scholarly journals Contribution of Interventional Radiologist in the Management of Pseudoaneurysm and Neck Hemorrhages in COVID-19 patients

2021 ◽  
Vol 100 (2_suppl) ◽  
pp. 148S-151S
Author(s):  
Norbert Zhang ◽  
Jérôme R. Lechien ◽  
Valéria Martinez ◽  
Robert-Yves Carlier ◽  
Mostafa El Hajjam
Keyword(s):  
Endovascular Embolization ◽  
Vascular Lesions ◽  
Superior Thyroid Artery ◽  
Lateral Neck ◽  
Risk Of Bleeding ◽  
Endothelial Inflammation ◽  
Increasing Risk ◽  
Glue Injection ◽  
Radiological Procedures ◽  
Ultrasonography Guidance

Patients with severe coronavirus disease 2019 (COVID-19) may have endothelial inflammation, pseudoaneurysm, and an increasing risk of bleeding, especially during surgical procedures. In this article, we reported 2 cases of COVID-19 patients with neck vascular lesions. The first patient had pseudoaneurysm of the cricothyroid artery, which was treated by percutaneous glue injection through ultrasonography guidance. The second patient presented lateral neck hematoma in front of the left superior thyroid artery, which was managed by coil endovascular embolization. In the context of pandemic, the management of vascular lesions may be performed through interventional radiological procedures that may reduce the risk of virus aerosolization and health care provider contamination.

scholarly journals Nongalenic arteriovenous fistulas: history of treatment and technology

2006 ◽  
Vol 20 (6) ◽  
pp. 1-8 ◽  
Author(s):  
Kristen Upchurch ◽  
Lei Feng ◽  
Gary R. Duckwiler ◽  
John G. Frazee ◽  
Neil A. Martin ◽  
...  
Keyword(s):  
Open Surgery ◽  
Interventional Neuroradiology ◽  
Endovascular Embolization ◽  
High Flow ◽  
Vascular Lesions ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Technological Developments ◽  
History Of ◽  
Endovascular Technology

✓ Nongalenic cerebral arteriovenous fistulas (AVFs) are uncommon, high-flow vascular lesions first treated by Walter Dandy and his colleagues by using open surgery with ligation of the feeding artery. Due to advances in endovascular technology over the past four decades that make possible the control of high flow in AVFs, treatment has evolved from the sole option of surgery to include the alternative or adjunct option of endovascular embolization. The authors of this review discuss the history of nongalenic AVF treatment, including techniques of both surgery and interventional neuroradiology and the technological developments underlying them.

scholarly journals Safety of concomitant treatment with Non-Vitamin K Oral Anticoagulants and SSRI/SNRI antidepressants

2018 ◽  
Vol 19 (4) ◽  
pp. 267-278 ◽  
Author(s):  
Piotr Boguta ◽  
Dariusz Juchnowicz ◽  
Paulina Wróbel-Knybel ◽  
Agnieszka Biała-Kędra ◽  
Hanna Karakuła-Juchnowicz
Keyword(s):  
Vitamin K ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Oral Anticoagulants ◽  
Critical Role ◽  
Selective Serotonin ◽  
Concomitant Treatment ◽  
Risk Of Bleeding ◽  
Noradrenaline Reuptake ◽  
Increasing Risk

Abstract Introduction: Warfarin has been considered as a “gold standard” in the prevention and treatment of thromboembolic events since 1954. Since the introduction of direct oral anticoagulants in the last few years (NOAC-Non-Vitamin K antagonist Oral Anticoagulants) prescriptions volume for apixaban, edoxaban, dabigatran and rivaroxaban have been gradually surpassing warfarin. The benefits include: anticoagulation from day one, fixed daily dosing, elimination for the need of international normalised ratio (INR) monitoring, fewer interactions with food and co-administered medicines with reduced risk of bleeding and better overall life quality. Objectives: Assessing evidence for the safe use of Non-vitamin K Oral Anticoagulants (NOAC) with Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitors (SNRI). Method: Review of literature published between 2014 and 2016 was made using the key words: Selective Serotonin Reuptake Inhibitor, Serotonin and Noradrenaline Reuptake Inhibitors, apixaban, dabigatran, edoxaban, rivaroxaban, bleeding, interaction, depression with time description from 2014 to 2018. Evidence within the literature was then compared with guidelines from the National Institute for Health and Care Excellence (UK), British National Formulary (UK), Clinical Excellence Commission (Australia), Thrombophilia and Anticoagulation Clinic (USA) and Summaries of Product Characteristics (SPC). Results: 1. Serotonin plays a critical role in maintaining homeostasis. Use of SSRI/SNRI compromises its platelet reuptake increasing risk of bleeding. 2. Increased tolerability and safety of NOAC over Warfarin, although caution is advised when NOAC is used with SSRI/SNRI with less evidence suggesting pharmacodynamic interactions. 3. It is not recommended to use NOAC with strong CYP and P-gp inhibitors. Conclusions: With limited literature evidence, caution is advised when co-prescribed NOACs with SSRI/SNRI, especially with other cofactors and interacting medicines further increasing risk of bleeding.

