ABSTRACT
PURPOSE: To evaluate prospectively the safety and efficacy of totally percutaneous placement of abdominal and thoracic aortic endografts using the Prostar XL suture-mediated closure system. METHODS: From January 2002 to January 2005, we attempted to insert percutaneously all bifurcated abdominal aortic and thoracic endografts. Consecutive patients (25 men, four women), with mean age 74.9 years (range 44-84), underwent endovascular repair for 20 abdominal aortic aneurysms (AAA) and nine thoracic aortic aneurysms (repeat operation in one case). Endografts used included 21 Zenith (Cook), eight Talent (Medtronic), one AneuRx (Medtronic). For the <
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Adult , Aged , Aged, 80 and over , Dilatation , Feasibility Studies , Female , Humans , Male , Middle Aged , Needles , Prospective Studies , SuturesABSTRACT
Intracranial unruptured aneurysm (ICUA) has become a common condition for patient consultation. The mortality rate after fissuration is estimated to be between 52% and 85.7%. The final therapeutic decision results from a balance between the risk of rupture and risks related to the aneurysmal exclusion. Analysis of the risk of rupture risk enables a classification of risk factors. Depending on the circumstances of diagnosis, we considered the ICUA at high risk of rupture for incidental ICUA larger than 7 mm and in the event of associated aneurysms. Classifying by morphologic features, high-risk ICUA were located in the vertebrobasilar system (RR: 4.4; 95%CI: 2.7-6.8), those with a size between 7 and 12 mm (RR: 3.3; 95%CO: 1.3-8.2), larger than 12 mm (RR: 17; 95%CI: 8-36.1), those that were multilobular or a larger size and those ones with a index P/L superior to 3.4 (risk x20). Familial ICUA would expose to a major rupture risk (2 to 7 times sporadic ICUA). Some systemic factors were related to ICUA rupture: arterial hypertension (RR: 1.46; 95%CI: 1.01-2.11) and smoking addiction (RR: 3.04; 95%CI: 1.21-7.66). After microsurgical exclusion, the morbidity and mortality rates were 10% and 2% respectively. Some microsurgical morbidity factors were identified: age (32%>65 years), size (14%>15 mm), vertebrobasilar location and temporary occlusion. The rupture incidence after microsurgical exclusion was estimated 0.26%/year. After endovascular exclusion, the morbidity and mortality rates were 8% and 1% respectively. The complete exclusion rate varied between 47% and 67%. The rupture risk was estimated at 0.9%/year. Treatment recommendations were classified into 3 categories.
Subject(s)
Intracranial Aneurysm/surgery , Humans , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/etiology , Microsurgery , Practice Guidelines as TopicABSTRACT
Spinal dural arteriovenous fistulas are a rare cause of myelopathy. Nonspecific symptoms may delay the diagnosis. Magnetic resonance imaging and spinal angiography are routinely used to establish the diagnosis. In our case abnormalities on magnetic resonance imaging only suggested spinal dural arteriovenous fistulas. Multidetector row computed tomography (MRCT) led to the diagnosis which was confirmed by angiography.
