scholarly journals Endovascular management of a vein of Galen aneurysmal malformation in an infant with challenging femoral arterial access

2016 ◽  
Vol 18 (2) ◽  
pp. 231-234 ◽  
Author(s):  
Bharathi D. Jagadeesan ◽  
Haralabos Zacharatos ◽  
David R. Nascene ◽  
Andrew W. Grande ◽  
Daniel J. Guillaume ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Transarterial Embolization ◽  
Arterial Embolization ◽  
Venous Access ◽  
Arterial System ◽  
Vein Of Galen ◽  
Foramen Ovale ◽  
Endovascular Management ◽  
Arterial Access ◽  
Femoral Arterial Access

A 5-month-old infant was to be treated with elective transarterial embolization for a vein of Galen aneurysmal malformation (VGAM). A team of endovascular surgical neuroradiologists, pediatric interventional radiologists, and pediatric cardiologists attempted conventional femoral arterial access, which was unsuccessful given the small caliber of the femoral arteries and superimposed severe vasospasm. Thereafter, eventual arterial access was achieved by navigating from the venous to the arterial system across the patent foramen ovale following a right femoral venous access. Embolization was then successfully performed. At a later date, the child underwent successful transvenous balloon-assisted embolization and eventual arterial embolization with cure of the VGAM.

scholarly journals Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

2019 ◽  
Vol 67 (2) ◽  
pp. 93-102
Author(s):  
Krzysztof Dziewiatowski ◽  
Piotr Siermontowski
Keyword(s):  
Left Atrium ◽  
Sensitivity And Specificity ◽  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Adult Population ◽  
Venous Blood ◽  
Arterial System ◽  
Foramen Ovale ◽  
Contrast Enhanced

Abstract Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.

scholarly journals Paradoxical Embolization in an Adult Cystic Fibrosis Patient

2007 ◽  
Vol 14 (5) ◽  
pp. 293-294 ◽  
Author(s):  
Nabil M Al Lawati ◽  
Pearce Wilcox
Keyword(s):  
Cystic Fibrosis ◽  
Cerebrovascular Accident ◽  
Patent Foramen Ovale ◽  
Venous Access ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Indwelling Catheter ◽  
Increased Risk ◽  
Full Neurological Recovery ◽  
Venous Access Device

Cystic fibrosis patients with an implantable venous access device (IVAD) and a patent foramen ovale (PFO) are at an increased risk of developing paradoxical embolism. A 33-year-old patient who had a cerebrovascular accident in the above setting is described. She had been anticoagulated because she had thrombosis of the tip of the indwelling catheter, and her PFO was closed percutaneuosly followed by replacement of her IVAD. She made a full neurological recovery. Echocardiography and prophylactic closure of the PFO, when present, as primary prevention for paradoxical embolism may be warranted in cystic fibrosis patients before placement of an IVAD.

scholarly journals Rapid cardiac ventricular pacing to facilitate embolization of vein of Galen malformations: technical note

2019 ◽  
Vol 23 (1) ◽  
pp. 86-91 ◽  
Author(s):  
Aaron Hockley ◽  
Michael K. Tso ◽  
Mohammed A. Almekhlafi ◽  
Abhay K. Lodha ◽  
Robin Clegg ◽  
...  
Keyword(s):  
Transient Flow ◽  
Transarterial Embolization ◽  
Venous Access ◽  
Technical Note ◽  
High Flow ◽  
Vein Of Galen ◽  
Ventricular Pacing ◽  
Vessel Occlusion ◽  
Temporary Pacing ◽  
Refractory Heart Failure

OBJECTIVEVein of Galen aneurysmal malformations (VGAMs) in infancy have a poor natural history if left untreated. Their high-flow nature can preclude safe and accurate therapeutic vessel occlusion and the risk of inadvertent pulmonary embolism is predominant. The authors describe the technique of rapid cardiac ventricular pacing for inducing transient hypotension to facilitate the controlled embolization of VGAMs.METHODSInitial transjugular venous access was obtained for placing temporary pacing leads for rapid cardiac ventricular pacing immediately prior to embolization. Definitive transarterial embolization procedures for the VGAMs were then performed in the same setting in which liquid embolic agents or coils were used.RESULTSBeginning in 2010, a total of five procedures were performed in three infants. Transvenous rapid cardiac ventricular pacing was successfully achieved to induce systemic transient flow arrest in all but two attempts, and facilitated partial embolization with n-butyl cyanoacrylate (n-BCA) and coils in all procedures. Ventricular fibrillation occurred twice in one patient and was successfully reversed with defibrillation on both occasions. One patient failed to improve and died from refractory heart failure. Two patients stabilized following staged embolization.CONCLUSIONSRapid transvenous cardiac ventricular pacing can be considered to induce transient hypotension and facilitate controlled embolization in challenging high-flow VGAMs.

scholarly journals Vein of Galen malformation: What to do when vascular access is not feasible?

