Surgical and Endovascular Management of Arteriovenous Malformation: Case Series from a Single Center

Vascular ◽  
2007 ◽  
Vol 15 (3) ◽  
pp. 134-140 ◽  
Author(s):  
Mohamed A. Elsharawy ◽  
Khaled M. Moghazy
Keyword(s):  
Arteriovenous Malformation ◽  
Case Series ◽  
Surgical Excision ◽  
Preoperative Embolization ◽  
Conventional Angiography ◽  
Ethanol Sclerotherapy ◽  
Superselective Embolization ◽  
Endovascular Approach ◽  
A Prospective Study

Management of arteriovenous malformation (AVM) remains a major challenge to vascular surgeons. A multidisciplinary approach was introduced in our hospital to manage these cases from October 2003 to date. This is a report of our experience in their management. A prospective study was done on all patients with symptomatic AVM admitted to our unit between October 2003 and May 2006. All patients had preoperative duplex scanning and magnetic resonance imaging with or without conventional angiography. A multidisciplinary team assessed and treated these cases according to the type of malformation. Thirty-two cases were included in this study, with a mean follow-up of 18.3 months. Of these, 20 cases were predominantly venous and treated with surgical excision ( n = 14) or ethanol sclerotherapy ( n = 6). Twelve cases were predominantly arterial or arteriovenous shunting; 10 were treated with preoperative embolization followed by surgical excision and the remaining 2 with superselective embolization alone. The overall complication rate was high (31%). However, all were minor and settled down conservatively. No recurrence was observed in the early follow-up period. Management of AVM by a surgical and endovascular approach can deliver excellent results, with acceptable morbidity and no recurrence in the early follow-up period.

scholarly journals Pulmonary arteriovenous malformation (PAVM) embolization: prediction of angiographically-confirmed recanalization according to PAVM Diameter changes on CT

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Jihoon Hong ◽  
Sang Yub Lee ◽  
Jung Guen Cha ◽  
Jae-Kwang Lim ◽  
Jongmin Park ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Case Series ◽  
Pulmonary Angiography ◽  
Endovascular Embolization ◽  
Pulmonary Arteriovenous Malformation ◽  
Conventional Angiography ◽  
Receiver Operating Characteristic Curves ◽  
Vein Diameter ◽  
Diameter Reduction

Abstract Background To assess pulmonary arteriovenous malformation (PAVM) recanalization after embolization based on PAVM diameter changes on computed tomography (CT), with pulmonary angiography used as a gold standard. Methods A retrospective review was done of patients from 2008 to 2019 with a PAVM treated with endovascular embolization. The treatment outcome was determined by conventional angiography. Follow-up pulmonary angiography was performed when recanalization was suspected on CT, or embolization of all lesions in multiple PAVM patients could not be completed in a single session. Patients who had no preprocedural or follow-up CT were excluded. Draining vein, feeding artery, and venous sac diameter were measured on CT, and diameter reduction rates were compared with the widely-used, binary 70 % criteria. Results Forty-one patients with 114 PAVMs were treated during the study period. Eight patients with 50 PAVMs met the inclusion criteria. Mean vein, artery, and venous sac diameter reduction rates were as follows: 59.2 ± 9.3 %, 47.5 ± 10.6 %, and 62.6 ± 13.2 %, respectively, in the occluded group and 5.4 ± 19.5 %, 11.3 ± 17.7 %, and 26.8 ± 14.2 %, respectively, in the recanalized group. The area under the receiver operating characteristic curves for PAVM recanalization for the draining vein was 1.00, showing a better result than the artery (0.97) and sac (0.99). Patients showed > 42 % draining vein diameter reduction in the occluded group and < 32 % in the recanalized group. The widely-used 70 % criteria showed low specificity for predicting recanalization (draining vein, 7.3 %; venous sac, 41.7 %) but 100 % sensitivity for both the draining vein and venous sac. Conclusions The widely-used 70 % binary criteria showed limited performance in predicting outcomes in this angiographically-confirmed case series. Further investigations are warranted to establish a strategy for detecting recanalization after PAVM embolization.

