Bronchoscopy-guided removal of intrabronchial coil migration after coil embolization of pulmonary arteriovenous malformation

Pulmonary arteriovenous malformations develop in approximately 50% of hereditary hemorrhagic telangiectasia patients. Pulmonary arteriovenous malformations are often treated with coil embolization therapy. We report a case of a 45-year-old female with multiple pulmonary arteriovenous malformations due to underlying hereditary hemorrhagic telangiectasia who had undergone 14 coil embolization procedures over 16 years. She presented with sudden onset severe, unremitting, nonproductive cough from a foreign body sensation in the airway. Computed tomography of the chest demonstrated a metallic foreign body extending from the left lower lobe of the lung into the left mainstem bronchus and trachea. Bronchoscopy-guided removal of the foreign body revealed an intact embolization coil placed 8 years prior to presentation had partially migrated through the vessel and airway walls into the airway lumen, extending from the left lower lobe bronchus to the left mainstem bronchus. Coil migration is a rare, but potentially dangerous, complication of coil embolization therapy.     

肺动静脉畸形经导管封堵术的疗效评价

目的对肺动静脉畸形(AVM)经导管封堵术进行疗效评估。方法16例肺AVM患者接受经导管弹簧圈栓塞术治疗,其中5例同时辅以经导管可脱式球囊栓塞术或国产自制双伞形血管封堵器置入术治疗。对所有患者的家族史,术前和术后的临床表现,动脉血气分析以及其影像学表现等作了回顾性分析。16例患者术后平均随访(21±1)个月,根据其胸部CTA检查结果及动脉血气分析结果评估疗效,并对其术前和术后血氧饱和度(SaO2)、动脉血氧分压(PaO2)进行统计学分析。结果16例首次经导管封堵治疗技术成功率75%(12/16),再次经导管封堵治疗技术成功率100%。16例患者术前SaO2平均值为(76±5)%,PaO2平均值为(46±3)mmHg;术后SaO2平均值上升为(94±5)%,PaO2平均值上升为(62±3)mmHg,与术前相比差异均有统计学意义(P<0.01和P<0.05)。术后随访,所有患者无症状复发,胸部CTA检查未发现明显血管再通。结论采用经导管弹簧圈栓塞术,或同时辅以经导管可脱式球囊栓塞术或国产自制双伞形血管封堵器置入术等治疗肺AVM,可获得满意的临床疗效。     

脑动静脉畸形栓塞治疗术并发颅内出血的原因及处理

目的探讨栓塞治疗脑动静脉畸形(AVM)及并发颅内出血的原因和处理方法。方法2006年至2011年收治45例脑AVM患者,其中35例为首发症状,表现为颅内血肿21例,蛛网膜下腔出血14例。6例患者反复出血2～4次不等。畸形血管团直径3～15 cm,平均(6.84±2.52)cm;体积50～200cm~3,平均(133.83±43.32)cm~3。对所有患者均采用Onyx液体栓塞剂进行栓塞治疗,并进行随访,观察有无并发症发生。结果45例中,37例随防时间3个月～3年,平均15个月;优31例(83.7%),良5例(13.5%),差1例(2.7%),无重残及死亡。栓塞术后出现颅内出血7例,均不同程度存在正常灌注压突破,2例行开颅血肿清除,其余均为小型血肿自行吸收。7例出血者中,2例痊愈,4例神经功能障碍,1例偏瘫。结论脑AVM栓塞治疗术并发颅内出血的机制较为复杂,掌握其发生机制可以更好地控制诱发因素,减少并发症的发生。     

经皮无水乙醇栓塞治疗儿童足部动静脉畸形11例

目的 评价经皮无水乙醇栓塞术(PEE)治疗儿童足部动静脉畸形(AVM)的安全性及疗效.方法 回顾性分析2007年1月至2016年1月经PEE术治疗的11例儿童足部AVM患者临床资料,评估临床症状、瘤巢分型、疗效及术后并发症.结果 11例患儿中男6例,女5例,平均年龄9岁;足部肿物8例,疼痛8例,跛行3例,皮肤缺血溃疡1例;ChoⅢb型10例,Ⅱ型1例;YakesⅣ型10例,Ⅱa型1例.共接受PEE治疗30次,平均2.7次/例;随访6～48个月,平均24个月.疗效评价显示,治愈7例,部分缓解3例,有效率为90.9％;治疗失败(无缓解)l例,无恶化患儿;术中发生一过性血氧下降1例,足趾缺血1例,术后水疱1例,局部皮肤溃疡1例,未见严重并发症.结论PEE术是治疗儿童足部AVM安全有效的方法.     