Subject(s)
Central Nervous System Vascular Malformations/diagnostic imaging , Central Nervous System Vascular Malformations/pathology , Humans , Lumbar Vertebrae , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, Spiral ComputedABSTRACT
BACKGROUND AND PURPOSE: The respective roles of endovascular and surgical treatment must be clearly defined in the management of ruptured anterior communicating artery (AcoA) aneurysm. The aim of our study was to report our results, using the aneurysm direction as the main morphological argument to choose between microsurgery and endovascular embolization. Morbidity and mortality, causes of unfavorable outcome and morphological results were also assessed. PATIENTS AND METHODS: Our prospective study included 119 patients: 89 treated by microsurgery and 30 undergoing embolization with Guglielmi Detachable Coils (GDC). When the aneurysm had an anterior direction (fundus of the aneurysm in front of the pericallosal arteries), we attempted microsurgery. If the fundus of the aneurysm was behind the pericallosal arteries, we selected the most adapted procedure after discussion with the neurovascular team, taking into account the physiological status, treatment risk and neck size. Preoperative status of the patients was assessed according to the Hunt and Hess (HH) classification. Cerebral CT-scan and angiograms were routinely performed after treatment to determine causes of unfavorable outcome (GOS>1) and the morphological results. RESULT: Overall clinical outcome was excellent (GOS1) for 63.0% of patients, good (GOS2) for 10.1%, fair (GOS3) for 13.4%, poor (GOS4) for 2.5%. The mortality rate was 10.9%. Among the 82 patients in good preoperative grade (HH
Subject(s)
Aneurysm, Ruptured/surgery , Cerebral Arteries/surgery , Cerebral Revascularization , Embolization, Therapeutic , Intracranial Aneurysm/surgery , Adolescent , Adult , Aged , Aneurysm, Ruptured/mortality , Aneurysm, Ruptured/pathology , Cerebral Angiography , Cerebral Arteries/pathology , Disability Evaluation , Female , Humans , Intracranial Aneurysm/mortality , Intracranial Aneurysm/pathology , Male , Middle Aged , Prospective Studies , Tomography, X-Ray Computed , Treatment Failure , Treatment OutcomeABSTRACT
BACKGROUND: The long-term effects of uterine artery embolization for the control of postpartum haemorrhage on menses, fertility and future pregnancy evolution have not been assessed. METHODS: Between November 1993 and July 1999, 31 women with obstetric haemorrhage underwent arterial embolization. Four patients underwent a hysterectomy. Gynaecological information on 25 of the 27 patients who did not undergo hysterectomy was obtained by interview. RESULTS: All women had a return of normal menses. Nine of the 25 patients desired subsequent pregnancy and five patients became pregnant with normal delay of conception. Moreover, two other patients who did not plan another pregnancy became pregnant. A total of 10 pregnancies was studied, four ended during the first trimester. For the six others, the maternal evolution of the pregnancy was uneventful until term. No case of pre-eclampsia was observed. The ultrasonographic examinations revealed normal fetal growth and umbilical and uterine Doppler studies showed no anomaly. No repetition of obstetric haemorrhage was observed. All full-term, newborns were healthy, weighing from 3220 to 4100 g. CONCLUSION: Our results suggest that women who undergo arterial embolization for obstetric haemorrhage should expect to have a return of normal menses with preservation of future fertility and successful uneventful pregnancies.
Subject(s)
Embolization, Therapeutic/adverse effects , Fertility , Menstruation , Postpartum Hemorrhage/therapy , Angiography , Arteries , Embryonic and Fetal Development , Female , Humans , Hysterectomy , Postpartum Hemorrhage/surgery , Pregnancy , Pregnancy Outcome , Recurrence , Uterus/blood supplyABSTRACT
OBJECTIVE: Abnormal placentation accounts for more than 50% of uterine artery embolization failure. The authors report their experience in this situation. STUDY DESIGN: Seven women presented with abnormal placentation. Uterine artery embolization was carried out in emergency or prophylactic control of postpartum bleeding. RESULTS: In five patients, control of postpartum hemorrhage was obtained without hysterectomy. In two cases with no placental removal and prophylactic procedures, hysterectomy and blood transfusion were not necessary. The manual removal of the placenta was achieved secondarily, respectively on the 25th and the 12th day. CONCLUSIONS: The success rate of uterine artery embolization for postpartum bleeding appears to be lower with abnormal placentation. In none of the cases with the placenta present was it possible to leave the residual placenta in place. However, embolization may permit a safe waiting period and spontaneous migration of the placenta. When the diagnosis is made before delivery, prophylactic uterine artery embolization without placental removal should be considered to reduce blood transfusion and preserve fertility.
Subject(s)
Embolization, Therapeutic/methods , Placenta Diseases/therapy , Adult , Arteries/surgery , Female , Humans , Placenta Diseases/surgery , Postpartum Hemorrhage/prevention & control , Pregnancy , Uterine Hemorrhage/prevention & control , Uterus/surgeryABSTRACT
We report three cases of post-partum haemorrhage following caesarean delivery attributed to a false aneurysm of the uterine pedicle and treated with artery embolization. These lesion were probably post-traumatic in origin related to hysterotomy. Angiographic study of the anterior division of hypogastric arteries confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the haemorrhage.
