Preservation of Posterior Tibial Artery Flow Following Dissection With Associated Aneurysmal Degeneration in Ehlers-Danlos Syndrome Type IV Treated With Flow-Diverting Stent.

Ehlers-Danlos syndrome type IV (EDS-IV), the vascular type, is a rare genetic disorder affects the large and medium size arteries resulting in dissections, often with aneurysmal degeneration, intramural hematomas and pseudoaneurysms. Embolization or ligation is standard management for aneurysm formation. We present a case of an EDS-IV patient with a posterior tibial artery dissection with associated aneurysm successfully treated with Flow Diversion stent (FDS) preserving vessel patency and excluding the aneurysm. FDS technology allows for low profile, micro-catheter deliverable treatment options to exclude aneurysms in EDS-IV patients that are may be prone to spasm and dissection using more conventional stent graft technology.

Collaboration is Key - Bridging the Gap and Building an IR Endoscopy Practice.

While the tools and techniques employed by interventional radiologists on a day-to-day basis translate well to learning the skills required to perform basic endoscopic interventions, collaboration with other specialties is crucial to the success of an interventional radiology endoscopy program. As in any field in medicine, the paramount goal is to improve patient care. Adding the ability to directly visualize structures through an endoscope to certain interventional radiologic procedures may greatly augment the efficacy, safety, and success of interventional radiology procedures. Colleagues in urology, gastroenterology, and surgery should be involved in decision-making and treatment planning to ensure that a shared vision for optimal patient care is achieved.

Prostate Artery Embolization for Giant Prostatic Enlargement: Short-Term Efficacy and Safety.

Eight patients with giant prostatic enlargement > 200 mL and lower urinary tract symptoms who underwent bilateral prostatic artery embolization (PAE) were reviewed. Mean prostate volume decreased from 318.2 mL to 212.2 mL (P < .01). At 5-month mean follow-up, International Prostate Symptom Score decreased by 16.7 points (P < .05), and urinary quality of life improved by 3.0 points (P < .01). Three of 4 catheter-dependent patients no longer needed catheterization after the procedure. No major complications were encountered. Preliminary results suggest PAE is safe and effective in patients with giant prostatic enlargement > 200 mL.

Interventional radiology-operated percutaneous cholecystoscopy with ultrasonic lithotripsy and stone basket retrieval: A treatment for symptomatic cholelithiasis in non-operative candidates.

Interventional radiology-operated percutaneous endoscopy has seen a recent resurgence with potential to return to the scope of Interventional Radiology practice. Endoscopy adds a new dimension to the Interventional Radiology armamentarium by offering a unique opportunity to diagnose and treat conditions under direct visualization with improved maneuverability. Cholecystoscopy (gallbladder endoscopy), as a method for percutaneous removal of gallstones, is an effective treatment option in patients with symptomatic cholelithiasis who are poor candidates for surgical cholecystectomy. This article presents a case of Interventional Radiology-operated cholecystoscopy using ultrasonic lithotripsy and stone basket retrieval with an emphasis on the equipment, technique, and peri-procedural management essential to the procedure, as well as a review of the literature.

Chronic portomesenteic venous thrombosis complicated by a high flow arteriovenous malformation presenting with gastrointestinal bleeding.

Portomesenteric venous thrombosis is a rare but potentially life-threatening condition. The presenting symptoms of chronic portomesenteric venous thrombosis are often non-specific but may present with variceal bleeding. We present the first reported case of chronic portomesenteric venous thrombosis causing a high flow arteriovenous malformation that resulted in extensive gastrointestinal bleeding.

Safety of hydroinfusion in percutaneous thermal ablation of hepatic malignancies.

