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1.
J Clin Ultrasound ; 51(8): 1390-1396, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37530531

ABSTRACT

PURPOSE: The objective of this study was to asses brain perfusion parameters and ischemic changes following treatment of aneurysm with flow diverters with two different perfusion MRI technique (Arterial spin labeling and DSC MRI), and to compare the results and effectiveness of these two methods. METHODS: The prospective data was collected from patients with aneurysm who treated with flow diverters. MR examinations, including diffusion-weighted imaging (DWI), ASL, and DSC perfusion MRI, were conducted before and after treatment within the first week and at 6 months. Perfusion parameters of territory area and contralateral side were measured and analyzed by statistically. The relationships between ASL and DSC parameters were analyzed by using Sperman's correlation analysis. RESULTS: A total of 14 cases of aneurysms in 11 patients treated successfully with endovascular flow diverter stent placement. Pretreatment and post treatment (within first week and 6 months) MRI images were evaluated. Asymptomatic randomly distributed millimetric restricted diffusion foci were observed in 8 of all patients. There was no statistically difference between pre and post treatment perfusion parameters (p > 0.05). A statistically significant correlation was found between variable ASL CBF, and the variables of DSC CBF and TTP. CONCLUSIONS: Notwithstanding the fact that flow diverters change flow dynamics in aneurysm sac, there is no any perfusion abnormality in the territory area. Asymptomatic randomly distributed diffusion restricted foci in the both cerebral hemisphere can be observed. ASL and DSC MRI are effective for evaluation of brain perfusion.


Subject(s)
Aneurysm , Cerebrovascular Circulation , Humans , Prospective Studies , Magnetic Resonance Imaging/methods , Brain/diagnostic imaging , Perfusion , Magnetic Resonance Angiography/methods
2.
J Neurointerv Surg ; 15(1): 63-69, 2023 Jan.
Article in English | MEDLINE | ID: mdl-35172983

ABSTRACT

BACKGROUND: Flow diversion is an innovative and increasingly used technique for the treatment of intracranial aneurysms. New flow diverters (FDs) are being introduced to improve the safety and efficacy of this treatment. The aim of this study was to assess the safety, feasibility, and efficacy of the new Pipeline Vantage (PV) FD. METHODS: Patients with intracranial aneurysms treated with the PV at 10 international neurovascular centers were retrospectively analyzed. Patient and aneurysm characteristics, procedural parameters, complications, and the grade of occlusion were assessed. RESULTS: 60 patients with 70 aneurysms (5.0% with acute hemorrhage, 90.0% located in the anterior circulation) were included. 82 PVs were implanted in 61 treatment sessions. The PV could be successfully implanted in all treatments. Additional coiling was performed in 18.6%, and in-stent balloon angioplasty (to enhance the vessel wall apposition) in 24.6%. Periprocedural technical complications occurred in 24.6% of the treatments, were predominantly FD deployment problems, and were all asymptomatic. The overall symptomatic complication rate was 8.2% and the neurological symptomatic complication rate was 3.3%. Only one symptomatic complication was device-related (perforator artery infarctions leading to stroke). After a mean follow-up of 7.1 months, the rate of complete aneurysm occlusion was 77.9%. One patient (1.7%) died due to aneurysmal subarachnoid hemorrhage which occurred before treatment, unrelated to the procedure. CONCLUSIONS: The new PV FD is safe and feasible for the treatment of intracranial aneurysms. The short-term occlusion rates are promising but need further assessment in prospective long-term follow-up studies.


Subject(s)
Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Retrospective Studies , Prospective Studies , Treatment Outcome , Stents , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/methods
3.
Diagn Interv Radiol ; 28(4): 370-375, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35950282

