Pelvic AVM Embolization: A Tricky Affair-Multicenter Retrospective Experience.

PURPOSE: Pelvic arteriovenous malformations (pAVMs) are congenital or acquired vascular anomalies, presenting with hematuria, menometrorrhagia, pelvic pain, and varices; they can be life-threatening in case of rupture. Surgical therapies have been proposed but endovascular embolization has been recognized as the primary modality. The aim of this article was to report a retrospective multicenter experience concerning embolization of pelvic AVMs and provide literature overview. MATERIALS AND METHODS: We describe 18 patients (14 female and 4 male) diagnosed with pAVM and treated with minimally invasive methods. The pre-procedural imaging evaluation was based on transpelvic and/or transvaginal color Doppler ultrasound, contrast-enhanced computed tomography, and/or magnetic resonance. In 3 cases, the malformation was congenital and in other 15, acquired. Most common symptoms were menometrorrhagia, hematuria, pelvic pain and pressure, and heaviness in the lower abdominal region. In 10 cases (56%), only 1 procedure was required. Eight patients underwent multistage treatment. RESULTS: Complete occlusion of the lesion in post-procedural angiography was observed in 12 patients (67%). No major periprocedural complications were observed. In 14 cases (78%), both satisfactory embolization and significant clinical improvement was achieved in long-term follow-up. Sixteen patients (88%) were at least satisfied with the clinical outcome. One patient reported subsequent successful pregnancy 5 years after the treatment. CONCLUSION: Hemodynamics of pAVM are variable and thorough understanding of the vessel anatomy is crucial in planning and choosing proper treatment. Both transarterial and percutaneous direct puncture embolization strategies appear safe, technically feasible, and clinically effective. CLINICAL IMPACT: In this manuscript, we discuss the role of interventional radiology methods in the treatment of pelvic arteriovenous malformations along with its advantages, limitations and possible complications. In addition to this, we review the current literature and confront our findings with those made by other authors. We believe that modern endovascular methods offer safe and reliable alternative for traditional surgical therapy and should be therefore considered during multidisciplinary treatment of these patients.

Preoperative embolisation of head and neck paragangliomas - a single-centre experience.

INTRODUCTION: Paragangliomas are neuroendocrine tumours commonly located in the abdomen, thorax, head and neck. The definitive treatment for these tumours is surgical resection, which in some cases can be very challenging due to the involvement of critical neurovascular structures and their high vascularity. Therefore, pre-operative embolisation may be performed to reduce the risk of complications. This study aimed to present our experience with endovascular embolisation of head and neck paragangliomas (HNP). MATERIAL AND METHODS: In this single-centre study, we reviewed data from consecutive patients with HNP who underwent pre-operative embolisation from 2017 to 2023. The efficacy of embolisation, the method of embolisation, as well as the rate of complications, were noted. RESULTS: A total of 27 patients (15 females) with an average age of 47 years underwent selective embolisation of HNP. Satisfactory embolisation, defined as occlusion of > 75% of the blood supply, was achieved in 22/27 cases (81.5%). The most commonly used embolic agents included coils and microspheres. With the exception of minor vessel dissections in two patients and embolic agent migration in two patients causing reversible occlusion of the intracranial vessels, there were no other complications associated with embolisation. No neurological deficits occurred in relation to the endovascular procedure. CONCLUSIONS: The results of our study indicate that endovascular embolisation of HNP prior to surgical resection is a safe and efficacious procedure, with a relatively low complication rate and associated morbidity.

Preoperative embolisation of renal cell carcinoma metastases to the spine - evaluation of procedural and clinical outcome.