Orbital Hydatid Cyst: An Interventional Case Series

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Tajamul Khan ◽  
Ibrar Hussain ◽  
Zaman Shah
Keyword(s):  
Visual Acuity ◽  
Hydatid Cyst ◽  
Teaching Hospital ◽  
Case Series ◽  
Surgical Excision ◽  
P Value ◽  
Presumptive Diagnosis ◽  
Female Ratio ◽  
Orbital Imaging

Purpose:  To find out the demographics, presentation, and outcome of surgical treatment in patients of orbital hydatid cyst. Study Design:  Interventional case series. Place and Duration of Study:  Khyber Teaching Hospital Peshawar, Pakistan from 2009 to 2019. Methods:  This study included 11 patients with orbital hydatid cyst who presented in Khyber Teaching Hospital, Peshawar. Detailed history, ocular examination and Orbital imaging (Ophthalmic B-Scan, CT scan and/or MRI) was performed. The patients underwent Orbitotomy, cyst extirpated and sent for histopathology. Albendazole was given to the patients for 12 weeks after surgery. The preoperative and postoperative data until last follow-up was analyzed. Results:  Male to Female ratio was 5:6 and the mean age of the patients was 18.17 ± 17.4 years. Mean amount of proptosis was 26.27 ± 2.05mm and visual acuity was 0.23 ± 0.33 decimal in the affected eye at presentation. Eight patients (72.8%) had Relative Afferent Pupillary Defect with swollen discs. After imaging studies, presumptive diagnosis of hydatid cyst was made. Histopathology confirmed the diagnosis of hydatid cyst in all cases. Mean proptosis at the last follow up improved to 19.04 ± 1.45mm (P value = 0.00) and visual acuity to 0.47 ± 0.22 decimals (P value = 0.048). Only one patient (9.1%) had an associated hydatid cyst in the lung. There was no recurrence until last follow-up. Conclusion:  Hydatid cyst should be considered in differential diagnosis of proptosis in patients under 20. Surgical excision followed by a course of oral Albendazole is effective for the treatment of orbital hydatid cyst. Key Words:  Orbital hydatid cyst, Proptosis, Orbitotomy.

Surgical Outcome of Large Solid Posterior Fossa Hemangioblastoma without Preoperative Embolization

2021 ◽  
Author(s):  
Prashant Raj Singh ◽  
Raghvendra Kumar Sharma ◽  
Jitender Chaturvedi ◽  
Nitish Nayak ◽  
Anil Kumar Sharma
Keyword(s):  
Posterior Fossa ◽  
Surgical Outcome ◽  
Karnofsky Performance Status ◽  
Obstructive Hydrocephalus ◽  
Case Series ◽  
Preoperative Embolization ◽  
Initial Symptom ◽  
Lower Cranial Nerve ◽  
The Mean

Abstract Background Large solid hemangioblastoma in the posterior fossa has an abundant blood supply as an arteriovenous malformation. The presence of adjacent vital neurovascular structures makes them vulnerable and difficult to operate. Complete surgical resection is always a challenge to the neurosurgeon. Material and Method We share the surgical difficulties and outcome in this case series of large solid hemangioblastomas without preoperative embolization as an adjunct. This study included five patients (three men and two women, with a mean age of 42.2 years). Preoperative embolization was attempted in one patient but was unsuccessful. All the patients have headache (100%) and ataxia (100%) as an initial symptom. A ventriculoperitoneal shunt was inserted in one case before definite surgery due to obstructive hydrocephalus. The surgical outcome was measured using the Karnofsky Performance Status (KPS) score. Result The tumor was excised completely in all the cases. No intra- and postoperative morbidity occurred in four patients; one patient developed transient lower cranial nerve palsy. Mean blood loss was 235 mL, and no intraoperative blood transfusion was needed in any case. The mean follow-up period was 14.2 months. The mean KPS score at last follow-up was 80.One patient had a KPS score of 60. Conclusion Our treatment strategy is of circumferential dissection followed by en bloc excision, which is the optimal treatment of large solid hemangioblastoma. The use of adjuncts as color duplex sonography and indocyanine green video angiography may help complete tumor excision with a lesser risk of complication. Preoperative embolization may not be needed to resect large solid posterior fossa hemangioblastoma, including those at the cerebellopontine angle location.