ABSTRACT

PURPOSE Thoracic endovascular aortic repair (TEVAR) is a safe and effective treatment method for a variety of thoracic aortic pathologies. We aimed to investigate the mortality and complication outcomes and associated factors of TEVAR treatment in Turkey. METHODS In this single-centered retrospective study, patients with thoracic aorta pathologies treated with TEVAR at Gazi University School of Medicine, Department of Radiology, between January 2009 and January 2020 were included. Perioperative, early, and late mortality, complications, and technical success were the outcomes. RESULTS The sample comprised 58 patients with 68 TEVAR interventions. Eleven (16.2%) patients were female, the mean age was 60.1 ± 13.4 years. Emergent TEVAR was required in 20.7% of the patients. The main indications of TEVAR were intact descending aorta aneurysms in 37.9% of the sample, 31.0% Stanford type-B dissection, and 12.1% traumatic transections. The technical success rate of primary and secondary interventions was 98.3% and 100%, respectively. The mortality rate in the first 30 days was 8.6%. Seventeen (29.3%) cases had at least 1 complication related to TEVAR treatment. The most common complication was type-1A endoleak (10.3%). Having acute symptoms, stroke, and acute renal failure were significantly associated with mortality (P=.020, .049, and .009, respectively). CONCLUSION This study reported the outcomes of TEVAR treatment from a tertiary medical center in Turkey over a decade. Patients presenting with acute symptoms and who developed stroke and acute renal failure after the procedure should be carefully followed up as these factors were found to be associated with mortality.


Subject(s)
Acute Kidney Injury , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Stroke , Aged , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures/adverse effects , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Retrospective Studies , Risk Factors , Stroke/complications , Time Factors , Treatment Outcome
4.
Neuroradiology ; 63(6): 943-952, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33392735

ABSTRACT

PURPOSE: Our aim was to determine the long-term safety and efficacy of the Flow Re-Direction Endoluminal Device (FRED) in this multicenter study with prospective design. MATERIALS-METHOD: This study included 136 consecutive patients with 155 aneurysms treated between March 2013 and June 2016 in 10 centers. Twenty-two (16.2%) patients presented with rupture of the index aneurysm. Large/giant aneurysms comprised 1/3 of the cohort. Adjuvant coil use during the treatment was 15.5%. The effectiveness measure in the study was the percentage of aneurysms with stable occlusion at follow-up. RESULTS: Vascular imaging follow-up was performed at least once in 131/136 (96.3%) patients with 148/155 (95.5%) aneurysms up to 75 months (mean: 37.3 months; median: 36 months according to latest follow-up), and 102/155(65.8%) aneurysms in 90/136 (66.2%) patients had ≥ 24-month control. According to the latest controls, the overall stable occlusion rate was 91.9% (95% CI, 87.5 to 96.3%). Three out of 148 aneurysms with follow-up were retreated (2%, 95% CI 0.0 to 4.3%). Adverse events were noted in 19/136 (14%, 95% CI, 9 to 21%) patients with a morbidity of 1.5% (95% CI, 0.0 to 3.5%). Mortality was 1/136 (0.7%, 95% CI, 0.02 to 2.2%) and was unrelated to aneurysm treatment. In-stent stenosis (ISS) was detected in 10/131 of the patients with follow-up (7.6%, 95% CI; 3.1 to 12.2%), only one being symptomatic. No adverse events have occurred in any of the patients with follow-up after 24 months, except the one resulting from ISS. CONCLUSION: In the treatment of cerebral aneurysms which were candidates for flow diversion technique, this study showed long-term efficacy of FRED with good safety and occlusion rates.


Subject(s)
Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Cerebral Angiography , Follow-Up Studies , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/therapy , Prospective Studies , Retrospective Studies , Stents , Treatment Outcome
5.
Neurol India ; 69(6): 1711-1715, 2021.
Article in English | MEDLINE | ID: mdl-34979674

ABSTRACT

PURPOSE: This study evaluated the hemodynamic effects of carotid artery stenting (CAS) on cerebral blood flow velocity (CBFV) in patients with carotid artery stenosis, before, 3 d, and 3 months after the procedure using transcranial Doppler ultrasound (TCD). METHODS: The study included 36 patients with atheromatous carotid artery stenosis. Cerebral computed tomography (CT) or magnetic resonance imaging (MRI) was performed in every patient, and carotid stenosis was evaluated using duplex sonography, CT, and MRI angiography before the procedure. To obtain baseline values, the CBFV was evaluated 1 d before CAS. Follow-up TCD evaluations were performed 3 d and 3 months postoperatively. RESULTS: The median degree of internal carotid artery (ICA) stenosis in the participants was 90% (range 50%-99%). The median CBFV at the anterior cerebral artery (ACA) was significantly lower on the ipsilateral side than on the contralateral side before stenting; however, there were no significant differences in CBFV in the ipsi and contralateral middle cerebral artery (MCA). The median CBFV in the ipsilateral MCA increased significantly 3 d after the procedure and remained higher than the basal values after 3 months. CONCLUSIONS: We observed significant increases in the median CBFV and pulsatility index (PI) in the MCA bilaterally, especially on the stented side, measured 3 d and 3 months after stenting in patients with severe ICA stenosis.


