Percutaneous microwave ablation for control of massive portal venous bleeding.

We present a case of a 46 years old female with decompensated liver cirrhosis who developed severe intraperitoneal hemorrhage secondary to inadvertent liver puncture during a paracentesis which resulted in a combined hepatic arterial and portal venous injury. The arterial injury was managed with transarterial embolization. The portal venous injury was managed with percutaneous microwave ablation. This article also highlights the importance of evaluating both arterial injury as well as portal venous injury in the setting of hepatic bleeding, particularly in patients with portal hypertension.

Primary aortogastric fistula following Nissen fundoplication: A case report.

INTRODUCTION: Aortoenteric fistula (AEF) is a rare condition and consists of an abnormal communication between the aorta and the gastrointestinal (GI) tract. The duodenum is the most common location. Fistulas involving the stomach are very uncommon and account for only 2% of the cases. AEF typically results in rapid and fatal exsanguination as diagnosis is frequently missed or made too late (Bixby et al., 2018; Kougias et al., 2003; Lookman, 1959; Genc et al., 2000; Ong et al., 2019; Li et al., 2020). PRESENTATION OF CASE: A 59 years old female with a history of Nissen fundoplication presented with lower gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) showed a large blood clot in the gastric fundus with no visible source of active bleeding. A mesenteric angiogram, performed for persistent gastro-intestinal bleeding and following two episodes of cardiac arrest, showed no evidence of active bleeding. The left gastric artery was prophylactically embolized. Persistent hemorrhage prompted an exploratory laparotomy followed by a left thoracotomy and confirmed the diagnosis of an aortogastric fistula (AGF). The patient expired intra-operatively. DISCUSSION: AGF is a very rare but often fatal condition (Busuttil and Goldstone, 2001). Computerized tomography angiography (CTA) can be a key to the diagnosis (Raman et al., 2012). EGD and catheter angiography have low sensitivity (Kuhara et al., 2015; Manduch et al., 2008). Definitive diagnosis is usually made during surgical exploration or autopsy (Wasvary et al., 1997). While open surgical repair is considered the gold standard therapy, endovascular therapy is becoming the preferred initial treatment option (Bixby et al., 2018). CONCLUSION: AGF should be considered in the differential diagnosis of GI bleeding, especially in patients with massive hemorrhage where EGD and mesenteric angiography are not diagnostic.

Balloon occlusion of the contralateral iliac artery to assist recanalization of the ipsilateral iliac artery in total aortoiliac occlusion: a technical note.

Endovascular recanalization of chronic total aortoiliac occlusion is technically challenging. Inability to reenter the true aortic lumen, following retrograde iliac recanalization, is one of the most common causes of failure. We describe a case of a total aortoiliac occlusion where balloon occlusion of the right common iliac artery, following its recanalization from a brachial approach, was used to facilitate antegrade recanalization of the occluded contralateral left common iliac artery.

The preclose technique in percutaneous endovascular aortic repair: a systematic literature review and meta-analysis.

PURPOSE: To establish the efficacy and safety of the preclose technique in total percutaneous endovascular aortic repair (PEVAR). METHODS: A systematic literature search of Medline database was conducted for series on PEVAR published between January 1999 and January 2012. RESULTS: Thirty-six articles comprising 2,257 patients and 3,606 arterial accesses were included. Anatomical criteria used to exclude patients from undergoing PEVAR were not uniform across all series. The technical success rate was 94 % per arterial access. Failure was unilateral in the majority (93 %) of the 133 failed PEVAR cases. The groin complication rate in PEVAR was 3.6 %; a minority (1.6 %) of these groin complications required open surgery. The groin complication rate in failed PEVAR cases converted to groin cutdown was 6.1 %. A significantly higher technical success rate was achieved when arterial access was performed via ultrasound guidance. Technical failure rate was significantly higher with larger sheath size (≥20F). CONCLUSION: The preclose technique in PEVAR has a high technical success rate and a low groin complication rate. Technical success tends to increase with ultrasound-guided arterial access and decrease with larger access. When failure occurs, it is unilateral in the majority of cases, and conversion to surgical cutdown does not appear to increase the operative risk.

Reported outcomes after the endovascular treatment of chronic cerebrospinal venous insufficiency.

Chronic cerebrospinal venous insufficiency (CCSVI) has recently been implicated as a potential causal factor in the development of multiple sclerosis (MS). The treatment of jugular and azygous vein stenoses, characteristic of CCSVI, has been proposed as a potential component of therapy for MS. In the few short years since Dr. Paulo Zamboni published "A Prospective Open label Study of Endovascular Treatment of Chronic Cerebrospinal Venous Insufficiency", there has been tremendous patient-driven demand for treatment. Concurrently, there have been numerous publications since 2009 addressing CCSVI and its association with MS. The purpose of this article is to present a brief review of CCSVI and its association with MS and to review the available literature to date with a focus on outcomes data.