2014 ◽  
Vol 21 (2) ◽  
pp. 201-208
Author(s):  
Marco Zenteno ◽  
Luis Rafael Moscote-Salazar ◽  
Jorge Santos-Franco ◽  
Angel Lee
Keyword(s):  
Technical Assistance ◽  
Vascular Malformations ◽  
Venous Access ◽  
Vascular Lesion ◽  
Direct Access ◽  
High Morbidity ◽  
Vein Of Galen ◽  
Endovascular Management ◽  
Vein Access ◽  
Velum Interpositum

Abstract Background: The vein of Galen aneurysmal malformation (GVAM) is a rare congenital vascular lesion, with high morbidity and mortality without treatment, endovascular management is the best alternative available today. Aim: The purpose of this work is to report the case of a female patient with imaginological and angiographical diagnosis of GVAM, which was difficult for endovascular managent alone, due to this was decided an alternative endovascular direct access guided by stereotactic assistance. Case report: We report the case of an infant with imaging and angiographic diagnosis of GVAM, with absence of the vein access through classical embolization could be done, complicating and making difficult for endovascular management alone, hence was decided an alternative endovascular direct access guided by stereotactic assistance, ensuring total embolization of the lesion with coils. The patient progressed satisfactorily. Discussion: VGAM generally represents only 1% or less of total cerebral vascular malformations, but in pediatrics may be as high as 30%. The malformation is occupying the subarachnoid space of the velum interpositum and the quadrigeminal cistern. It is characterized by the presence of the vein embryonic precursor of the vein of Galen, and abnormal arterial shunts from arteries normally developed but extremely dilated. Mortality rate is high in these patients without treatment, developing hydrocephalus and cerebral complications related to the occupying mass that could drive to epilepsy, serious cognitive sequelae, intracerebral emorrhage and death within the possibilities. Heart failure is often a common complication. To our knowledge this is the first report of the use of stereotactic assistance in the endovascular therapeutic management of VGAM. Conclusions: In cases where clasical venous access cannot be achieved as in the case we report, further technical assistance can be obtained with stereotactic guidance, making easier the procedure, remembering that without therapy, VGAM result in lifethreatening hydrocephalus and/or intracranial hemorrhage, rapidly driving to death.

Endovascular management of vascular complications after percutaneous nephrolithotomy

VASA ◽  
2014 ◽  
Vol 43 (6) ◽  
pp. 459-464 ◽  
Author(s):  
Selim Kervancioglu ◽  
Feyza Gelebek Yilmaz ◽  
Sakip Erturhan
Keyword(s):  
Treatment Outcomes ◽  
Percutaneous Nephrolithotomy ◽  
Coil Embolization ◽  
Vascular Complications ◽  
Arterial Embolization ◽  
Arterial System ◽  
Vascular Lesions ◽  
Endovascular Management ◽  
Arterial Complications ◽  
Endovascular Coil Embolization

Background: Bleeding is one of the most common and most important complications of percutaneous nephrolithotomy (PCNL), which is mainly controlled with conservative treatment options. Transcatheter arterial embolization is required in less than 1 % of the patients undergoing PCNL. There are only a few studies about endovascular treatment of vascular complications of PCNL. The purpose of this study was to evaluate renal arterial complications of PCNL and treatment outcomes with endovascular coil embolization. Patients and methods: This retrospective study evaluated 16 patients who underwent endovascular management for complications after PCNL, including diagnostic angiography. We analyzed the angiographic appearances of the vascular lesions that caused hemorrhages, treatment outcomes for endovascular coil embolization, and renal parenchymal loss rate following this treatment. Results: Seven patients had a pseudoaneurysm, two patients had an arteriocaliceal fistula (ACF), five patients had a pseudoaneurysm and an arteriovenous fistula (AVF), and two patients had a pseudoaneurysm and an ACF. Of the 14 patients with pseudoaneurysms, five had more than one pseudoaneurysm. Endovascular coil embolization was successful in all patients, and it was able to stop the bleeding. After embolization, 12 patients had less than 10 % parenchymal loss, and 4 patients had 10–20 % parenchymal loss. Mean hospital stay after embolization was 2.3 ± 0.7 days (range, 1 to 3 days). Conclusions: The injuries seen in the intrarenal arterial system during the PCNL procedure can result in pseudoaneurysms and/or AVFs and/or ACFs, and more than one artery can be harmed. Arterial complications of PCNL can be treated with endovascular coil embolization while preserving renal function at a maximum level.

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