Secondary endovascular repair of a reconstructed superior vena cava in a patient with a malignant thymic epithelial neoplasm.

Thymic epithelial tumors can cause venous obstruction from compression or direct invasion of the superior vena cava (SVC) or the innominate veins. We report a case of a 40-year-old patient with a Masaoka stage III thymoma that resulted in obstruction of the left innominate vein and extrinsic compression of the SVC. All macroscopic tumors were resected together with ligation of the left innominate vein and reconstruction of the SVC with an ePTFE graft. Early graft thrombosis occurred in the first postoperative month with clinical signs of SVC syndrome. Endovascular repair was performed with the deployment of self-expanding nitinol stents, resulting in immediate relief of symptoms. The stented graft has remained patent for a follow-up period of 7 months.

[Angiographic evaluation and embolization of juvenile nasopharyngeal angiofibroma]. / Juveniles Angiofibrom: Angiographische Diagnostik und präoperative Embolisation.

OBJECTIVE: In juvenile nasopharyngeal angiofibroma (JNA), analysis of tumor extension and blood supply is useful for controlling intraoperative bleeding and helps in determining the appropriate surgical approach. The purpose of this study was to evaluate angiographic findings and the efficacy and benefits of preoperative embolization of JNA. PATIENTS AND METHODS: Twenty-one male patients with JNA (mean age 13.3 years) were included in this study. The tumors were embolized with particles of gel foam. Surgical removal was achieved through transantral approach (n=2), lateral rhinotomy (n=13), midfacial degloving (n=4), and endonasally (n=2). RESULTS: The blood supply was exclusively homolateral in 18 patients, deriving mainly from the external carotid artery, and bilateral in three. There were no connections between the branches of the internal and external carotid arteries. Intratumoral embolization was achieved in all patients. No major complications occurred. Mean blood loss during surgery was 560 ml. The recurrence rate was 14%. CONCLUSION: Preoperative angiographic evaluation and embolization of JNA are important tools for planning surgical approach. Embolization reduces significantly the intraoperative blood loss, minimizes the need of blood transfusion, and makes resection easier.

Congenital extrahepatic portal vein aneurysm.

Portal vein aneurysm is a rare clinical entity, with only 41 published cases in the English-language literature. Twenty-five of them were congenital. We present the case of a 50-year-old woman who was incidentally diagnosed with a congenital extrahepatic portal vein aneurysm during an investigation for dyspepsia. Ultrasonographic features are described with correlation of computed tomographic and magnetic resonance findings. Etiology, clinical significance, and management strategies for these lesions are discussed and a review of the literature regarding this entity is presented.

Main arterial supply of a kidney from the opposite renal artery: an unusual case.

Variations in renal anatomy and blood supply are not uncommon, but a supplementary renal artery arising from the opposite renal artery is rare. In such cases the kidneys are usually malrotated and anomalous in position and form. The case of a 65-year-old man with the left main renal artery arising from the opposite renal artery and without such anomalies of the kidneys is presented.

Idiopathic renal arteriovenous fistula treated by transcatheter embolization.

Renal arteriovenous fistulas (RAVFs) are unusual lesions with a variety of clinical manifestations. Traditionally, these lesions have been treated surgically. We report on an idiopathic, high-flow RAVF and an aneurysm treated successfully with the embolization technique. The endovascular management of RAVFs in carefully selected patients is a safe and effective therapeutic technique.

Intracranial aneurysms: evaluation using CTA and MRA. Correlation with DSA and intraoperative findings.

Computed tomographic angiography (CTA) and magnetic resonance angiography (MSA) have been used recently for evaluation of intracranial aneurysms. If they are to replace conventional digital subtraction angiography (DSA), their sensitivity and specificity should be equal to the latter. In order to determine whether computed tomographic angiography and magnetic resonance angiography can provide the necessary information for presurgical evaluation we compared blindly the results of helical CT angiography and MR angiography with the results of digital subtraction angiography and the intraoperative findings. We evaluated 35 patients with the possible clinical diagnosis of intracranial aneurysm. Our data suggest that both CTA and MRA can provide valuable preoperative information concerning the location, the characteristics and the relationships of most intracranial aneurysms. Both original and reconstructed images should be evaluated together for higher accuracy. In addition helical CT, being a fast, inexpensive and noninvasive method, can be used as a reliable alternative to DSA in emergency situations demanding immediate operation.

Coronary-subclavian steal syndrome: treatment with percutaneous transluminal angioplasty and stent placement.

The aim of this study was to assess the efficacy of percutaneous transluminal angioplasty (PTA) and stenting in the management of the coronary-subclavian steal syndrome (CSSS). A 56-year-old man presented with CSSS due to occlusion of the left subclavian artery. He was treated with PTA and placement of two stents in the left subclavian artery. Systolic blood pressure became equal in both arms and dizziness disappeared. There were no complications. Percutaneous transluminal angioplasty and stenting can effectively and safely manage CSSS.

"Retroantegrade" catheterization of the branches of the femoral artery: technical note.

Antegrade catheterization is the preferred approach to angioplasty and selective fibrinolysis of branches of the femoral artery. A simple method of antegrade catheterization beginning with a retrograde puncture and using a new catheter is described. The method can reduce the number of punctures and manipulations needed for selective antegrade catheterization of the common femoral artery.