstruction often located in both the inferior vena cava and hepatic veins (14%-84%). Classical BCS presents with acute abdominal pain, ascites, and hepatomegaly. HVC-BCS presents with chronic abdominal pain and abdominal wall varices. Myeloproliferative neoplasms (MPN) are the most common etiology of classical BCS (16%-62%) with the JAK2V617-F mutation found in 26%-52%. In HVC-BCS, MPN are found in 4%-5%, and the JAK2V617-F mutation in 2%-5%. Classical BCS responds well to medical management alone and 1(st) line management of HVC-BCS involves percutaneous recanalization, with few managed with medical management alone. CONCLUSION: Systematic review of recent data suggests that classical BCS and HVC-BCS may be two clinically different disorders that involve the disruption of hepatic venous outflow.

Endovascular management of thrombosed axillary artery to right atrium hemodialysis graft.

PURPOSE: To describe the salvage of a left axillary artery to right atrium hemodialysis graft using endovascular techniques. CASE REPORT: A 54-year-old man with multiple arteriovenous graft failures presented with a thrombosed left axillary artery to right atrium Gore-tex hemodialysis graft. The graft was salvaged using rheolytic catheter thrombectomy, mechanical thrombectomy, balloon angioplasty, and stenting. CONCLUSIONS: This single case report suggests that when axillary to right atrium grafts fail, various endovascular techniques can be employed to salvage the graft and maintain dialysis access.

Bronchial artery pseudoaneurysm with symptomatic mediastinal hematoma.

PURPOSE: To discuss the rare finding of bronchial artery aneurysms and pseudoaneurysms as well as describing available endovascular treatment options. CASE REPORT: A 61-year-old male presented to the emergency department and was found to have a paraesophageal hematoma and 1cm bronchial artery pseudoaneurysm. The patient was taken for successful endovascular exclusion by embolization. CONCLUSION: Bronchial artery pseudoaneurysms are rare but have a chance of rupture. Percutaneous embolization is a reasonable treatment option for these patients.

Ultrasound-guided needle localization to aid foreign body removal in pediatric patients.

Patients with podiatric foreign body injury commonly present to the emergency department. Often, the foreign object cannot be easily located or removed, and radiographs are frequently obtained to aid in localization. In cases requiring tissue dissection to remove the foreign bodies, accurate localization is required for safe removal of small and difficult to visualize bodies. We present 2 pediatric cases in which an ultrasound-guided needle localization technique was used to facilitate successful removal of small, difficult to visualize foreign bodies from the plantar foot. Ultrasound-guided needle localization reduced the required incision length and depth and helped to minimize the risk of damage to surrounding tissue.

Conservative management of iatrogenic superior vena cava (SVC) perforation after attempted dialysis catheter placement: case report and literature review.

A 68-year-old male with end-stage renal disease, congestive heart failure, and facial and bilateral arm swelling was referred for placement of a tunneled dialysis catheter. Distal left subclavian vein access was obtained. The procedure was complicated by iatrogenic perforation of the superior vena cava (SVC). This resulted in rapid development of a right-sided hemothorax and hemodynamic instability. A right-sided thoracostomy tube was placed to drain the pleural cavity. Extrapericardial perforation of the SVC can be managed conservatively in select cases without endovascular balloon dilatation and/stent graft deployment or surgical repair provided the antegrade blood flow is maintained via patent collateral circulation.

Endovascular management of anastomotic blowout of proper hepatic to common hepatic artery saphenous vein bypass with coil embolization and hepatic artery stent placement.

Mesenteric and visceral artery pseudoaneurysms in the abdomen are a relatively rare complication after abdominal surgery. It is a complication primarily associated with pancreatic and hepatobiliary surgery, trauma, iatrogenic causes and inflammatory diseases. Regardless of etiology, visceral artery pseudoaneurysms of the abdomen reportedly occur only in 0.01% to 2% of the population. Although rare, these are associated with life-threatening bleeding complications and need to be appropriately managed. We present the case of a patient who presented with bleeding after developing a pseudoaneurysm at the distal anastomotic site of a common hepatic to proper hepatic artery interposition saphenous vein bypass that was subsequently excluded by coil embolization and stent graft placement.

Incapacitating pelvic congestion syndrome in a patient with a history of May-Thurner syndrome and left ovarian vein embolization.

BACKGROUND: The aim of this article is to report a rare case of unresolved incapacitating pelvic congestion syndrome (PCS) in a patient with a history of May-Thurner syndrome previously treated with stenting and left ovarian vein embolization. Additionally, this article highlights the role of pelvic venography in patients with PCS and reviews the coexistence. METHODS: A 32-year-old woman was referred to us for the evaluation of recurrent pelvic pain and dyspareunia requiring analgesics. Initially, she developed left lower-extremity deep vein thrombosis a few months after her first pregnancy. On further workup, she was diagnosed with May-Thurner syndrome and underwent left common iliac and left external iliac vein stenting. Furthermore, left ovarian vein coil embolization was performed for symptoms suggesting PCS at the same outside facility. The patient was referred to us for persistent pelvic pain approximately 1 year after she underwent left ovarian vein coil embolization. A diagnosis of incompletely resolved PCS was considered. RESULTS: Iliocaval venogram demonstrated patent left common iliac and external iliac venous stents in situ. Subsequent right ovarian venogram revealed a patent, but grossly dilated, right ovarian vein with retrograde flow and cross-pelvic collaterals confirming grade III PCS. Right ovarian vein coil embolization was performed, with excellent patient outcome. CONCLUSION: In the setting of a combined diagnosis of PCS and May-Thurner syndrome, persistent incapacitating PCS after initial iliac stenting should be followed with a complete pelvic venous evaluation including ovarian and left renal venography to rule out residual pelvic congestion secondary to any coexisting ovarian vein incompetencies or nutcracker syndrome.

