Interventional management of high-flow craniofacial vascular malformations: a database analysis and review of the literature

2016 ◽  
Vol 9 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Guilherme Dabus ◽  
Italo Linfante ◽  
James Benenati ◽  
Chad A Perlyn ◽  
Mario Martínez-Galdámez
Keyword(s):  
Vascular Malformations ◽  
Treatment Session ◽  
High Flow ◽  
Institutional Review ◽  
Procedural Complication ◽  
Procedural Complications ◽  
Location Type ◽  
Scalp Lesions ◽  
Symptomatic Control

BackgroundHigh-flow craniofacial vascular malformations are uncommon, locally aggressive lesions that pose a therapeutic challenge.ObjectiveTo report our experience with the treatment of high-flow craniofacial vascular malformations.MethodsAfter institutional review board approval was obtained, the neurointerventional databases of two institutions were retrospectively reviewed for vascular malformations from October 2010 to June 2015. All patients who had been treated for a high-flow craniofacial vascular malformation were included in the analysis. Clinical presentation, location, type, agent and techniques used, procedural complications, and clinical and imaging follow-up were included in the analysis.ResultsEighteen patients (12 female and 6 male) harboring 21 high-flow vascular malformations met the inclusion criteria in our study. All patients were symptomatic. One patient had two separated arteriovenous malformations (AVMs) (one nasal and the other forehead/scalp), and one patient had three separated scalp lesions. One patient with a nasal AVM had capillary malformation-AVM syndrome. Overall, 13 AVM and 8 arteriovenous fistuli were treated in 31 targeted embolization procedures (ranging from 1 procedure to 4 procedures, mean 1.7 procedures). Onyx was the predominant agent used in 25 procedures. In 31 procedures, 1 procedural complication (skin ulceration) occurred. At the end of the last treatment session 14 of the 21 lesions were cured. Symptomatic control was achieved in all cases, with resolution or significant improvement of the symptoms (mean follow-up of 10 months).ConclusionsHigh-flow craniofacial vascular malformations can be successfully managed with interventional techniques.

Balloon-assisted Onyx embolization of cerebral single-channel pial arteriovenous fistulas

2011 ◽  
Vol 7 (6) ◽  
pp. 637-642 ◽  
Author(s):  
C. Benjamin Newman ◽  
Yin C. Hu ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque
Keyword(s):  
Treatment Strategy ◽  
Pediatric Patients ◽  
Single Channel ◽  
Vascular Malformations ◽  
High Flow ◽  
Flow Dynamics ◽  
Arteriovenous Fistulas ◽  
Male Patients ◽  
The Brain

Object Pial arteriovenous fistulas (AVFs) of the brain are rare vascular malformations associated with significant risks of hemorrhage and neurological deficit. Depending on their location and high-flow dynamics, these lesions can present treatment challenges for both endovascular and open cerebrovascular surgeons. The authors describe a novel endovascular treatment strategy that was used successfully to treat 2 pediatric patients with a pial AVF, and they discuss the technical nuances specific to their treatment strategy. Methods A single-channel high-flow pial AVF was diagnosed in 2 male patients (6 and 17 years of age). Both patients were treated with endovascular flow arrest using a highly conformable balloon followed by Onyx infusion for definitive closure of the fistula. Results Neither patient suffered a complication as a result of the procedure. At the 6-month follow-up in both cases, the simple discontinuation of blood flow had resulted in durable obliteration of the fistula and stable or improved neurological function. Conclusions Onyx can be delivered successfully into high-flow lesions after flow arrest to allow a minimally invasive and durable treatment for pial AVFs.

scholarly journals Congenital intrahepatic aorto-portal fistula presenting with cardiac failure

2020 ◽  
Vol 6 (4) ◽  
pp. 20200006
Author(s):  
Adithya Pathanki ◽  
Khalid Sharif ◽  
Ian McCafferty ◽  
Jane Hartley ◽  
Simon McGuirk
Keyword(s):  
Cardiac Failure ◽  
Congenital Heart ◽  
Unusual Case ◽  
Vascular Malformations ◽  
High Flow ◽  
Ductus Venosus ◽  
First Case ◽  
Left And Right ◽  
Portal Veins

