Intrahepatic arterioportal fistulae: Role of transcatheter embolization

Management of 26 arterioportal fistulae (APFs) is reported. Among 13 hepatoma-induced fistulae (group A), conservative treatment was inefective in 8 patients, and arterial embolization alleviated portal hypertension in the other 5. Of 10 iatrogenic APFs (group B), the 3 largest were successfully embolized, the remaining lesions resolved spontaneously. Three spontaneous nonmalignant APFs (group C) were embolized. Excellent results were obtained in 2 patients, and the other died of severe postembolization hepatic failure. Because long-standing APFs may cause severe portal hypertension with consequent variceal bleeding they should be treated. Arterial embolization is indicated in most patients.     

Detachable balloon embolization of an aneurysmal gastroduodenal arterioportal fistula

Extrahepatic arteriovenous fistulas involving the gastroduodenal artery and the portal venous system are rare and almost always a late complication of gastric surgery. Secondary portal hypertension and mesenteric ischemia may provoke abdominal pain, upper and lower gastrointestinal hemorrhage, diarrhea, and weight loss. Until recently, surgical excision has been the therapy of choice with excellent results. The authors report a case of gastroduodenal arterioportal fistula with a rare large interpositioned aneurysm in a cardiopulmonary-compromised patient who was considered a non-surgical candidate. The gastroduodenal arterioportal fistula was occluded endovascularly by means of a detachable balloon. A survey of the literature of this rare type of arterioportal fistula is included.     

血管内栓塞治疗颈动脉海绵窦瘘

目的 进一步探讨颈动脉海绵窦瘘的血管内介入治疗方法及其临床应用。方法 回顾性分析８年来应用可脱性球囊栓塞治疗颈动脉海绵窦瘘１３３例,其中有外伤史者１２９例,自发性者４例。球囊内充填１８０ｍｇｌ／ｍｌ水溶性造影剂者１３１例,充填ＨＥＭＡ者２例,全部病例均在神经安定麻醉及全身肝素化下完成。结果 一次栓塞既闭塞瘘口,双保持颈内动脉通畅者１０６例,占７９．９％;一次栓塞瘘口部及颈内动脉者２４例,占１８％;     

Transarterial embolization of a direct carotid cavernous fistula with Guglielmi detachable coils.

Four patients underwent transarterial embolization of a carotid-cavernous fistula with Guglielmi detachable coils; in three cases as the initial form of treatment and in one case after treatment via transarterial balloon embolization failed. The fistulas were 2 to 3 mm in diameter on pretreatment angiograms. Complete obliteration was achieved in two patients; in the other two, minimal residual flow remained immediately after embolization but disappeared by follow-up angiography. One to four coils were used to occlude the fistulas. The internal carotid artery remained patent in all patients, and there were no complications.     

可脱球囊栓塞术在海绵窦瘘治疗中的应用 (附 2 7例报告 )

目的　研究微导管可脱球囊技术治疗海绵窦瘘的临床意义。方法 :2 6例外伤性颈内动脉海绵窦瘘 (TCCF)患者和 1例大脑前动脉 (A1段 )动脉瘤破裂合并海绵窦瘘患者采用微导管可脱球囊技术进行栓塞治疗 ,以经颅多普勒 (TCD)进行复查 ,所有患者均随访 6月以上。结果 :2 2例CCF患者均成功栓塞瘘口并保持颈内动脉通畅 ,其中 2 0例为一次栓塞成功 ,2例因球囊过早泄漏而行 2次栓塞治疗。对 1例A1段动脉瘤破裂合并海绵窦瘘患者成功施行了双球囊动脉瘤颈孤立术。 4例行颈内动脉闭塞术。本组病例未发生严重并发症。结论 :微导管可脱球囊技术是对海绵窦瘘的一种微创、安全、有效的治疗方法。     

Treatment of varicoceles with detachable balloon embolization

Testicular varicocele is the single most common cause of male infertility. Varicoceles are due to either absent or nonfunctioning valves that permit retrograde flow in the internal spermatic vein resulting in increased temperature within the scrotum and interfering with spermatogenesis. Our method to treat varicoceles is occlusion of the spermatic vein with detachable silicone balloons. In our first 70 patients, this has proven to be a safe and effective nonsurgical method of occluding varicoceles in outpatients with results similar to those of surgery.     

