Management of endograft infections.

Endovascular abdominal aortic aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR) have become well-accepted alternatives to traditional open surgery because of the diminished perioperative complications. Aortic stent-graft infection is an uncommon complication and little is known about the general features of and potential risk factors for aortic stent-graft infection, and treatment is administered on a case-by-case basis with no consensus guidelines. Despite a low infection rate, the associated mortality rates are extremely high and the morbidity rate, even with aggressive surgical interventions, is also high. Since 1991 only 117 cases of thoracic and abdominal endograft infections have been reported in the literature. This paper presents a detailed analysis of the features of all cases reported to date and reviews the epidemiology, diagnosis, management, and outcomes of thoracic and abdominal endograft infections.

Percutaneous balloon angioplasty of renovascular hypertension in pediatric cases.

PURPOSE: To investigate effectiveness of percutaneous transluminal renal angioplasty (PTRA) in treatment of renal artery stenoses due to Takayasu arteritis (TA), fibromuscular dysplasia (FMD) and neurofibromatosis (NF). MATERIALS-METHODS: Between December 1991-October 2006, 20 pediatric cases (age range 3-18 years, meanly 12.5 year) with at least 60% stenoses were underwent PTRA. Main presenting symptom was hypertension. The aetiologies were TA in 12, and FMD in 5, NF in three cases. RESULTS: Totally, 46 procedures were performed on 35 stenotic segments of 20 cases. A technically good result was obtained in 21/24 arteries of TA patients, 7/7 arteries of FMD patients, and 1/3 arteries of NF1 patients. Clinical followup for a mean of 55.7 months revealed 100% success in all cases. Delayed clinical response was seen in two cases with NF1. Restenosis was detected 5/12 of TA patients, 1/5 of FMD patients and 1/3 NF1 patients. CONCLUSION: PTRA can be safely performed resulting in excellent angiographic and clinical results. It should be first choice in renal artery stenosis in pediatric age when medical treatment fails to control renovascular hypertension or renal function is decreasing although initial results might be not encouraging in NF1.

Dissection of the abdominal aorta in a child with Takayasu's arteritis.

Takayasu's arteritis is a chronic inflammatory disease that primarily involves the aorta and its main branches. Varying degrees of narrowing, occlusion, or dilatation develop in the involved vessel segments. However, dissection of the aorta is quite rare in this disease, and it may develop particularly after angioplasty. We report a very rare case of Takayasu's arteritis with dissection of the abdominal aorta just distal to the origin of the inferior mesenteric artery in a 9-year-old girl. She was treated conservatively with close follow-up. At the end of 1 year's follow-up, the dissection of the aorta did not show progression, and new lesions were not identified. To our knowledge, this patient is the youngest child presented with arterial dissection as the initial manifestation of the disease.

Computed tomography-guided percutaneous catheter drainage of primary and secondary iliopsoas abscesses.

AIM: To report our experience with computed tomography (CT)-guided percutaneous catheter drainage (PCD) of iliopsoas abscesses. MATERIALS AND METHODS: Twenty-two iliopsoas abscesses in 21 patients (11 women, 10 men) aged between 18 and 66 years (mean 36 years) were treated with PCD. Abdominal CT demonstrated the iliopsoas abscesses, which were definitively determined by Gram staining and aspirate cultures. Twenty of the 22 iliopsoas abscesses were primary and two were secondary. All PCD procedures were performed under local anaesthesia using a single-step trocar technique (n=19) or Seldinger technique (n=3). RESULTS: PCD was an effective treatment in 21 out of the 22 iliopsoas abscesses. Recurrence was seen in three abscesses as minimal residual collections. Two of them resolved spontaneously with anti-tuberculous regimen. One required percutaneous needle aspiration. The procedure failed in a diabetic patient with a secondary abscess, who died due to sepsis. The length of time that catheters remained in place ranged from 21 to 75 days (mean 59.7 days). Complications included catheter dislocation in four abscesses, which required removal of dislocated catheters and indwelling new ones. CONCLUSION: CT-guided PCD is a safe and effective front-line treatment of iliopsoas abscesses. Surgery should be reserved for failure of PCD and presence of contraindications to PCD.

Emergency endovascular embolization of traumatic intrarenal arterial pseudoaneurysms with N-butyl cyanoacrylate.

AIM: The aim of this study is to report the effectiveness of selective endovascular embolization with N-butyl cyanoacrylate (NBCA) in the treatment of traumatic intrarenal arterial pseudoaneurysms. MATERIALS AND METHODS: Five patients (four males and one female) presented with massive haematuria. Five pseudoaneurysms were detected angiographically, and in all of the cases the aetiology was penetrating trauma. The pseudoaneurysms ranged in size between 7 and 30 mm (mean: 13.8 mm). After the superselective catheterization with a microcatheter-microguidewire system, embolization was performed using NBCA and Lipiodol mixture. RESULTS: All the pseudoaneurysms were successfully embolized and excluded from the circulation without any other major intrarenal arterial branch occlusion. There were no major or minor complications related to the embolization procedures. Haematuria ceased in 1-3 days after the embolization, and during the follow-up period both re-bleeding and deterioration of renal function did not occur. CONCLUSION: The endovascular management of renal artery branch pseudoaneurysms by embolization with NBCA is a reasonable and an effective therapeutic technique.

