Transvenous embolization using the Amplatzer Vascular Plug II in patent ductus arteriosus concomitant with Stanford type B aortic dissection: A case report.

RATIONALE: Thoracic endovascular aneurysm repair (TEVAR) is commonly used to treat Stanford type B aortic dissections. However, coexistence of aortic dissection and patent ductus arteriosus (PDA) is an extremely rare phenomenon, and TEVAR alone is insufficient for treatment. Herein, a case of endovascular treatment in a patient with both aortic dissection and PDA is reported. PATIENT CONCERNS: A 31-year-old woman presented to the authors' hospital with chest pain extending to the back. At presentation, her blood pressure was 130/70 mm Hg. Her father, brother, and uncle were all diagnosed with aortic dissection. DIAGNOSES: Computed tomography (CT) revealed Stanford type B aortic dissection from the aortic arch to the infrarenal abdominal aorta; however, PDA was incidentally identified. INTERVENTIONS: TEVAR was immediately performed. Follow-up CT scan performed 2 months later did not reveal any thrombosis or remodeling of the false lumen, and the PDA remained open. Therefore, an additional PDA embolization procedure was performed using the Amplatzer Vascular Plug II via the transvenous route. OUTCOMES: On follow-up CT performed 6 months after PDA embolization, successful remodeling, and shrinkage of the false lumen were observed, and PDA closure was confirmed. LESSONS: If Stanford type B aortic dissection and PDA coexist, TEVAR alone may not be a sufficient treatment and additional PDA embolization may be required. In the present case, transvenous embolization of PDA using an Amplatzer Vascular Plug II was safe and effective.

Simultaneous use of plug-assisted and coil-assisted retrograde transvenous obliteration for treating refractory hepatic encephalopathy in a patient with two portosystemic shunts: A case report.

RATIONALE: Plug-assisted retrograde transvenous obliteration (PARTO) or coil-assisted retrograde transvenous obliteration (CARTO) are alternative treatments for gastric variceal bleeding and hepatic encephalopathy. Both procedures have fewer complications related to balloon rupture or sclerosing agents and are shorter than balloon-occluded retrograde transvenous obliteration. Herein, we report a case of PARTO and CARTO was performed simultaneously to treat refractory hepatic encephalopathy in a patient with 2 portosystemic shunts. PATIENT CONCERNS: A 59-year-old man with alcoholic liver cirrhosis presented to the emergency room with mental change. At presentation, the patient's plasma ammonia level was 340 µg/dL. DIAGNOSES: A computed tomography scan revealed perisplenic collateral vessels and 2 splenorenal shunts. INTERVENTION: PARTO and CARTO were performed to treat hepatic encephalopathy via the 2 splenorenal shunts. OUTCOMES: A follow-up computed tomography scan showed the splenorenal shunt was successfully embolized using a vascular plug and coil. After 3 weeks, the patient's plasma ammonia level decreased to 80 µg/dL, and repeated hospitalizations due to hepatic encephalopathy ceased. LESSONS: Depending on the patient's anatomy, PARTO and CARTO can be performed simultaneously and, similar to balloon-occluded retrograde transvenous obliteration, are useful for treating hepatic encephalopathy.

Efficacy and Technical Feasibility of Plug-Assisted Retrograde Transvenous Obliteration of Gastric Varices via Pathways Other than the Gastrorenal Shunt.

PURPOSE: To evaluate the efficacy and technical feasibility of plug-assisted retrograde transvenous obliteration of gastric varices via pathways different from the typical gastrorenal shunt. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 130 patients who underwent plug-assisted retrograde transvenous obliteration for gastric varices between 2013 and 2022. Eight patients underwent plug-assisted retrograde transvenous obliteration via different pathways. We evaluated the types of portosystemic shunts in these patients, the procedure technical and clinical success rates, and clinical outcomes. RESULTS: In these eight patients (6 males, 2 females; mean age = 60 ± 6 years), the most common type of portosystemic shunt was a gastrocaval shunt (n = 7). Five patients had a gastrocaval shunt only; two had coexisting gastrocaval and gastrorenal shunts. One patient had a pericardiacophrenic shunt without a gastrorenal or gastrocaval shunt. The mean procedure time was 55 min. For patients with a gastrocaval shunt alone (n = 5), the mean procedure time was 40.8 min. The technical and clinical success rates were 100%. No major complication related to the procedure occurred. An initial follow-up computed tomography was performed within 2-3 weeks in all patients and revealed complete thrombosis of the gastric varices. Subsequent follow-up computed tomography (interval: 2-6 months) was performed in seven patients and showed complete disappearance of the gastric varices in all patients. During the follow-up period (range: 42 days-6.25 years), no patients experienced rebleeding or recurrence of gastric varices. CONCLUSION: Plug-assisted retrograde transvenous obliteration via alternative portosystemic shunts is effective and technically feasible in the treatment of gastric varices.

The Role of Interventional Radiology and Management of an Angiography Suite in the Treatment of COVID-19 Patients: Single-Center, 2-Year Experience.