Subject(s)
Carotid Stenosis , Blood Flow Velocity , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/surgery , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/surgery , Cerebrovascular Circulation , Humans , Magnetic Resonance Angiography , Middle Cerebral Artery/diagnostic imaging , Stents , Ultrasonography, Doppler, Transcranial
6.
Clin Neuroradiol ; 28(2): 245-252, 2018 Jun.
Article in English | MEDLINE | ID: mdl-27783127

ABSTRACT

BACKGROUND: The treatment strategy and the correct incidence of near occlusion (NO) of the internal carotid artery (ICA) is still controversial. In routine radiological imaging NO can easily be misdiagnosed as complete occlusion and there is no consensus on the standard treatment strategy. PURPOSE: To present our perioperative and long-term follow-up results of ICA NO patients treated with carotid artery stenting (CAS). MATERIAL AND METHODS: Between 2004-2014 a total of 182 patients with ICA NO were evaluated for CAS. The study included 132 male (72.5 %) and 50 female (27.5 %) patients with a mean age of 70.2 years. Patients underwent a clinical neurological evaluation and radiological imaging of the carotid arteries before the CAS procedure. Of the patients 80 (44 %) were asymptomatic. The median clinical and carotid Doppler ultrasound (DUS) follow-up period was 64 months (range 18-124 months). RESULTS: In 182 patients CAS were performed, 4 patients (2.2 %) developed minor stroke, 2 patients (1.1 %) developed myocardial infarction but no major stroke or death occurred in the following 30-day period. Asymptomatic restenosis was detected in seven patients (3.8 %) in the follow-up period. CONCLUSION: With sufficient neurological evaluation during pretreatment and posttreatment periods and when the procedure is performed with technologically developed products by an experienced interventional team, CAS is beneficial in patients with ICA NO.


Subject(s)
Carotid Artery, Internal , Carotid Stenosis/therapy , Endarterectomy, Carotid , Aged , Aged, 80 and over , Carotid Stenosis/complications , Female , Follow-Up Studies , Humans , Japan , Male , Middle Aged , Retrospective Studies , Stents , Stroke/etiology , Treatment Outcome
7.
Turk Neurosurg ; 2017 Jul 11.
Article in English | MEDLINE | ID: mdl-28944944

ABSTRACT

AIM: We report our experience with flow diverter devices in the treatment of intracranial aneurysms arising from anterior circulation with mid and long-term follow-up. MATERIAL AND METHODS: 78 aneurysms in 61 patients (range 25-81 years, 13 male, 48 female) were treated with flow diverter devices. 40 (51,3%) aneurysms were treated with pipeline embolization device (PED), 24 (30,8%) aneurysms were treated with SILK stent, 12(15,4%) aneurysms were treated with flow redirection endoluminal device (FRED) and two aneurysms were treated with P64 Flow Modulation Device (P64). Angiographic follow-up data at six month and one yea were recorded and the occlusion degrees of aneurysms were evaluated according to the scale which was formed by Kamran et al. RESULTS: At six month follow-up, complete occlusion (grade 4) rate was 60,8% and at one year increased to 74,3%. Statistical analysis revealed significant difference (p=0,002) between six month and one year follow-up results but there was no significant association (p=0,531, p=1,000) between aneurysm occlusion rate and aneurysm diameter. Two patient (3,2%) died due to hemorrhagic complication. CONCLUSION: Endovascular treatment of intracranial anterior circulation aneurysms with flow diverters is a safe and effective treatment option. A high rate of stable occlusion is achieved at long term follow-up.