Angiographic embolization of intrahepatic arterioportal fistula

We report the case of a posttraumatic arteriovenous fistula between the right hepatic artery and the right portal vein remarkable in that clinical manifestations, including portal hypertension and mesenteric insufficiency findings, appeared latently and progressively worsened. This hepatoportal fistula was diagnosed by Doppler sonography and successfully treated by transcatheter embolization of feeding hepatic artery branch with steel coils. We emphasize the interest of pulsed Doppler in the diagnosis of hepatoportal fistula, in assessment of hemodynamic changes related to the fistula, and in follow-up after treatment. Correspondence to: P. Taourel     

Left carotido-cavernous fistula with right exophthalmos: treatment by detachable balloon

Summary A case of left carotidocavernous fistula with right exophthalmos is reported. It is the thirteenth reported case in the literature since 1907. Mechanism of the exclusively contralateral exophthalmos is discussed. Temporary venous thrombosis of the ipsilateral ophthalmic vein and inferior petrosal sinus is likely. Successful treatment by detachable balloon with occlusion of the carotid siphon is described.     

Bronchial artery embolization with detachable coils for the treatment of haemoptysis. Preliminary experience

PURPOSE: This paper reports our early experience in the treatment of haemoptysis with embolization of the bronchial arteries using detachable coils. MATERIALS AND METHODS: Ten patients (mean age 45 years, range 23-83) with haemoptysis due to bronchoscopic biopsy of indeterminate lung nodules, lung cancer, tubercular bronchiectasis, cystic bronchiectasis or sarcoidosis underwent embolization of the bronchial arteries responsible for the bleeding using detachable coils. Patients were followed-up for a median of 14 months. RESULTS: In all patients the procedure halted the bronchial bleeding within 24 hours. Eight patients had no recurrence of haemoptysis. In one patient with lung cancer and another with sarcoidosis, haemoptysis recurred within 1-3 months due to recruitment of additional feeding arteries and to a missed large feeding artery originating from the subclavian artery, which required a new procedure. CONCLUSIONS: Use of detachable coils for embolization of bronchial arteries in patients with haemoptysis is advantageous since it eliminates the risk of migration typical of other embolic materials and enables rapid and permanent vessel occlusion.     

可脱性弹簧圈栓塞治疗脑血管痉挛期颅内动脉瘤

目的　探讨可脱性弹簧圈在脑血管痉挛期 (4～ 14d)栓塞治疗颅内动脉瘤的方法及效果。方法　 2 0 0 4年 3～ 8月共栓塞颅内动脉瘤 14例 ,其中颈内动脉瘤 1例 ,后交通动脉瘤 8例 ,前交通动脉瘤5例 ,所有患者均在 4～ 14d内采用DCS MATRIX材料进行栓塞。结果　 11例栓塞 10 0 % ,2例栓塞 70 %～ 90 % ,1例栓塞 5 0 % ;其中有 6例发现有脑血管痉挛。结论　在脑血管痉挛期 ,血管内栓塞动脉瘤也是一种安全、微创、有效的治疗方法。     

Treatment of external carotid arteriovenous fistula with detachable balloon

Summary A simple fistula between the external carotid artery and the internal jugular vein was treated for the first time using Debrun's technique with a detachable balloon catheter. The nature of the fistulous connection makes the release of the balloon inflated with silicone completely harmless. The occlusion of the fistula, while maintaining the patency of the remaining branches of the external carotid artery, proves this technique to be the most appropriate for the treatment of arteriovenous fistulae in the neck.     

电解可脱弹簧圈栓塞治疗颅内动脉瘤

目的：分析应用电解可脱卸弹簧圈(GDC)栓塞治疗颅内动脉瘤的临床效果。方法：6例因蛛网膜下腔出血或其它神经系统症状入住我科的病人，经CT或(和)MR以及DSA检查证实为颅内动脉瘤，其中左侧后交通动脉3例，右侧后交通动脉1例，前交通动脉1例，C2段1例。瘤体直径在5．0-20．0mm之间。在神经安定 局麻下行动脉瘤栓塞术。先作载瘤动脉造影，明确动脉瘤的大小、形状、体／颈比以及与载瘤动脉的关系。再将微导管和微导丝塑型为相应的形状后经导引导管送至动脉瘤腔中部，选择合适的GDC进行填塞，直至致密填塞。结果：全部病人均一次性栓塞治疗成功，技术成功率为100％。栓塞后即刻行脑血管造影显示动脉瘤腔填塞满意，填充程度均在95％以上。全部病人均无再次出血和并发症产生。结论：GDC栓塞颅内动脉瘤是安全、有效和微创的治疗手段。     

Transarterial embolization of an extrahepatic portal vein aneurysm with arterioportal fistula

We successfully performed transcatheter arterial embolization of an extrahepatic arterioportal fistula with a portal vein aneurysm. The fistula was considered secondary to cholecystectomy for cholecystolithiasis 5 years earlier. After occlusion of the fistula with platinum coils, the aneurysmal cavity thrombosed.     