Background and Objectives: Hospital angiography suites with negative-pressure ventilation facilities are challenging to equip. During the COVID-19 pandemic, we aimed to introduce interventional radiology procedures performed on COVID-19 patients and understand management of the angiography suite without a negative-pressure ventilation facility before and after the procedures to prevent the spread of infection. Materials and Methods: Between December 2020 and November 2022, 52 COVID-19 patients underwent interventional radiology procedures in an angiography suite, where no negative-pressure ventilation facility was installed. During the procedure, all staff members wore full personal protection equipment, and after the procedure for the COVID-19-positive patient was completed, the angiography suite was disinfected and entry to the angiography suite was prohibited for 1-3 h. In this angiography suite, procedures for COVID-19 patients and non-COVID-19 patients were performed. Results: A total of 61 interventional radiology procedures were performed in 52 patients with COVID-19. Of 52 patients, 21 underwent procedures under intubation and mechanical ventilation. All procedures were performed according to the guidelines set by the Infection Control Committee of our hospital. No major or minor complications were associated with the procedures. There were no cases of infection among staff members or other non-COVID-19 patients related to procedures on COVID-19 patients. Conclusions: Interventional radiology can play an important role in solving the complications of COVID-19 and the problems caused by patients' underlying diseases. In addition, if accurate guidelines are followed, both COVID-19 and non-COVID-19 patients can undergo procedures in an angiography room without negative-pressure ventilation while preventing infection.

Stent graft placement in anterior tibial artery pseudoaneurysm in a patient with type I neurofibromatosis: A case report.

RATIONALE: Vascular involvement manifests as aneurysms, stenosis, and arteriovenous malformations in patients with type I neurofibromatosis (NF-I). Aneurysms are rare; however, the renal artery is the most common site. Herein, we report a rare case of stent graft placement in an anterior tibial artery (ATA) pseudoaneurysm in a patient with NF-I. PATIENT CONCERNS: A 52-year-old woman with NF-1 was admitted to the emergency room with painful swelling in the left lower leg. At presentation, the patient's blood pressure was 100/60 mmHg and the hemoglobin level was 9 g/dL. DIAGNOSES: Computed tomography scan revealed a small aneurysm arising from the left ATA and an adjacent large hematoma. INTERVENTION: Stent graft placement was performed to treat ATA pseudoaneurysm. OUTCOMES: After stent graft placement, the aneurysm disappeared and the distal flow was patent through the ATA. LESSONS: Stent graft placement should be considered as another option for endovascular treatment in patients in whom coil embolization or surgery cannot be performed.

Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal bleeding in absence of gastrorenal or gastrocaval shunt: A case report.

RATINALE: Plug-assisted retrograde tansvenous obliteration (PARTO) is commonly used to treat gastric variceal bleeding. PARTO is typically performed via the gastrorenal shunt or gastrocaval shunt and there have been no reports of PARTO performed through the pericardial vein in cases of gastric varices in which there is no gastrorenal or gastrocaval shunt. Herein, we report a case of PARTO was performed to treat gastric variceal bleeding in a patient with a gastric varix without a gastrorenal or gastrocaval shunt. PATIENT CONCERNS: A 54-year-old man with alcoholic liver cirrhosis presented to the emergency room with hematemesis and melena. At presentation, the patient's blood pressure was 130/70 mm Hg and hemoglobin level was 10.1 g/dL. DIAGNOSES: Computed tomography (CT) scan and endoscopic examination revealed a gastric varix at the gastric fundus. INTERVENTIONS: PARTO was performed to treatment of gastric variceal bleeding via the pericardial vein. OUTCOMES: The patient did not show any signs of variceal bleeding after the procedure, and follow-up CT at 3 weeks showed complete resolution of the gastric varix. LESSONS: Although PARTO is technically difficult to perform through pathways other than the gastrorenal or gastrocaval shunt, it can be a beneficial alternative in cases in which other treatments fail or are not feasible.

Clinical Outcome of the Visible Coil During Endoscopy After Transcatheter Arterial Embolization for Gastrointestinal Bleeding.

PURPOSE: This study was designed to evaluate the clinical outcome of the visible coil during endoscopy after transcatheter arterial embolization (TAE) for gastrointestinal bleeding. METHODS: We retrospectively reviewed the medical records of 1415 patients who underwent TAE for gastrointestinal bleeding between 2001 and 2017. Among these 1415 patients, 70 underwent TAE using coils and consecutive follow-up endoscopy. Finally, 11 patients with an extravascular coil seen on follow-up endoscopic examination were included in this study. We evaluated the underlying cause of the gastrointestinal bleeding, the technical and clinical success rates, the type of extravascular coil after TAE, and the clinical outcomes of the extravascular coil seen on follow-up endoscopic examination. RESULTS: Of the 11 patients, the most common underlying cause of gastrointestinal bleeding was a duodenal ulcer (n = 7). On angiography, the bleeding artery was most commonly found in the gastroduodenal artery (n = 6). The technical success and clinical success rates of TAE were 100% and 90.9%, respectively. The type of extravascular coil found on endoscopic examination was classified by submucosal migration (n = 6) and protrusion (n = 5). On second-look endoscopic evaluation, 10 of 11 (90.9%) patients showed healing ulceration. On the final-look endoscopic evaluation, healing ulceration without further bleeding was seen in one (9.1%) patient and scar formation was seen in ten (90.9%) patients. CONCLUSIONS: Extravascular coil after TAE for gastrointestinal bleeding is rare, and the most common underlying cause is duodenal ulcer bleeding. The extravascular coils eventually show a healing process with adequate treatment of underlying bowel pathologies.