Purpose: Renal cell carcinoma (RCC) is the fourth most common metastatic tumour of the spine. RCC metastases are highly vascular and might cause life-threatening intraoperative bleeding. That is why preoperative embolisation is performed to reduce intraoperative blood loss. The aim of this study was to evaluate the procedural and clinical outcomes of preoperative embolisation of RCC metastases to the vertebral column. Material and methods: In this single-centre retrospective study, data of 59 consecutive patients undergoing endovascular treatment prior to surgical resection were collected and evaluated. In all cases superselective catheterisation and occlusion of feeding vessels was attempted and performed if deemed safe and possible. Completeness of embolisation, procedural details, and the complication rate were evaluated. Surgical procedures were carried out within 48 hours after embolisation. The surgical approach was dependent on the anatomical site and osseous destruction. Intraoperative blood loss was estimated. Results: Fifty-nine patients with a mean age of 63 years were included. Complete embolisation was successful in 76% (45/59) and partial in 15% (9/59). Microspheres were the most commonly used embolic material. In 5 cases (8%) safe occlusion was not possible due to the radiculomedullary artery originating from the same pedicle as the tumour. Minor complications (vomiting, increased pain) occurred in 8 patients. Paraplegia (one transient and one permanent) was noted in 2 cases. Estimated intraoperative blood loss was 830 ± 410 ml. Conclusions: The results of our study show that preoperative embolisation is a feasible and effective method with a relatively high rate of occlusion and low complication rate.

Endovascular embolisation as minimally-invasive treatment for spinal dural arteriovenous fistulas - evaluation of long-term results.

AIM OF STUDY: Spinal dural arteriovenous fistulas (sDAVF) are rare spinal cord lesions formed between a radicular artery and medullary vein leading to venous hypertension resulting in neurological impairment. Endovascular embolisation is a minimally-invasive method aiming to interrupt the shunt between the artery and vein. We report our experience with sDAVF treated endovascularly. MATERIAL AND METHODS: Clinical and procedural data of 16 consecutive patients diagnosed with sDAVF was reviewed. Pre- and post-operative neurological condition was evaluated using both the Aminoff and Logue disability scale and the VAS scale. Rates of complete occlusions, technical difficulties, and procedural complications were noted. RESULTS: Four of the patients were female and 12 were male; mean age was 62.4 years. Mean interval between symptom onset and treatment was 13.3 months. Complete occlusion was achieved in 88% (14/16 patients). Significant or moderate clinical improvement in long-term follow-up was observed in eight patients (50%). Recurrence was observed in two cases (13%). CONCLUSIONS AND CLINICAL IMPLICATIONS: While endovascular methods are being refined and thus achieving an increasing percentage of successful occlusions, patients should be closely monitored since this condition is recurrent and the clinical consequences of myelopathy can persist despite complete occlusion of the shunt.

Endovascular Treatment of Acute Ischemic Stroke With the Penumbra System in Routine Practice: COMPLETE Registry Results.

BACKGROUND AND PURPOSE: The purpose of the COMPLETE (International Acute Ischemic Stroke Registry With the Penumbra System Aspiration Including the 3D Revascularization Device) registry was to evaluate the generalizability of the safety and efficacy of the Penumbra System (Penumbra, Inc, Alameda) in a real-world setting. METHODS: COMPLETE was a global, prospective, postmarket, multicenter registry. Patients with large vessel occlusion-acute ischemic stroke who underwent mechanical thrombectomy using the Penumbra System with or without the 3D Revascularization Device as frontline approach were enrolled at 42 centers (29 United States, 13 Europe) from July 2018 to October 2019. Primary efficacy end points were successful postprocedure angiographic revascularization (modified Thrombolysis in Cerebral Infarction ≥2b) and 90-day functional outcome (modified Rankin Scale score 0-2). The primary safety end point was 90-day all-cause mortality. An imaging core lab determined modified Thrombolysis in Cerebral Infarction scores, Alberta Stroke Program Early CT Scores, clot location, and occurrence of intracranial hemorrhage at 24 hours. Independent medical reviewers adjudicated safety end points. RESULTS: Six hundred fifty patients were enrolled (median age 70 years, 54.0% female, 49.2% given intravenous recombinant tissue-type plasminogen activator before thrombectomy). Rate of modified Thrombolysis in Cerebral Infarction 2b to 3 postprocedure was 87.8% (95% CI, 85.3%-90.4%). First pass and postprocedure rates of modified Thrombolysis in Cerebral Infarction 2c to 3 were 41.5% and 66.2%, respectively. At 90 days, 55.8% (95% CI, 51.9%-59.7%) had modified Rankin Scale score 0 to 2, and all-cause mortality was 15.5% (95% CI, 12.8%-18.3%). CONCLUSIONS: Using Penumbra System for frontline mechanical thrombectomy treatment of patients with large vessel occlusion-acute ischemic stroke in a real-world setting was associated with angiographic, clinical, and safety outcomes that were comparable to prior randomized clinical trials with stringent site and operator selection criteria. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03464565.

