Endovascular Treatment for Acute Aortic Syndrome

Background: The term "acute aortic syndrome" (AAS) includes conditions of high mortality, such as ruptured aneurysm, pseudoaneurysm and, aortic dissection. Open surgery for these cases has demonstrated unsatisfactory results, and endovascular treatment has become an excellent alternative. Methods: We performed a retrospective review of patients with AAS who underwent endovascular treatment in our emergency department from July 2009 to February 2011. They represent 64% (16 of 25) of all patients with AAS seen during this period. Results: Sixteen patients underwent endovascular treatment: eight ruptured aneurysms, six aortic dissections, one nonruptured painful aneurysm, and one pseudoaneurysm. No intramural hematoma or penetrating atherosclerotic ulcer was found. The mean age was 64.3 years, and arterial hypertension (100%) and smoking (64.7%) were the major comorbidities. Technical success rate was 93%, and overall 30-day mortality was 6.25%. Conclusion: Endovascular treatment for AAS was feasible. Technical success, 30-day mortality, hospital stay, and procedure time were similar to those of the other series reported in the literature, and the endovascular approach has became the main technique for AAS in our hospital.

Endovascular Treatment of Tentorial Dural Arteriovenous Fistulae

Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which accounts for less than 4% of all cases of intracranial DAVF Because of the high risk of intracranial hemorrhage, patients with tentorial DAVF need aggressive treatment. Management approaches are still controversial, and endovascular treatment has emerged as an effective alternative. In the current work, we describe our experience with the endovascular approach in the treatment of these deep and complex DAVF of the tentorium. Eight patients were treated between January 2006 and July 2009. Six patients (75%) presented with intracranial hemorrhage related to the DAVF rupture. Four patients (50%) had subarachnoid bleeding and two had intraparenchymal hematoma. Endovascular treatment was performed via the transarterial route alone in five cases (62.5%), by the transvenous approach in two cases (25.0%) and in a combined procedure using both arterial and venous routes in one patient (12.5%). Complete obliteration of the fistula was achieved in all cases. The outcome at 15 months was favorable (modified Rankin scale 0-3) in seven (87.5%) patients. Complete cure of the lesion was confirmed in these cases. This paper reports on the effectiveness of endovascular treatment in tentorial DAVF management The choice of the venous versus the arterial approach is determined by regarding different anatomical dispositions.

Tratamento endovascular dos aneurismas da aorta abdominal com anatomia complexa: resultados preliminares com a segunda geração de endoprótese com arcabouço metálico circular

INTRODUÇÃO: O tratamento endovascular dos aneurismas da aorta abdominal tem revolucionado o tratamento dessa afecção, em decorrência das baixas taxas de morbidade e mortalidade. Apesar dos avanços tecnológicos ocorridos nas endopróteses, ainda existem limitações anatômicas para o emprego da técnica. Este estudo teve por objetivo avaliar os resultados imediatos do tratamento de pacientes portadores de aneurisma da aorta abdominal com anatomia complexa com uma endoprótese de segunda geração. MÉTODOS: Estudo observacional, prospectivo, não-randomizado, realizado em um único centro, em uma série de pacientes submetidos a tratamento endovascular de aneurismas da aorta abdominal infrarrenais complexos, com prótese com arcabouço metálico disposta em anéis (Anaconda - Vascutek, Terumo, Inchinnan, Escócia). Foram avaliados as características clínicas e angiográficas, o sucesso técnico, o sucesso terapêutico, a morbidade e a mortalidade, e a taxa de reintervenção perioperatória. RESULTADOS: Foram analisados, no período de fevereiro de 2010 a dezembro de 2011, 108 pacientes consecutivos portadores de aneurisma da aorta, dos quais 16 eram portadores de aneurisma da aorta abdominal com anatomia complexa tratados com a prótese Anaconda . A média de idade foi de 76 + 7 anos e 75% eram do sexo masculino. Houve sucesso técnico em 94% e êxito terapêutico em 75% dos casos. Ocorreu um óbito no pós-operatório. As complicações perioperatórias mais prevalentes foram sangramento da ferida operatória (2/16) e embolia periférica (2/16). Foram necessárias reintervenções em 12,5% dos pacientes durante o seguimento. CONCLUSÕES: Neste estudo, a segunda geração da endoprótese Anaconda foi efetiva e apresenta resultados imediatos satisfatórios no tratamento do aneurisma da aorta abdominal infrarrenal de anatomia complexa.

