Selective Angioembolisation of Iatrogenic Renal Artery Pseudoaneurysms Following Minimally Invasive Urological Procedures: A Single Centre Case Series.

INTRODUCTION: The purpose of this study was to report our centre's experience using selective angioembolisation in the treatment of iatrogenic renal artery pseudoaneurysms (RAP) following minimally invasive urological procedures. METHODS: Our retrospective analysis included four consecutive patients treated with angioembolisation for iatrogenic RAP between October 2016 and October 2021. Data on demographics, minimally invasive urological intervention, clinical features, imaging findings, embolization procedure and perioperative details were collected. Rates of technical and clinical success, defined as 1. total occlusion of the extravasation site on completion digital subtraction angiography (DSA), and 2. resolution of symptoms, signs, and serum hemoglobin (Hb) derangements secondary to RAP, were analysed. Renal function, measured by serum creatinine (Cr) and estimated glomerular filtration rate (eGFR), was recorded prior to and post - angioembolisation procedure and compared. RESULTS: Mean time between urological intervention and angioembolisation was 9 days (range, 2-17 days). Rates of technical and clinical success were 100% and 100% respectively. No additional angioembolisation procedures were required, and there were no peri or post-operative complications identified during mean follow-up of 662 days (range, 30-1845 days). Mean serum Cr prior to and post angioembolisation was 83 mmol/L and 79.5 mmol/L. Mean eGFR prior to and post angioembolisation was 73.8 and 77.8 mL/min/1.73 m2. In all patients, no significant difference was observed in serum Cr and eGFR prior to and post angioembolisation. CONCLUSION: Iatrogenic renal artery pseudoaneurysms can occur following a range of minimally invasive urological procedures. This retrospective review highlights the utility of angioembolisation as a safe and effective treatment with high clinical and technical success rates. Further studies involving larger populations are required to validate its broader application.

Acquired Carotid-Jugular Fistula Secondary to a Pseudoaneurysm Following Carotid Endarterectomy.

Acquired arteriovenous fistulas involving the carotid artery are most frequently the result of trauma and iatrogenic causes such as central venous catheterisation. Occasionally, they may develop spontaneously due to erosion of an aneurysm into an adjacent vein. We report a rare case of an acquired carotid-jugular fistula secondary to a pseudoaneurysm that occurred four months following carotid endarterectomy.

Arteriovenous fistula formation with adjuvant endovascular maturation.

BACKGROUND: The clinical utility of the native arteriovenous fistula (AVF) has been limited by the prolonged time required for maturation, the low overall maturation rate, and subsequent abandonment. Endovascular intervention has been increasingly accepted as the first-line therapy for AVF stenosis. The objective of the present study was to evaluate the AVF formation outcomes when early endovascular intervention was selectively performed to bring about timely AVF maturation. METHODS: We performed a retrospective study (February 2014 to February 2020) of 82 AVF consecutive patients (mean age, 62.5 ± 13.5 years; range, 17-83; 58 men [70.7%]) with end-stage renal failure who had undergone vascular access construction at a single institution. The 4-year AVF patency, vascular diameters, hemodialysis parameters, reintervention rate, and mortality were analyzed. RESULTS: Radiocephalic AVF was the most common fistula constructed (71 patients; 88.6%). The evaluation at a mean of 46.2 ± 56.0 days (range, 5-343 days) after AVF formation revealed 33 immature AVFs (40.2%). Subsequently, 19 patients had undergone endovascular procedures, including angioplasty and/or stenting of the juxta-anastomosis, cannulation zones, and/or outflow segments to bring about timely maturation of the AVF. Hence, 93.9% of the AVFs had reached functional patency (maturation) by 6 months after formation, with a mean time to maturation of 67.8 ± 65.9 days (range, 5-320 days). After reaching maturation, the primary access functional patency was 82% ± 4.3% at 6 months, 58% ± 5.5% at 12 months, and 34% ± 6.8% at 48 months. The primary assisted access functional patency was 95% ± 2.4% at 6 months, 90% ± 3.3% at 12 months, and 83% ± 4.7% at 48 months. A total of 121 endovascular interventions were performed to maintain patency, equating to an endovascular reintervention rate of 0.37 procedure/patient year. The mean arterial, venous, and brachial flow rates did not change significantly after maturation with a mean AVF (primary assisted functional patency) survival time of 5.9 ± 0.26 years (range, 5.33-6.36 years) from maturation. Only 12 thromboses had occurred after the first follow-up review after AVF formation. These were all salvaged using endovascular techniques, leading to 100% total secondary functional patency at 4 years. The 5-year estimated all-cause mortality was 45.6% ± 12.7%. CONCLUSIONS: The AVF maturation rate and interval to maturation were improved when early endovascular intervention was selectively performed after AVF formation. This allowed for near universal maturation. In addition, once matured, the use of ongoing endovascular reinterventions allowed for a low reintervention rate and long-term patency, providing reliable long-term renal vascular access.

