Interventional Treatment of Vascular Anomalies.

Vascular anomalies are highly variable in their angioarchitecture, location, and flow dynamics. An individualized, multidisciplinary approach to treatment is required, focusing on improving patient quality of life. With appropriate percutaneous or endovascular treatment, patient satisfaction following interventional therapy is generally high, acknowledging that a complete cure may not always be possible.

Dieulafoy lesions and gastrointestinal bleeding.

A Dieulafoy lesion is a dilated, submucosal artery that can erode through the adjacent gastrointestinal mucosa, resulting in spontaneous rupture and massive gastrointestinal bleeding. If misdiagnosed or left untreated, these lesions have up to an 80% mortality rate. Here we present the case of a 70-year-old woman with abdominal pain who was found to have a submucosal gastric vascular structure on computed tomography angiography of the pulmonary arteries. She underwent outpatient esophagogastroduodenoscopy to confirm the presence of a gastric Dieulafoy lesion and was successfully treated with mesenteric angiography and transarterial embolization.

Embolization of a hemorrhaging abdominal plexiform neurofibroma.

In rare instances, neurofibromas may spontaneously bleed. In this case, a 21-year-old woman with a known cutaneous neurofibroma presented with a rapidly enlarging right abdominal wall mass. After embolization of a focal pseudoaneurysm and the right internal mammary artery, her hemoglobin continued to decline. The right internal mammary artery and inferior epigastric artery were then embolized. The patient eventually underwent mass resection, hematoma evacuation, and flap reconstruction. Final surgical pathology confirmed the expected diagnosis of plexiform neurofibroma. The Schwann cells of plexiform neurofibromas, present in approximately 50% of patients with neurofibromatosis-1, have invasive and angiogenic properties, often resulting in hemorrhage.