无水乙醇栓塞治疗耳部动静脉畸形

目的 介绍22例耳部动静脉畸形无水乙醇介入栓塞治疗的经验.方法 对22例耳部动静脉畸形患者,通过局部穿刺或经导管内超选择径路达到耳部病变的异常血管团内,根据病变的血管团构筑,采用无水乙醇或稀释乙醇进行栓塞,间隔1个月进行电话随访,间隔3～4个月进行临床随访,根据临床检查或血管造影评价临床效果.结果 22例患者共进行了38次无水乙醇栓塞,每次无水乙醇的用量为4～65 ml.9例病变局限患者,1～2次栓塞后达到临床治愈;13例病变广泛患者,无水乙醇栓塞3～5次后,溃疡愈合,出血停止,耳呜消失或减弱.血管造影见9例异常血管团完全消失;8例血管团消失50%～75%;5例血管闭消失小于50%.最常见的并发症为可逆性局部坏死和水疱形成.结论 无水乙醇栓塞是耳部动静脉畸形安全、有效的治疗方式,并有可能成为首选的治疗方式.     

Novel approach to complex pulmonary arteriovenous malformation embolization using detachable coils and Amplatzer vascular plugs

Introduction

We evaluated the feasibility of a modified embolization technique of pulmonary arteriovenous malformations (PAVM) using venous sac embolization with detachable coils combined with the feeding artery embolization with the Amplatzer vascular plug (AVP).

Materials and methods

We retrospectively studied technical and clinical success in the treatment of 11 complexe PAVMs. We recorded number and size of feeding arteries and draining vein, the last prior and post treatment in the follow up CT, size of PAVMs; and the number of devices needed to occlude each PAVM.

Results

11 complexe PAVM were treated with detachable coils to venous sac embolization followed by AVP to embolize feeding arteries. In all but one case a complete occlusion of the PAVM was angiographically achieved. The mean number of feeding vessel was 2.64 ± 0.92 (2–5). The mean number of coils was 7.82 ± 5.09 (3–20 coils). CT-follow-up, that was possible in 8 patients, showed a significant reduction of the draining vein size. The mean diameter reduction of the draining vein was 62 ± 18% varying between 29% and 77%. In all but one case with the complexe angioarchitecture the reduction of draining vein size close to 70% was achieved.

Conclusions

Our study implies that the venous sac embolization using the detachable coils followed by occlusion of the large feeding arteries using the AVP is a highly efficient method for the treatment of the complex PAVMs with large out-flow vessels and short feeding arteries.     

Coil embolization of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVMs) are uncommon lesions that can be treated by surgery or interventional radiology. Forty-four PAVMs in 11 patients were occluded by transcatheter coil embolization with only one symptomatic complication, deep venous thrombosis, attributable to the procedure. There was a significant improvement in symptoms and a reduction in pulmonary AV shunting in the 9 patients in whom embolization of all visible discrete lesions was successfully completed. Coil embolization is an effective alternative to other methods of treating PAVMs.     

Massive hemoptysis from a pulmonary sequestration controlled by embolization of aberrant pulmonary arteries: Case report

A case of massive hemoptysis due to pulmonary sequestration is presented. Initially, the diagnosis of sequestration was unsuspected and bronchial artery embolization was done for management of hemoptysis from the left lower lobe, but 4 days later massive hemoptysis recurred. Repeat arteriography, including a thoracoabdominal aortogram, revealed two large abdominal arteries penetrating the left diaphragm and feeding the lower lung. Embolization of the aberrant artery from the celiac trunk and the left inferior phrenic artery resulted in complete hemostasis until elective surgical ligation of the two arteries was performed 2 months later. The massive hemoptysis from a pulmonary sequestration could only be controlled after embolization of the transdiaphragmatic aberrant pulmonary arteries.     

Pseudoaneurysm and renal arteriovenous fistula after nephrectomy: two cases treated by transcatheter coil embolization

Pseudoaneurysms and arteriovenous fistulas of renal arteries are rare clinical lesions. Invasive renal procedures may lead to pseudoaneurysm or arteriovenous fistulas (AVFs). We report two pseudoaneurysms and arteriovenous fistula cases that were treated by transcatheter embolization with metallic coils. The first case is left main renal artery pseudoaneurysm after nephrectomy in a patient with a solid renal tumor. The second case is right main renal artery AVF with giant pseudoaneurysm after both gunshot injury and nephrectomy. On the basis of color Doppler sonography and computed tomography (CT) findings, cases were diagnosed as pseudoaneurysm after nefrectomy. Contrast-enhanced CT scans showed a hyperdense area within the hematoma consistent with pseudoaneurysm. Endovascular treatment with coil embolization succeeds to total occlusion in renal artery pseudoaneurysm. Delayed hemorrhage related to postnephrectomy may be life-threatening conditions because of diagnostic difficulties. AVF and pseudoaneurysm can be treated safely and successfully by transcatheter arterial embolization.     