Ewing’s Sarcoma of the Hand

2008 ◽  
Vol 34 (1) ◽  
pp. 35-39 ◽  
Author(s):  
O. A. ANAKWENZE ◽  
W. L. PARKER ◽  
L. E. WOLD ◽  
K. K AMRAMI ◽  
P. C. AMADIO
Keyword(s):  
Radiation Therapy ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Case Series ◽  
Surgical Excision ◽  
Case Review ◽  
Retrospective Case ◽  
Postoperative Radiation Therapy ◽  
Definitive Surgery

A retrospective case review was carried out to report the outcomes in a contemporary case series of Ewing’s sarcoma originating in the hand. We identified five patients treated since 1995. All five had wide surgical excision, one by ray amputation. All were treated with chemotherapy. Four patients also received radiation therapy, two to treat metastases and two as an adjunct to local excision. There were no local recurrences. Two patients developed metastases. Both died of their disease. Neither of these two patients had received local postoperative radiation therapy; one did not receive chemotherapy before definitive surgery. The other three patients were alive and free of disease at last follow-up, 4 to 12 years after initial presentation.

P4657Cardiac myxomas: are we dealing with distinct clinical entities?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Sa Mendes ◽  
J Abecasis ◽  
A Ferreira ◽  
R Ribeiras ◽  
C Reis ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Significant Proportion ◽  
Case Series ◽  
Surgical Excision ◽  
Non Invasive ◽  
Cardiac Tumours ◽  
Asymptomatic Patients ◽  
Grade 5 ◽  
Cardiac Myxomas

Abstract Background Cardiac myxomas are rare, despite being the most common primary cardiac tumours. A significant number of myxomas are discovered accidentally in asymptomatic patients (pts), as there is increased use of non-invasive cardiac imaging. Our aim was to describe the experience of a cardiac surgery centre managing cardiac myxomas during the last 28 years. Methods Single-center retrospective study of consecutive pts admitted with the diagnosis of a cardiac myxomas between 1990 and 2018. Registry data concerning clinical presentation, non-invasive imaging assessment and definitive histopathology were collected. Results From 154 pts with the diagnosis of cardiac tumours, we identified 106 (68.8%) myxomas (67% females; mean age at diagnosis 61,5±13,1 years). Myxoma diagnosis increased throughout the 3 decades (27 cases until 2000; 26 cases in the second decade; 52 cases from 2010 until present). 30% of the pts were asymptomatic at diagnosis. Obstructive symptoms (heart failure and syncope) and embolic events were the most common complaints among symptomatic pts. Transthoracic echocardiography firstly identified the tumours in 88% of the cases. Cardiac magnetic resonance and computed tomography were performed for further investigation in 7% of the cases. Presumptive pre-operative diagnosis was correct in 83.8% pts. Surgical excision was successfully achieved in all cases. 89% of the tumours were located in the left atrium with inter-atrial septum implantation (13 in right chambers; 1 valvular tumour). There were 10 multifocal tumours. At histopathology myxomas were grossly described as mucous jelly appearance (80%), solid (15%) and mixed type lesions (5%). Rare histologic findings were described in 30% of the cases (8 tumours with bone tissue; 1 with forming bone marrow; 4 with endocrine type glandular epithelium; 16 with lympho-plasmocytic infiltrates; 3 with high mitotic grade; 5 with concomitant thrombus). For a median follow up of 86 [31–214] months there were 15 deaths (2 of them with tumour related deaths). There were 3 recurrences (2 with high mitotic grade histology), mostly occurring 3 years after the first intervention. Conclusion In this case series cardiac myxomas are the most common cardiac tumours, with a significant proportion of asymptomatic lesions. Clinical heterogeneity followed polymorphic histology, with recognized differences when compared to classical descriptions of this kind of tumour.

