A Case of Pial Arteriovenous Fistula with Giant Venous Aneurysm and Multiple Varices Treated with Coil Embolization

Intracranial pial arteriovenous fistulas (AVFs) are rare vascular lesions of the brain. These lesions consist of one or more arterial connection to a single venous channel without true intervening nidus. A 24-year-old woman visited to our hospital because of headache, vomiting, dizziness and memory disturbance that persisted for three days. She complained several times of drop attack because of sudden weakness on both leg. Cerebral angiograms demonstrated a giant venous aneurysm on right frontal lobe beyond the genu of corpus callosum, multiple varices on both frontal lobes fed by azygos anterior cerebral artery, and markedly dilated draining vein into superior sagittal sinus, suggesting single channel pial AVF with multiple varices. Transarterial coil embolization of giant aneurysm and fistulous portion resulted in complete disappearance of pial AVF without complication.     

Factors that affect the surgical outcomes of spinal dural arteriovenous fistulas

BACKGROUND: Authors disclose the factors that affect the surgical outcome of the spinal dural AVFs from the retrospective analysis of 13 cases. METHODS: Thirteen patients with spinal dural AVF underwent microsurgical treatments between 1990 and 2004 at the Department of Neurosurgery, Aso Iizuka Hospital. The mean age was 62 years, and the median time to diagnosis was 38 months (range, 4-120 months). There were 12 men and 1 woman. The clinical features were characterized by spastic paraparesis in all 13 patients and micturition problem in 11 patients. All 13 patients showed the longitudinal extension of the high T2 intramedullary signals in magnetic resonance (MR) image. The microsurgical obliterations of the spinal dural AVFs were performed for all 13 patients because the endovascular treatments were difficult or failed to obliterate the lesions. RESULTS: The durations of the symptoms were not directly correlated to the preoperative neurological conditions and the postoperative outcomes. The patient's age and the preoperative severity of myelopathy affected the postoperative outcomes. The mode of the longitudinal extension of the high T2 intramedullary signals in MR image, rostral or caudal, did not show the statistical significance to the outcome. The poor outcomes were observed in elderly patients and patients with preoperative modified Rankin Scale 4 and 5. A case with multiple spinal dural AVFs is also presented. CONCLUSION: The spinal AVFs are treatable lesions through microsurgery or embolization. The likelihood of favorable outcome was affected by the severity of deficits and the patient's age.     

Posttraumatic splenic pseudoaneurysm and arteriovenous fistula: diagnosis by computed tomography angiography and treatment by transcatheter embolization

The current treatment of splenic injury in children is conservative. The common concern with nonoperative management of splenic injury involves increased risk of posttraumatic splenic complications. Computed tomography angiography is a noninvasive and useful technique for the detection of the vascular abnormalities in conservatively managed splenic injuries. We present a case of posttraumatic splenic pseudoaneurysm and arteriovenous fistula (AVF) in a 12-year-old boy, which were prediagnosed by color Doppler ultrasound and consecutively shown by computed tomography angiography. The treatment of splenic AVF is indicated to avoid portal hypertension, high output cardiac failure, and related complications. To preserve the splenic immune function and to avoid the risk of surgery and splenectomy complications, splenic pseudoaneurysm and AVF were successfully occluded by transcatheter embolization.     

25例髓周动静脉瘘的分型与治疗

目的：评价选择性脊髓动脉造影在髓周动静脉瘘的诊断、分型、治疗等方面的作用，正确选择栓塞与手术治疗的适应证、栓塞途径与栓塞材料。方法：２５例病人均经脊髓动脉造影证实。栓塞材料采用可脱球囊、弹簧圈、微粒、ＮＢＣＡ等。结果：痊愈９例，显效２例，好转１１例，加重２例，死亡１例。结论：作者强调选择性动脉造影在髓周动静脉瘘的诊断、分型、治疗等方面的重要性，指出栓塞对Ⅱ、Ⅲ型病人是一种安全、有效的方法。     

Giant intradural cervical spine arteriovenous malformations – A case and review of literature

Introduction

Spinal arteriovenous malformations (SAVMs) are very rare and can be very challenging to treat since none of the therapeutic options does provide a definitive cure to these lesions. We believe that incorporation of intraoperative angiography during surgery in a hybrid theatre can help achieve a better cure.

Incidental discovery of a long standing arteriovenous fistula after thrombectomy for acute lower limb ischaemia

INTRODUCTION

Arteriovenous fistula (AVF) is the abnormal connection between an artery and vein. Congenital AVF of the popliteal artery is very rare.