Predictors of favorable outcome after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in young patients.

BACKGROUND: Mechanical thrombectomy (MT) became a standard of care for patients with acute ischemic stroke (AIS) with its efficacy demonstrated by meta-analysis and randomized studies. Although ischemic stroke is associated more with older patients, it may also have devastating neurological effects on young patients. PURPOSE: To present our experience with stroke patients aged <50 years treated with endovascular means and to evaluate clinical and procedural factors associated with outcome and mortality. MATERIAL AND METHODS: This study was conducted on 34 young stroke patients treated with MT. Clinical features including baseline results, radiological imaging, procedural details, and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated after three months using mRS. Mortality rate was calculated. RESULTS: The rate of successful recanalization (TICI ≥2c) was 79% (27/34). Symptomatic intracranial hemorrhage (sICH) was observed in 5 (15%) patients. After 90 days, the mortality rate was 12%. Favorable clinical outcome (mRs 0-2) was regained in 65% of the patients whereas satisfactory clinical outcome was seen in 85%. Poor clinical outcome (mRs >2) was observed in 9 (23.7%) patients. CONCLUSION: In conclusion, the results of this study demonstrate that MT for AIS in young patients is feasible and provides an excellent rate of arterial recanalization and high rate of favorable outcomes. Statistical analysis showed that shorter time from onset to arrival and reperfusion, successful recanalization and absence of hemorrhagic transformation are the predictors of favorable clinical outcome and overall survival rate.

Unilateral Uterine Artery Embolization as a Treatment for Patients with Symptomatic Fibroids-Experience in a Case Series.

Background and Objectives: Uterine artery embolization (UAE) has become an accepted and widely performed therapy for patients with symptomatic (reporting at least two of the following symptoms: severe or prolonged menstrual bleeding, abdominal pain, tension in abdomen, problems with urination, constipation or anemia) uterine fibroids. Although in the majority of cases, bilateral occlusion is required to obtain a successful clinical outcome, there are patients in whom treatment of only one uterine artery could be attempted. There are several reasons for unilateral UAE: hemodynamic conditions, technical difficulties, anatomical variants and unilateral dominancy of blood supply to the fibroid. Our aim is to present our 10-year experience with unilateral UAE and evaluate the radiological and clinical outcomes. Materials and Methods: Records of 369 patients with fibroids who underwent UAE from 2010 to 2021 were analyzed. We identified 26 patients treated with unilateral uterine artery embolization and analyzed the data of these patients. All patients attended medical consultation, were assessed using a five-grade symptom scale and underwent MRI examination. Clinical response was evaluated at least 6 months after the procedure and was categorized to one of the following groups: complete improvement, partial improvement, no change and a worsening in symptoms. Results: Twenty-two patients (85%) reported at least partial improvement 6 months following the procedure. One patient required secondary embolization due to recanalization. The secondary procedure was successful, and complete improvement was achieved. One patient did not observe any clinical improvement, and in two cases, symptom recurrence was observed. All three patients were referred for surgical treatment. No major complications were noted. Overall, the success rate was 88%. Conclusions: The results of our study support the statement that elective unilateral embolization is an appropriate treatment in patients with a dominant uterine artery.

Mechanical thrombectomy for acute ischemic stroke in the posterior circulation: assessment of efficacy and outcome and identification of prognostic factors.