Enteroclysis findings of intestinal Behcet disease: a comparative study with Crohn disease.

BACKGROUND: The aim of this study was threefold; to define the enteroclysis (EC) findings of intestinal involvement in Behcet disease (BD), to compare these findings with those seen in Crohn disease (CD), and to determine the relation between the duration of BD and severity of the EC findings. METHODS: From 1997 to 2000, 17 BD and 50 CD cases were examined by EC examination. EC was performed with a 13-F balloon catheter via transnasal entubation. Mucosal and mural changes were evaluated. Statistical analysis was performed with the Mann-Whitney U test to determine the relation between duration of BD and severity of the EC findings. P

Endovascular management of postpartum massive vaginal bleeding. A case presenting with a pseudoaneurysm following subtotal hysterectomy.

In the management of massive vaginal bleeding resulting from obstetrics and gynecological diseases, the percutaneous endovascular embolization procedures have been widely used in recent years. We report a case of massive vaginal hemorrhage due to arterial pseudoaneurysm formation following postpartum subtotal hysterectomy which was successfully treated via the percutaneous endovascular embolization.

Percutaneous embolization in the management of intractable vaginal bleeding.

AIM: To assess the effectiveness of arterial embolization in gynecological malignancies by Polyvinyl Alcohol particles. MATERIAL AND METHODS: Six patients, four with cervix carcinoma, one endometrium carcinoma, and one vaginal metastasis of ovarian carcinoma underwent percutaneous embolization due to intractable vaginal bleeding. As an embolic agent PVA particles were used. RESULTS: Cessation of the bleeding was observed immediately after the embolization. Complete embolization has been achieved in all the patients Recurrent bleeding did not occur in any of the cases. There were no complications related to the embolization procedure. CONCLUSION: Transarterial embolization is a lifesaving procedure in treating intractable vaginal bleeding. PVA particles are effective and it is a simple way in ceasing the hemorrhage due to pelvic malignancies.

Color Doppler ultrasound in subclinical varicocele: an attempt to determine new criteria.

OBJECTIVE: The aim of this study is to determine new criteria in the diagnosis of subclinical varicocele in infertile patients. METHODS: A total of 208 testes in 104 patients who were infertile and had no varicocele on physical examination were studied by color Doppler ultrasonography (CDUS) with classical and new criteria. Population proportion difference test was used to compare two methods. RESULTS: One hundred and fourteen testes were accepted as varicocele negative in the same testes units in both methods. Ninety-four testes were varicocele positive with new criteria while 88 of these 94 testes were diagnosed also varicocele positive with the classical criteria. The value of Z* with population proportion difference test was 0.59 which is less than 1.96, which means the proportion of varicocele detection in two methods did not differ. CONCLUSION: Because a gold standard that defines the presence of a subclinical varicocele has not yet been established, new criteria may be needed. However, our new criteria did not add new information to the diagnosis of subclinical varicocele in infertile patients.

Spontaneously regressing infundibular cyst: a case report.

A 74-year-old man reported headaches and blurring of vision for 1 month. MRI showed a nonenhancing infundibular cyst. Neurologic findings, blood and cerebrospinal fluid examinations, and chest and abdominal CT were all normal. MRI 4 months later showed no change. The patient was without any medication other than simple analgesics. One year later, the stalk had returned to its normal size and configuration on MRI.

Traumatic intracranial carotid tree aneurysms.

OBJECTIVE: This study was designed to elucidate the requirements for angiographic evaluation in blunt head injuries, the timing of angiography, and the selection of appropriate therapeutic approaches. METHODS: Twelve cases of traumatic aneurysms (TAs) in the intracranial carotid tree were analyzed in this study. Neurological examination results, computed tomographic scans, pre- and postembolization cerebral angiograms, and follow-up data were included. RESULTS: In 11 of 12 cases, TAs were of cranial base origin; in 1 case, the aneurysm was located in the distal anterior cerebral artery. In seven of the cases with cranial base lesions, aneurysms were located in the intracavernous segment of the internal carotid artery; all of the computed tomographic scans for these cases demonstrated sphenoid sinus wall fractures and hematoma in the sphenoid sinus. In two cases, although the initial angiograms revealed no lesions, a second study performed 2 weeks later demonstrated the presence of aneurysms. Nine of the aneurysms were treated with endovascular techniques, two were managed conservatively, and the remaining one patient died with massive epistaxis while awaiting surgical treatment. No morbidity or additional permanent neurological deficits occurred in the endovascularly treated patient group. CONCLUSION: Patients with head trauma who present with sphenoid sinus fractures and massive epistaxis should be evaluated for the development of TAs as soon as possible. If the patients exhibit fractures without epistaxis, angiography should be deferred for 2 to 3 weeks; if the first angiographic evaluation reveals normal findings, repeated epistaxis should prompt a second angiographic evaluation. Current treatment of TAs involves occlusion of the main artery through the use of endovascular techniques. Cases involving internal carotid artery TAs of cranial base origin and patients who do not tolerate test occlusion require extracranial-to-intracranial bypass surgery.