Efficacy and safety of embolization of dural arteriovenous fistulas via the ophthalmic artery

2020 ◽  
pp. 159101992096927
Author(s):  
Vera A Mayercik ◽  
Eric S Sussman ◽  
Benjamin Pulli ◽  
Robert L Dodd ◽  
Huy M Do ◽  
...  
Keyword(s):  
Ophthalmic Artery ◽  
Vision Loss ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
Vascular Lesions ◽  
Ischemic Optic Neuropathy ◽  
Efficacy And Safety ◽  
Artery Embolization ◽  
Permanent Disability ◽  
Arteriovenous Fistulas

Introduction Dural arteriovenous fistulae (DAVF) are vascular lesions with arteriovenous shunting that may be treated with surgical obliteration or endovascular embolization. Some DAVF, such as anterior cranial fossa DAVF (AC-DAVF) derive their arterial supply from ophthalmic artery branches in nearly all cases, and trans-arterial embolization carries a risk of vision loss. We determined the efficacy and safety of trans-ophthalmic artery embolization of DAVF. Materials and methods We performed a retrospective cohort study of all patients with DAVF treated by trans-ophthalmic artery embolization from 2012 to 2020. Primary outcome was angiographic cure of the DAVF. Secondary outcomes included vision loss, visual impairment, orbital cranial nerve injury, stroke, modified Rankin Scale at 90-days, and mortality. Results 12 patients met inclusion criteria (9 males; 3 females). 10 patients had AC-DAVF. Patient age was 59.7  ±  9.5 (mean ± SD) years. Patients presented with intracranial hemorrhage (4 patients), headache (4 patients), amaurosis fugax (1 patients), or were incidentally discovered (2 patients). DAVF Cognard grades were: II (1 patient), III (6 patients), and IV (5 patients). DAVF were embolized with Onyx (10 patients), nBCA glue (1 patient), and a combination of coils and Onyx (1 patient). DAVF cure was achieved in 11 patients (92%). No patients experienced vision loss, death, or permanent disability. One patient experienced a minor complication of blurry vision attributed to posterior ischemic optic neuropathy. 90-day mRS was 0 (10 patients) and 1 (2 patients). Conclusions Trans-ophthalmic artery embolization is an effective and safe treatment for DAVF.

Removal of distal fragments of liquid embolic agents during arteriovenous malformation embolization using the TIGERTRIEVER 13: a technical report

2020 ◽  
Vol 12 (8) ◽  
pp. 794-797 ◽  
Author(s):  
Faith LY Ho ◽  
René Chapot
Keyword(s):  
Cerebral Artery ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
Embolic Agent ◽  
Embolic Material ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Retrograde Filling ◽  
Distal Migration

BackgroundArteriovenous malformations (AVMs) are vascular lesions that may be treated by an endovascular approach using liquid embolic agents but the control of the liquid embolic agent remains poor and a potential complication may be distal migration of embolic material. The TIGERTRIEVER 13 is a new stent retriever designed for stroke thrombectomy and has a version ideal for distal occlusions. We report our experience in the removal of embolic agent which had migrated into the distal vessels using the TIGERTRIEVER during PHIL/Onyx embolization of AVMs.Clinical presentationsThree patients with brain and spinal AVMs underwent endovascular embolization. During trans-arterial embolization of the AVM with PHIL/Onyx, retrograde filling of distal arterial feeders was followed by migration into the normal arterial branches (cortical middle cerebral artery, distal posterior cerebral artery, and anterior spinal artery). This resulted in occlusion or sluggish distal flow in these branches with potential significant neurological deficits. In all three cases, a Headway Duo microcatheter was navigated distally in the occluded vessel beyond the embolic material using a Traxcess microwire. The TIGERTRIEVER 13 was deployed with recanalization of the vessel after a single attempt. In all three patients there were no complications related to the retrieval of embolic agent.ConclusionDistal migrated embolic agents such as PHIL or Onyx can be removed from various arterial vascular territories using stent retrievers dedicated to small vessels.