BACKGROUND: Mechanical thrombectomy (MT) is well-established in the treatment of acute ischemic anterior circulation stroke. However, there is no evidence from randomized trials or meta-analyses that MT is safe and effective in the treatment of patients with acute ischemic posterior circulation stroke (PCS). PURPOSE: To evaluate the clinical and procedural factors associated with recanalization and outcome of patients with PCS treated with MT. MATERIAL AND METHODS: Forty-three patients with PCS (median age 73 years) who underwent treatment with MT were included. Data including demographics, baseline stroke severity, radiological imaging, procedure and post-procedure complications were documented. Clinical outcome was evaluated using the modified Rankin Scale (mRS). The patients were classified into two groups based on clinical outcome (favorable vs. unfavorable mRS after 90 days). RESULTS: Median baseline National Institute of Health Stroke Scale (NIHSS) was 17. Twenty patients were eligible for intravenous thrombolysis and received recombinant tissue plasminogen activator before MT. Successful recanalization was observed in 88.4% of patients. After 90 days, favorable outcome (defined as mRS 0-2) was achieved in 26 patients; six patients had an unfavorable outcome (mRs >2). Final mortality rate was 25.5%. Baseline NIHSS, onset to reperfusion time, procedure duration, and successful recanalization had a statistically significant association with outcome. Failed recanalization and occurrence of intracranial hemorrhage were found to be associated with a higher mortality rate. CONCLUSION: MT is feasible and effective method in treatment of PCS. Baseline NIHSS and onset to reperfusion time were found to be independent predictive factors of clinical outcome.

Endovascular treatment of vertebrobasilar system aneurysms - long term results.

INTRODUCTION: Microsurgical treatment of VBSA is complex and challenging due to the deep location of the vessels and the proximity of important structures. Therefore, minimally invasive endovascular techniques have been introduced to the treatment of VBSA. The aim of this study was to present long-term results and technical aspects of VBSA embolisation. In this manuscript, we describe our experience in the treatment of VBSA with long-term results. Furthermore, we discuss the advantages and disadvantages of this treatment modality, paying special attention to the technical aspects. We believe that this is an important contribution to this topic because the number of previous reports is limited. It adds to a population that can be compared to patients treated using different methods. MATERIALS AND METHODS: We analysed the medical records of patients with aneurysms of vertebral and basilar arteries referred for endovascular treatment between 2015 and 2020. RESULTS: A total of 44 patients were selected for the study. From this group, 10 patients (22.7%) were admitted with SAH caused by ruptured VBSA. The median age of the patients was 58 years (31-80), with 27 (61.4%) females and 17 (38.6%) males. The majority of the VBSAs (35, 79.5%) were located on the basilar artery. Complete occlusion was achieved in 39 patients (88.6%). Procedural complications occurred in three cases (6.8%). In long-term follow-up, complete embolisation was achieved in 81.8% (36 of 44 patients). In 18.2% (eight patients), recurrence of VBSA was observed. Two patients were qualified for recoiling. Clinical follow-up was uneventful in 37 (84%) patients. Four patients (9%) reported mild headaches. Three (7%) patients required assistance for daily living. CONCLUSIONS: Endovascular embolisation of VBSA is feasible and provides an excellent rate of complete occlusion and a high rate of favourable long-term outcomes, which support using this technique as a first-line treatment. A relatively high rate of recurrence remains the major drawback, especially in cases of wide-neck VBSA.

Successful endovascular treatment of intralobar pulmonary sequestration - an effective alternative to surgery.

INTRODUCTION: Pulmonary sequestration is a rare congenital malformation characterised by the presence of non-functional and dysplastic pulmonary tissue that lacks communication with the tracheobronchial tree and has an aberrant non-pulmonary blood supply. Depending on its location, presence of the pleura covering, and venous drainage, 2 forms of pulmonary sequestration have been described: intra- and extralobar. Traditionally, surgical resection was performed; however, a growing number of cases have been treated with endovascular intervention. CASE REPORT: A 38-year-old female patient was admitted to the hospital with severe haemoptysis for several hours. Examination at admission revealed tachycardia and tachypnoea. Computed tomography-examination disclosed the presence of an area of consolidation in the left lower lobe with a tortuous feeding artery arising from the descending aorta. Visible ground glass opacification indicated diffuse alveolar haemorrhage. Based on these findings, a diagnosis of intralobar sequestration of the left lung was made. The patient was consulted by a cardiothoracic surgeon and an interventional radiologist and qualified for endovascular treatment. In local anaesthesia femoral access was obtained and selective angiography of the common trunk of both bronchial arteries was performed. It depicted a dilated left bronchial artery supplying the sequestration and visible contrast extravasation. Embolisation of the vessel was performed with Glubran (n-butyl-cyanoacrylate). Control contrast injection showed complete elimination of the sequestration's blood supply with no residual capillary blush. Clinical improvement was observed. No complications were encountered, and the patient was discharged 7 days after the procedure. CONCLUSIONS: Arterial embolisation is a promising alternative to surgery in the treatment of symptomatic pulmonary sequestration.