介入栓塞治疗胃十二指肠动脉-门静脉瘘1例

临床资料 患者女,27岁.因“体检发现腹腔动静脉畸形1个月余”于2016年10月25日入院.既往无手术、创伤、动脉瘤、胰腺炎或其他腹部感染性病变.腹部体检阴性.入院后CT增强示胰十二指肠后血管弓增粗,局部动脉端可见“囊袋状”膨大,并通过一瘘口经其上方引流静脉回流至肠系膜上静脉,该引流静脉起始部呈瘤样扩张.考虑胃十二指肠动脉-门脉瘘合并门静脉端动脉瘤形成.遂于2016年10月27日行血管造影及介入栓塞治疗(图1):首先采用5 F Yashiro导管经腹腔干及肠系膜上动脉造影证实该动-门瘘的供血动脉、瘘口、引流静脉及合并的动脉瘤;然后采用同轴3F微导管经腹腔干、胃十二指肠动脉插至胰十二指肠后血管弓动-门脉瘘口远端置入弹簧圈行瘘口远端供血动脉栓塞;再经皮肝穿门静脉并采用5 F Cobra导管逆行插管至胰十二指肠上静脉动-门脉瘘门静脉端,置入弹簧圈栓塞门静脉端动脉瘤及引流血管;经动脉造影证实门静脉引流血管栓塞满意后,再经微导管置入弹簧圈行动-门脉瘘口近端供血动脉栓塞;最后造影复查示动-门瘘及合并的门静脉端动脉瘤未见显影.术后患者恢复良好,痊愈出院.     

Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization

AIM: To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs). METHODS: Six patients (3 males, 3 females; mean age, 63.8 years; age range, 60-71 years) with chronic liver disease and severe APFs due to percutaneous intrahepatic treatment (n=5) and portal vein (PV) tumor thrombosis of hepatocellular carcinoma (n=1) underwent TAE for symptoms related to severe APFs [refractory ascites (n=4), hemorrhoidal hemorrhage (n=1), and hepatic encephalopathy (n=1)]. Control of symptoms related to APFs and complications were evaluated during the follow-up period (range, 4-57 mo). RESULTS: In all patients, celiac angiography revealed immediate retrograde visualization of the main PV before TAE, indicating severe APF. Selective TAE for the hepatic arteries was performed using metallic coils (MC, n=4) and both MCs and n-butyl cyanoacrylate (n=2). Three patients underwent repeated TAEs for residual APFs and ascites. Four patients developed PV thrombosis after TAE. During the follow-up period after TAE, APF obliteration and symptomatic improvement were obtained in all patients. CONCLUSION: Although TAE for severe APFs may sometimes be complicated by PV thrombosis, TAE can be an effective treatment to improve clinical symptoms related to severe APFs.     

Diffuse hepatic hemangiomas: percutaneous transcatheter embolization with detachable silicone balloons

Two infants with severe congestive cardiac failure secondary to diffuse hepatic hemangiomas were treated by percutaneous transcatheter embolization of the hepatic arteries using detachable silicone balloons. One infant experienced dramatic improvement of the cardiac failure and showed no impairment of hepatic function. The other infant remained in a low cardiac output state following the procedure and developed acute hepatic and renal failure followed by generalized sepsis and death. Autopsy examination revealed massive hepatic hemangioendothelioma as well as areas of necrotic and viable liver parenchyma. A review of reported patients with hepatic hemangiomas treated by hepatic artery ligation or embolization showed no others who had hepatic failure. These techniques were curative in 14 of 18 patients (78%), an improvement compared with the results of other available methods of therapy.     

Coil embolization of arterioportal fistula that developed after partial gastrectomy

A 51-year-old man suffered from bleeding esophageal varices. He had undergone partial gastrectomy for gastric cancer 1 year before. An extrahepatic arterioportal fistula and resultant portal hypertension were found. We successfully performed transarterial embolization of the fistula using stainless steel coils. Portal hypertension improved dramatically. RID=" ID=" <E5>Correspondence to:</E5> K. Ishigami, M.D.