Delayed hemorrhage from the tissue of an occluded arteriovenous malformation after stereotactic radiosurgery: report of 3 cases

2016 ◽  
Vol 126 (6) ◽  
pp. 1899-1904 ◽  
Author(s):  
Conor Grady ◽  
Omar Tanweer ◽  
David Zagzag ◽  
Jafar J. Jafar ◽  
Paul P. Huang ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Case Series ◽  
Imaging Findings ◽  
Cerebral Arteriovenous Malformations ◽  
Conventional Angiography ◽  
Delayed Hemorrhage ◽  
Negative Findings ◽  
Angiographic Evidence ◽  
Risk Of Hemorrhage

Stereotactic radiosurgery is widely used to treat cerebral arteriovenous malformations (AVMs), with the goal of complete angiographic obliteration. A number of case series have challenged the assumption that absence of residual AVM on follow-up angiograms is consistent with elimination of the risk of hemorrhage. The authors describe 3 cases in which patients who had angiographic evidence of AVM occlusion presented with late hemorrhage in the area of their prior lesions. They compare the radiographic, angiographic, and histological features of these patients with those previously described in the literature.Delayed hemorrhage from the tissue of occluded AVMs has been reported as early as 4 and as late as 11 years after initial stereotactic radiosurgery. In all cases for which data are available, hemorrhage occurred in the area of persistent imaging findings despite negative findings on conventional angiography. The hemorrhagic lesions that were resected demonstrated a number of distinct histological findings.While rare, delayed hemorrhage from the tissue of occluded AVMs may occur from a number of distinct, angiographically occult postirradiation changes. The hemorrhages in the authors' 3 cases were symptomatic and localized. The correlation of histological and imaging findings in delayed hemorrhage from occluded AVMs is an area requiring further investigation.

scholarly journals Office Hysteroscopic Laser Enucleation of Submucous Myomas without Mass Extraction: A Case Series Study

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Sergio Haimovich ◽  
Maite López-Yarto ◽  
Julio Urresta Ávila ◽  
Alejandro Saavedra Tascón ◽  
José L. Hernández ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Case Series ◽  
Uterine Cavity ◽  
Hysteroscopic Myomectomy ◽  
Submucous Myoma ◽  
Case Series Study ◽  
Laser Enucleation ◽  
A Prospective Study ◽  
Series Study

Background and Objectives. A new two-step hysteroscopic myomectomy carried out in the office setting and without anesthesia was feasible for the excision of submucous myomas. The objective of this study was to assess whether removal of submucous myomas from the uterine cavity after hysteroscopic laser enucleation is necessary.Methods. Between June 2009 and April 2013, all outpatients with symptomatic myomatosis (bleeding, pelvic pain, and infertility) assessed ultrasonographically were eligible to participate in a prospective study. All patients underwent office hysteroscopic enucleation of submucous myomas. Enucleated myomas were left in the uterine cavity. Neither anesthesia nor antibiotic prophylaxis was used.Results. Sixty-one women (mean age: 47.3 years) were included. Regardless of hysteroscopic localization and grading, all myomas were enucleated. The mean (standard deviation, SD) diameter of the myoma as measured by the ultrasound scan was 22.6 (8.5) mm. In 29 cases (47.5%), the diameter of the resected myoma was >20 mm and in 10 cases (16.4%) >30 mm. After a mean follow-up of 68.2 (16.5) days, none of the patients showed a residual myoma inside the uterine cavity.Conclusions. The present results indicate that leaving laser-enucleated submucous myoma in the uterine cavity is a feasible and safe therapeutic option.

Obliteration of a metameric spinal arteriovenous malformation (Cobb syndrome) using combined endovascular embolization and surgical excision

2012 ◽  
Vol 10 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Clemens M. Schirmer ◽  
Steven W. Hwang ◽  
Ron I. Riesenburger ◽  
In Sup Choi ◽  
Carlos A. David
Keyword(s):  
Arteriovenous Malformation ◽  
Vascular Malformation ◽  
Surgical Excision ◽  
Endovascular Embolization ◽  
Neurological Function ◽  
High Morbidity ◽  
Partial Recovery ◽  
Spinal Vascular Malformation ◽  
Spinal Arteriovenous Malformation

Cobb syndrome represents the concurrent findings of a metameric spinal vascular malformation and a cutaneous vascular malformation within several dermatomes of each other. This rare entity engenders many difficult decisions with respect to appropriate therapeutic management. Historically, surgical excision carried a high morbidity, and conservative management without intervention was preferred. More recently, several cases of endovascular embolization have been reported with good success. The authors describe the case of a 17-year-old boy who presented with a right gluteal angioma and was found to have a spinal arteriovenous malformation. Multiple embolizations failed to prevent neurological deterioration, and the patient eventually became wheelchair dependent. Surgical excision of the malformation led to partial recovery of neurological function, and at the latest follow-up, 52 months postoperatively, the patient was able to ambulate independently. This case demonstrates the successful treatment of a patient with Cobb syndrome with surgical excision after multiple refractory embolizations. A multidisciplinary approach, which balances the patient's current neurological function against the risks and potential gains from any interventional and surgical procedure, is recommended.

