Coil Embolization of True, Common and Proper, Hepatic Artery Aneurysms: Technique, Safety and Outcome.

PURPOSE: To retrospectively assess the safety and efficacy of coil embolization for catheter-directed true common and proper hepatic artery aneurysm exclusion. MATERIALS AND METHODS: Nine consecutive patients (2005-2021) in two university centers presenting with true common and proper hepatic artery aneurysms (> 2 cm in diameter) were treated with 'frontdoor-backdoor' coil embolization. Patients presenting with a hepatic artery pseudoaneurysm, mycotic aneurysm or patients with small (< 2 cm diameter) aneurysms and followed up by imaging were excluded. Technical and clinical success was defined as complete coil-exclusion of the aneurysm on completion angiography and absence of post-embolization adverse events, in particular mass effect or hemorrhage, respectively. Patient characteristics, technical and clinical success, liver function tests and follow-up results were assessed based on the patients' electronic medical records. RESULTS: Technical and 30-day clinical success was achieved in all procedures (100%). No major procedural complications were reported. Liver function test values were available in 6/9 patients, showing transient elevation of bilirubin in one patient. No end organ ischemia was reported. The mean clinical follow-up period of the study patients was 72 months (12-168 months). Long-term stable occlusion of the hepatic aneurysms was achieved in 9/9 patients (100%). One patient showed late complication (3 years) with coil migration into a bulbar ulcer, without aneurysm recanalization, however with fatal outcome. CONCLUSION: Coil embolization for the endovascular exclusion of true common and proper hepatic artery aneurysms is safe and effective.

Transjugular intrahepatic portosystemic shunt placement for symptomatic non- bleeding anorectal varices in nodular regenerative hyperplasia.

In this paper we present the case of a male 55-year old patient with known ulcerative colitis and nodular regenerative hyperplasia, a rare form of noncirrhotic portal hypertension. He presented four visits to the emergency department with rapidly progressive anal discomfort. After two weeks a transjugular intrahepatic portosystemic shunt was placed using the gun-sight technique with immediate relief of the unbearable anal pain and pressure. To our knowledge, this is the first case where transjugular intrahepatic portosystemic shunt placement is applied for non- bleeding, congestive anorectal varices.

Malignant peritoneal mesothelioma: contribution and limitation of imaging for its diagnosis.

Malignant mesothelioma of the peritoneum is a rare primary peritoneal tumor with a pore prognosis. The overall prevalence is one to two cases per million. The tumor arises from mesothelial cells in the pleura or, in this case, peritoneum. Peritoneal malignant mesotheliomas account for only 10 to 20% of all malignant mesotheliomas. Exposure to asbestos fibers is a known risk factor for the development of mesothelial tumors. Although imaging features can be suggestive of malignant peritoneal mesothelioma, histologic examination of tissue with specific immunohistologic markers are mandatory for diagnosis.

Outcome of carotid artery stenting at 2 years follow-up: comparison of nitinol open cell versus stainless steel closed cell stent design.

AIM: The aim of this study was to compare the clinical and ultrasound outcome of carotid artery stenting at 2-year follow-up in patients treated with open-cell nitinol stents versus patients treated with closed cell stainless steel stents. METHODS: This was a non-randomized, retrospective study including 123 patients in whom 132 carotid stent-procedures were performed. Nine patients were treated bilaterally. All patients presented with severe asymptomatic (80%) or symptomatic (>70%) carotid artery stenosis and were treated by carotid angioplasty and stent placement with or without filter embolic protection system. Follow-up consisted of physical evaluation at 1, 6, 12 and 24 months and assessment of the stent patency by ultrasound examination at 6, 12 and 24 months after the stent procedure. RESULTS: In 72 procedures a closed cell stainless steel stent was implanted, in the remaining 60 procedures an open cell nitinol stent was placed. In 8 patients with a stainless steel stent (11%) and in 6 patients with a nitinol stent (10%) a stroke occurred during the follow-up period (P=0.79). Ultrasound examination revealed an in-stent restenosis of 50% to 80% in the stainless steel group (N.=9, 15%) and in the nitinol group (N.=10, 17%) (P=0.7). CONCLUSIONS: At 2-year follow-up after carotid artery stenting, there is no difference in clinical outcome or in stent patency among patients treated with open versus closed cell design stents. Subsequently the type of carotid stent design does not seem to impact the overall midterm outcome after carotid artery stenting.

Jaw fixation as the key to diagnosis of fibrodysplasia ossificans progressiva.

Fibrodysplasia ossificans progressiva is a very rare and disabling hereditary disorder of connective tissue characterised by symmetric congenital anomalies of the great toes and thumbs and by progressive heterotopic ossification of tendons, ligaments, fasciae and striated muscles. In this case we report a 17-year-old boy who presented with a painful swelling of the right mandibula with trismus. Multiple heterotopic soft tissue calcifications, severe scoliosis and typical anomalies of toes and thumbs on the radiographs were pathognomonic for fibrodysplasia ossificans progressiva.

Fibrolamellar hepatocellular carcinoma in a 65-year-old woman: CT features.

A 65-year old woman with recurrent deep vein thrombosis underwent a CT scan of the upper abdomen for detection of underlying malignancy. A fibrolamellar hepatocellular carcinoma with extrahepatic subdiaphragmatic satellite lesion was found. This uncommon tumor has distinct clinical, pathological, radiological and prognostic features and therefore it is important to distinguish it from benign liver tumors, especially FNH, and from other malignant liver tumors such as conventional HCC. Though the tumor characteristically occurs in younger patients, our case proves that older patients can also be affected.