Ismail Oran

Retrieval of intravascular foreign bodies with goose neck snare

PURPOSE to evaluate the efficacy and advantages of the snare systems in the retrieval of foreign bodies from vascular system. MATERIALS AND METHODS the snare technique has been used for intravascular foreign body retrieval. We performed percutaneous extraction of intravascular foreign bodies using combination multipurpose catheters and a nitinol snare loop. In this report, we evaluated the patients who had performed endovascular device reposition or foreign body retrieval from 1998 to 2001. RESULTS foreign body retrieval was performed in 15 patients. The foreign bodies consisted of seven fractured port catheters, one sheath fragment, one embolization coil, four wire fragments, one pace-maker transducer and one dislocated endovascular stent. In no case were surgical procedures required, and no complications were encountered. CONCLUSION the snare technique is a useful and a safe method as an alternative procedure to surgery. This technique is highly effective with low rate complications.

Embolization of visceral pseudoaneurysms with platinum coils and N-butyl cyanoacrylate.

AbstractBackground: We evaluated the efficacy of transcatheter embolization in visceral artery pseudoaneurysms with platinum coils and N-butyl-cyano-acrylate (NBCA). Methods: Over the past 7 years, 20 patients were treated by transcatheter embolization in the same sitting with diagnostic angiography. Four right hepatic, one cystic, two gastroduodenal, one cavernosal artery, three superior mesenteric artery branch, and 11 renal artery branch pseudoaneurysms were included in the study. Results: Surgery was completely avoided in 19 patients. In the remaining patient with a superior mesenteric artery branch pseudoaneurysm, endovascular embolization was unsuccessful. Eighteen pseudoaneurysms were thrombosed with coil embolization alone. The remaining three pseudoaneurysms needed NBCA embolization. Two patients died from sepsis within 5 weeks after embolization. Conclusion: Emergent diagnosis and treatment are essential in visceral artery pseudoaneurysms because of the high rate of death. Transcatheter embolization with platinum coils is an efficient, safe treatment of choice. NBCA may be used to avoid proximal embolization of the visceral arteries that could not be catheterized selectively because of tortuosity, vessel size, or anatomic location.

Vascular complications after liver transplantation: evaluation with Doppler US

PurposeTo demonstrate the spectral and color Doppler ultrasonography (US) findings that would indicate vascular complications after liver transplantation and to report our single center results of vascular complications detected in liver transplant recipients.Materials and methodsOur study was consisted of 326 patients who underwent liver transplantation procedures between November 1997 and May 2004. The records of all patients were reviewed retrospectively for the details of each patient’s post-transplant Doppler US examinations, visceral angiographic examinations, and/or surgical procedures. Doppler US findings were correlated with angiographic results or surgery. Sensitivity and specificity of Doppler US parameters for the diagnosis of vascular complications of the hepatic artery, portal vein, and hepatic veins were calculated.ResultsVascular complications occurred in 47 patients (14%). Eight instances of vascular complications were detected intraoperatively by Doppler US at the time of transplantation. For hepatic artery complications, use of a Doppler US criteria resulted in a sensitivity and a specificity of 92% and 97%, respectively. Doppler US parameters also resulted in a sensitivity and a specificity of 100% in detecting portal vein complications, and resulted in a sensitivity of 99% and a specificity of 100% in detecting hepatic vein complications.ConclusionAlthough it is clear that Doppler US evaluation is an effective choice for diagnosing vascular complications after liver transplantation, we also observed that Doppler US examination plays an important role in detecting vascular complications intraoperatively and improving the patient’s chance for a successful outcome.

Multiple intracranial aneurysms in polyarteritis nodosa: MRI and angiography

Abstract In polyarteritis nodosa involvement of the central nervous system is infrequent; small cerebral infarcts are the most common neuroradiological finding. We report a 10-year-old boy with polyarteritis nodosa and intracranial haemorrhage. MRI showed an intracerebral haemorrhage. Angiography revealed two peripheral aneurysms in the posterior cerebral circulation, previously reported on only two occasions, and multiple microaneurysms in the hepatic, renal, mesenteric and even the lumbar arteries.

Endovascular treatment of cranial aneurysms with the pipeline flow-diverting stent: preliminary mid-term results.

