Amplatzer Plug to Occlude the Internal Iliac Artery During Endovascular Aortic Aneurysm Repair: A Large Multicenter Study.

OBJECTIVE: During endovascular repair of abdominal aortic aneurysms (EVAR), in the absence of a distal iliac landing zone, the Amplatzer plug is increasingly being used to replace other internal iliac artery (IIA) embolization techniques. This study aimed at assessing the technical success, complication occurrence, and durability of the Amplatzer plug for IIA embolization. METHOD: From January 1, 2007 to December 31, 2013, all consecutive patients who underwent internal iliac embolization with an Amplatzer plug during EVAR were included in the study. There were 169 patients, (160 men, 9 women, mean 75 ± 9 years), treated by unilateral (158 cases, 93%) or bilateral (11 cases, 7%) embolization of the IIA, performed either separately prior to (65 cases, 38.5%) or during EVAR (104 cases, 61.5%). Follow up CT scan and/or US scan were performed 1 month after treatment and yearly thereafter. The inclusions were done retrospectively but the series was continuous and consecutive. Data were collected and analyzed using acquisition REDCap software. RESULTS: The technical success rate was 97.6%. Failures were device migration (n = 1), navigation failure (n = 2), and release outside the target zone (n = 1). On average, 1.43 plugs were required to achieve the embolization. The average amount of contrast agent for the embolization procedure was 111 ± 51 mL and the radiation dose was 127,777 ± 89,528 mGy/cm(2). The total fluoroscopy time was 854 ± 538 seconds. No re-canalization of the IIA trunk was observed during follow up. Complications were buttock claudication (n = 41, 24.3%), which resolved in 24 cases (58.5%, 24/41) at the first follow up, and intestinal ischemia requiring limited bowel resection in two cases. CONCLUSION: This multicenter study is the largest published to date. It demonstrates the efficacy and reliability of the Amplatzer plug to embolize the IIA during EVAR, with few side effects.

Obliterative Endoaneurysmorrhaphy with Stent Graft Preservation for Treatment of Type II Progressive Endoleak.

OBJECTIVE/BACKGROUND: Persistent type II endoleak (EL II) with sac enlargement after endovascular repair of abdominal aortic aneurysm requires treatment to prevent rupture. Embolization is not always effective. Conversion to open repair with stent graft (SG) explantation is a high risk option. The aim of this study was to evaluate the feasibility and immediate results of an alternative technique combining obliterative endoaneurysmorrhaphy (OEA) with SG preservation. METHODS: The open surgical technique combined sacotomy, ligation of all patent back-bleeding vessels and SG preservation. The aneurysmal shell was tightly closed over the SG to protect it from the intestines. An intra-aortic occlusion balloon was used when clamping was required. RESULTS: Twelve patients were treated with the OEA technique at Amiens University Hospital. All 12 procedures were successful. Four patients had previously undergone unsuccessful transarterial or translumbar embolization. Aortic clamping was performed in four cases. No SG migration or graft dislocation was observed. Follow up computed tomography scan at a median of 12 months showed shrinkage of the aneurysm sac with stable diameters and no recurrence of EL II in all cases. CONCLUSION: The OEA technique is an alternative option for the treatment of progressive EL II, which can be particularly useful after failure of embolization.

Gestación extratterina canina: relato de un caso / Canine extrautriine gestation: casereeport

Se reporta un caso de gestación extrauterina en una hembra canina de raza Pinscher de dos años de edad, la cual fue remitida al Centro de Medicina Veterinaria y Zootecnia de la Universidad CES (Medellín, Colombia) por presentar un cuadro de descarga vaginal de color oscuro; a la evaluación se confirmó gestación de 42 días. En la imagen radiográfica se constató presencia de abundante material gaseoso y en la ecografía, ausencia de fetocardia y disminución de líquido amniótico. Se realizó ovariohisterectomía que permitió evidenciar un cuadro de gestación extrauterina con fetos en cavidad abdominal. El artículo reporta un cuadro gineco-obstétrico poco frecuente y descrito por primera vez en Colombia.

A clinical case of extrauterine gestation is reported in a female canine breed Pinscher 2 years of age, which was derived at the Center for Veterinary Medicine CES University (Medellin, Colombia) with dark vaginal discharge. During the evaluation, a gestation of 42 days was confirmed and abundant gaseous material in the radiographic images. In addition, the ultrasound indicated an absence of fetocardia and decreased amniotic fluid. An ovariohysterectomy was performed and extrauterine gestation fetuses were found in the abdominal cavity. This article reports and describes for the first time a case involving a pregnancy outside the womb in a canine as an uncommon case and first described in Colombia.