Transcatheter embolization of an arteriovenous malformation of the scrotum

There are several vascular abnormalities that could affect the scrotum. The commonest is a varicocele, and differentiation between this and other lesions is possible using Doppler ultrasound and pelvic angiography. A patient with a scrotal arteriovenous malformation (AVM) is presented in whom transcatheter embolization was possible.     

小脑动静脉畸形伴发动脉瘤栓塞治疗

目的：探讨血管内栓塞治疗小脑动静脉畸形（AVM）伴发动脉瘤的技术要点及临床效果。方法回顾性分析就诊于我科、诊断为小脑AVM患者142例,其中42例伴发动脉瘤。将患者分为伴发动脉瘤组和不伴发动脉瘤组,采用单因素及多因素分析方法研究两组病例的性别、年龄、是否伴有出血、畸形团位置、大小及是否伴有深静脉引流。结果42例患者共伴发61个动脉瘤,其中位于畸形团内14个,位于供血动脉上47个。畸形团内动脉瘤与畸形团破裂出血及伴有深静脉引流密切相关。42例患者栓塞治疗后随访期间,未见复发出血。结论为了降低远期复发出血发生率,栓塞治疗小脑AVM伴发动脉瘤患者时应围绕动脉瘤处理制定治疗措施。     

Iatrogenic pulmonary artery perforation associated with 5-Fr catheter manipulation during pulmonary arteriovenous malformation embolization with a vascular plug

Vascular plugs have been increasingly used because they have lower recanalization rates than coil embolization in pulmonary arteriovenous malformation (PAVM) embolization. To deliver the vascular plug close to the PAVM, a large-diameter catheter should be advanced into the feeding pulmonary artery, which carries a risk of vascular damage. Fifty-three-year-old women was admitted to our hospital for embolization of a single PAVM. Pulmonary angiography revealed a simple PAVM with a tortuous, small feeding artery in the right middle lobe, and feeding artery negotiation was attempted using a 5-Fr headhunter-type catheter to deliver the vascular plug. However, unintentional arterial perforation occurred suddenly when the guide wire was withdrawn after the catheter was advanced to the feeding artery adjacent to the sac. Immediate embolization using a vascular plug and microcoils at the proximal site of the perforation was performed to stop both PAVM shunt flow and bleeding. To prevent such a catheter-induced complication, it is necessary to select a diagnostic catheter with appropriate stiffness and angle and to switch to a small-diameter delivery system depending on the situation.     

Cirsoid renal arteriovenous malformation treated by endovascular embolization with n-butyl 2-cyanoacrylate

The authors report a rare case of renal arteriovenous malformation (rAVM) which was diagnosed by arteriography years after onset of intermittent haematuria. The rAVM of the cirsoid type was superselectively catheterized and embolized in toto with n-butyl 2-cyanoacrylate. Diagnostic imaging modalities and the technique of embolization are discussed. Received: 16 July 1999; Revised: 17 September 1999; Accepted: 20 September 1999     

Severe pulmonary oedema following therapeutic embolization with Onyx for cerebral arteriovenous malformation

Acute respiratory distress syndrome (ARDS) is characterized by sudden onset of respiratory distress, infiltrates on radiographs consistent with pulmonary oedema, hypoxaemia and increased work in breathing. Infiltrates on radiographs are bilateral, but may be patchy or diffuse and fluffy or dense. It is associated with absence of left heart failure and a PaO₂/FiO₂ ratio of ≤200. Ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (DMSO), which was approved by the US FDA in July 2005, is used as an embolic agent for cerebral arteriovenous malformation (AVM). It is a biocompatible liquid polymer that precipitates and solidifies on contact with blood, thus forming a soft and spongy embolus. We report a case of ARDS following therapeutic embolization with ethylene vinyl alcohol copolymer for cerebral AVM under general anaesthesia. Experienced perioperative physicians adopted standard anaesthetic technique and monitoring for this procedure. Acute respiratory distress and hypoxaemia developed in the patient following extubation of the trachea. Infiltrates seen on postprocedural chest radiographs were consistent with pulmonary oedema. DMSO, the solvent for the ethylene vinyl alcohol copolymer, is excreted via the lungs after administration and we postulate that DMSO was the possible cause of ARDS in this patient. Monitoring of haemodynamic parameters (invasive blood pressure, electrocardiography) and ventilatory parameters (ETCO₂, SpO₂, airway pressure monitoring) are important in the recognition of this possible event. One should be vigilant and anticipate this complication following therapeutic embolization with ethylene vinyl alcohol polymer for the treatment of cerebral AVM.     

