[Atypical course of cervical vessels--2 case reports]. / Atypischer Verlauf der zervikalen Gefässe--2 Kasuistiken.

BACKGROUND: The atypical course of cervical arteries can be reason for vascular complications including stroke and persistent neurological deficits in surgery in the cervical region. METHODS: Computed tomography and magnetic resonance imaging including angiographic procedures such as contrast enhanced magnetic resonance angiography are suitable to detect atypical course of cervical arteries. RESULTS: The two cases demonstrate rare variants of atypical course of cervical arteries detected by computed tomography and magnetic resonance imaging including contrast enhanced magnetic resonance angiography. The knowledge of these variants is important for planning of surgical intervention. CONCLUSIONS: Modern imaging techniques such as computed tomography and magnetic resonance imaging including contrast enhanced magnetic resonance angiography should be used for detection of suspected variants in the course of cervical arteries. The relevant structures and the abnormalities can be clearly defined.

[Stent PTA in secondary symptomatic proximal subclavian artery obstruction]. / Stent-PTA bei sekundär symptomatischen proximalen Subclaviaobstruktionen.

Stent-PTA of secondary symptomatic proximal subclavian artery stenosis In comparison with conventional surgical revascularisation, percutaneous transluminal angioplasty (PTA) is an alternative treatment for short stenoses or occlusions involving the origin of the subclavian artery. If there is clinical suspicion of subclavian artery obstruction (e.g. blood pressure difference in both arms), digital subtraction angiography of the aortic arch and upper limb should be performed prior to creating radial haemodialysis shunts or coronary bypass crafting involving the internal mammary artery. PTA and stenting can be successfully carried out in symptomatic secondary proximal subclavian artery stenosis, e.g. in radial haemodialysis fistulas with distal ischaemia.

[Veno-occlusive dysfunction as a cause of erectile impotence: therapy of venous leak with retrograde embolization of the internal pudendal vein]. / Venookklusive Dysfunktion als Ursache der erektilen Impotenz: Therapie des venösen Lecks durch retrograde Embolisation der V. pudenda interna.

"Venous leak impotence" remains a therapeutic challenge as long term success rates with all interventions are only 50%. Surgical venous ligation is a well established procedure, yet not all pathological venous groups can always be occluded. Retrograde embolisation of angiographically identified pathological venous groups represent a promising alternative to surgical isolation and antegrad embolisation of deep dorsal penile veins. Four young men (19-42 years) presented with complete loss of erection. Vaginal intercourse was impossible. Pharmaco-duplex sonography with Prostaglandin E, 10-20 micrograms demonstrated normal arterial flow in all 4 penile arteries but even after intra-cavernosoal injection of Prostaglandin E, 20 micrograms no complete erection was achieved. Dynamic infusion cavernosometry showed increased maintenance flow. Cavernosography showed a venous leak involving the deep dorsal penile vein in all four cases. Embolisation was carried out via the femoral vein by coaxial technique using Histoacryl-Lipiodol solution in order to embolise all angiographically identified insufficient veins. At one year follow up all 4 patients still achieved spontaneous erections without any additional medical treatment.