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1.
Tech Vasc Interv Radiol ; 23(3): 100690, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308535

RESUMO

Prostate artery embolization (PAE) is a minimally invasive treatment for benign prostatic hyperplasia associated lower urinary tract symptoms. The prostatic arterial anatomy, origins and collaterals, are highly variable and can lead to technical pitfalls and suboptimal results during PAE. In this paper we aim to discuss the variant prostate artery origins and collateral circulation to provide a primer on relevant anatomy for interventional radiologists performing PAE.


Assuntos
Circulação Colateral , Embolização Terapêutica , Artéria Ilíaca/anormalidades , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Fluxo Sanguíneo Regional
4.
BMC Surg ; 20(1): 47, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32178647

RESUMO

BACKGROUND: In pelvic surgery, it is important to anticipate potential anatomic variations, which may be unknown, and inter-relationships among intrapelvic vessels. Here, we comprehensively analyzed intrapelvic vessel patterns. METHOD: This retrospective analysis included 81 patients that underwent colorectal surgery in our institution in 2016. A total of 162 half-pelvises were imaged with contrast-enhanced computed tomography. We scrutinized thin-slice images. RESULTS: We found variations in the number of internal iliac veins. In 47.5% of cases, one internal iliac vein drained into the ipsilateral common iliac vein in both halves of the pelvis. In the other cases, several internal iliac veins were observed in one or both halves of the pelvis. We analyzed the inter-relationships between the superior gluteal artery and the sacral nerve plexus in pelvic halves. Superior gluteal arteries ran between the 5th lumbar nerve and 1st sacral nerves, in 82% of halves, and lateral to the 5th lumbar nerve, in 17% of halves. Dorsally, the superior gluteal artery ran on the medial side of the internal iliac vein in 15% of halves. In 28% of half-pelvises, two superior gluteal veins were observed. Superior gluteal veins passed through the sacral nerve plexus lateral to 5th lumbar, between 5th lumbar and 1st sacral, and between 1st and 2nd sacral nerve, in 42.0, 47.5, and 37.7% of halves, respectively. We evaluated the rate of symmetric pelvic anatomies, and found that all anatomic variations formed symmetrically, except the number of internal iliac veins. CONCLUSION: This study clarified the anatomical variations of intrapelvic vessels and their inter-relationships. These findings will benefit our understanding of pelvic anatomy and enhance the safety of radical surgery for treating pelvic diseases.


Assuntos
Artéria Ilíaca/anormalidades , Pelve/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacro
7.
Clin Radiol ; 74(10): 819.e1-819.e6, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31420188

RESUMO

AIM: To investigate the accuracy of ultrasonography in the diagnosis of persistent sciatic artery (PSA) compared to computed tomography angiography (CTA). MATERIALS AND METHODS: From May 2002 to Dec 2018, 61 consecutive patients seen at Shandong Medical Imaging Research Institute with a clinical suspicion of PSA were included. Ultrasonography was used to assess the abdominal and lower-limb arteries. The main sonographic criteria for a positive diagnosis were the visualisation of PSA, the enlarged internal iliac artery, and abnormality of common femoral artery and superficial femoral artery. These data were compared with CTA findings. Kappa statistics was applied to determine the level of agreement. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography as a diagnostic method were assessed. RESULTS: Ultrasonography findings were positive in 16 of 61 patients with a clinical suspicion of PSA. The diagnosis was confirmed by CTA in 17 patients. There was one false-positive result and two false-negative results at ultrasonography. The kappa value was 0.875. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography were 88.2%, 97.7%, 93.8%, 95.6%, 95.1% and 0.859, respectively. CONCLUSIONS: Ultrasonography could be a reliable, accurate, and non-invasive diagnostic imaging method in the diagnosis of patients with suspected PSA.


Assuntos
Ultrassonografia , Malformações Vasculares/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Feminino , Artéria Femoral/anormalidades , Artéria Femoral/diagnóstico por imagem , Humanos , Artéria Ilíaca/anormalidades , Artéria Ilíaca/diagnóstico por imagem , Lactente , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Adulto Jovem
9.
Reumatismo ; 71(1): 31-36, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932441

RESUMO

We discuss the case of a 27-month-old girl afflicted with fibromuscular dysplasia. She presented with hemiatrophy of left upper and lower limbs, nail dystrophy, ulcers on the tips of her toes, cold and painful limbs, foot drop, and hypertension. The initial appearance started at 2 months of age and other diagnoses such as complex regional pain syndrome, reflex sympathetic syndrome, vasculitis and coagulation disorders had been considered. Angiography revealed that all the arterial branches of the left lower and upper limbs, from brachial to ulnar and radial, and from iliac and femoral to tibialis arteries were affected. Sural nerve biopsy confirmed the diagnosis. In the follow-up visits until 2 years after the patient's discharge she did not develop any new problem and her blood pressure was controlled by enalapril and amlodipine.