PURPOSE We aimed to present our initial experience with a new self-expanding flow diverter device designed for wide-neck aneurysm treatment, assess its safety for intracranial deployment and efficacy of occlusion at mid-term follow-up. MATERIALS AND METHODS Forty-five consecutive patients with difficult aneurysmal anatomy underwent an endovascular treatment. Fifty-five intracranial aneurysms were clipped using the Pipeline flow-diverting stent (ev3 Inc., Plymouth, Minnesota, USA) between November 2009 and December 2011. Data including antiplatelet therapy, technical issues, complications, and imaging findings were recorded during the follow-up period. RESULTS Twenty-seven aneurysms were asymptomatic, 13 were symptomatic due to mass effect, seven were recurrent, six had subarachnoid hemorrhage, and two subjects presented with ischemia. There were 45 saccular, six fusiform-dissecting, and four blister aneurysms. The six-month control angiography was available in 34 subjects with an 85.3% (29/34 patients) complete occlusion rate. The overall occlusion rate according to the last angiography was 91.9% (34/37 patients). The following three major technical complications without clinical consequences were encountered: one distal wire fracture of the stent delivery system and two insufficient stent expansion. There was one fatal nonaneurysmal cerebellar hemorrhage. The overall mortality rate was 2.2% with no permanent morbidity. CONCLUSION The Pipeline flow-diverting stent represents an important advancement in endovascular therapy for cerebral aneurysms. Standard endovascular techniques are typically not suitable for these types of aneurysms. The device targets primary parent vessel reconstruction rather than endosaccular occlusion to achieve exclusion of the aneurysm and maintain a relatively high occlusion rate at six months.

Aortic origin of right hepatic artery and superior mesenteric origin of splenic artery: two rare variations demonstrated angiographically.

Abstract Anatomical variations of the celiac trunk and superior mesenteric artery are not infrequent. Knowledge of the existing aberrations is important in planning and conducting surgical or radiological procedures. A case of right hepatic artery arising independently from the aorta supplying an hepatocellular carcinoma was identified, through which transarterial chemoembolization was successfully performed. A second case is presented with a common splenomesenteric trunk branching into the splenic and superior mesenteric arteries. These two cases represent exceptional arterial variations in the upper abdomen.

Fracture of a Renal Artery Stent Due to Mobile Kidney

Kidney Renal artery stenoses (RAS) are clinically significant lesions because of their potential to compromise renal function and lead to or exacerbate hypertension [1]. There are many reports about percutaneous and surgical treatment of RAS. Although, recently, percutaneous treatment is preferred to surgery because of lower morbidity and mortality rates, it also has its own complications. We report a case of a renal stent fracture caused by a mobile kidney in a 55-year-old woman who had undergone bilateral renal arterial stenting due to hypertension.

Use of Histoacryl and a Covered Nitinol Stent to Treat a Bronchobiliary Fistula

JVIR 2000; 11:1337–1340 BRONCHOBILIARY fistula is an uncommon condition usually seen in endemic regions as a complication of hydatid or amebic disease of the liver (1,2). In western society, trauma, previous surgery, and biliary obstruction are the most frequent causative factors (3,4). Although large series in the literature emphasize the surgical management of the disease, the operative procedures have high mortality and morbidity. Endoscopic or transhepatic biliary drainage has been used successfully to avoid surgical re-exploration in such cases (2,4,5–7). We present a case of bronchobiliary fistula in a patient with previous hepatic resection for hydatid disease and the new onset of common hepatic duct obstruction. The fistula is sealed by Histoacryl (B. Braun, Melsungen, Germany) embolization of leakage in conjunction with covered self-expanding stent implantation.

Sinistral portal hypertension; imaging findings and endovascular therapy

Sinistral portal hypertension, a rare and localized form of portal hypertension, is the result of splenic vein thrombosis or obstruction and may cause gastrointestinal hemorrhages from the esophageal and gastric varices. This report presents two cases (69- and 10-year-old females) of bleeding gastric varices. The patients were diagnosed as having sinistral portal hypertension. Splenic artery embolization was performed in both patients to overcome intractable bleeding, and the clinical outcome was good.

Nitric oxide and oxidative stress in atherosclerotic renovascular hypertension: effect of endovascular treatment.

PURPOSE Because activation of the renin-angiotensin system leads to an increase in oxidative stress, the authors investigated nitric oxide (NO; nitrite + nitrate), superoxide dismutase (SOD), catalase, and malondialdehyde (MDA) levels and the effect of endovascular treatment on these parameters in patients with atherosclerotic renovascular hypertension. The relationship of NO with blood pressure and renal functional indexes was also investigated. MATERIALS AND METHODS In this prospective cohort study, serum creatinine, NO, SOD, catalase, plasma MDA, urinary microalbumin, and NO levels, and blood pressure were determined in 21 patients with hypertension and unilateral renal artery stenosis caused by atherosclerosis at entry and after 24 hours, 2 weeks, and 6 weeks of endovascular treatment. RESULTS MDA concentrations decreased 24 hours after intervention and remained low 2 and 6 weeks later. In addition, serum SOD and NO and urine NO levels were increased significantly 24 hours after endovascular treatment and decreased after 2 and 6 weeks. However, serum catalase levels did not differ after the intervention. Blood pressures decreased after treatment. There were no significant differences in urinary microalbumin levels, estimated glomerular filtration rates, and creatinine levels after endovascular treatment. CONCLUSIONS Endovascular treatment decreases oxidative stress and may offer new benefits in the treatment of patients with hypertension associated with renal artery stenosis. The decrease in oxidative stress and/or the upregulation of SOD may increase the bioavailability of NO, which in turn may lead to the rapid hypotensive response.