Congenital intrahepatic arterio-portal fistulae (cIAPF) are rare, high-flow vascular malformations that usually present with portal hypertension. They almost never cause heart failure, unless there is associated congenital heart disease or the ductus venosus in patent. We present an unusual case of IAPF in an 11-day-old boy, who presented with features of cardiac failure associated with increased N-terminal pro-brain natriuretic peptide (NT pro-BNP). The IAPF arose directly from the aorta, separated from the hepatic artery and divided to separately supply both left and right portal veins. The ductus venosus was occluded. The IAPF was treated with embolization of the aorto-portal fistula, accessed through a direct percutaneous puncture of the fistula. Embolization was associated with an immediate clinical improvement and a rapid and sustained normalization of the NT pro-BNP level. A similar re-presentation was noted and treated with repeat embolization. The child is well on follow-up. To our knowledge, this is the first case of cIAPF, which was presented with cardiac failure when the ductus venosus has closed and has been treated successfully with direct, percutaneous transhepatic embolization of the fistula, twice. Serial clinical follow-up and ultrasonographical examinations have proven to be an effective strategy to detect recurrent fistulae.

scholarly journals Flow Diversion for Treatment of Acutely Ruptured Intracranial Aneurysms

2019 ◽  
Vol 30 (4) ◽  
pp. 835-842 ◽  
Author(s):  
Muhammad AlMatter ◽  
Marta Aguilar Pérez ◽  
Victoria Hellstern ◽  
Goran Mitrovic ◽  
Oliver Ganslandt ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Attractive Alternative ◽  
Complication Rates ◽  
Acute Setting ◽  
Complete Occlusion ◽  
Procedural Complication ◽  
Procedural Complications

Abstract Background Reports about the use of flow diverter stents (FDS) in the acute setting of subarachnoid hemorrhage (SAH) are limited. This article presents a single center experiences based on 45 consecutive cases with emphasis on complication rates and clinical and radiologic outcomes. Methods A prospectively maintained database of all cases treated with FDS as a stand-alone or adjunct device was retrospectively reviewed. All patients treated within 30 days of SAH were included. Records were made of clinical presentation, details of endovascular treatment, procedural complications, clinical outcome, and degree of occlusion on follow-up. Results In this study 45 patients (48.9% females; mean age 58.8 ± 12.4 years) were included. Flow diversion was performed after a median of 4 days. The procedural complication rate was 13.3% resulting in 2.2% permanent morbidities and 4.4% mortalities. No major hemorrhagic complications related to antiplatelet therapy were recorded. Immediate complete occlusion was achieved in 13.3%. Among survivors, complete occlusion was achieved in 94.6%. Excellent clinical outcome was recorded in 68.9% and 81.6% of the total population and survivors, respectively. There were no records of rebleeding from the target lesions. Conclusion Flow diversion is an attractive alternative strategy for management of acutely ruptured aneurysms with high rates of delayed complete occlusion and acceptable complication rates.

scholarly journals Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results

2016 ◽  
Vol 9 (2) ◽  
pp. 147-151 ◽  
Author(s):  
Guilherme Dabus ◽  
Jonathan A Grossberg ◽  
C Michael Cawley ◽  
Jacques E Dion ◽  
Ajit S Puri ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Long Term Follow Up ◽  
Procedural Complications ◽  
Mean Size ◽  
Location Type ◽  
Mid Term Results ◽  
Flow Diverters

BackgroundThe off-label use of flow diverters in the treatment of distal aneurysms continues to be debated.ObjectiveTo report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED).MethodsThe neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016. All patients treated for anterior cerebral artery aneurysms were included in the analysis. Clinical presentation, location, type, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis.ResultsTwenty patients (13 female) with 20 aneurysms met the inclusion criteria in our study. Fifteen aneurysms were classified as saccular and five as fusiform (mean size 7.3 mm). Thirteen aneurysms were located in the anterior communicating region (ACOM or A1/2 junction), six were A2-pericallosal, and one was located in the A1 segment. Six patients had presented previously with subarachnoid hemorrhage and had their aneurysms initially clipped or coiled. There was one minor event (a small caudate infarct) and one major event (intraparenchymal hemorrhage). Sixteen of the 20 patients had angiographic follow-up (mean 10 months). Eleven aneurysms were completely occluded, one had residual neck, and four had residual aneurysm filling.ConclusionsThe treatment of complex anterior cerebral artery aneurysms with the PED as an alternative for patients who are not good candidates for conventional methods is technically feasible and safe. Mid-term results are promising but larger series with long-term follow-up are required to assess its effectiveness.