Assuntos
Braço/anormalidades , Displasia Fibromuscular/complicações , Perna (Membro)/anormalidades , Doenças Raras/complicações , Braço/irrigação sanguínea , Artéria Braquial/anormalidades , Artéria Braquial/diagnóstico por imagem , Pré-Escolar , Feminino , Artéria Femoral/anormalidades , Humanos , Hipertensão/tratamento farmacológico , Artéria Ilíaca/anormalidades , Rim/anormalidades , Rim/patologia , Perna (Membro)/irrigação sanguínea , Unhas Malformadas/etiologia , Neuropatias Fibulares/etiologia , Artéria Poplítea/anormalidades , Úlcera Cutânea/etiologia , Dedos do Pé
10.
Cardiovasc Intervent Radiol ; 42(7): 956-961, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30847499

RESUMO

BACKGROUND: Twenty percent of the patients with AAA have an aneurysm involving the common iliac arteries. Large common iliac diameter can be treated with an iliac branched device or extension of the stent graft to the external iliac artery with occlusion of the ipsilateral internal iliac artery (IIA) to prevent type 2 endoleaks. This study describes and evaluates a embolization technique using Onyx in conjunction with EVAR in aneurysms with poor landing zones in the common iliac arteries. METHODS: Patients with Onyx IIA embolization during EVAR, identified from the hospital operating code database, constitute the study population. Onyx embolization was performed by injection at the IIA origin. Peri- and postoperative complications were collected from the medical records. Thin-sliced CT scan was performed 1 month and 1 year after the procedure. RESULTS: Thirty-six patients with complex iliac anatomy and insufficient landing zones (without sealing possibility for standard stent grafts) were identified out of 243 consecutive EVAR treatments during a 13-year period. In seventeen patients (7%), the IIA was embolized with Onyx. Technical success was obtained in all 17 patients, without adverse event or procedural complication. No complication related to the embolization procedure was noted during follow-up. CONCLUSIONS: During EVAR treatment of patients with aneurysm involving the common iliac artery, Onyx embolization of IIA is a feasible option without need of selective catheterization of the IIA orifice, potentially preserving important branches of the IIA and simplifying emergency procedures.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/complicações , Aneurisma Ilíaco/terapia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/métodos , Combinação de Medicamentos , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Artéria Ilíaca/anormalidades , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Polivinil/administração & dosagem , Estudos Retrospectivos , Stents , Tantálio/administração & dosagem , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Morphologie ; 103(341): 24-31, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30595337

RESUMO

OBJECTIVES: A severe and potentially lethal complication in pelvic injuries is arterial bleeding commonly involving the iliac arteries. Hence, the objective of our study was to systematically document the morphology and variations of the external iliac artery in human cadaveric pelvises. MATERIALS AND METHODS: Study was conducted on 48 pelvic halves which were obtained by making mid-line saw cuts through formalin embalmed adult human male cadaveric pelvises. The external iliac artery was cleaned, its length and diameter were measured using a scale. Following parameters were noted: variations of the external iliac artery in terms of its location, course, termination, relations with other vessels and variations in its branching pattern. RESULTS: Variations related to the morphology and branching pattern of the external iliac artery was observed in 20 hemipelvises (42%). Nine (19%) hemipelvises showed morphological variations of the artery (looped, tortuous, curved, twisted or 'S' shaped). Variations in the branching pattern of the artery were seen in 6 (13%) hemipelvises and the artery was superficial or medial to the external iliac vein in 5 (10%) hemipelvises. Mean length of the artery was 10cm on the right and 9.9cm on the left side of the pelvis. Its mean diameter was 0.94mm on the right and 0.99mm on left side. CONCLUSION: Diagnostic and interventional radiologic procedures on the pelvic arteries are becoming more frequent, and hence in here, we have performed the morphological study of the external iliac artery is necessary to guide interventional procedures.