PURPOSE: Hydroinfusion is a commonly used ancillary procedure during percutaneous thermal ablation of the liver that is used to separate and protect sensitive structures from the ablation zone. However, risks of hydroinfusion have not been systematically studied. The purpose of the present study was to systematically examine the frequency and severity of local and systemic complications related to hydroinfusion. MATERIALS AND METHODS: From January 2009 to April 2012, 410 consecutive patients underwent percutaneous thermal hepatic tumor ablation. One hundred fifty patients in the study group underwent hydroinfusion and 260 in the control group did not. Patient charts and imaging studies of both groups were reviewed to compare incidences of complications that could potentially be caused by hydroinfusion, including pleural effusion, bowel injury, infection, electrolyte imbalance, and hyperglycemia. RESULTS: Pleural effusions were found to occur more commonly in the hydroinfusion group (45.3%) than in the control group (16.5%). Pleural effusions were significantly larger (P < .001) and more likely to be symptomatic (six of 150 patients; P = .006) in the hydroinfusion group than in the control group (one of 260 patients). Multiple patient and tumor characteristics were analyzed for association with development of major hydroinfusion-type complications (requiring therapy or extended/repeat hospitalization). Subcapsular location of tumor was the only variable to reach statistical significance (P = .009), with all major hydroinfusion-type complications (n = 10) occurring in patients with subcapsular tumors. CONCLUSIONS: Hydroinfusion is a safe procedure overall. However, pleural effusions occur commonly after hydroinfusion, tend to be moderate or large in size, and are occasionally symptomatic.

Current treatment of renal artery aneurysms may be too aggressive.

OBJECTIVE: Most studies recommend repair of renal artery aneurysms (RAAs) >2 cm in diameter in asymptomatic patients, but other studies have suggested that their natural history may be more benign. We hypothesized that rupture and death in patients with asymptomatic RAAs is low and that current recommendations for RAA treatment at 2 cm may be too aggressive. METHODS: Retrospective review of all RAAs treated at a tertiary care medical center from 2002 to 2012. RESULTS: Fifty-nine RAA were identified in 40 patients (mean age at diagnosis, 56 years; male:female ratio, 17:23); 31 were saccular, 8 were fusiform, and 5 were bilobed. Twenty-nine patients were asymptomatic; the remainder of patients presented with hematuria (n = 4), abdominal pain (n = 3), difficult-to-control hypertension (n = 3), or flank pain (n = 2). Aneurysm location included the main renal artery bifurcation (n = 35), main trunk (n = 7), primary branch (n = 6), pole artery (n = 6), and secondary branch (n = 1). Operative management of RAAs included vein patch (n = 6), prosthetic patch (n = 4), primary repair (n = 3), plication (n = 1), patch and implantation (n = 1), and ex vivo repair (n = 1). Eight asymptomatic RAAs were treated surgically (mean RAA diameter = 2.4 ± 0.1 cm, range, 2-3 cm), with the remaining 33 asymptomatic RAAs being managed conservatively (mean RAA diameter = 1.4 ± 0.1 cm, range, 0.6-2.6 cm). Mean hospital length of stay was 4 days, with no late postoperative complications and 0% mortality. Non-operated patients were followed for a mean of 36 ± 9 months, with no late acute complications and 0% mortality. Mean RAA growth rate of patients with multiple imaging studies was 0.60 ± 0.16 mm/y. CONCLUSIONS: The rate of aneurysm rupture and death in our untreated RAA patients is zero, the growth rate is 0.60 ± 0.16 mm/y, and there were no adverse outcomes in asymptomatic RAAs >2 cm that were observed. We may currently be too aggressive in treating asymptomatic RAAs.

Splenic angiosarcoma metastasis to the brain.

Angiosarcoma is a rare primary non-haematolymphoid malignant neoplasm of the spleen. This neoplastic process has a poor prognosis, with disease usually widespread by the time of presentation. In the literature there has been only six case reports of cerebral metastasis from splenic angiosarcomas. We report a 61-year-old woman who presented with a right occipital metastasis of a splenic angiosarcoma, 5 years after initial diagnosis, treated by stereotactic occipital craniotomy and resection of metastasis.