Natural History of Adult-Onset Laryngeal Papillomatosis following Multiple Cidofovir Injections

2006 ◽  
Vol 115 (3) ◽  
pp. 175-181 ◽  
Author(s):  
Ana Nusa Naiman ◽  
Darius Abedipour ◽  
Sonia Ayari ◽  
Elizabeth Fresnel ◽  
Bruno Coulombeau ◽  
...  
Keyword(s):  
Complete Remission ◽  
Surgical Excision ◽  
Intralesional Injection ◽  
Adult Onset ◽  
Laryngeal Papillomatosis ◽  
Long Term Follow Up ◽  
History Of ◽  
A Prospective Study

Objectives: A prospective study was performed to assess the intermediate and long-term efficacy of intralesional cidofovir therapy associated with surgical excision in laryngeal papillomatosis in adults. Methods: Endoscopy with intralesional injection of cidofovir 5 mg/mL was performed 3 times at 4-week intervals. The concentration was later increased to 7.5 mg/mL and the interval between injections shortened to 2 weeks. Further treatment was performed at 3 or 6 months, depending on the evolution of the papillomas. After complete remission, the treatment was stopped and the patients were reviewed every 6 months. Results: Nineteen patients completed the protocol, with a mean of 4.5 injections each. Complete remission was obtained in 17 cases (89%) after a mean of 3.8 procedures. Remission was stable after a mean follow-up of 24 months (range, 8 to 57 months). With higher cidofovir concentrations at shorter intervals, patients needed fewer injections to achieve remission (mean, 2.1 versus 4.7 injections). Conclusions: The effectiveness of intralesional cidofovir therapy in adult-onset recurrent respiratory papillomatosis was impressive. Once obtained, complete remission was stable on intermediate or long-term follow-up. The concentration and the interval between injections seemed to influence the number of injections necessary to achieve remission.

scholarly journals 12-month interim results of a prospective study of patients with mild to moderate open-angle glaucoma undergoing combined viscodilation of Schlemm’s canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery

2021 ◽  
pp. 112067212199823
Author(s):  
Iwona Grabska-Liberek ◽  
Patrycja Duda ◽  
Monika Rogowska ◽  
Julita Majszyk- Ionescu ◽  
Agnieszka Skowyra ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Open Angle ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Prospective Case Series ◽  
A Prospective Study ◽  
Time Point

Purpose: To characterize clinical outcomes of combined viscodilation of Schlemm’s canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery in eyes with mild to moderate open-angle glaucoma (OAG). Methods: In this prospective case series, the OMNI glaucoma surgical platform (Sight Sciences, Menlo Park, CA) was utilized to perform the procedure either combined with phacoemulsification or as a standalone procedure. Changes from baseline in intraocular pressure (IOP) and IOP-lowering medications were evaluated through the first 12 months of a planned 24-month follow-up period. Results: Among 17 eyes of 15 subjects, mean IOP was reduced from 20.4 mmHg to 12.7–13.7 mmHg through 12 months of follow-up ( p < 0.001 at every time point) and mean medications reduced from 2.5 to 0.1–0.6 ( p < 0.001 at every time point). IOP reductions in eyes undergoing standalone surgery were approximately 2–4 mmHg greater at each time point compared to eyes undergoing surgery combined with phacoemulsification; this may be related to a higher baseline IOP in the former eyes (22.1 vs 18.5 mmHg). Six eyes developed hyphema, of which three required washout for elevated IOP on the first postoperative day; six additional eyes had IOP elevations that resolved with medical management. Conclusion: Viscodilation of Schlemm’s canal and collector channels paired with ab interno trabeculotomy performed with a single integrated instrument (OMNI), whether as standalone or combined with phacoemulsification, effectively lowers both IOP and the need for IOP-lowering medications through 12 months of follow-up.

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