8.
Cardiovasc Intervent Radiol ; 40(9): 1338-1343, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28477214

ABSTRACT

PURPOSE: This study was designed to present our preliminary experience with the Roadsaver® double-layer micromesh (DLM) stent in the endovascular treatment of supra-aortic and visceral aneurysms and to utilize the flow-diverting effect of this new design in the treatment of these aneurysms. METHODS: DLM stent (Roadsaver®, Terumo, Tokyo, Japan) was used in five patients (median age 61.8 years; three men) for treating arterial aneurysms (one common carotid artery, one vertebral artery V1 segment, one superior mesenteric artery, and two renal artery aneurysms). RESULTS: All stents were successfully deployed. Follow-up imaging with conventional catheter angiography or computed tomography showed successful treatment of all aneurysms. CONCLUSIONS: The new DLM stent appears to be promising for the treatment of supra-aortic and visceral aneurysms.


Subject(s)
Aneurysm, False/therapy , Aneurysm/therapy , Endovascular Procedures/instrumentation , Stents , Aged , Carotid Artery, Common , Equipment Design , Female , Humans , Japan , Male , Mesenteric Artery, Superior , Middle Aged , Renal Artery , Time Factors , Tomography, X-Ray Computed , Vertebral Artery , Viscera/blood supply
9.
Epilepsy Behav ; 63: 67-72, 2016 10.
Article in English | MEDLINE | ID: mdl-27566969

ABSTRACT

OBJECTIVE: This study aimed to investigate the efficacy of resective surgery in children with focal lesional epilepsy by evaluating the predictive value of pre- and postsurgical factors in terms of seizure freedom. METHODS: This study included 61 children aged between 2 and 18years who were admitted to the pediatric video-EEG unit for presurgical workup. Each patient was evaluated with a detailed history, video-EEG, neuroimaging, and postsurgical outcomes according to Engel classification to predict postsurgical seizure freedom. All the possible factors including history, etiology, presurgical evaluation, surgical procedures, and postsurgical results were analyzed for their predictive value for postoperative seizure freedom. RESULTS: Of the 61 patients, 75% were diagnosed as having temporal lobe epilepsy (TLE), and 25% were diagnosed with extra-TLE. Two years after the surgery, 78.6% were seizure-free, of which 89% had TLE, and 50% had extra-TLE (p<0.05). Patients were more likely to have a favorable outcome for seizure freedom if they had rare seizure frequency, focal EEG findings, and focal seizures; had a temporal epileptogenic zone; or had TLE and hippocampal sclerosis. On the other hand, patients were more likely to have unfavorable results for seizure freedom if they had younger age of seizure onset, frequent seizures before the surgery, a frontal or multilobar epileptogenic zone, secondarily generalized seizures, extra-TLE with frontal lobe surgery, or focal cortical dysplasia. SIGNIFICANCE: Resective surgery is one of the most effective treatment methods in children with intractable epilepsy. A history of young age of seizure onset, frequent seizures before surgery, secondarily generalized seizures, a multilobar epileptogenic zone, frontal lobe surgery, and focal cortical dysplasia (FCD) are the most important predictive factors indicating that a patient would continue having seizures after surgery. On the other hand, focal seizure semiologies, temporal lobe localization, and hippocampal sclerosis indicate that a patient would have better results in terms of seizure freedom.


Subject(s)
Epilepsies, Partial/surgery , Epilepsy, Temporal Lobe/surgery , Malformations of Cortical Development/surgery , Temporal Lobe/surgery , Adolescent , Child , Child, Preschool , Electroencephalography , Epilepsies, Partial/complications , Epilepsies, Partial/etiology , Epilepsy, Temporal Lobe/etiology , Female , Humans , Male , Malformations of Cortical Development/complications , Neuroimaging , Treatment Outcome
10.
Clin Respir J ; 10(6): 693-697, 2016 Nov.
Article in English | MEDLINE | ID: mdl-25773166

