Embolization of Congenital Renal Arteriovenous Malformations Using Ethanol and Coil Depending on Angiographic Types

Purpose

To evaluate effectiveness and safety of embolization of congenital renal arteriovenous malformations (AVMs) using ethanol and/or coil according to angiographic type.

Long-Term Patency of Arteriovenous Fistulae Salvaged by Balloon Angioplasty with and without Accessory Vein Embolization: A Retrospective Study

Purpose

To investigate whether accessory vein embolization (AVE) improves long-term performance of salvaged nonmaturing arteriovenous fistulae (AVFs).

Thermal Resistance Anastomosis Device for the Percutaneous Creation of Arteriovenous Fistulae for Hemodialysis

Purpose

To evaluate the safety and efficacy of arteriovenous fistula (AVF) creation with a thermal resistance anastomosis device (TRAD).

Transcatheter Embolization of a Renal Arteriovenous Fistula Complicated by an Aneurysm of the Feeding Renal Artery

Renal arteriovenous fistula (AVF) is rare. Renal AVF complicated by aneurysm of the feeding artery presents a technical challenge for endovascular treatment. We report a case managed by covered stenting of the renal artery aneurysm, coil embolization of the fistula, and bare stenting of the aorta.     

Mechanical Thrombectomy in Acute Thrombosis of Dialysis Arteriovenous Fistulae and Grafts Using a Vacuum-Assisted Thrombectomy Catheter: A Multicenter Study

Purpose

To prospectively analyze technical and clinical outcome of percutaneous thrombectomy aspiration using a vacuum-assisted thrombectomy catheter in acutely thrombosed dialysis arteriovenous fistula (AVF) and/or arteriovenous graft (AVG).

Venous Sac and Feeding Artery Embolization versus Feeding Artery Embolization Alone for Treating Pulmonary Arteriovenous Malformations: Draining Vein Size Outcomes

PurposeTo investigate and compare venous sac and feeding artery embolization (VFE) with feeding artery embolization (FAE) alone for treatment of pulmonary arteriovenous malformations (PAVMs), based on difference in outcomes in decrease of the size of the draining vein.Materials and MethodsTwenty-six patients (7 male and 19 female; median age [interquartile range], 58 years [46–65 years]) with 42 simple PAVMs treated with coil embolization between August 2005 and December 2018 were retrospectively evaluated. Twenty PAVMs were treated with FAE early in the study period and compared with 22 PAVMs treated with VFE later in the study period. Follow-up computed tomography images obtained 8–20 months after embolotherapy were used for outcome analysis. Data related to patient demographics; follow-up period; baseline diameters of the feeding artery, venous sac, and draining vein; draining vein diameter after treatment; and decrease in the size of the draining vein, including the number reaching a threshold of 70% decrease, were compared between the 2 groups.ResultsThe draining vein decreased in size by a median of 46.4% in the FAE group and 66.3% in the VFE group, and the difference between the 2 groups was statistically significant (P = .009). There were no significant differences in the other parameters.ConclusionsVFE leads to a greater decrease in the size of the draining vein than FAE, suggesting that VFE results in more complete occlusion than FAE for treatment of PAVMs.     

Efficacy of Venous Sac Embolization for Pulmonary Arteriovenous Malformations: Comparison with Feeding Artery Embolization

PurposeTo examine the efficacy of venous sac embolization (VSE) in comparison with transcatheter feeding artery embolization (FAE) for treatment of pulmonary arteriovenous malformations (PAVMs).Materials and MethodsFrom 1989–2009, 21 patients underwent embolization of 37 PAVMs. Safety and long-term efficacy of VSE were evaluated retrospectively and compared with FAE.ResultsFAE was performed in 22 (18 simple and 4 complex type) PAVMs, and VSE was performed in 15 (14 simple and 1 complex type) PAVMs. There were significant differences between FAE and VSE in treated periods, PAVM location, coil type used, number of coil combinations and coils per PAVM, coil position, and reperfusion; there were no significant differences in most PAVM characteristics, follow-up durations (58 mo±54 vs 42 mo±42; P= .32), and minor complications (pleurisy [2 vs 2]). Reperfusion occurred in 11 (50%) of 22 PAVMs in the FAE group and no PAVMs in the VSE group (P<.01). Of 22 PAVMs in the FAE group, 17 (77%) were treated with 0.035-inch coils alone; of 15 PAVMs in the VSE group, 14 (93%) were treated with 0.018-inch interlocking detachable coils (IDCs), 0.018-inch pushable fibered coils, or IDCs and pushable fibered coils combined (P<.01). The number of coils used was 8±4 in the VSE group and 4±4 in the FAE group (P= .002).ConclusionsThe high reperfusion rate in the FAE group was mainly due to the use of large 0.035-inch coils alone. Although more coils are needed, VSE can be used to treat PAVMs with a venous sac safely and achieve long-term efficacy.     