Assuntos
Variação Anatômica , Artéria Ilíaca/anormalidades , Pelve/irrigação sanguínea , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Pelve/lesões , Radiografia
13.
Arch Ital Urol Androl ; 90(3): 215-217, 2018 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-30362691

RESUMO

INTRODUCTION: Uretero-arterial fistulas are a rare condition. The most frequent clinical sign is hematuria. Since these bleedings occur intermittently, the diagnosis is very difficult. If not discovered, uretero-arterial fistulas involve a very high rate of mortality or even results in loss of kidney function. CASE REPORT: The clinical case we describe is an unusual one. After a radical hysterectomy and a subsequent radiotherapy, a hydronephrosis caused by ureteral fibrosis occurred on both sides. Therefore, the patient received bilateral ureteral stents. During a change of the ureteral stents 18 months later, a massive bleeding appeared in the right ureter. Initially, a clear evidence of a fistula was not possible - neither through CT scan nor through selective angiography. There were some indicators of a uretero-arterial fistula, so an endoluminal vessel stent was placed. Subsequently the fistula probably led to an erosion of the vessel stent. DISCUSSION: A fistula between the ureter and the iliac artery (UAF) is a rare complication. The increase in known cases during the last years is linked to the possibility of ureteral stenting since 1978. Until now only 140 cases have been described in literature. The mortality rate through UAF has decreased from 69% in 1980 to 7-23% today. Its development can be traced through the pulsation of the artery and the pressure on the ureter. The most important clinical symptom is bleeding. Diagnosis is generally difficult and represents the real problem. The sensitivity of the standard angiography examination is 23- 41%; it can be improved to 63% using the "provocative" method, which means mobilizing the ureteral stent during examination. The therapy in course of the angiography consists of a simultaneous endovascular stent and/or a co-embolisation. CONCLUSION: Arterial or uretero-arterial fistulas (UAF) are a rare condition; the diagnosis is very difficult and most of the time the treatment requires a multidisciplinary team.


Assuntos
Stents , Doenças Ureterais/diagnóstico , Obstrução Ureteral/cirurgia , Fístula Urinária/diagnóstico , Idoso , Feminino , Fibrose , Humanos , Hidronefrose/etiologia , Histerectomia/métodos , Artéria Ilíaca/anormalidades , Doenças Ureterais/etiologia , Fístula Urinária/etiologia , Fístula Urinária/patologia
14.
J Med Case Rep ; 12(1): 312, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30360754

RESUMO

BACKGROUND: Poland syndrome is a congenital malformation characterized by ipsilateral hand and chest wall depression, including an absence or hypoplasia of the breast and pectoral muscles. These hypoplastic defects are reportedly caused by a subclavian artery supply disruption sequence. CASE PRESENTATION: A 45-year-old Japanese woman, an out-patient, underwent an emergency examination for intense left lower abdominal pain. Computed tomography images revealed a hydronephrotic left kidney and dilatation of the left ureter. No ureteral calculus or neoplasm was found. In addition, no abnormalities connected to her left abdominal pain were found. Nephritis was diagnosed based on the results of urine analysis, and a course of antibiotics was administered. Computed tomography images also revealed a history of breast reconstruction with a custom-made silicone implant in her right breast. The present case showed symptoms of Poland syndrome, which were absence of the sternal head of the right pectoralis major and asymmetrical malformation of the chest wall due to hypoplasia of the right rib cage. In addition to typical Poland syndrome symptoms, she had hypoplasia of her right kidney, hypoplasia of the right gluteus minimus muscle, right-sided pelvic hypoplasia, spinal curvature to the right, and a cystic mass in her right ovary. CONCLUSIONS: In the present case of Poland syndrome, computed tomography images revealed malformation of the chest wall, absence of the pectoral muscle, and hypoplasia of a left kidney. Unilateral visceral hypoplasia is reported to be caused by a subclavian artery supply disruption sequence that occurs around 7 to 8 weeks of gestation. The present case can be considered a rare atypical phenotype of Poland syndrome with possible subclavian artery supply disruption sequence with internal iliac artery supply disruption.


Assuntos
Dor Abdominal/etiologia , Artéria Ilíaca/anormalidades , Nefropatias/diagnóstico por imagem , Síndrome de Poland/diagnóstico por imagem , Parede Torácica/anormalidades , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/genética , Feminino , Glaucoma/fisiopatologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Nefropatias/genética , Nefropatias/fisiopatologia , Mamoplastia , Pessoa de Meia-Idade , Músculos Peitorais/anormalidades , Síndrome de Poland/genética , Síndrome de Poland/fisiopatologia , Doenças Raras , Parede Torácica/diagnóstico por imagem , Parede Torácica/fisiopatologia , Tomografia Computadorizada por Raios X
16.
Cardiovasc Revasc Med ; 19(8S): 23-24, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29691184

RESUMO

Atrial septal device occluders such as amplatzer occluder have been designed to close atrial septal defects of paten formal ovale. Off label use of this device has been reported in pathological conditions that connect two vascular compartments with narrow neck. In this report, we describe a successful closure of a traumatically occurred AV fistula between iliac artery and iliac vein using amplatzer occluder device that has not been reported previously. This rare case is followed by a review of the literature.