ABSTRACT

BACKGROUND AND AIMS: Hemoptysis in children is a rare but potentially life-threatening symptom of an underlying respiratory tract abnormality. Hemoptysis, when massive and untreated, has a mortality rate of more than 50%. With interventional radiological procedures and surgery, this rate has dropped to 7%-18%. The experience with bronchial arterial embolization in childhood is very limited; only a few case reports with short-term follow-up have been reported. METHODS: We report herein two patients with massive hemoptysis due to abnormal systemic arterial bleeding of the lung; neither patient had any lung or systemic disease. In both cases, the bleeding was controlled with endovascular embolization. The first case had bronchopulmonary arterial anastomosis and represents the first reported case with this anomaly. The second case had recurrent massive hemoptysis due to bronchial artery bleeding, and repeat embolization was performed. RESULTS: Both of these children had rare vascular anomalies without parenchymal lung disease and were treated successfully with bronchial arterial embolization. CONCLUSION: Massive hemoptysis due to abnormal systemic bleeding of the lung in the absence of parenchymal disease is an uncommon and severe symptom in childhood. Embolization can be a treatment option in children with abnormal vasculature bleeding and can be repeated safely when needed.


Subject(s)
Bronchial Arteries/abnormalities , Embolization, Therapeutic/methods , Hemoptysis/therapy , Angiography , Bronchial Arteries/diagnostic imaging , Child , Female , Hemoptysis/diagnostic imaging , Hemoptysis/etiology , Humans , Lung/blood supply , Male , Treatment Outcome
11.
Eur J Radiol ; 84(10): 2013-8, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26123843

ABSTRACT

INTRODUCTION: The knowledge of anatomic variations of the cerebral arterial circulation may be important to decide on the safest surgical or endovascular treatment method. Variations in the middle cerebral artery (MCA) territory seems to be less frequent than the other intracranial arteries. During the embryonic stage the primitive MCA is hypothesized to be made up of arterial twigs and these twigs will generate the definitive MCA at the end of the development stage. As in our cases, an early interruption in this period will prevent the evolution of MCA normally and a plexiform arterial network will create the M1 segment of MCA which is the so-called extremely rare unfused or twig-like (Uf/Tw) MCA variation. Our aim is to define and evaluate the angiographical features of Uf/Tw MCA. METHODS: The diagnosis of Uf/Tw MCA was evaluated in a total of 4855 diagnostic cerebral catheter angiograms, retrospectively. The coexisting intracranial pathologies were also interpreted with former radiological examinations. A review of the literature is provided. RESULTS: A total of six cases of Uf/Tw MCA was identified on angiograms accompanying ipsilateral internal carotid artery (ICA) occlusion and contralateral ICA supraclinoid segment aneurysm in one case, and cingulate gyrus AVM in the other. In two different cases, CT or MRI examinations revealed coexisting subarachnoid hemorrhage and misdiagnosis of forniceal AVM in one case, and temporal arachnoid cyst and parenchymal hematoma in the other. CONCLUSION: Lack of data and knowledge about the Uf/Tw MCA variation may cause misdiagnosis and unnecessary treatment attempts.


Subject(s)
Anatomic Variation , Middle Cerebral Artery/anatomy & histology , Adult , Carotid Artery, Internal/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Cerebral Angiography/methods , Diagnosis, Differential , Female , Gyrus Cinguli/blood supply , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Arteriovenous Malformations/diagnostic imaging , Magnetic Resonance Angiography/methods , Male , Middle Aged , Middle Cerebral Artery/diagnostic imaging , Retrospective Studies , Subarachnoid Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed/methods
12.
J Vasc Access ; 15(5): 418-23, 2014.
Article in English | MEDLINE | ID: mdl-25041914

ABSTRACT

PURPOSE: We report on the endovascular management of hemorrhage with stent-graft due to a misplaced central venous catheter in the vertebral artery (VA) during percutaneous internal jugular vein catheterization in a child. METHODS: A 16-year-old female was presented with the diagnosis of familial Mediterranean fever related chronic renal insufficiency. An attempt was made to place a central venous catheter via the right internal jugular vein without image guidance and the patient experienced dyspnea and pain at the catheter insertion site. Computerized tomography (CT) showed hemorrhage in the cervical region and upper mediastinum, also reformatted images showed that the catheter was passing through the proximal part of the VA and terminating in the right mediastinum. The catheter was removed during manual compression under angio-flouroscopic monitoring and ongoing extravasation was observed. A stent-graft was placed to the bleeding site of the VA. RESULTS: Angiography immediately after the stent-graft placement revealed complete disappearance of extravasation and patency of vertebral and subclavian arteries. CONCLUSION: Central venous catheterization (CVC) is not a risk-free procedure and arterial injuries are in a wide spectrum from a simple puncture to rupture of the artery. Inadvertent VA cannulation is a rare and serious complication necessitating prompt diagnosis and early treatment. If an arterial injury with a large-caliber catheter occurs, endovascular treatment with stent-graft seems to be a safe and effective option in terms of achieving hemostasis and preserving arterial patency. Recent findings suggest that endovascular management of inadvertent cervical arterial injury secondary to CVC seems to be the safest strategy.


