Makiyo Hagihara

Emergent coil embolization for ruptured renal artery aneurysm

We report a case of ruptured renal artery aneurysm successfully treated by emergent transcatheter embolization with microcoils. A 66-year-old woman was referred for emergency treatment after presenting with sudden-onset left flank pain and vomiting. Blood examination showed anemia. Computed tomography demonstrated a partly calcified mass with massive retroperitoneal hematoma. With the diagnosis of a ruptured left renal artery aneurysm, emergency angiography was performed. Left renal arteriography demonstrated a saccular aneurysm at the lower aspect of the renal hilum. A total of five microcoils were placed at the arterial branch, including the orifice of the aneurysm. The first coil was partly lodged in a branch near the orifice of the aneurysm that was used as an “anchor” to prevent subsequent coils from migrating and effectively occluding the parent artery with a short segment. Two branches originating from the renal hilum were preserved. The postoperative course was favorable. Endovascular treatments, including coil embolization, appear to be effective, safe, and less invasive than surgery. This method should be considered as a treatment of choice for ruptured renal artery aneurysm.

A Case of Patent Ductus Arteriosus in an Elderly Patient Treated by Thoracic Endovascular Aortic Repair.

The patient described herein was a 75-year-old female. Echocardiography showed patent ductus arteriosus (PDA). Heart failure symptoms gradually appeared, and she was referred to our department for treatment. Contrast-enhanced computed tomography (CT) revealed a tubular structure communicating between the aortic arch and pulmonary artery trunk, suggesting adult PDA. Thoracic endovascular aortic repair (TEVAR) was performed to close PDA. Completion angiography confirmed the disappearance of PDA. Post-TEVAR CT revealed no endoleak. The patient was discharged from the hospital on the 11th day after surgery. TEVAR is more useful and less invasive for adult PDA than conventional open surgery.