PRESENTATION OF CASE

89 year old lady presented with right acute lower limb ischaemia. She had unilateral chronic venous hypertensive change in the right leg. Femoral embolectomy was performed. Backflow was achieved. Arteriotomy was closed. The patient''s leg continued to deteriorate. She returned to theatre. On-table angiogram showed an occluded SFA. Thrombectomy was completed. SFA was patent but no blood flowed into the distal popliteal artery. A second on table angiogram revealed AVF between popliteal artery and vein. Dissection to the posterior aspect of the knee revealed the fistula. The vein was arterialized and enlarged. The AVF was ligated. Normal distal blood flow was achieved. Retrospectively we measured the leg lengths. Right leg was 3 cm longer than the left. The right leg circumference was 7 cm greater than the left. She reported chronic venous change from a young age. She did not report any history of trauma to the limb.

DISCUSSION

Popliteal artery to popliteal vein fistula is a rare. Trauma is the most common cause of popliteal AVF. Should the condition develop before closure of the epiphyses, there may be an increase in leg measurements.

CONCLUSION

We postulate that this case of AV fistula may be congenital due to discrepancy in leg measurements and unilateral chronic venous hypertensive change. Rarely persistent remnants of the embryonic sciatic artery can lead to arteriovenous anastomoses, which may be a possible aetiology.     

What can 3D CT angiography add in evaluation of facial vascular lesions?

Purpose

To demonstrate the value of 3D CT angiography (CTA) in the evaluation of facial vascular lesions regarding diagnosis, characterization and full extensions compared to conventional 2D CTA.

Patients and methods

This prospective study included 16 patients with facial vascular lesions with ages that range from 1 to 45 years and mean age of 23 years, patients performed CT angiography (2D and 3D) utilizing the coronal and sagittal MPR and VR techniques. Lesions were evaluated by both 2D and 3D sequences regarding characterization and complete extension including intracranial extension. Our results were correlated with maxillofacial and plastic surgery results.

Results

Among the 16 patients, 7 had hemangiomas, 5 had AVMs and 4 had AVFs. In hemangiomas, 2D successfully evaluated (regarding diagnosis, characterization and full extensions) 5 patients (71.5%) and 2 patients were in doubt regarding diagnosis, while 3D CTA successfully evaluated all the patients (100%). In AVMs, 2D CTA successfully evaluated 4 patients (80%), one patient was in doubt regarding intracranial extension, while 3D CTA successfully evaluated all the patients (100%). In AVFs, 2D and 3D CTA successfully evaluated all the patients (100%). For all cases, diagnostic accuracy of 2D CTA was 81.3%, while diagnostic accuracy of 3D CTA was 100%.

Conclusion

CTA offered noninvasive excellent angiographic imaging modality of the facial vascular lesions. The 3D CTA in particular (with high spatial and temporal resolution) provided distinct features that enabled excellent lesion detection, characterization, visualization of feeding arteries and draining veins and complete extensions. The 3D CTA allowed accurate differentiation of hemangiomas from AVMs that is sometimes difficult using clinical examination and 2D CTA. The 3D CTA plays an important role in extension evaluation, treatment planning (through full orientation of vascular tree) and follow up, thus eliminates the need for invasive DSA.     

Patient and Clinician Perspectives on Shared Decision Making in Vascular Access Selection: A Qualitative Study

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功能性端侧吻合自体动静脉内瘘中的血流动力学分析

目的 应用计算流体动力学(computational fluid dynamics, CFD)方法探索功能性端侧吻合自体动静脉内瘘(arteriovenous fistulas, AVF)中的血流动力学特征,为AVF的临床应用提供理论依据。方法 建立功能性端侧吻合(STE组)与常规端侧吻合法(cSTE组)AVF模型。分析远端动脉血流逆向与顺向两种情况下各组模型的血流动力学参数,包括血流速度、压降、低壁面切应力区域面积(low wall shear stress area, LWSSA)。结果 远端动脉血流逆向时,STE组总LWSSA较cSTE组下降5.70%,STE组静脉壁LWSSA较cSTE组下降49.71%。远端动脉血流顺向时,STE组总LWSSA较cSTE组增加6.97%,STE组静脉壁LWSSA较cSTE组下降10.62%。结论 远端动脉血流逆向时,功能性端侧吻合可以明显减少AVF的LWSSA;顺向时,功能性端侧吻合对LWSSA的改善作用不明显。