Effectiveness and safety of ICA stenting in conjunction with mechanical thrombectomy (antegrade approach) in acute ischaemic stroke patients due to tandem occlusion.

AIM OF STUDY: We investigated the effectiveness and safety of an antegrade approach consisting of emergency ICA stenting in conjunction with mechanical thrombectomy (MT) in a one-stage procedure as a treatment for Tandem Occlusion (TO). CLINICAL RATIONALE FOR STUDY: We here describe our experience in the treatment of TO with an antegrade approach with long-term results. We also discuss the advantages and drawbacks of this treatment modality with special attention to possible haemorrhagic complications that can be encountered in patients with ischaemic stroke who receive antiplatelet treatment. We believe that our study adds to the limited number of reports on this topic. MATERIALS AND METHODS: We selected 34 patients diagnosed with acute ischaemic stroke due to ICA and ipsilateral intracranial occlusion treated with ICA stenting in conjunction with MT. We analysed the short- and long-term results as well as investigating complications with special regard to haemorrhagic transformation associated with the need for antiplatelet treatment after stent implantation in patients after acute ischaemic stroke treatment. RESULTS: A favourable angiographic outcome was defined as mTICI 2b-3. This was achieved in 33/34 patients (97%). On average, NIHSS at 24 hours after the procedure was 8.5 ± 7, which indicates a significant clinical improvement. Four cases of symptomatic ICH were observed (11.8%). One re-occlusion in stent was noted. At three-month follow-up, mRS scores were 0 in 11 (34.3%), 1 in 5 (16%), 2 in 1 (3%), 3 in 3 (9.3%), 4 in 3 (9.3%), and 5 in 2 (6%) patients. Seven patients did not survive (22%). Overall, a favourable outcome (mRS 0-2) was achieved in 17/34 patients (50%). The final mortality rate was 26.5% (9/34 patients). CONCLUSIONS AND CLINICAL IMPLICATIONS: We conclude that an antegrade approach is a feasible and effective method for treating acute TO stroke, giving the patient the chance to regain his or her full independence in everyday life, with low overall complication and final mortality rates.

Acute renal artery stenting recovered renal function after spontaneous rupture of renal artery aneurysm - case report.

PURPOSE: Renal artery aneurysms (RAAs) are a rare vascular pathology with an estimated prevalence of 0.1% to 2.5%. Rupture of RAA is an extremely unusual cause of acute flank pain and haemodynamic instability with acute kidney failure and high mortality rate (20%). CASE REPORT: A 37-year-old male with no relevant history presented to the Emergency Room with acute right flank pain. Initial examination revealed BP 90/60 mm Hg and tachycardia. Initial blood testing was unremarkable, with a haemoglobin level of 9.4 g/dl. Urinalysis revealed moderate blood. Ultrasound (US) examination depicted aneurysm of the right renal artery 6 x 6 cm, with signs of blood extravasation visible in colour and power Doppler. The patient was referred for urgent computed tomography angiography, which revealed active bleeding from the ruptured aneurysm with haematoma spreading into the right retroperitoneum. He was subjected to emergency endovascular treatment. The patient was treated by successful implantation of a Viabahn stent (GORE, Daleware, USA). Selective nephrography revealed lack of flow through one of the segmental arteries resulting from vasospasm due to the placement of the guiding wire necessary for safe stent implantation. CONCLUSIONS: The authors present a rare case of spontaneous RAA rupture in a young male successfully treated with endovascular methods. Stent implantation required selective catheterisation of segmental arteries of the kidney, which resulted in the loss of one of them. However, control Doppler US disclosed no ischaemia and successful exclusion of the aneurysm.

Percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract.

