Role Of Renal Artery Embolization In Treatment Of Iatrogenic Renal Bleeding.

Objectives: To review institutional experience about the effectiveness and safety of percutaneous trans-arterial renal artery embolization in the treatment of iatrogenic renal bleeding. Method: The prospective study was conducted from December 2019 to December 2021 at Ain Shams University Hospital and Kafrelsheikh University Hospital, Egypt, and comprised patients of either gender who underwent renal artery embolization for iatrogenic arterial renal bleeding caused by percutaneous nephrolithotomy, renal biopsy and percutaneous nephrostomy. Diagnostic renal angiography was done to detect pseudoaneurysm and arteriovenous fistula. Embolization was done with either micro-coils or glue. Success of the procedure was defined astotal occlusion of the bleeding artery proved by post-embolization angiogram. RESULTS: Of the 15 patients, 9(60%) were males and 6(40%) were females. The overall mean age was 35+/-14 years. Percutaneous nephrolithotomy was the main cause 8(53.3%), followed by renal biopsy 5(33.3%) and percutaneous nephrostomy 2(13.2%). There were 9(50%) cases of pseudoaneurysm and 6(40%) of arteriovenousfistula. Embolization was done with micro-coils in 5(33.3%) cases and with glue in 10(66.6%). The technical success rate was 15(100%). No major complicationsrequiring intensive care orsurgical intervention were encountered, and there was no significant differences in estimated glomerular infiltration rate or renal function after renal artery embolization (p>0.05). CONCLUSIONS: Percutaneous endovascular renal artery embolization was found to be a safe and effective technique in the management of iatrogenic renal arterial injury.

Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region.

INTRODUCTION: The treatment of aneurysms in the internal carotid bifurcation region (ICABR), including aneurysms of the true internal carotid artery (ICA) terminus, those inclined on the proximal A1 or M1 segments or at the most distal pre-bifurcation (ICA) segment, is often challenging in microsurgical clipping and endovascular surgery. Few reports had discussed flow diversion as a therapeutic option for this group. METHODS: This was a retrospective study analysing flow diversion in treating ICABR aneurysms. Seven patients harbouring eight aneurysms in the ICABR were treated with flow diversion. Five aneurysms were inclined on the proximal A1 segment, and three were located at the most distal pre-bifurcation segment. Patients' demographics, presentation, procedure technical description, angiographic and clinical follow-up were recorded. PubMed and Ovid MEDLINE were also reviewed for articles published in English, including case series or case reports, for ICABR aneurysms treated with flow diverters. RESULTS: All patients except one underwent angiographic follow-up. The Karman-Byrne occlusion scale was used to determine the occlusion rate. All six patients with documented angiographic follow-up had a class IV occlusion score. No permanent or transient neurological or non-neurological complications were encountered in this study. CONCLUSION: Treating ICABR aneurysms using flow diversion is feasible, with a promising angiographic occlusion rate. Further studies are needed to analyse long-term clinical and angiographic results.

Pial fistula in infancy: Report of two cases and literature review with special emphasis on the ruptured group.

Cerebral pial fistula is a rare vascular pathology with no more than 150 cases reported. Most cases reported in infancy have been published as case reports. Owing to its high flow, its occurrence in this age group carries the potential risk of heart failure, chronic venous hypertension, seizures and, less frequently, cerebral haemorrhage. We present two cases of pial fistulae in infancy treated by endovascular embolisation using N-butyl cyanoacrylate. A review of the English-language literature was performed for this age group with special emphasis on ruptured cases.