Assuntos
Fístula Arteriovenosa/cirurgia , Cateterismo Cardíaco/métodos , Artéria Ilíaca/cirurgia , Veia Ilíaca/cirurgia , Dispositivo para Oclusão Septal , Procedimentos Cirúrgicos Vasculares/instrumentação , Fístula Arteriovenosa/diagnóstico , Angiografia por Tomografia Computadorizada , Ecocardiografia Transesofagiana , Feminino , Humanos , Artéria Ilíaca/anormalidades , Veia Ilíaca/anormalidades , Pessoa de Meia-Idade
18.
Ann Vasc Surg ; 50: 298.e1-298.e5, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29518508

RESUMO

BACKGROUND: Major pelvic ilio-iliac arteriovenous fistula (AVF) is an exceedingly rare diagnosis with only a few described cases in the literature, most of them related to congenital defects or trauma. In this case report, we aim to present a case of an ilio-iliac AVF with an atypical clinical presentation. METHODS: Relevant medical data were collected from hospital database. RESULTS: The patient is a 77-year-old woman, with a relevant medical history of a temporally remote hysterectomy. She developed an exuberant unilateral right leg edema and was diagnosed with a femoro-iliac deep vein thrombosis (DVT) and started on anticoagulation and daily use of elastic compression stockings. No improvement in leg edema was evident, and she reported painful complaints refractory to medication. She also progressively developed right foot numbness and foot drop. A computed tomography angiography (CTA) was performed to exclude any compressive or paraneoplastic syndrome, with no remarkable findings other than common iliac vein (CIV) occlusion. As the patient's symptoms continued to worsen, a new CTA was performed 5 months later, which revealed an ilio-iliac AVF that was confirmed by angiography. After 2 ineffective attempts to embolize AVF afferents, we chose to completely embolize the arterial component of the AVF with Helix EV3 coils and Onyx glue (Covidien, Irvine, CA, USA). CIV recanalization and deployment of a Venovo stent (Bard Inc, Tempe, AZ, USA) was also performed. The final angiograms showed exclusion of the AVF and rapid venous flow through the stent. There was progressive improvement of edema and pain but little improvement of foot drop. CONCLUSION: AVF etiology and mechanism of neurologic deficits are controversial, with multiple possible explanations. Endovascular treatment modalities are promising a safer and more efficient approach when compared with open surgery. Our experience in this case was encouraging, but long-term results are currently lacking.


Assuntos
Fístula Arteriovenosa/complicações , Edema/etiologia , Deformidades Adquiridas do Pé/etiologia , Transtornos Neurológicos da Marcha/etiologia , Artéria Ilíaca/anormalidades , Veia Ilíaca/anormalidades , Trombose Venosa/etiologia , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/terapia , Angiografia por Tomografia Computadorizada , Edema/diagnóstico , Edema/fisiopatologia , Edema/terapia , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Deformidades Adquiridas do Pé/diagnóstico , Deformidades Adquiridas do Pé/fisiopatologia , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Flebografia , Fluxo Sanguíneo Regional , Stents , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Trombose Venosa/terapia
19.
Mil Med ; 183(1-2): e172-e174, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29401342

RESUMO

Introduction: Anomalies of the inferior vena cava (AIVC) are rare but well-recognized anatomic abnormalities that can lead to clinically significant deep vein thrombosis (DVT) in a subset of otherwise healthy patients. This report illustrates an uncommon congenital anomaly that military clinicians should consider when evaluating unprovoked DVT in young patients. Materials and Methods: Single case report and literature review. Results: We describe a case of a 24-yr-old United States Marine who presented with abdominal pain for 2 wk. After conservative therapy failed, a contrast-enhanced abdominal computed tomography (CT) scan was performed. The CT scan revealed an absent inferior vena cava with evidence of right venous thrombophlebitis. We include four contrast-enhanced helical CT scans that illustrate this phenomenon. Conclusion: Due to the lack of available studies and data, we do not know the relative risk of DVT in patients with AIVC. However, the literature review suggests that there is a pro-thrombogenic effect of this congenital anomaly. Clinicians should include AIVC in their differential when treating young, otherwise healthy patients with unprovoked DVT. This population is much more likely to have an AIVC than the general population. In addition to thrombophilia markers, a contrast-enhanced CT scan should be considered as part of the initial workup.


Assuntos
Militares/psicologia , Veia Cava Inferior/anormalidades , Trombose Venosa/complicações , Anticoagulantes/uso terapêutico , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/uso terapêutico , Humanos , Artéria Ilíaca/anormalidades , Artéria Ilíaca/cirurgia , Masculino , Radiologia Intervencionista/métodos , Terapia Trombolítica/métodos , Estados Unidos , Veia Cava Inferior/anatomia & histologia , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/congênito , Trombose Venosa/cirurgia , Varfarina/uso terapêutico , Adulto Jovem
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