子宫动静脉畸形介入栓塞治疗19例临床研究

目的探讨子宫动静脉畸形采用子宫动脉介入栓塞治疗的临床效果。 方法选取2014年4月至2019年12月在我院就诊并接受治疗的19例子宫动静脉畸形患者作为研究对象,均给予子宫动脉栓塞术（UAE）治疗,评价治疗效果和患者预后。 结果19例患者中有15例患者均一次性UAE治疗止血成功,术后患者主诉右下腹轻度疼痛不适,术后2～5 d症状消失,剩余4例治疗后阴道仍有出血,其中2例患者转手术治疗,另2例给予保守治疗后好转。19例患者术后均未发生严重并发症。 结论子宫动静脉畸形虽然在临床较为少见,但很容易引起严重后果,UAE治疗子宫动静脉畸形是一种微创、高效且可重复的治疗方式,对无手术禁忌症者可作为首选的治疗方式。     

Cerebral embolism—First manifestation of pulmonary arteriovenous malformation in patient with hereditary hemorrhagic telangiectasia

Four of five patients with asymptomatic small or moderate-size pulmonary arteriovenous malformation (PAVM) presented with a paradoxical embolus and stroke. In these patients chest radiographic findings were subtle and arterial hypoxemia provided the real clue to diagnosis. Computed tomography (CT) and cerebral arteriography confirmed embolic occlusion in four of five patients. Careful family screening including posteroanterior (PA) and lateral chest radiographs and arterial oxygen determinations in siting or standing positions are recommended for early detection of asymptomatic patients with PAVM. Early therapeutic intervention (with balloon embolotherapy) is recommended to avoid paradoxical embolization.     

Osteomyelitis mimicking a primary bone tumor in a patient with pulmonary arteriovenous malformation and Osler-Weber-Rendu disease

Extremity pain is a common presenting symptom seen by the practitioner; the etiology may be related to problems in the bone, joint, soft tissues, or neurovascular bundle. The differential diagnosis is extensive for each, with a careful history and physical exam narrowing the list. Imaging begins with plain radiographs, reserving CT and MRI for further work-up. We report an unusual presentation of osteomyelitis mimicking a bone tumor in a patient with Osler-Weber-Rendu disease. Electronic Publication     

Visualization of left bronchial-to-coronary artery communication after distal bronchial artery embolization for bronchiectasis

We present a 44-year-old woman in whom a bronchialto-coronary artery communication via the conus branch was discovered after distal bronchial artery embolization with gelatin sponge for hemoptysis. If this bronchial-to-coronary artery anastomosis, not visible prior to embolization, had been inadvertently embolized, the patient could have developed a myocardial infarction. To reduce the likelihood of a serious complication, the possibility of this anastomosis should be kept in mind and angiography should be repeated before attempting proximal bronchial artery embolization.     

Thrombosis of aggressive dural arteriovenous fistula after incomplete embolization

We report the cases of three patients diagnosed with dural arteriovenous fistula (DAVF) and cortical venous reflux (CVR). All were treated by transarterial endovascular embolization. Residual shunting and cortical venous drainage continued to be present at the end of the treatment procedure, despite the fact that during endovascular embolization glue penetration into the proximal venous component of the fistula had been achieved. Subsequently, follow-up angiography showed total obliteration of the fistulas and absent associated CVR. The fistulas were no longer opacified, and no additional treatment was performed. We demonstrate that residual aggressive DAVF may progress to total thrombosis if strategic deposition of the glue into the venous side has been achieved. Early follow-up angiogram is recommended prior to a planned complementary surgical approach.     

脑动静脉畸形的X刀治疗

目的　探讨立体定向放射外科治疗脑动静脉畸形的临床效果。方法　对 87例脑动静脉畸形患者采用X刀治疗 ,畸形团大小大小 5～ 4 0mm。单独接受X刀治疗 5 5例 ,联合血管内栓塞治疗32例。治疗周边剂量 17～ 30Gy ,平均 2 2 .6Gy ,等剂量曲线 70 %～ 90 %。随访时间 6～ 96个月 ,平均 5 3.4个月。结果　单独应用X刀治疗的脑动静脉畸形患者 ,完全闭塞 4 1例 ,部分闭塞 9例 ,无变化 5例 ;联合血管内栓塞治疗患者 ,完全闭塞 2 6例 ,部分闭塞 3例 ,无变化 3例。全组完全闭塞 6 7例 (77.0 % )。癫痫完全缓解 7例 (2 6 .2 % ) ,头痛头昏症状缓解 18例 (38.3% )。并发症 :再出血 2例 ,症状性放射性脑水肿 6例 ,经治疗后 ,完全缓解 2例 ,遗留神经功能障碍 4例。结论　立体定向放射外科是脑动静脉畸形的安全而有效的治疗方法之一。