A double shunt technique for the prevention of ischaemia of a congenital, solitary, pelvic kidney during abdominal aortic aneurysm repair: a case report.

INTRODUCTION: Congenital solitary pelvic kidney is a rare condition, and its association with an abdominal aortic aneurysm is even more unusual. To the best of our knowledge, only two such cases have been reported in the literature to date. CASE PRESENTATION: We report the case of a 59-year-old Caucasian man with a congenital solitary pelvic kidney, who was found to have an abdominal aortic aneurysm 83 mm in diameter. Abdominal computed tomography angiography clearly identified two renal arteries, one originating from the aortic bifurcation. and the other from the proximal portion of the right common iliac artery. At surgery, renal ischaemia was prevented by introduction of an axillofemoral shunt (consisting of two femoral cannulas and a vent tube of extracorporeal circulation) from the right axillary to the right femoral artery, and a second Argyle shunt from the right common iliac artery to the origin of the left renal artery. A 20 mm Dacron tube graft was then implanted. Our patient's postoperative renal function was normal. CONCLUSION: The renal preservation double shunt technique used in this case seems to be effective during abdominal aortic aneurysm repair.

Atypical chest pain: coronary, aortic, and pulmonary vasculature enhancement at biphasic single-injection 64-section CT angiography.

PURPOSE: To prospectively evaluate the enhancement of coronary, pulmonary, and thoracic aortic vasculature by using biphasic single-acquisition 64-section computed tomographic (CT) angiography and to prospectively evaluate if differences in right side of the heart and coronary venous enhancement interfere with interpretation of coronary arteries. MATERIALS AND METHODS: With internal review board approval and HIPAA compliance, 50 patients (16 men, 34 women; mean age, 51.5 years; range, 30-75 years) with atypical chest pain were referred from the emergency department and were imaged with a 64-section CT scanner after premedication with oral atenolol and/or intravenous metoprolol. Thoracic CT angiography with retrospective gating was subsequently performed with a single biphasic injection of 130 mL of iso-osmolar contrast material (100 mL at 5 mL/sec and 30 mL at 3 mL/sec) in caudal-to-cranial acquisition. Coronary, aortic, and pulmonary arterial attenuation values were obtained. Coronary venous and right atrial enhancement were evaluated to assess whether there was interference with coronary artery evaluation. A two-tailed Friedman test was used to evaluate differences among segments within each artery. RESULTS: Mean coronary arterial, pulmonary arterial, and aortic attenuation values were significantly higher than the 250-HU threshold (P < .05). Mean pooled coronary arterial (288.9 HU +/- 64.8), pulmonary arterial (316.4 HU +/- 79.9), and aortic (329.9 HU +/- 63.3) attenuation values were significantly higher than the 250-HU threshold (P < .0001). Coronary venous enhancement did not affect depiction or interpretation of coronary arteries. Right atrial streak artifact focally traversed the right coronary artery in only one study. CONCLUSION: The aforementioned thoracic CT angiographic protocol provides enhancement of coronary, aortic, and pulmonary vasculature in a single breath hold without interference from right side of the heart streak artifact or coronary venous enhancement.

Covered stents to treat partial recanalization of onyx-occluded giant intracavernous carotid aneurysm.

PURPOSE: To present the application of a covered stent for the management of a left internal carotid artery (ICA) aneurysm that had recanalized following embolization with Onyx. CASE REPORT: A 54-year-old man had a giant intracavernous aneurysm of the left ICA successfully occluded with Onyx. Recurrence of symptoms 5 months later prompted control angiography, which showed partial recanalization of the aneurysm. The aneurysm neck was successfully sealed by placing 2 polytetrafluoroethylene-covered stents across it. Control angiography performed at 12 months after stent placement showed no stenosis or signs of recanalization of the aneurysm. CONCLUSIONS: Recanalization of giant intracavernous carotid aneurysms post-Onyx treatment may be safely treated with placement of covered stents across the aneurysm neck.

Percutaneous management of extensive clot trapped in a temporary vena cava filter.

PURPOSE: To present percutaneous management of extensive clot trapped in a temporary inferior vena cava (IVC) filter. CASE REPORT: A 20-year-old man with a large sacral tumor and left external iliac vein thrombosis had a wire-mounted Günther temporary filter (GTF) prophylactically placed in the infrarenal IVC prior to tumor resection. The 7-day postsurgical venogram prior to filter removal showed extensive clot trapped by the filter, as well as interval cephalic migration, with the filter tip now at the level of the renal veins. A Günther Tulip MReye (GTM) filter was deployed but not released above the renal veins to prevent clot migration during caudal withdrawal of the wire-mounted GTF. After creating enough space in the infrarenal IVC, the GTM was repositioned and fully released with its apex now below the renal veins. The GTF was then uneventfully removed. There was no clinical evidence for significant pulmonary embolism 12 months after placement. CONCLUSIONS: Cephalic migration of a clotted temporary IVC filter can be managed with intraprocedural protection against pulmonary embolism by first deploying a Günther Tulip filter above the renal veins, with subsequent advancement below the renal veins before temporary filter removal.

Contrast-enhanced three-dimensional MR angiography of the pulmonary vascular tree.

Contrast-enhanced three-dimensional MR angiography has evolved into a promising technique in the study of the pulmonary vasculature. Both congenital and acquired entities can be now morphologically demonstrated in a non-invasive manner obviating the need for conventional pulmonary angiography. Due to spatial resolution limitations, however, it is still premature to routinely apply the method in the detection of small subsegmental emboli, in cases of suspected pulmonary embolism, and further technical developments will be required. In this paper we present a spectrum of congenital and acquired disorders affecting the pulmonary vascular tree as demonstrated with contrast-enhanced three-dimensional MR angiography.