scholarly journals Long-term outcomes of catheter ablation for ventricular arrhythmias in post- myocarditis patients; Insights from a meta-analysis of current datv

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Androulakis ◽  
A Briasoulis ◽  
D Falconer ◽  
W Lim ◽  
G Siasos ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Relapse Rate ◽  
Complication Rate ◽  
Ventricular Arrhythmias ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Procedural Complication ◽  
Procedural Complications

Abstract Background In the past decade, catheter ablation (CA) has become a rapidly expanding treatment option for ventricular tachycardia (VT), however it is not commonly utilized for patients with post-myocarditis VT. We aimed to systematically review up-to-date evidence regarding feasibility, effectiveness, and safety of CA, with a specific focus on long-term relapse rate and procedural complications. Methods A structured electronic database search (PubMed, Embase, Cochrane) of the scientific literature was performed for studies describing outcomes at up to 7.3 years after CA. The primary outcome measured was VT recurrence post-ablation. Procedural success was defined as freedom of ventricular arrhythmias (at the end of follow-up after an ablation procedure). The secondary outcome was significant procedural complications which included procedural death, stroke, cardiac tamponade, acute myocardial infarction, major vascular complications, and major bleeding, assessed on a study-by-study basis. Results A total of 186 patients were included in analysis with most patients (88%) being male. Over the follow up period there was a 18% relapse rate (n=34) (Confidence Interval (CI); 0.12–0.24, I2≈0, p=0.77) with the majority of patients remaining VT free for the duration of follow up. Only one study recorded the percentage of re-do procedures. The overall procedural complication rate was 3.0% (n=7, (CI; 0.01–0.07, I2≈0, p=0.44) and of note, there were no peri-procedural deaths or heart transplant surgeries reported. However, a single study reported a mortality of 10% (n=2) during the follow up period. Conclusions CA is an effective and durable long-term therapeutic strategy for post myocarditis VT patients with limited relapse rate and very low complication rates based on these non-randomised data. Larger randomised-controlled trials with standardised treatment and long follow-up are required to compare CA versus conventional treatment in the post-acute myocardial phase. FUNDunding Acknowledgement Type of funding sources: None. Relapse rate during follow-up Procedural complication rate

scholarly journals Predictors of mortality in patients with hereditary hemorrhagic telangiectasia

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
K. P. Thompson ◽  
◽  
J. Nelson ◽  
H. Kim ◽  
L. Pawlikowska ◽  
...  
Keyword(s):  
Hereditary Hemorrhagic Telangiectasia ◽  
Cox Regression ◽  
Clinical Symptoms ◽  
Vascular Malformations ◽  
Smoking Status ◽  
Treatment Options ◽  
Gi Bleeding ◽  
Cox Regression Analysis ◽  
Predictors Of Mortality

