G. Narayanan

Endovascular Coil Embolization in the Treatment of a Rare Case of Post-Traumatic Abdominal Aortic Pseudoaneurysms: Brief Report and Review of Literature

Traumatic aortic injury, a consequence of penetrating injuries or blunt trauma, is a life threatening condition which requires prompt diagnosis and management. Most abdominal aortic injuries have been repaired via an open surgical approach with endovascular stent graft as an alternative. Traumatic pseudoaneurysms (PSA) of the abdominal aorta are uncommon, and they are managed similar to other abdominal aortic injuries. However, the presence of a perianeurysmal hematoma and the potential risk of an associated concomitant bowel communication could make surgery and endovascular stent graft placement risky. In such patients, coil embolization could be a valued option. In this article, we present a case in which traumatic PSAs are repaired using coil embolization with technical and clinical success. Endovascular coil embolization could be an alternative approach for PSAs that cannot be treated by stent grafting or open surgical repair, in the appropriate anatomy and by using the right coil material and technique.

Amplatzer vascular plug as an embolic agent in different vascular pathologies: A pictorial essay

The Amplatzer Vascular Plug (AVP) is a cylindrical plug made of self-expanding nitinol wire mesh with precise delivery control, which can be used for a variety of vascular pathologies. An AVP is an ideal vascular occlusion device particularly in high-flow vessels, where there is high risk of migration and systemic embolization with traditional occlusion devices. We performed 28 embolizations using the AVP from 2009 to 2014 and achieved complete occlusion without complications.

Radiofrequency ablation in primary non-small cell lung cancer: What a radiologist needs to know.

Lung cancer continues to be one of the leading causes of death worldwide. In advanced cases of lung cancer, a multimodality approach is often applied, however with poor local control rates. In early non-small cell lung cancer (NSCLC), surgery is the standard of care. Only 15-30% of patients are eligible for surgical resection. Improvements in imaging and treatment delivery systems have provided new tools to better target these tumors. Stereotactic body radiation therapy (SBRT) has evolved as the next best option. The role of radiofrequency ablation (RFA) is also growing. Currently, it is a third-line option in stage 1 NSCLC, when SBRT cannot be performed. More recent studies have demonstrated usefulness in recurrent tumors and some authors have also suggested combination of RFA with other modalities in larger tumors. Following the National Lung Screening Trial (NLST), screening by low-dose computed tomography (CT) has demonstrated high rates of early-stage lung cancer detection in high-risk populations. Hence, even considering the current role of RFA as a third-line option, in view of increasing numbers of occurrences detected, the number of potential RFA candidates may see a steep uptrend. In view of all this, it is imperative that interventional radiologists be familiar with the techniques of lung ablation. The aim of this article is to discuss the procedural technique of RFA in the lung and review the current evidence regarding RFA for NSCLC.

Successful management of a case of refractory prostatic hematuria by prostate artery embolization via a brachial artery access

Therapy for prostatic hematuria includes functional, biochemical approaches and transurethral resection of the prostate (TURP). If these fail, a life-threatening situation called refractory prostatic hematuria (RPH) can result. Hemostatic packing of the prostatic bed and salvage cystectomy under general anesthesia maybe the only options left; however, most of these patients are not surgical candidates (1). Prostate artery embolization (PAE) is a novel, minimally invasive option for treating prostatic hematuria (2). We present an emergent case of RPH where femoral access for PAE was not available, therefore brachial access was performed. An 86-year-old male with prostate cancer presented with gross hematuria. In spite of blood transfusion, continuous bladder irrigation, and a channel TURP, he continued to bleed. Hemoglobin (Hb) was 6.9 mg/dL in spite of blood transfusions. An emergent arteriography was planned. The patient had a recent six-week history of bilateral femoral cut-down access for placement of an aortic endograft (Fig. 1). Hence, we used a brachial artery access using ultrasound guidance. Selective right and left PAE were performed via right common femoral artery access using Embosphere® Microspheres (Biosphere Medical, Rockland, MA, USA (Fig. 2). Procedure time was 120 minutes, fluoroscopy time was 68 minutes and total radiation dose 94649 μGyM2. Post-procedure ultrasound of the brachial artery demonstrated a small brachial hematoma that was treated conservatively using a compression dressing with no further complications. By the ninth post-procedure day, hematuria resolved, Hb stabilized at 7.2 without blood transfusions. The femoral artery has been the route of choice for endovascular interventions. However, in conditions such as severe infra-renal aortic disease and recent intervention, other vessels have to be used. There is a general reluctance to puncture the brachial artery due to the risk of spasm, brachial neuropathy, distal embolization, the need for long instruments and potential risk of stroke (3). In spite of this, brachial punctures are frequently described in coronary artery literature, with a technical success of 99.6%. Ultrasound may useful to visualize surrounding critical structures, as well as arterial anatomic variations (4). Brachial artery access for PAE has not been described. The technique of PAE has often been compared to uterine artery embolization (UAE) due to similar vascular anatomy and vascular approach. In a recent report, UAE performed via a brachial approach was shown to be safe and technically valid, with ease of selective catheterization and without the need of catheter exchanges. This also may be better accepted by patients due to early ambulation, avoidance of bladder catheterization, and also a lower radiation dose (5). Fig. 1 Coronal CT scan reveals the aortic endograft (red arrows).