Subject(s)
Aneurysm, False/complications , Aneurysm, False/diagnosis , Cesarean Section , Embolization, Therapeutic , Postpartum Hemorrhage/etiology , Uterus/blood supply , Adult , Aneurysm, False/therapy , Angiography , Arteries , Female , Gestational Age , Humans , Hysterotomy/adverse effects , Ovary/blood supply , Pelvis/blood supply , PregnancyABSTRACT
PURPOSE: To report the exclusion of a subclavian pseudoaneurysm by a combination of covered stent implantation and coil embolization. CASE REPORT: A 30-year-old man presented with a posttraumatic pseudoaneurysm of the left subclavian artery. A covered Jostent was inserted via a percutaneous femoral approach and deployed in the injured subclavian artery. Because of tapering of the artery proximally, apposition of the covered stent to the arterial wall was insufficient, leading to persistent filling of the pseudoaneurysm. Exclusion of the pseudoaneurysm was achieved by coil embolization through a gap between the stent-graft and the arterial wall. CONCLUSIONS: This report illustrates that successful endovascular treatment of a left subclavian pseudoaneurysm may require a combination of catheter-based techniques.
Subject(s)
Aneurysm, False/therapy , Subclavian Artery/injuries , Adult , Catheterization , Embolization, Therapeutic , Humans , Male , Salvage Therapy/methods , Stents/adverse effectsABSTRACT
We have reported a case of acute acalculous cholecystitis occurring after hepatic artery embolization in a woman sustaining multiple traumatic injuries. Although many classical factors such as shock, sepsis, transfusion or narcotic administration may be involved in the genesis of gall-bladder necrosis, we have discussed the possible involvement of hepatic artery embolization in the ischaemic process. Indeed, this mechanism has already been reported in non traumatic patient following hepatic tumor chemoembolization.
Subject(s)
Cholecystitis/etiology , Embolism/complications , Hepatic Artery , Multiple Trauma/complications , Acute Disease , Adult , Angiography , Embolism/diagnostic imaging , Female , Hepatic Artery/diagnostic imaging , HumansABSTRACT
A 29-year-old woman presented with dilated epidural veins and incapacitating headache after undergoing a lumbar puncture. Two months later, the results of follow-up MR imaging were normal. These findings suggest that temporary dilation of the epidural vein may occur in association with post-lumbar puncture intracranial hypotension syndrome. In these cases, it seems useful to confirm whether the patient has recently undergone a lumbar puncture.
Subject(s)
Intracranial Hypotension/complications , Spinal Cord/blood supply , Spinal Puncture/adverse effects , Vascular Diseases/etiology , Adult , Female , Humans , Intracranial Hypotension/etiology , NeckSubject(s)
Ureterocele/diagnosis , Child, Preschool , Female , Humans , Ultrasonography , Ureter/diagnostic imaging , Ureterocele/diagnostic imaging , UrographyABSTRACT
Septic arthritis of spinal apophyseal joint, seldom described, mainly concern the lumbar spine. We report three cases. Inflammatory lesions of the paravertebral soft tissues were associated in each case; an epidural abscess was present twice. Our three cases were due to Staphylococcus aureus. The initial clinical features were consistent with a spondylodiscitis. Imaging led to the correct diagnosis in all cases. According to our observations and several others of the literature: facet joint lesions are visible too late on plain films. Bone scintigraphy is sensitive, but not specific. CT scan and MRI are the most contributive investigations. A pathologic aspect of the paravertebral soft tissues is visible less than one week after the beginning of the symptoms on CT scan and MRI. Lesions of the facet joint are detectable as soon as the first week on MRI, and after 15 days of clinical course on CT scan. Epidural abscess, when present, is best shown by MRI as early as the first week. CT scan can guide percutaneous needle biopsies of the paravertebral abscesses or of the concerned facet joint.