Resection of an Embolized Cirsoid Aneurysm With Intracranial Venous Drainage: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. E94-E94 ◽  
Author(s):  
Daniel M Heiferman ◽  
Hasan R Syed ◽  
Daphne Li ◽  
Brian D Rothstein ◽  
Ali Shaibani ◽  
...  
Keyword(s):  
Surgical Excision ◽  
Venous Drainage ◽  
Vascular Supply ◽  
Endovascular Embolization ◽  
Vascular Lesions ◽  
Definitive Treatment ◽  
Cirsoid Aneurysm ◽  
Institutional Review ◽  
Diagnostic Angiography ◽  
Scalp Lesion

Abstract Cirsoid aneurysms, also known as scalp arteriovenous malformations (AVM), are rare congenital extracranial vascular anomalies that often present as an enlarging pulsatile scalp mass. A 14-yr-old male presented with a pulsatile scalp lesion that was first noticed 3 yr prior and had progressively enlarged. No history of trauma was reported. MRI demonstrated a 4 cm wide and 2 cm tall nidus and catheter angiography was performed to further define the vascular supply and drainage. The patient underwent transvenous endovascular embolization followed by surgical excision via a bicoronal incision, as shown in this operative video. Care was taken to identify, cauterize, and transect feeding vessels from the superficial temporal, supratrochlear, and supraorbital arteries circumferentially to completely devascularize and resect the galeal nidus from overlying scalp tissue and underlying pericranium. Previously unreported in the literature, transosseous emissary veins partially draining the lesion were noted on angiography and were waxed thoroughly during surgery. Six-month follow-up examination demonstrated a well-healed incision without evidence of AVM recurrence. The unique venous drainage of this cirsoid aneurysm highlights the value of diagnostic angiography to fully characterize these rare and complex vascular lesions prior to pursuing definitive treatment.  IRB approval was obtained from the Ann & Robert H. Lurie Children's Hospital of Chicago Institutional Review Board (IRB #2018-1799). The IRB waives the requirement of obtaining informed consent for this study in accordance with 45 CFR 46.116(d).

scholarly journals Overview of the current role of endovascular and surgical treatment in spinal dural arteriovenous fistulas

2009 ◽  
Vol 26 (1) ◽  
pp. E8 ◽  
Author(s):  
Amir R. Dehdashti ◽  
Leodante B. Da Costa ◽  
Karel G. terBrugge ◽  
Robert A. Willinsky ◽  
Michael Tymianski ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Vascular Lesions ◽  
Current Role ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Spinal Dural Arteriovenous Fistulas

Dural arteriovenous fistulas are the most common vascular malformations of the spinal cord. These benign vascular lesions are considered straightforward targets of surgical treatment and possibly endovascular embolization, but the outcome in these cases depends mainly on the extent of clinical dysfunction at the time of the diagnosis. A timely diagnosis is an equally important factor, with early treatment regardless of the type more likely to yield significant improvements in neurological functioning. The outcomes after surgical and endovascular treatment are similar if complete obliteration of the fistulous site is obtained. In the present study, the authors evaluated the current role of each modality in the management of these interesting lesions.

scholarly journals Endonasal Arteriovenous Fistula Following Transsphenoidal Resection of Pituitary Adenoma Treated with N-Butyl-2-Cyanoacrylate

2019 ◽  
Vol 08 (03) ◽  
pp. 196-198
Author(s):  
Giancarlo Saal-Zapata ◽  
Walter Durand Castro ◽  
Rodolfo Rodriguez Varela
Keyword(s):  
Pituitary Adenoma ◽  
Carotid Artery ◽  
Arteriovenous Fistula ◽  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
Vascular Lesions ◽  
External Carotid ◽  
Transsphenoidal Pituitary Surgery