Abstract Background Retrospective questionnaire and healthcare administrative data suggest reduced life expectancy in untreated hereditary hemorrhagic telangiectasia (HHT). Prospective data suggests similar mortality, to the general population, in Denmark’s centre-treated HHT patients. However, clinical phenotypes vary widely in HHT, likely affecting mortality. We aimed to measure predictors of mortality among centre-treated HHT patients. HHT patients were recruited at 14 HHT centres of the Brain Vascular Malformation Consortium (BVMC) since 2010 and followed annually. Vital status, organ vascular malformations (VMs) and clinical symptoms data were collected at baseline and during follow-up (N = 1286). We tested whether organ VMs, HHT symptoms and HHT genes were associated with increased mortality using Cox regression analysis, adjusting for patient age, sex, and smoking status. Results 59 deaths occurred over average follow-up time of 3.4 years (max 8.6 years). A history of anemia was associated with increased mortality (HR = 2.93, 95% CI 1.37–6.26, p = 0.006), as were gastro-intestinal (GI) bleeding (HR = 2.63, 95% CI 1.46–4.74, p = 0.001), and symptomatic liver VMs (HR = 2.10, 95% CI 1.15–3.84, p = 0.015). Brain VMs and pulmonary arteriovenous malformations (AVMs) were not associated with mortality (p > 0.05). Patients with SMAD4 mutation had significantly higher mortality (HR = 18.36, 95% CI 5.60–60.20, p < 0.001) compared to patients with ACVRL1 or ENG mutation, but this estimate is imprecise given the rarity of SMAD4 patients (n = 33, 4 deaths). Conclusions Chronic GI bleeding, anemia and symptomatic liver VMs are associated with increased mortality in HHT patients, independent of age, and in keeping with the limited treatment options for these aspects of HHT. Conversely, mortality does not appear to be associated with pulmonary AVMs or brain VMs, for which patients are routinely screened and treated preventatively at HHT Centres. This demonstrates the need for development of new therapies to treat chronic anemia, GI bleeding, and symptomatic liver VMs in order to reduce mortality among HHT patients.

scholarly journals Early clinical experience with the p48MW HPC and p64MW HPC flow diverters in the anterior circulation aneurysm using single anti-platelet treatment

2021 ◽  
pp. 159101992110295
Author(s):  
Pervinder Bhogal ◽  
Andrey Petrov ◽  
Ganbaatar Rentsenkhu ◽  
Baatarjan Nota ◽  
Erdenebat Ganzorig ◽  
...  
Keyword(s):  
Clinical Results ◽  
Dome Height ◽  
Anterior Circulation ◽  
Post Procedure ◽  
Neurological Morbidity ◽  
Procedural Complications ◽  
Previously Treated ◽  
Flow Diverters ◽  
Overall Mortality

Background The p64MW HPC and p48MW HPC flow diverters have reduced thrombogenicity due to hydrophilic coating. The purpose of this study was to evaluate its safety and efficacy in Mongolian patients under single antiplatelet therapy (SAPT) with prasugrel. Materials and methods We performed a retrospective review of patients enrolled into our prospectively maintained database to identify all patients treated with either the p48MW HPC or p64MW HPC under SAPT. We recorded baseline demographics, aneurysm size and location, procedural complications, angiographic and clinical results. Results 24 patients, (female = 21, 87.5%), age 48.2 ± 11.6 years (range 25–63) underwent treatment of 30 aneurysms with either p64MW HPC or p48MW HPC. All aneurysms were saccular with dome width 8.2 ± 6.5 (range 1.6–26.0 mm) and dome height 7.6 ± 6.7 (range 1.6–30.0 mm). None of the aneurysms were previously treated. The average PRU was 54.6 ± 31.2 (range 1–127) on pre-operative VerifyNow testing. Angiographic follow-up was available for 13 patients (17 aneurysms), 183 ± 36 days post-procedure, at which point 64.7% of aneurysms (n = 11/17) were completely occluded and 11.8% (n = 2/17) had only neck remnants resulting in 76.5% of aneurysms being adequately occluded A single intra-operative complication (4.2%) occurred however all patients were mRS ≤1 at last follow-up. There were two post-operative complications neither of which resulted in permanent neurological morbidity. There were no instances of post-operative aneurysmal rupture or delayed parenchymal haemorrhage. The overall mortality was 0%. Conclusion The efficacy and safety of p64MW HPC coated devices under SAPT is similar to uncoated flow diverters that require DAPT.

scholarly journals Amlodipine induced Gingival Overgrowth in Patients at a Tertiary Level Hospital of Nepal

2018 ◽  
Vol 2 (1) ◽  
pp. 2-5
Author(s):  
Arun Sharma ◽  
Rinku Joshi ◽  
Sweta Rajya Laxmi Rana ◽  
Dhan Bahadur Shrestha ◽  
Pramod Raj Joshi ◽  
...  
Keyword(s):  
Large Scale ◽  
Tertiary Level ◽  
Gingival Overgrowth ◽  
Record Keeping ◽  
Institutional Review ◽  
Short Term Study ◽  
Rare Side Effect ◽  
Low Prevalence ◽  
Ethical Clearance