Selective Embolization of Large Symptomatic Iatrogenic Renal Transplant Arteriovenous Fistula

We report on the successful treatment of hypertension by occlusion of a large iatrogenic renal transplant arteriovenous fistula using detachable embolization coils with concomitant flow reduction by occlusion balloon in two patients.     

Uterine Artery Embolization with Gelfoam for Acquired Symptomatic Uterine Arteriovenous Shunting

PurposeTo evaluate the technical and clinical success rates and safety of bilateral gelfoam uterine artery embolization (UAE) for symptomatic acquired uterine arteriovenous shunting due to prior obstetric or gynecologic event.Materials and MethodsThis was a retrospective study of consecutive patients of reproductive age who presented with abnormal uterine bleeding after recent gynecologic procedures or obstetric events between January 2013 and February 2018. Bilateral UAE was performed in all patients using gelfoam slurry. Technical success was defined as angiographic resolution of arteriovenous shunting. Clinical success was defined as cessation of symptomatic bleeding, resolution on follow-up imaging, or minimal estimated blood loss (EBL) (<50 ml) on subsequent elective dilation and curettage (D&C) procedure.ResultsEighteen patients (mean age, 32.8 ± 7.1 years) were included. Technical success and clinical success were experienced by 17/18 (94.4%) and 16/17 (94.1%) patients, respectively. Angiography demonstrated arteriovenous shunting in 18/18 (100%) patients, with early venous drainage. Seven of 18 (38.9%) patients underwent subsequent scheduled D&C due to remaining retained products of conception, with an EBL of 17.9 ± 15.6 ml. There was 1 minor complication of a self-limited vascular access groin hematoma (1/18, 5.6%) and 1 major complication (1/18, 5.6%) of a pulmonary embolism detected 3 days after UAE. The length of clinical follow-up was 19.3 ± 15.5 months, in which 41.2% (7/17) of the patients became pregnant.ConclusionsUAE with gelfoam alone for symptomatic uterine arteriovenous shunting is a feasible treatment option that has a high technical and clinical success rate with a low rate of complications.     

用国产胶体栓塞剂经血管内治疗脑动静脉畸形

报告了经血管内采用微导管超选择导入技术，并应用国产氰基丙烯酸异丁酯（Ｉｓｏｂｕｔｙ１２－ｃｙａｎｏａｃｒｙｌａｔｅ，ＩＢＣＡ）和α－氰基丙烯酸正丁酯（Ｎ－ｂｕｔｙｌｃｙａｎｏａｃｒｙｌａｔｅ，ＮＢＣＡ）栓塞治疗４４例脑动静脉畸形，获较满意效果。文中就栓塞材料的选择、ＩＢＣＡ和ＮＢＣＡ之间的特点比较及应用方法，栓塞术中并发症的预防与处理等进行了讨论。本组资料表明，国产ＩＢＣＡ和ＮＢＣＡ具有与国外产品性能相似的弥散好、易控制、聚合速度快等优点。     

以癫痫发病的脑AVM的影像特点与血管内治疗

目的 :探讨 2 6例以癫痫发病的脑AVM的影像学特点与血管内治疗的技术操作。材料和方法 :2 6例以癫痫发病的病例经DSA全脑血管造影证实为脑AVM。根据AVM病灶的特点 ,选择经血管内超选择应用NBCA栓塞或结合放射外科治疗。结果 :2 6例在 1～ 3次栓塞后 ,17例症状完全消除 ,9例症状得到明显有效的控制。结论 :AVM病灶粗大的皮层引流静脉产生的搏动性刺激及脑皮层静脉回流受阻 ,损害脑功能 ,进而引起皮层放电导致癫痫发作 ,所以在栓塞中应尽量减少畸形血流量 ,使粗大的引流静脉萎陷 ,从而降低对皮层脑组织的刺激 ,达到控制和缓解癫痫发作的目的。     