Symptomatic fibromuscular dysplasia of the external iliac artery.

The aim of this article is to report a case of symptomatic fibromuscular dysplasia (FMD) involving the external iliac arteries (EIAs). An 88-year-old woman was admitted to the vascular service, with a painful right posterior ankle ulcer that had progressively worsened during the course of a month. Her medical history included diabetes and hypertension. Bilateral lower-extremity pulses were absent, and femoral and tibial Doppler waveforms were monophasic. Pelvic and bilateral lower-extremity angiograms were obtained, which revealed findings in both EIAs consistent with a diagnosis of extrarenal FMD. Percutaneous transluminal angioplasty with subsequent stenting of the right EIA was performed, using a self-expanding stent. Completion digital subtraction angiography demonstrated a widely patent right EIA with brisk flow of contrast across the stent. Postprocedural arterial duplex scan showed a biphasic waveform pattern in the common femoral artery. FMD can involve the EIA and be associated with critical limb ischemia. FMD of the EIA responds well to endovascular management.

Lymphangiography in the diagnosis and localization of various chyle leaks.

PURPOSE: Chyle leaks are rare entities infrequently encountered by most physicians. However, large centers providing advanced surgical care are inevitably confronted with chyle leaks as a complication of surgery, an extension of disease, or as a primary disorder. Regardless of the etiology, proper diagnosis and localization are paramount in the management of any chyle leak. MATERIALS AND METHODS: Here we present 16 patients with 17 chyle leaks (5 chyluria, 8 chylothorax, and 4 chylous ascites) who underwent bipedal lymphangiography (LAG) and postprocedure computed tomography (CT) imaging. RESULTS: In each case, the source of the chyle leak was identified and properly localized to guide further treatment. Of the 16 patients who underwent LAG and postprocedure CT imaging, the initial LAG alone provided the diagnosis and localized the chyle leak in 4 patients (25%); the postprocedure CT imaging provided the diagnosis and localized the chyle leak in 6 patients (37.5%); and the two modalities were equal in the diagnosing and localizing the chyle leak in the remaining 6 patients (37.5%) CONCLUSION: These cases highlight the unparalleled abilities of LAG and the added benefit of post-LAG CT imaging in the diagnosis and fine anatomic localization of chyle leaks. In addition, these cases demonstrate the retained utility of LAG in these investigations despite the development of alternative tests involving CT, magnetic resonance imaging, and nuclear medicine imaging.

Unintended coil migration into the right ventricle during the right ovarian vein coil embolization.

PURPOSE: The aim of this article is to report a rare case of unintended coil migration into the right (Rt) ventricle. MATERIALS AND METHODS: A 36-year-old Brazilian female was referred to us for the evaluation of pelvic pain. Venous duplex ultrasound findings were consistent with incompetent venous systems of right lower extremity (RLE). The diagnosis of grade III pelvic varices was confirmed with ovarian venography, and bilateral ovarian vein coil embolization was performed. The procedure was complicated with unintended migration of a small coil into the Rt ventricle. DISCUSSION: In cases where coil or foreign body migration into the Rt heart or pulmonary circulation has occurred, endovascular retrieval or a thoracotomy has been performed. In our case, the migrated coil was left in situ without any hemodynamic disturbances in the follow-up. CONCLUSIONS: Coil migration to the Rt ventricle can be conservatively managed depending upon the location and coil profile.

Collapse of Viabahn stent-graft secondary to rheolytic thrombectomy: a rare complication of the AngioJet device.

There is increased use of percutaneous mechanical thrombectomy for treatment of occluded dialysis access. The AngioJet rheolytic thrombectomy device is one such device available. Reports have shown safety and efficacy of these techniques with relatively few complications. We describe a case report of a collapsed Viabahn endoprosthesis in an arteriovenous fistula during treatment with an AngioJet device.

Percutaneous management of segmental pulmonary artery aneurysm in a patient without pulmonary artery hypertension.

PURPOSE: The aim of this article is to report the percutaneous management of a case of idiopathic segmental pulmonary artery aneurysm (SPAA) in a patient without pulmonary arterial hypertension. MATERIALS AND METHODS: A 69-year-old female was referred for the evaluation of an incidental finding of a solitary right pulmonary nodule on chest radiograph (CR). Chest computed tomography and pulmonary arteriogram findings were consistent with a solitary SPAA. Successful percutaneous endovascular coil occlusion of the SPAA was performed. DISCUSSION: Segmental pulmonary artery aneurysm considered on CR should be confirmed on initial contrast chest computed tomography. CONCLUSIONS: Endovascular coil occlusion is a minimally invasive therapeutic option for idiopathic SPAA.

Lymphangiography in the diagnosis, localization, and treatment of a lymphaticopelvic fistula causing chyluria: a case report.

We present a 25-year-old man with chyluria resulting from a posttraumatic, postinflammatory lymphaticopelvic fistula. This aberrant connection between the lymphatic system and the urinary tract is rarely seen in the United States and can be difficult to diagnose. In this particular case, lymphangiography and postprocedure computed tomography (CT) imaging were used to diagnose and localize a fistula involving the right renal pedicle lymphatics and right urinary collecting system. This fistula ultimately resolved after the procedure and did not require sclerotherapy or surgical intervention. Lymphangiography is now rarely performed at most centers due to advancements in alternative diagnostic imaging modalities. However, this procedure remains a useful tool for the investigation and treatment of chyluria and other chyle leaks.