Electrical neuromodulation in bladder dysfunction: Mapping the state-of-the-art with bibliometric analysis of field and top 100 cited articles.

AIMS: Electrical neuromodulation of bladder function has been extensively investigated in the literature. To date, there has been no characterization of the field, and there is a lack of bibliometric literature to guide future studies. We directed this scientometric analysis to characterize the distribution, characteristics and relationships of the field, with subanalysis of top 100 articles. METHODS: The Web of Science Core Collection of the Thompson Reuters Web of Science was searched and analyzed to determine distributions and characteristics of clinical research investigating electrical neuromodulation in bladder dysfunction. Field citation and coauthorship networks were mapped, and recent citation bursts of the past decade are described. The top 100 cited articles were categorized, with level of evidence rating system applied. RESULTS: A total of 872 articles published from 1949 until October 2020 were included in field analysis. Europe demonstrated the highest continental productivity within field (n = 539, 61.81%), and the United States the top nation (35.55% of field, 39.24% of top 100 articles). The Journal of Urology has historically published the most articles in the field (n = 150, 17.20%), and top 100 articles (n = 41, 40.20%). Top 100 articles reported studies of neuromodulation effects via sacral neuromodulation (n = 59); of non-neurological bladder dysfunction (n = 72); urinary incontinence (n = 92), frequency (n = 73) and urgency (n = 68) symptomology. CONCLUSIONS: Analysis of electrical neuromodulation of bladder dysfunction literature reveals historical development, core research clusters and relationships, and an increase in publication activity over past decades.

Contemporary outcomes of continuous-flow left ventricular assist devices-a systematic review.

BACKGROUND: End stage heart failure is a major cause of morbidity and mortality, and its prevalence is expected to rise with the ageing population. For suitable patients, orthotopic heart transplantation remains the gold standard therapy, however, a paucity of donor organs has led to the development of left ventricular assist devices (LVAD). These devices can be utilized as either a bridge-to-transplant (BTT) or as an alternative to heart transplantation. While these devices can prolong life and improve quality of life, they are associated with a significant number of adverse events. We aim to systematically review the literature to quantify survival and the incidence of adverse events following implantation of continuous-flow LVADs (cf-LVAD). METHODS: A systematic review was performed to determine outcomes following implantation of a cf-LVAD. Primary outcomes were survival and frequency of adverse events (such as bleeding, infection, thrombosis, stroke and right ventricular failure). Secondary outcomes included quality of life and assessment of functional status. RESULTS: Sixty-three studies reported clinical outcomes of 9,280 patients. Survival after cf-LVAD varied between studies. Industry-funded trials generally reported better overall survival than the single- and multi-center case series, which showed significant variation. The largest registry report documented twelve, twenty-four and forty-eight-month survival rates of 82%, 72% and 57% respectively. The most commonly reported adverse events were gastrointestinal bleeding (GIB), device-related infection, neurological events and right heart failure (RHF). Bleeding, RHF and infection were the most frequent complications experienced by those supported with cf-LVAD, occurring in up to 35%, 40% and 55% of patients, respectively. Quality of life as measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and functional status as measured with the 6-minute walk test (6MWT) improved after cf-LVAD implantation with no decline evident two years after implantation. CONCLUSIONS: The paucity of donor hearts has led to the development of left-ventricular assist devices as a BTT or as a destination therapy (DT). Outcomes after cf-LVAD implantation are excellent, with short-term survival comparable to heart transplantation, but long-term survival remains limited due to the incidence of post-implantation adverse events. Despite these complications, quality of life and functional status improve significantly post-implantation and remain improved over the long-term. This study demonstrates the potential benefits of cf-LVAD therapy whilst also identifying adverse events as an area of increased morbidity and mortality.

Concurrent Ilio-Enteric and Ilio-Vesical Fistula From Large Aorto-Iliac Aneurysm.

Iliac artery aneurysms (IAA) are associated frequently with abdominal aortic (AAA) and other degenerative large-vessel aneurysms. Concurrent fistulization of the aortoiliac tree into the gastrointestinal tract (GIT) and bladder is exceptionally rare. We herewith report a unique case of concurrent ilio-enteric and ilio-vesical fistula arising from a large aorto-iliac aneurysm.

Alternative access - Iliac artery angioplasty performed via left arm brachiocephalic fistula.

The majority of peripheral endovascular interventions are performed with access through the groin, followed by brachial and radial artery approaches. We describe a unique case of successful iliac artery endovascular intervention, performed via a left upper limb brachiocephalic fistula access site.

Kounis Syndrome after Angioplasty of the Superficial Femoral Artery with Paclitaxel-Coated Balloon.

Drug-coated balloons are used widely as a form of endovascular treatment for peripheral arterial disease, to improve patency by reducing neointimal hyperplasia and restenosis. We present a rare case of acute coronary syndrome secondary to anaphylaxis after inflation of a paclitaxel-coated balloon used to treat a recurrent superficial femoral artery stenosis.