Feyyaz Baltacıoğlu

Endovascular Stent-Graft Applications in Iatrogenic Vascular Injuries

AbstractPurpose: To report the results of covered stent applications in iatrogenic vascular injuries. Methods: We report 17 patients (11 men, 6 women; age range 20–59 years, mean age 40 years) who underwent repair of different iatrogenic vascular lesions by means of endovascular covered stents. The patient population consisted of 8 femoral arteriovenous fistulae, 4 common femoral artery pseudoaneurysms, 1 subclavian artery pseudoaneurysm, 1 abdominal aortic aneurysm, 1 iliac artery perforation, 2 porto-biliary fistulae that developed during TIPS procedure. Balloon-expandable stent-grafts were used in all patients except one. Control studies were performed with angiography. Results: Technical success was achieved in all 17 patients. The mean clinical follow-up period for all 17 patients was 8 months. There were no signs of stent migration or leaks in the control studies. Only one patient developed a hemodynamically insignificant stenosis at the proximal end of the stent. There have been no stent deformations or related complications during the follow-up period. Conclusion: Our short-term results suggest that endovascular treatment is a low-risk procedure and appears less invasive than surgery for the treatment of different types of iatrogenic vascular injuries. Intermediate and long-term results are not available.

Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: technical and clinical results.

OBJECTIVES To report our experience with transarterial glue embolization of the bronchial artery for life-threatening hemoptysis. MATERIALS AND METHODS Twenty-five patients underwent bronchial artery embolization, using coaxial microcatheter technique, with a liquid agent, n-butyl-2-cyanoacrylate (NBCA), named glue, for life-threatening hemoptysis. The technical and clinical outcomes were followed in terms of immediate control of bleeding, recurrence of hemoptysis and complications of the procedure. RESULTS Four patients had acute hemoptysis when they were evaluated. The average number of arteries embolized per patient was 2.9. BAEs were successful in controlling hemoptysis immediately in all 25 patients (100%) and in 24 patients (96%) at 1 month follow-ups. One patient had recurrent hemoptysis on the tenth day after embolization. The follow-up time ranged from 2 to 63 months (mean 14 months). Six patients (25%) died all as a result of their disease process. Bleeding recurred in 3 patients after 30 days (7th, 11th, 12th months). One patient had vomitting attacks with dysphagia after the procedure that lasted 24h. Three patients had transient thoracic pain lasting 3-5 days. There were no procedure related spinal or vascular complications. CONCLUSIONS Glue embolization with microcatheter technique is a safe and effective treatment in cases of life-threatening hemoptysis with a very high rate of success and low rate of complications.

Fat necrosis mimicking liposarcoma in a patient with pelvic lipomatosis: CT findings

Pelvic lipomatosis is a rare condition characterized by an overgrowth of normal fat in the perirectal and perivesical spaces. The most important differential diagnosis is liposarcoma. We present a case of pelvic lipomatosis associated with a mass, which was diagnosed radiologically as a liposarcoma, but surgical biopsy result revealed fat necrosis.

Demographic, procedural and 30-day safety results from the WEB Intra-saccular Therapy Study (WEB-IT).

Introduction The Woven EndoBridge (WEB) represents a novel intrasaccular therapeutic option for the treatment of intracranial wide-necked bifurcation aneurysms (WNBAs). The WEB-IT Study is a pivotal Investigational Device Exemption (IDE) study to determine the safety and effectiveness of the WEB device for the treatment of WNBAs located in the anterior and posterior intracranial circulations. We present the patient demographics, procedural characteristics, and 30-day adverse event data for the US WEB-IT study. Methods WEB-IT is a prospective multicenter single-arm interventional study conducted at 25 US and 6 international centers. The study enrolled 150 adults with WNBAs of the anterior and posterior intracranial circulations. All patients were intended to receive a WEB device delivered via standard endovascular neurosurgical embolization techniques. The study was conducted under Good Clinical Practices and included independent adjudication effectiveness outcomes and all adverse events. Results One hundred and fifty patients enrolled at 27 investigational sites underwent attempted treatment with the WEB. Mean age was 59 years (range 29–79) and 110 (73.3%) of the patients were female. Treated aneurysms were located at the basilar apex (n=59, 39.3%), middle cerebral artery bifurcation (n=45, 30%), anterior communicating artery (n=40, 26.7%), and internal carotid artery terminus (n=6, 4%). Average aneurysm size was 6.4 mm (range 3.6–11.4) with a mean neck size of 4.8 mm (range 2.0–8.2, mean dome to neck ratio 1.34). Nine patients presented with ruptured aneurysms. Of the enrolled patients, 98.7% were treated successfully with WEB devices. Mean±SD fluoroscopy time was 30.2±15.7 min. One primary safety event (PSE) (0.7%)—a delayed parenchymal hemorrhage 22 days after treatment—occurred between the index procedure and 30-day follow-up. In addition to the single PSE, there were seven (4.7%) minor ischemic strokes (5 resolved without sequelae and 2 had a modified Rankin Scale score of 1 at 30 days), five (2.7%) transient ischemic attacks, and two (1.3%) minor subarachnoid hemorrhages, which did not meet the prospectively established criteria for PSEs. Conclusions The WEB device can be used to treat WNBAs with a high level of procedural safety and a high degree of technical success. Trial registration number NCT02191618; Pre-results.