Subject(s)
Angioplasty, Balloon , Blood Vessel Prosthesis Implantation , Catheterization, Central Venous/instrumentation , Catheters, Indwelling , Central Venous Catheters , Device Removal/adverse effects , Hemorrhage/surgery , Jugular Veins , Vascular System Injuries/surgery , Vertebral Artery/surgery , Adolescent , Angioplasty, Balloon/instrumentation , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Catheterization, Central Venous/adverse effects , Female , Hemorrhage/diagnosis , Hemorrhage/etiology , Humans , Jugular Veins/diagnostic imaging , Radiography, Interventional , Stents , Tomography, X-Ray Computed , Treatment Outcome , Vascular System Injuries/diagnosis , Vascular System Injuries/etiology , Vertebral Artery/diagnostic imaging , Vertebral Artery/injuries
13.
Turk Kardiyol Dern Ars ; 42(4): 389-94, 2014 Jun.
Article in Turkish | MEDLINE | ID: mdl-24899485

ABSTRACT

A 53-year-old female patient was admitted with dyspnea and fatigue. On transthoracic echocardiography, systolic pulmonary artery pressure (PAP) was measured as 90 mmHg, and right heart catheterization revealed pulmonary arterial hypertension. Pulmonary angiography demonstrated bilateral pulmonary artery stenosis, and the diagnosis was determined as Takayasu arteritis. Balloon angioplasty was performed under corticosteroid and immunosuppressive treatment. In this case report, we describe a patient in whom bilateral pulmonary artery stenosis developed due to Takayasu arteritis, and we discuss the patient in light of the current literature.


Subject(s)
Coronary Restenosis/diagnosis , Hypertension, Pulmonary/diagnosis , Takayasu Arteritis/diagnosis , Angioplasty, Balloon , Coronary Restenosis/complications , Coronary Restenosis/therapy , Diagnosis, Differential , Dyspnea , Echocardiography, Transesophageal , Fatigue , Female , Humans , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Middle Aged , Stents , Takayasu Arteritis/complications , Takayasu Arteritis/therapy
14.
Diagn Interv Radiol ; 18(1): 87-91, 2012.
Article in English | MEDLINE | ID: mdl-21305467

ABSTRACT

PURPOSE: Vascular access device fragment embolization is a relatively rare but potentially serious complication. The purpose of this study was to report our experience with endovascular retrieval of embolized vascular access device fragments by interventional radiological means. MATERIALS AND METHODS: Ten patients with a vascular access device fragment embolism were treated between 2004 and 2010. Attempted retrieval from the vascular bed was performed for five port catheter fragments, two temporary catheter fragments and three guide wires. The demographic data, underlying disease of the patients, type of inserted catheters, interval between implantation and discovery of embolism, interval between discovery of embolization and retrieval and localization and length of the embolized fragments were identified from the patient charts. RESULTS: In nine of the ten patients (90%), radiologic intervention retrieval of the embolized vascular access device fragments was successful. The reasons for intravascular fragment embolism consisted of rupture at the connection site of the chamber or the external hub and the intravascular catheter (n=4), pinchoff syndrome (n=3), operator inexperience (n=3). Embolized catheter fragments or guide wires were retrieved under fluoroscopy by a gooseneck snare. The postprocedural course was uneventful. CONCLUSION: The radiological retrieval of embolized vascular access device fragments is the preferred method, and it has a high success rate. Considering the potential for devastating complications, patients should be referred to interventional radiology, and the embolized catheters should be retrieved using interventional endovascular techniques.


