Successful transcatheter embolization of splenic artery pseudoaneurysm in acute necrotising pancreatitis.

Splenic artery pseudoaneurysm is a rare condition commonly arises as a sequelae of pancreatitis. Pseudoaneurysm is clinically silent until it ruptures. Thus, untreated pseudoaneurysm carries a high mortality rate up to 90%. We present a case of necrotising pancreatitis complicated with unruptured splenic artery pseudoaneurysm, which was found incidentally from computed tomography (CT) of abdomen. Patient was presented with symptomatic anemia and bleeding from the abdominal drain. We proceeded with embolization of pseudoaneurysm by using Histoacryl glue, resulting in successful complete resolution of pseudoaneurysm with good patient outcome. Transcatheter embolization is considered the current treatment of choice for pseudoaneurysm as it provides an alternative to conventional surgery due to its high successful rate. In this case report, we want to shed light on an alternative treatment approach of the splenic artery pseudoaneurysm.

Transcatheter Embolization of Systemic-to-pulmonary Artery Fistulas: a Case Report

The systemic artery to pulmonary vessel fistula(SAPVF) is an uncommon vascular abnormal communication between systemic arteries (except bronchial arteries) and the lung parenchyma[1]. It can be divided into congenital and acquired causes. Congenital SAPVF is often accompanied by cardiac or pulmonary artery hypoplasia, and acquired are usually caused by pleural adhesions after pleurisy, empyema, trauma, or surgery[2].We report a case of transcatheter arterial embolization for the treatment of congenital right inferior phrenic artery to pulmonary artery fistula.

Idiopathic Pulmonary Arteriovenous Malformation - A Rare Entity

Pulmonary arteriovenous malformation (PAVM) is one of the rare pulmonary vascular anomalies. Pulmonary arteriovenous malformation results in right to left shunt due to the abnormal communications between the pulmonary arteries and the pulmonary veins bypassing the normal capillary bed.1 This condition being rare could be easily missed, hence, it is essential for clinicians to suspect it based on the classical clinical features. This helps in early diagnosis and deciding further appropriate treatment option. Here we report the case of a patient affected by a large idiopathic pulmonary arteriovenous malformation in the right lung. Most patients with pulmonary arteriovenous malformation are asymptomatic. This is due to the chronic compensation and secondary erythrocytic response. Dyspnoea due to PAVMs are a result of right-to-left shunt. Initial diagnostic tools include chest radiography and contrast enhanced computed tomography but the gold standard is pulmonary angiography.2 Because AVM has substantial morbidity rates associated with it, all patients with PAVMs who can undergo embolization should be treated with transcatheter embolization. In rest of the patients, surgical excision should be considered. The main objective of this study was to highlight the early suspicion and diagnosis of pulmonary arteriovenous malformation as this is easily missed and leads to undue delay of treatment.

Successful experience of transcatheter arterial embolization for gonarthrosis in patients with severe pain syndrome and ineffectiveness of conservative therapy

Osteoarthritis is a common disease of the musculoskeletal system, the cause of pain, loss of joint function and, as a consequence, a factor in the disability of the population. The treatment strategy for patients with gonarthrosis is not fully defined, especially in patients with stage 1–2. One of the treatment options for such patients is transcatheter embolization of the hypervascular network of the popliteal arteries. The article presents a series of clinical cases of embolization of the popliteal artery branches. Retrograde percutaneous puncture and catheterization of the target femoral artery were performed under local anesthesia. Then, selective angiography of the popliteal artery was performed to identify the hypervascular vasculature of the knee joint. After revealing the target artery along the interventional guidewire, selective catheterization of the artery of the hypervascular vascular network was performed using a microcatheter. Transcatheter arterial embolization of the hypervascular vascular network in osteoarthritis of various origins and localization can be successfully applied as an alternative treatment if conservative therapy is ineffective and if there are contraindications to surgical treatment. It should be noted that further randomized multicenter studies and meta-analyzes are needed to introduce this treatment method into everyday clinical practice.

Diagnosis and endovascular management of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVM) are abnormal communication of a branch of the pulmonary artery and pulmonary vein circumventing the intervening pulmonary capillaries. This results in a right-to-left (R-L) shunt and its related manifestations, which include hampered gas exchange leading to hypoxaemia, dyspnoea, paradoxical emboli leading to stroke, cerebral abscess, myocardial infarction and pulmonary haemorrhage due to rupture of the PAVM. Endovascular transcatheter embolization of the feeding vessels with coils or occlusion devices is the current standard care of treatment and preferred treatment modality. The articles aim to provide insights into the current trends in diagnosis, the current recommendations, approach and management options for patients with PAVM.

A case of a high-flow priapism treated with superselective transcatheter embolization

High-flow priapism is a rare condition characterized by prolonged and painless erection. It is defined as contusion or thrombosis of the cavernous body of the penis usually secondary to blunt trauma. Due to the rarity of the disease, there is no well-defined consensus about treatment. Conservative treatment is often applied with non-steroidal anti-inflammatory drug. We present a case of 58-year-old man with proximal partial priapism that developed secondary to blunt trauma to the penis. The patient did not benefit from non-steroidal anti-inflammatory drug therapy and then was successfully treated with selective embolization.

Single-institution retrospective review of elective and emergency embolization of renal angiomyolipoma

Introduction: We aimed to evaluate the size reduction and complications after transcatheter embolization of renal angiomyolipomas (AMLs). Methods: Cases from a single tertiary center were analyzed retrospectively. A blinded radiologist provided measurements of AMLs using a combination of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Electronic clinical notes, radiographic imaging, and laboratory data were reviewed. Results: Twenty-one embolization procedures from 2002–2019 were analyzed. Four cases were emergency, the remainder elective. The average followup time after intervention was 42 months. Techniques included ethanol, PVA, Gelfoam, Embospheres®, Histacryl®, and coils. The median diameter size of AMLs was 8.6 cm pre-procedure and 6.0 cm post-procedure. The median volume of AMLs was 200 cc pre-procedure and 67 cc post-procedure, with a median reduction in volume of 55%. One case (4.8%) had a re-embolization and three cases (14.3%) proceeded with surgical management of the AML. No cases re-presented with bleeding. Post-embolization syndrome is common. Renal arterial dissection and renal abscess are infrequent complications (9% and 4.5%, respectively). There was no treatment-based mortality. Conclusions: Embolization for renal AMLs is an established, safe, and effective method of treatment and our series further supports that. Determining when to intervene and how long to follow up patients is an issue that has not been well-described; more research needs to be done in this area.