Transarterial glue embolization in iatrogenic renovascular injuries

Iatrogenic injuries of the intrarenal arterial system include pseudoaneurysms and fistulas. They can cause hematuria and life-threatening hemodynamic instability, and therefore should be treated promptly. Endovascular treatment is recommended for these cases due to its effectiveness. Among the different agents used for embolization, n-butyl-2-cyanoacrylate (glue) has rarely been used. We present 15 patients with pseudoaneurysms and/or arteriovenous or caliceal fistulas who were treated by glue embolization. In our patient group, five had a history of percutaneous nephrolithotomy, six had renal biopsies, three had nephron-sparing surgery, and one had percutaneous nephrostomy. Glue embolizations were performed with the microcatheter technique. All patients were successfully treated, and all but one had excellent follow-ups. One patient suffered from disseminated intravascular coagulation secondary to transfusion and died after the procedure. We think glue embolization is a safe and effective treatment for this group of patients and present our experience along with the technical approach.

Approach to Fragmented Central Venous Catheters

Prolonged venous access devices are needed in cancer patients for central venous access. Catheter fragmentation leading to catheter malfunction represents a rare problem. Herein we present our experience in the management of fragmented catheters. Between 2001 and 2003, 183 catheters were placed via the subclavian vein, and five cases of fragmented catheters were observed. Fragments were removed by an Amplatz gooseneck snare (Microvena, St. Paul, MN) with angiographic intervention. The diagnosis of the breakage was made by chest radiography. The incidence of catheter rupture was 2.7%. All fragments were removed by the snare, without any complications. Catheter narrowing and breakage owing to its medial positioning in the subclavian vein were the main causes of catheter malfunction. In any case of catheter malfunction, radiologic evaluation of the catheter must be done to rule out its rupture. Removal of the fragments using the Amplatz snare is a safe and easily applied procedure.

Temporal bone measurements on high-resolution computed tomography.

The distances between the important neural and vascular structures in normal temporal bones were measured by using high-resolution computed tomography (HRCT). We examined 100 normal ears in 50 subjects ranging in age from 15 to 72 years (mean age 39 years). We measured the distances from the medial lip of the posterior wall of the internal auditory canal to the medial wall of the vestibule (mean 9.7 mm), from the cochlea to the tympanic segment of the facial canal (mean 1.76 mm), from the medial wall of the vestibule to the lateral aspect of the lateral semicircular canal (mean 8.03 mm), and from the external auditory canal to the lateral sinus (mean 13.2 mm). HRCT examination is the best method for defining the morphology of temporal bone.

A rare cause of hyperprolactinemia: persistent trigeminal artery with stalk-section effect.

Abstract The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries are fetal anastomoses between the carotid and vertebrobasilar systems. Persistent trigeminal artery (PTA) is the most frequent embryonic communication between the vertebrobasilar and carotid systems in adults. We report a case of PTA compressing the left side of the pituitary gland and stalk, in a patient with elevated blood prolactin level.

Is any landmark reliable in vertebral enumeration? A study of 3.0-Tesla lumbar MRI comparing skeletal, neural, and vascular markers

PURPOSE This study aimed to determine the reliability of the iliolumbar ligament (ILL), 12th costa, aortic bifurcation (AB), right renal artery (RRA), and conus medullaris (CM) for numbering of vertebral segments. SUBJECTS AND METHODS Five hundred five patients underwent routine lumbar MRI examinations including a cervicothoracic sagittal scout and T1 and T2-weighted sagittal and axial turbo spin echo images. Images were evaluated by two radiologists separately. RESULTS The identifiability of ILL and 12th costa were 85.7% and 48.1%. AB, RRA, and CM were located more caudally in lumbarized S1 and more cranially in sacralized L5 cases. CONCLUSION Landmarks suggested by previous studies are not reliable alternatives to cervicothoracic scout images due to wide ranges of distribution and inconsistencies in identification.

Cervical neural foraminal widening caused by the tortuous vertebral artery

A case of cervical neural foraminal widening due to tortuous vertebral artery is presented. This entity is rarely seen. Plain radiography, CT, 3-D CT angiography, MRI, and MRA findings of the case are presented and the importance of this vascular anomaly in the differential diagnosis of neural foraminal widening is discussed.