PURPOSE: In the present study, the effectiveness and safety of minimally invasive percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract were assessed. MATERIAL AND METHODS: Between 2000 and 2015, 12 patients (seven women and five men, mean age 78 ± 8 years) after open cholecystectomy with common bile duct exploration and T-tube drainage underwent percutaneous extraction of residual gallstones through the T-tube tract. RESULTS: The intervention was successful in 92% (11/12). In seven patients complete extraction of the retained gallstones was achieved, and in four cases partial extraction combined with passage of small residual fragments to the duodenum was obtained. In one case the extraction attempt was ineffective. Mild haemobilia was observed in two patients. No mortality or major complications were observed. CONCLUSIONS: Our findings are consistent with literature data and confirm that percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract is an effective and safe treatment method. Although the presented technique is not a novel approach, it can be beneficial in patients unsuitable for open surgery or laparoscopic intervention when ERCP attempt occurs ineffective or there exist contraindications to ERCP.

Endovascular embolisation strategies for pulmonary arteriovenous malformations.

PURPOSE: To assess the immediate efficacy of distinct embolisation devices in the endovascular treatment of pulmonary arteriovenous malformations as well as to identify and analyse the possible determinants of the technical success of the procedure. MATERIAL AND METHODS: Prospective analysis of 16 consecutive patients was carried out, who underwent transcatheter endovascular embolisation therapy for pulmonary arteriovenous malformations between 2005 and 2017. Pre- and post-procedural angiography studies were implemented to confirm the diagnosis and to evaluate the technical success defined as the complete occlusion of the feeding artery. Embolisation devices - coils, microcoils, occluders, or combination of the above - were used. All the patients were advised to conduct a follow-up computed tomography evaluation 12 months after the procedure. RESULTS: A total of 40 pulmonary arteriovenous malformations (PAVMs) were observed and embolised. The immediate technical success was achieved in all (n = 40; 100%) treated PAVMs, as confirmed by the post-procedural angiographic result. The statistical analysis revealed no significant impact of the number of PAVMs per patient (p > 0.05), their angioarchitecture (p > 0.05), localisation within the lung (p > 0.05) or particular lobe (p > 0.05), and the selection of embolisation device (p > 0.05) on the procedural success rates. The procedure-related complication rate was equal to 6.25%. CONCLUSIONS: The immediate success rate of the transcatheter PAVM embolisation reached 100% in this study. The statistical model of logistic regression revealed no significant impact of the number of PAVMs per patient, their angioarchitecture, localisation, and distribution pattern, as well as device selection, on the immediate technical success of the procedure.

Mechanical thrombectomy in acute stroke - Five years of experience in Poland.

OBJECTIVES: Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. METHODS AND RESULTS: We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. RESULTS: Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b-TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization - in 30.7%, mRS of 0-2 - in 31.4% and mRS of 6 in 22% of cases. CONCLUSION: Our results can help harmonize standards for MT in Poland according to international guidelines.

Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure.

BACKGROUND: Formation or pre-existence of collateral gonadal veins in varicocele patients has been reported as the main cause of surgical treatment failure. PURPOSE: To describe venographic findings in patients with postsurgical recurrent varicoceles and to assess the efficacy of the following minimally invasive endovascular treatment. MATERIAL AND METHODS: Thirty-three men with failed surgical treatment of left-sided varicocele were examined between 2006 and 2013, using retrograde venography to assess the anatomy of varicocele draining veins before the attempted transcatheter embolization. Anatomic variants of gonadal veins were categorized according to the classification modified for the purpose of the present study. 3% polidocanol was used as an embolic agent together with pushable fibered coils. RESULTS: In 31 (93%) out of 33 patients venography demonstrated incompetence of the gonadal vein or veins draining varicoceles after failed surgical treatment. The most frequent venographic finding was gonadal vein duplication - 66% of cases (39% in its mid-portion). Technical success of embolization was achieved in all 31 patients. No major complications were observed. CONCLUSION: Retrograde varicocele embolization may be superior to surgery because of its ability to detect gonadal vein variants. In our study group, transcatheter embolization with 3% polidocanol and fibered coils allowed successful, minimally invasive treatment of postsurgical varicoceles.

Evaluation of effectiveness of endovascular embolisation for the treatment of pelvic congestion syndrome--preliminary study.