Subject(s)
Catheters, Indwelling/adverse effects , Device Removal/methods , Embolism/etiology , Embolism/surgery , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/surgery , Radiography, Interventional , Adult , Aged , Aged, 80 and over , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Retrospective Studies
15.
Turk Neurosurg ; 19(4): 380-6, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19847759

ABSTRACT

AIM: Endothelin-1 (ET-1) has been implicated in the pathophysiology of cerebral vasospasm. Chloride (Cl-) channels exist in vascular smooth muscle and activation of these channels leads to depolarization and contraction. The aim of the present study was to test the effect of 5-nitro-2-(3-phenylpropylamino)-benzoate (NPPB), a Cl- channel antagonist, on the ET-1-induced cerebral vasospasm in rabbit basilar artery and thus investigate the contribution of Cl- channels. MATERIAL AND METHODS: Thirty rabbits were divided into five groups and received intra-arterial injection of isotonic saline (Group I, n=6), ET-1 (group II, n=6), ET-1 plus NPPB (Group III, n=6), dimethylsulfate (DMSO4) (Group IV, n = 6) and NPPB (Group V, n=6). Pre and post injection basilar artery diameters were measured in each group and transmission electron microscopic investigations on basilar arteries were performed. RESULTS: The mean pre-injection and post-injection vessel diameters were 0.8833 mm and 0.7000 mm in ET-1 group, 0.6833 mm and 0.8500 mm in ET-1 + NPPB group. NPPB administered prior to ET-1 injection, prevented the ET-1-induced vasoconstriction. Additionally, NPPB prevents the ET-1 induced changes in vessel wall and neurons in the brain stem. CONCLUSION: The results of this study add further insights to our armamentarium against cerebral vasospasm.


Subject(s)
Angiogenesis Inhibitors/pharmacology , Nitrobenzoates/pharmacology , Vasoconstriction/drug effects , Vasospasm, Intracranial/drug therapy , Animals , Basilar Artery/diagnostic imaging , Basilar Artery/drug effects , Basilar Artery/ultrastructure , Cerebral Angiography , Chloride Channels/antagonists & inhibitors , Chloride Channels/metabolism , Endothelin-1/toxicity , Female , Male , Microscopy, Electron, Transmission , Muscle, Smooth, Vascular/drug effects , Muscle, Smooth, Vascular/metabolism , Muscle, Smooth, Vascular/pathology , Neurons/pathology , Neurons/ultrastructure , Rabbits , Vasoconstriction/physiology , Vasospasm, Intracranial/chemically induced , Vasospasm, Intracranial/diagnostic imaging
16.
Diagn Interv Radiol ; 15(3): 215-20, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19728271

ABSTRACT

PURPOSE: To review our experience with embolic materials used in the selective arterial embolization of high-flow priapism and present the results of long-term follow-up. MATERIALS AND METHODS: Eight patients with traumatic high-flow priapism were reviewed. The patients were evaluated with clinical findings, laboratory examinations, and imaging findings including color Doppler ultrasonography and angiography. Diagnostic angiography demonstrated a connection between the cavernosal artery and the corpus cavernosum. Fistulas were embolized using autologous blood clot, polyvinyl alcohol particles, detachable coils, or acrylic glue. One or more procedures per patient were needed to achieve success. RESULTS: Eleven embolization procedures were performed in eight patients. Immediate resolution of priapism was obtained after the procedures. Three patients (37.5%) had recurrence of priapism in the subsequent 1-3 weeks and required a repeat procedure. After the final procedures, all patients had complete resolution of priapism. Normal recurrence of erectile function was obtained in six of the patients (75%) after the final embolization. CONCLUSION: Selective arterial embolization is a useful therapeutic option in the management of patients with high-flow priapism. Various materials can be used successfully as embolizing agents in the procedures according to the patient's status.