Perimedullary arteriovenous fistulas in children: report on six cases

Background Perimedullary arteriovenous fistulas (PMAVFs) are rare spinal lesions and even more uncommon in children. Objective The aim of this study was to document rare occurrences of this type of arteriovenous malformation in six children treated at our institution. Methods The clinical data, radiological findings, and treatment in six cases of PMAVFs were reviewed. Six patients with PMAVFs were managed at our institution over a 5-year period. The patients (four girls and two boys), ranging in age from 6 to 15 years, presented with initially fluctuating, and eventually permanent and progressive, sudden-onset paraparesis, sensory disturbances, and sphincter dysfunction. The duration of symptoms before diagnosis ranged from 1 week to 13 years. Results All the patients underwent magnetic resonance imaging and spinal selective angiography, which demonstrated the characteristic imaging of an arteriovenous fistula. Embolization of the arteriovenous fistula was initially attempted in three patients with successful occlusion of the fistula in two. For the remaining cases, open surgery was performed, with complete occlusion of the fistula. There was no morbidity, regardless of the treatment performed. All the patients experienced neurological improvement after treatment. Conclusions No specific clinical or radiological characteristic of PMAVFs in the pediatric population was observed when our series was compared with a general series. Early diagnosis and timing of the therapeutic intervention seemed to avoid the development of irreversible ischemic myeloradiculopathy and prevented hemorrhage. Treatment for PMAVFs is difficult to standardize because these are extremely rare lesions with different angioarchitecture configurations.

Angiographic Results in Intracranial Aneurysms Treated with Inert Platinum Coils

This study was designed in an attempt to identify the risk factors that could be significantly associated with angio graphic recurrences after selective endovascular treatment of aneurysms with inert platinum coils. A retrospective analysis of all patients with selective endovascular coil occlusion of intracranial aneurysms was prospectively collected from 1999 to 2003. There were 455 aneurysms treated with inert platinum coils and followed by digital subtraction angiography. Angio graphic results were classified according Roy and Raymond's classification. Recurrences were subjectively divided into minor and major. The most significant predictors for angio graphic recurrences were determined by ANOVAs logistic regression, Cochran-Mantel-Haenszel test, Fisher exact probability. Short-term (4.3 +/- 1.4 months) follow-up angiograms were available in 377 aneurysms, middle-term (14.1 +/- 4.0 months) in 327 and long-term (37.4 +/- 11.5 months) in 180. Recurrences were found in 26.8% of treated aneurysms with a mean of 21 +/- 15.7 months of follow-up. Major recurrences needing retreatment were present in 8.8% during a mean period follow-up of 17.9 +/- 12.29 months after the initial endovascular treatment. One patient (0.2%) experienced a bleed during the follow-up period. Recurrences after endovascular treatment of aneurysms with inert platinum coils are frequent, but hemorrhages are unusual. Single aneurysm, ruptured aneurysm, neck greater than 4 mm and time of follow-up were risk factors for recurrence after endovascular treatment. The retreatment of recurrent aneurysm decreases the risk of major recurrences 9.8 times. Long-term angiogram monitoring is necessary for the population with significant recurrence predictors.

Urgent percutaneous transcatheter embolization of hemorrhagic hepatic lesions with N-butyl cyanoacrylate

PURPOSE To report on our clinical experience with and the success rate and safety of percutaneous transcatheter embolization with N-butyl cyanoacrylate (NBCA) as the lone primary embolic agent used for arterial embolization of hemorrhagic liver lesions. MATERIALS AND METHODS This retrospective study enrolled all patients who presented to the emergency room with hemorrhagic liver lesions during a two-year period and were treated by percutaneous transcatheter embolization with NBCA. RESULTS Eight consecutive patients were evaluated, and 13 lesions were embolized exclusively with NBCA: eight pseudoaneurysms and five active bleeds. All patients were treated successfully using percutaneous transcatheter embolization with NBCA without re-bleedings or major complications. CONCLUSION Percutaneous transcatheter embolization with NBCA is a safe and effective method for treating hemorrhagic lesions.