OBJECTIVES: The Aim: The aim of the study was to evaluate the effectiveness, safety and clinical outcomes of endovascular embolisation of pelvic congestion syndrome (PCS). MATERIAL AND METHODS: This prospective, observational study carried out between January and May of 2014 encompassed 24 female patients aged 22-44 years (average - 31 years) diagnosed with PCS. Diagnosis of PCS was established by medical history physical examination, transvaginal Doppler ultrasound examination and confirmed by MRI. The patients were qualified for phlebography and ovarian vein embolization with 0.035" detachable coils and/or microcoils. Pelvic pain scores were assessed before and 3 months after the procedure with the visual analog scale (VAS; 0 - no pain, 10 - unbearable pain). RESULTS: Embolisation procedures were performed in 23 out of 24 patients. Nineteen patients underwent unilateral and 4 patients bilateral embolisation of the ovarian vein. In one case, safe and selective vessel catheterization was not possible due to the anatomical variant of venous flow. Nineteen patients underwent unilateral embolisation of the left ovarian vein. Four patients had the left and right ovarian veins embolized; in one of them, the internal iliac vein was additionally closed (the two-stage procedure). The technical success rate was 96%. Procedures lasted 23-78 minutes (32 minutes on average). An average of 40 ml of contrast was administered during the procedures. The total mean radiation dose at the reference point was 389 mGy (from 127 mGy to 1112 mGy). A decrease in pelvic pain intensity according to VAS was considered a clinical success. The median VAS pelvic pain score before the procedure was 8. Three months after the procedure median pelvic pain score decreased to 1 (p < 0.001). In two cases, the ovarian vein was injured and the contrast medium extravasated, which was clinically insignificant. In one case, a small injection site haematoma developed. CONCLUSION: Embolisation is a minimally invasive, effective and safe method of treatment for PCS. The cooperation between gynaecologists and interventional radiologists is essential for successful outcomes.

The role of interventional radiology in treatment of patients with hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu disease is a rare autosomal dominant, multi-organ disorder that leads to formation of abnormal vascular connections resulting in devastating and life-threatening complications. Due to its multisystem character, wide range of clinical manifestations and variable expressivity, HHT remains a diagnostic challenge and requires close cooperation of specialists from various medical fields. Interventional radiology plays a key role in the management of this disease, helping maintain the health of HHT patients and minimize the risk of fatal complications. The aim of this article is to review clinical manifestations, diagnostic guidelines and criteria of HHT as well as to present the means of endovascular therapy in the management of HHT patients.

Contrast-Enhanced Ultrasound Feasibility in Assessing Carotid Plaque Vulnerability-Narrative Review.

The risk assessment for carotid atherosclerotic lesions involves not only determining the degree of stenosis but also plaque morphology and its composition. Recently, carotid contrast-enhanced ultrasound (CEUS) has gained importance for evaluating vulnerable plaques. This review explores CEUS's utility in detecting carotid plaque surface irregularities and ulcerations as well as intraplaque neovascularization and its alignment with histology. Initial indications suggest that CEUS might have the potential to anticipate cerebrovascular incidents. Nevertheless, there is a need for extensive, multicenter prospective studies that explore the relationships between CEUS observations and patient clinical outcomes in cases of carotid atherosclerotic disease.

Head and neck cancer: value of perfusion CT in depicting primary tumor spread.

BACKGROUND: The aim of this study was to assess head and neck squamous cell cancer and surrounding tissue in computed tomography contrast enhanced and perfusion studies, and to examine the role of perfusion imaging in depiction of tissue infiltration. MATERIAL/METHODS: We prospectively evaluated 43 primary malignant head and neck tumors, using standard CT followed by perfusion. Blood flow, blood volume, mean transit time, and permeability values were obtained using regions of interest (ROIs) over lesions and surrounding tissue. Results were compared with histological analysis of resected tissue. Sensitivity, specificity, accuracy, positive and negative predictive values were calculated for both methods. RESULTS: We found significant differences between infiltrated and non-infiltrated tissue, especially with regard to muscles. In case of bone and salivary gland infiltration, change in perfusion parameters did not allow proper diagnosis. CONCLUSIONS: CTP shows promise in depicting malignant infiltration. The combined use of CECT plus CTP results in correct staging of the majority of head and neck tumors.