Subject(s)
Embolization, Therapeutic/methods , Priapism/diagnostic imaging , Priapism/therapy , Adult , Aged , Angiography , Child, Preschool , Humans , Iliac Artery/diagnostic imaging , Male , Penile Diseases/diagnostic imaging , Penile Diseases/therapy , Penile Erection , Penis/blood supply , Penis/diagnostic imaging , Recurrence , Retrospective Studies , Ultrasonography , Young Adult
17.
J Cardiol ; 54(2): 317-21, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19782273

ABSTRACT

Coronary artery fistulae are very rare congenital anomalies which constitute 0.2-0.4% of all congenital heart diseases. The right chambers of the heart are the most frequent communication site of the coronary fistulae and may cause hemodynamic impairment in the coronary circulation. The fistulae arise frequently from right coronary and left anterior descending arteries. Fistulae from left circumflex artery are very rare. We report a case in which transcatheter embolization was performed with 3-mm Guglielmi detachable coils in a young adult with a rare type of congenital fistula originating from the circumflex artery and draining into the coronary sinus.


Subject(s)
Arteriovenous Fistula/therapy , Coronary Sinus/abnormalities , Coronary Vessel Anomalies/therapy , Embolization, Therapeutic/methods , Adult , Embolization, Therapeutic/instrumentation , Humans , Severity of Illness Index , Treatment Outcome
18.
Surg Today ; 38(2): 166-9, 2008.
Article in English | MEDLINE | ID: mdl-18239879

ABSTRACT

Wegener's granulomatosis (WG) is a systemic necrotizing vasculitis of unknown etiology characterized mainly by the involvement of the upper airways, lungs, and kidneys. Although most organ systems can be involved, gastrointestinal involvement in WG is notably uncommon. We herein present the case of a WG patient who developed two massive gastrointestinal hemorrhages treated respectively by surgery and angiographic embolization of the bleeding artery. The present case indicates that gastrointestinal manifestations might thus be considered in the natural history of WG.


Subject(s)
Colonic Diseases/etiology , Granulomatosis with Polyangiitis/complications , Jejunal Diseases/etiology , Adult , Colonic Diseases/therapy , Embolization, Therapeutic , Gastrointestinal Hemorrhage/etiology , Humans , Jejunal Diseases/surgery , Male
19.
Adv Ther ; 24(3): 639-47, 2007.
Article in English | MEDLINE | ID: mdl-17660175

ABSTRACT

A 24-y-old male patient underwent elective open cholecystectomy at another center. On the third postoperative day, he developed fever and jaundice, for which he underwent reoperation at the same center on the seventh postoperative day. During the second surgery, massive bleeding was encountered, suture ligations were applied, and T-tube drainage was performed. After the surgery was completed, the patient developed hepatic microabscess, and sepsis ensued. The patient presented at this hospital for further evaluation. To rule out vascular injury, which was suspected in this patient, celiac angiography was performed; it showed that the hepatic artery was occluded near the eminence of the gastroduodenal artery, and the liver was supplied by many collaterals. After the patient's condition had stabilized and the sepsis had resolved, Roux-N-Y hepaticojejunostomy was performed on the 59th d after admission.


Subject(s)
Cholecystectomy/adverse effects , Hepatic Artery/injuries , Hepatic Duct, Common/injuries , Multiple Trauma/etiology , Adult , Humans , Jaundice/etiology , Jaundice/surgery , Liver Abscess/etiology , Liver Abscess/surgery , Male , Multiple Trauma/diagnosis , Multiple Trauma/surgery , Postoperative Period , Plastic Surgery Procedures/methods , Reoperation
20.
Diagn Interv Radiol ; 12(4): 174-6, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17160799

ABSTRACT

The most common causes of intracranial air are head trauma and neurosurgical procedures. Less common etiologies include infection due to gas-forming organisms, mucoceles, tumours, congenital neuroenteric cysts, and dural defects. Here, we present a case of a frontal sinus osteoma associated with longstanding pneumocephalus.


Subject(s)
Frontal Sinus , Osteoma/diagnosis , Paranasal Sinus Neoplasms/diagnosis , Adult , Diagnosis, Differential , Headache/etiology , Humans , Male , Osteoma/complications , Osteoma/diagnostic imaging , Osteoma/pathology , Osteoma/surgery , Paranasal Sinus Neoplasms/complications , Paranasal Sinus Neoplasms/diagnostic imaging , Paranasal Sinus Neoplasms/pathology , Paranasal Sinus Neoplasms/surgery , Pneumocephalus/etiology , Tinnitus/etiology , Tomography, X-Ray Computed
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