AbstractVascular lesions of the external carotid artery after transsphenoidal pituitary surgery are rare. Immediate diagnosis must be done and endovascular embolization is the treatment of choice.We report the case of a 53-year-old woman with visual complaints who underwent transsphenoidal surgery of a pituitary adenoma with good clinical and radiological evolution. Five days after surgery nasal tampons were removed and suddenly the patient started to bleed: nasal packing and air way protection were required. Digital subtraction angiography revealed an endonasal arteriovenous fistula with a feeder from the sphenopalatine artery and drainage to sphenopalatine veins. Embolization with N-butyl-2-cyanoacrylate was performed with total obliteration of the arteriovenous fistula. We suggest that endovascular treatment of external carotid artery lesions after transsphenoidal surgery is the best alternative in cases of active bleeding.

Surgical Dissection of a Perimedullary Fistula of Conus Medullaris With Long-Term Follow-Up: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (2) ◽  
pp. E59-E59 ◽  
Author(s):  
Thomas J Sorenson ◽  
Giuseppe Lanzino
Keyword(s):  
Surgical Excision ◽  
Vascular Supply ◽  
Conus Medullaris ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
Clinical And Radiological Outcome

Abstract Perimedullary fistulae of the spinal cord are rare vascular lesions that can present with different clinical patterns: hemorrhage, progressive myelopathy due to arterial steal and/or venous congestion, or symptoms due to compression of neural structures by engorged vessels. Treatment consists of surgical excision, endovascular embolization, or a combination of the two. If complete obliteration of the nidus exposes the patient to undue risk of permanent neurological deficits, incomplete obliteration with reduction of the vascular supply is a reasonable compromise to improve clinical symptomatology. Partial devascularization may also alter the natural history by decreasing the risk of further growth and bleeding. In this video we illustrate the case of a patient with a perimedullary fistula of the conus treated with surgical disconnection of the main fistulous component. Partial devascularization resulted in resolution of MRI signal changes and symptoms with documented good clinical and radiological outcome and progressive regression of the residual nidus over six years of follow-up.

Endovascular Embolization of Sinus Pericranii Using Plastic Cup During Glue Injection

2019 ◽  
Vol 124 ◽  
pp. 93-97 ◽  
Author(s):  
Tomotaka Ohshima ◽  
Shigeru Miyachi ◽  
Masahiro Joko ◽  
Naoki Matsuo ◽  
Reo Kawaguchi ◽  
...  
Keyword(s):  
Endovascular Embolization ◽  
Sinus Pericranii ◽  
Glue Injection

scholarly journals National trends in spinal arteriovenous malformations

2009 ◽  
Vol 26 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Shivanand P. Lad ◽  
Justin G. Santarelli ◽  
Chirag G. Patil ◽  
Gary K. Steinberg ◽  
Maxwell Boakye
Keyword(s):  
Hospital Stay ◽  
Arteriovenous Malformations ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Endovascular Embolization ◽  
Outcome Data ◽  
Vascular Lesions ◽  
Hospital Treatment ◽  
Management Options ◽  
Spinal Arteriovenous Malformations

Object Spinal arteriovenous malformations (AVMs) are rare and understudied vascular lesions that cause neurological insult by mass effect, venous obstruction, and vascular steal. These lesions are challenging entities to treat because of their complicated anatomy and physiology. Current management options include open microsurgery, endovascular embolization, and stereotactic radiosurgery. Methods Our study used the National Inpatient Sample database to analyze outcome data for spinal AVMs treated nationwide over an 11-year period from 1995 through 2006. Trends in procedural management, hospital course, and epidemiology of spinal AVMs are investigated. Results Annually, an average of 300 patients presented with spinal AVMs requiring hospital treatment. The average length of hospital stay for this treatment has declined from more than 9 days in 1995 to 6 days in 2006. However, the average cost of a hospital stay has increased from < $30,000 to nearly $70,000. Whereas one-half of spinal AVMs were treated operatively in 1995, one-third were managed operatively in 2006. Conclusions Spinal AVMs are being increasingly treated by endovascular, radiosurgical, or combined means. A discussion of modern strategies to treat these disorders is presented.

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