Time-Dependent Effects of Cryoablation for Renal Tumor on Overall and Split Renal Function

Purpose

To evaluate the influence of percutaneous cryoablation for renal cell carcinoma on function of the affected kidney.

Treatment Outcomes of Embolization for Peripheral Arteriovenous Malformations

PurposeTo evaluate treatment outcomes of embolization for peripheral arteriovenous malformations (AVMs) in a tertiary referral center where ethanol is the primary agent of choice.MethodsA retrospective study was performed of 93 patients (median age, 31 years; range, 2–66 years) with peripheral AVMs treated with embolization (n = 442; median, 2 per patient; range, 1–82) between January 2010 and July 2016. Ethanol was used in most cases (n = 428; 97%). AVMs were classified as type I (n = 3), type II (n = 57), type IIIa (n = 5), type IIIb (n = 15), and type IV (n = 13) according to the Yakes classification system. Effectiveness of embolization was based on AVM devascularization on angiography: 100% (total), 90%–99% (near-total), 70%–90% (substantial), 30%–70% (partial), and 0%–30% (failure). Complications were graded according to the Society of Interventional Radiology classification.ResultsIn 69% of patients, 70%–100% devascularization was achieved. Total and near-total occlusion of the nidus were more often achieved in AVMs of types I and IIIa (both 100%) than in AVMs of types II, IIIb, and IV (56%, 67%, and 39%, respectively; P = .019). A total of 109 complications were identified: 101 minor (22.9%) and 8 major (1.8%). Major complications included wounds (n = 5), false aneurysm (n = 1), finger contracture (n = 1), and severe pain (n = 1) requiring therapy. The patient complication risk was significantly affected by the number of procedures (relative risk = 2.0; P < .001). Age, AVM location, and angioarchitecture type did not significantly affect complication risk.ConclusionsAVM embolization resulted in 70%–100% devascularization in 69% of patients, with few major complications. This study indicates that the type of AVM angioarchitecture affects the number of procedures needed and the achievability of AVM devascularization.     

A New Device for Vascular Embolization: Report on Case of Two Pulmonary Arteriovenous Fistulas Embolization Using the Amplatzer Vascular Plug

A pulmonary arteriovenous fistula (PAVF) is a rare vascular malformation commonly treated by embolization with coils or balloons to prevent the risk of several serious complications such as cerebral embolism and brain abscess. A 32-year-old female with two PAVFs and neurological ischemic manifestations has been successfully treated by transcatheter embolization of both fistulas using a new device (Amplatzer Vascular Plug). This self-expanding cylindrical nitinol mesh cage with high radial strength allows a chance of relocation until properly positioned. It is preferred to coils or balloons because a large caliber of feeding artery implied high risk of uncontrollable distal embolization. There appear to be no reports in the literature concerning use of this device, which could represent a useful innovative tool in embolotherapies, especially in large vascular areas.     

Percutaneous Transcatheter Embolization of a Large Pulmonary Arteriovenous Fistula with an Amplatzer Vascular Plug

Percutaneous transcatheter embolization has become the treatment of choice for pulmonary arteriovenous fistulas (PAVFs), in most cases replacing surgical intervention. However, while "classic" devices, such as intravascular coils and detachable balloons, have proved to be successful for interventional occlusions of small or medium-sized PAVFs, they are not ideal in larger fistulas because of the risk for embolization to the systemic circulation. We describe the case of a 61-year-old woman with a symptomatic huge solitary pulmonary arteriovenous fistula (4.5 cm in diameter), occupying part of the lung in the lower right lobe with two feeding arteries (10 and 4 mm in diameter, respectively), who underwent successful transcatheter closure with an Amplatzer Vascular Plug, a new device designed for the occlusion of vascular abnormalities.     