Background: Amlodipine is a commonly prescribed anti-hypertensive in clinical practice. Gingival overgrowth is a rare side effect of this drug; with a reported prevalence of 1.7-3.3% in literature. Gingival overgrowth can cause aesthetic and functional problems as well as cause hindrance to maintain proper oral hygiene, thereby deteriorating the periodontal condition of the patient. The prevalence of Amlodipine induced gingival overgrowth is poorly defined in our country. Aim: This study aims to assess Amlodipine induced gingival overgrowth in a tertiary level referral hospital of Nepal Army. Materials and Methods: This study was conducted on hypertensive patients with amlodipine therapy under regular follow up in the Department of Internal Medicine of Shree Birendra Hospital from September to December 2017. The data from record keeping was used for the study. Ethical clearance from Institutional Review committee of Nepal Army Institute of Health Sciences was obtained before conducting the study. Results: Out of 507 patients taking amlodipine, 240 were eligible for study and six (2.5%) were found to have amlodipine induced gingival overgrowth. These patients were on a dose of 5-10 mg over six months to 25 years. The gingival overgrowth was correlated with dose and duration which was statistically significant (p<0.05). Conclusion: Low prevalence of amlodipine induced gingival overgrowth and correlation with dose and duration was seen in this short-term study. However further large-scale follow-up studies may be required to assess the severity of the problem.

scholarly journals Illuminating the nidus: The role of FDG PET/CT in high flow arteriovenous vascular malformations

2021 ◽  
Vol 16 (6) ◽  
pp. 1374-1377
Author(s):  
Ayyaz Quddus ◽  
Priyesh Karia ◽  
Ruhaid Khurram ◽  
Arum Parthipun ◽  
Jocelyn Brookes
Keyword(s):  
Fdg Pet ◽  
Vascular Malformations ◽  
High Flow ◽  
Pet Ct ◽  
Fdg Pet Ct

Heads-up 3D eye surgery: Safety outcomes and technological review after 2 years of day-to-day use

2021 ◽  
pp. 112067212110128
Author(s):  
Claudia Del Turco ◽  
Giuseppe D’Amico Ricci ◽  
Marco Dal Vecchio ◽  
Caterina Bogetto ◽  
Edoardo Panico ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Case Series ◽  
Depth Of Field ◽  
Procedural Complication ◽  
Long Time ◽  
Procedural Complications ◽  
Resolution Imaging ◽  
Visualization Systems ◽  
3D Surgery

Background: 3D heads-up visualization systems are aimed to improve the surgical experience by providing high-resolution imaging. Objective of our study is to analyze, over a long-time span, the grade of satisfaction and safety of day-to-day 3D surgery compared to standard surgery and to investigate the technical distinctiveness between the heads-up systems currently in use. Methods: In this retrospective observational case series. we reviewed all surgical records of our ophthalmology-dedicated operatory rooms since the arrival of 3D heads-up viewing system, in November 2017. In particular, we compared the procedural complications of 3D-equipped operatory room (3DR) with the standard microscope operatory room (2DR). Moreover, a satisfaction questionnaire was administered to those surgeons shifting on both rooms to test their preferences on seven specific parameters (comfort, visibility, image quality, depth perception, simplicity of use, maneuverability and teaching potential). Results: 5483 eye surgeries were considered. 2777 (50.6%) were performed in 3DR and 2706 (49.3%) in 2DR. Procedural complication rate was comparable in 3DR and 2DR, also when considering different subtypes of surgery. Twelve surgeons (100% of our surgery team) participated in our satisfaction survey, expressing highest satisfaction score for 3D when applied in retina surgery. For cataract surgery, 3D scored best in all the parameters except for facility in use and depth of field perception. Conclusion: Long-term day-to-day use of 3D heads-up visualization systems showed its safety and its outstanding teaching potential in all ophthalmic surgical subtypes, with higher surgeons confidence for retina and cataract surgery.

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