Bilhemia After Percutaneous Liver Tumor Core Biopsy With the Percutaneous Embolization of Bilio-venous Fistula With Coils and Onyx.

Bilhemia is a rare but potentially lethal condition representing abnormal communication and flow of bile into the bloodstream. We present a case of iatrogenic bilhemia after a percutaneous liver biopsy in a patient with cholangiocarcinoma. The bilio-venous fistula was visualized with percutaneous cholangiography and successfully embolized using coils and the liquid embolic agent Onyx. To our knowledge, this is the first report of using Onyx for the embolization of a bilio-venous fistula.

Endovascular Aortic Repair After Abdominal Aortic Injury in a Patient With an Aberrant Renal Artery.

Abdominal aortic injury (AAI) due to blunt trauma is rare and is often complicated by thrombosis within the true and false lumens and sometimes aortic rupture. No standard guidelines for treatment are available. We present the case of a 44-year-old female patient with posttraumatic dissection of the abdominal aorta, which was referred to our institution for endovascular aortic repair (EVAR). The patient was referred to our institution after emergency surgery following blunt abdominal trauma due to a car accident. Initial computed tomography (CT), performed at the referring hospital, showed multiple bone injuries with pneumothorax, liver and spleen lacerations, and rupture of the anterior abdominal wall with mesenteric injury and active intraperitoneal extravasation of contrast media from visceral arteries. Initial CT also showed dissection of the distal part of the abdominal aorta. Due to hemodynamic instability, emergency surgery was performed for intraperitoneal injuries. Control computed tomography angiography (CTA) after surgery confirmed a dissection of the distal part of the abdominal aorta at the level of the bifurcation protruding into the right common iliac artery with partial thrombosis of the right iliac artery and no active extravasation of the contrast media at the level of the aorta. An aberrant left renal artery was also identified. A hemodynamically stable patient was transferred to our institution for emergency EVAR which was performed without intraprocedural complications. Control CTA after EVAR showed a good result of the procedure with minimal type 2 endoleak and no extravasation. EVAR can also be used to treat AAI without active extravasation to prevent future total rupture of the aortic wall.

Fatal bleeding due to an aorto-esophageal fistula: A case report and literature review.

BACKGROUND: Aorto-esophageal fistula is an extremely rare cause of acute upper gastrointestinal bleeding (UGIB). CASE SUMMARY: We present a case of an 80-year-old woman with esophageal cancer who was admitted to our department with hemorrhagic shock due to UGIB. During the diagnostic procedure, emergency computed tomography angiography was performed and confirmed aorto-esophageal fistula. Interventional radiologists inserted a stent graft into the aorta, successfully closing the fistula. Unfortunately, the patient later died of heart failure following irreversible hemorrhagic shock. Autopsy confirmed the aorto-esophageal fistula, which formed 1 cm below the distal edge of the stent previously inserted into the esophagus for a malignant stricture. CONCLUSION: There are very rare causes of UGIB. Although clinical decisions are made during the diagnostic workup of these patients, we must be aware of the limitations of various therapeutic options, even the most contemporary.

Endovascular Treatment of Haemodialysis Arteriovenous Fistula with Drug-Coated Balloon Angioplasty: A Single-Centre Study.

PURPOSE: To evaluate the effect of percutaneous transluminal angioplasty (PTA) on haemodialysis fistulas utilising drug-coated balloons with plain balloon vessel preparation (DCB). MATERIALS AND METHODS: In the study group, 31 patients (16 men; mean age 62.8 ± 17.2 years) with failing arteriovenous fistulas were treated, with DCB, and compared with a control group (31 patients; 15 men; mean age 67.0 ± 8.44 years), in which only plain balloon PTA was performed. All stenoses were dilated with regular PTA balloons. After achieving haemodynamic success (< 30% residual stenosis), drug-coated balloons were used for drug administration in the study group. The follow-up intervals were 6, 12 and 24 months. Target lesion primary patency, primary assisted patency and secondary patency were compared. The statistical significance was set at 0.05. RESULTS: Target lesion primary patency was compared in both groups and was significantly higher in the study group (DCB) at 6 months (90.3 vs. 61.3%; p = 0.016), 12 months (77.4 vs. 29%; p = 0.0004) as well as 24 months (45.2 vs. 16.1%; p = 0.026). Kaplan-Meier survival curves also showed a significant difference for target lesion primary patency (534.2 vs. 315.7 days; p = 0.0004). There were no significant differences in target lesion primary assisted patency and in secondary patency. However, only 38.7% of patients in the study group were treated twice or more versus 80.6% in the control group (p = 0.002). CONCLUSION: DCB increases target lesion primary patency during the first 24 months and decreases the rate of reinterventions.

Treatment of tongue cavernous haemangioma with direct puncture and sclerotization with ethanol.

BACKGROUND: Haemangiomas of tongue are rare type of malformations. They can be treated mostly conservatively but in some cases they need more aggressive treatment with preoperative intra arterial embolization and surgical resection. Lesions of tongue that are localized superficially can also be treated with direct puncture and injection of sclerosing agent (absolute ethanol). CASE REPORT: We present a case of a 48 years old female patient, where we performed embolization of cavernous haemangioma with mixture of absolute ethanol and oil contrast. After the procedure the patient received analgetics and antioedematous therapy. After the sclerotization the planed surgery was abandoned. Control MRI examinations 6 and 12 months after the procedure showed only a small remnant of haemangioma and no signs of a larger relapse. CONCLUSIONS: In our case the direct puncture of haemangioma and sclerotherapy with ethanol proved to be a safe and effective method to achieve preoperative devascularization of the lesion. Direct puncture of the lesion is not limited by the anatomy of the vessels or vasospasm, which can occur during the intra-arterial approach.