Efficacy and Safety of AMPLATZER Vascular Plug Type IV for Embolization of Pulmonary Arteriovenous Malformations

PurposeTo assess the efficacy and safety of the AMPLATZER Vascular Plug type IV for pulmonary arteriovenous malformation (PAVM) treatment.Materials and MethodsBetween June 2013 and January 2018, 13 patients with 26 PAVMs were treated with the type IV AVP. Patients without follow-up computed tomography (CT) were excluded. Technical success was defined as flow occlusion on angiography. Plug-to-sac distance was measured on angiographic images. Feeding artery and venous sac diameter changes were measured on preprocedural and follow-up CT. Successful embolization was defined as > 70% sac size regression. Procedure time, device migration, and complications were evaluated.ResultsNine female patients (mean age, 49 y; range, 40–71 y) with 19 PAVMs were enrolled. Four patients with 7 PAVMs were lost to follow-up. Nineteen PAVMs were treated in 11 sessions, and the mean procedure time was 29 min. The technical success rate was 100%. Mean feeding artery diameter was 3.1 mm ± 0.7 (range, 2.1–4.9 mm). Mean plug-to-sac distance was 5.4 mm ± 4.9 (range, 0–13.3 mm). The mean CT follow-up period was 14 months ± 7 (range, 6–30 mo). Sixteen of 19 PAVMs (84%) were successfully embolized. Minor complications (tachycardia and chest discomfort) arose in 2 of 11 sessions. No device migrations or major complications occurred.ConclusionsThe type IV AVP showed an 84% treatment success rate based on 70% sac size regression criteria in small PAVMs. There were no device migrations or major complications.     

Predictors and Outcomes of Postcontrast Acute Kidney Injury after Endovascular Renal Artery Intervention

Purpose

To determine incidence, predictors, and clinical outcomes of postcontrast acute kidney injury (PC-AKI) following renal artery stent placement for atherosclerotic renal artery stenosis.

Transcatheter Embolization of a Large Symptomatic Pelvic Arteriovenous Malformation with Glubran 2 Acrylic Glue

A young patient affected by a pelvic arteriovenous malformation (pAVM) with recurrent episodes of hematuria following exercise, underwent transcatheter embolization using Glubran 2 acrylic glue (GEM, Viareggio, Italy). All branches of the pAVM were successfully occluded. The patient showed prompt resolution of symptoms and persistent occlusion of the pAVM at the 6 month follow-up.     

Long-Term Follow-up After Embolization of Pulmonary Arteriovenous Malformations with Detachable Silicone Balloons

Long-term follow-up results after embolization of 13 pulmonary arteriovenous malformations in 10 patients by use of 14 detachable silicone balloons are given. Patients were followed for a mean of 99 months (range, 63–123 months) with chest x-rays and for a mean of 62 months (range, 3–101 months) with pulmonary angiography. Fifty-four percent of the balloons were deflated at latest radiographic chest film follow-up, but at pulmonary angiographic follow-up all embolized malformations were without flow irrespective of whether or not the balloons were visible. Detachable silicone balloons are not available anymore, but use of these balloons for embolization of pulmonary arteriovenous malformations has been shown to be a safe and precise method, with immediate occlusion of the feeding artery and with long-lasting occlusion, even though many balloons deflate with time, leaving a fibrotic scar replacing the pulmonary arteriovenous malformation. No case of recanalization has been discovered, and these results seem to justify a reduced number of controls of these balloon-embolized malformations.     

选择性肾动脉栓塞治疗肾损伤出血的临床应用

目的 分析选择性肾动脉栓塞治疗肾损伤出血的疗效和安全性。资料与方法 1992年7月至2005年6月,39例肾脏损伤性出血患者,其中肾脏外伤28例,医源性损伤11例,采用金属弹簧圈行选择性肾动脉栓塞术。结果 DSA证实损伤部位位于肾段或段以下肾动脉分支,全部患者术后1～4d肉眼血尿消失（除2例再次栓塞外）,随访4个月～2年,无复发性血尿,无并发症出现。结论 选择性肾动脉栓塞治疗肾损伤出血创伤小、安全、疗效确切,能避免肾脏外科手术。