Michał Sojka

Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure.

Background Formation or pre-existence of collateral gonadal veins in varicocele patients has been reported as the main cause of surgical treatment failure. Purpose To describe venographic findings in patients with postsurgical recurrent varicoceles and to assess the efficacy of the following minimally invasive endovascular treatment. Material and Methods Thirty-three men with failed surgical treatment of left-sided varicocele were examined between 2006 and 2013, using retrograde venography to assess the anatomy of varicocele draining veins before the attempted transcatheter embolization. Anatomic variants of gonadal veins were categorized according to the classification modified for the purpose of the present study. 3% polidocanol was used as an embolic agent together with pushable fibered coils. Results In 31 (93%) out of 33 patients venography demonstrated incompetence of the gonadal vein or veins draining varicoceles after failed surgical treatment. The most frequent venographic finding was gonadal vein duplication – 66% of cases (39% in its mid-portion). Technical success of embolization was achieved in all 31 patients. No major complications were observed. Conclusion Retrograde varicocele embolization may be superior to surgery because of its ability to detect gonadal vein variants. In our study group, transcatheter embolization with 3% polidocanol and fibered coils allowed successful, minimally invasive treatment of postsurgical varicoceles.

Saccular Aneurysm of Superior Vena Cava Treated with Percutaneous, Transcatheter Thrombin Injection

We report the case of successful endovascular treatment of large saccular aneurysm of SVC in a patient with vascular malformation of right hand and chest. Considering the high risk of surgery, the patient was referred for percutaneous intervention. Venography showed communication between the aneurysm and SVC, just below brachiocephalic confluence. That is why the decision of balloon-protected transcatheter thrombin injection was made. Selective catheter was placed in the aneurysm and balloon occlusion catheter in SVC. Both catheters were withdrawn right after thrombin injection. During follow-up, aneurysm slightly enlarged in early observation and after a year shrinkage was observed.

Uterine artery embolisation for the treatment of symptomatic uterine fibroids

Introduction. Uterine fibroids are the most common benign uterine tumours which can be treated with conservative, surgery or minimally invasive methods. Selection of patients for embolisation seems to be essential. Aim. Assessment of efficacy and safety of uterine artery embolisation with hydrogel microparticles coated with an anti-inflammatory agent for reduction in symptomatic uterine fibroid volumes. Material and methods. In the prospective observational study carried out between January 2011 and December 2013, 206 patients with symptomatic fibroids were qualified for uterine artery embolisation. 118 aged 32 to 51 (average 39), who reported for follow-ups 3-4 months after procedures, were evaluated. According to the number of fibroids, patients with 2/4 fibroids predominated (78 patients), followed by those with single fibroids (25) and with myomatous uteri (14 patients). According to fibroid sizes, 4 groups were distinguished: < 7 cm in 77 patients, 7-12 cm in 19, > 12 cm in 8, and myomatous uteri in 14 patients Results. A mean decrease in fibroid volume in the entire study population was 62%, ranging from 9% in the patient with a hyalinised fibroid to 100% in patients with separated submucosal fibroids. Conclusions. UAE is a safe and effective treatment for symptomatic uterine fibroids. In addition to reducing the symptoms, significantly reduces their volume. The key to success is proper qualification, as well as cooperation between the radiologist and the gynecologist.

Endovascular Treatment of Renal Arteriovenous Fistula with N-Butyl Cyanoacrylate (NBCA)

Summary Background Renal arteriovenous malformation (RAVM) is a rare disease. The causes of pathological connections between renal arteries may be congenital or iatrogenic – mainly as a consequence of a biopsy or due to renal carcinomas and postinflammatory changes. Computed tomography, ultrasound Doppler and angiography are the main diagnostic tools used for the detection of RAVMs. Case Report The aim of this study is to present a case of endovascular treatment of RAVM with a mixture of NBCA and lipiodol. A 29-year-old woman was suffering from drug-resistant hypertension secondary to RAVM. The malformation was embolized using NBCA mixed with lipiodol. The postoperative course was uneventful. A follow-up angio-CT, performed 3 months and one year after the procedure, showed a complete occlusion of the RAVM. Conclusions NBCA can be used alone to embolize RAVMs. Procedures involving a combination of NBCA and lipiodol are difficult and should be performed by experienced specialists.

Percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract

Purpose In the present study, the effectiveness and safety of minimally invasive percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract were assessed. Material and methods Between 2000 and 2015, 12 patients (seven women and five men, mean age 78 ± 8 years) after open cholecystectomy with common bile duct exploration and T-tube drainage underwent percutaneous extraction of residual gallstones through the T-tube tract. Results The intervention was successful in 92% (11/12). In seven patients complete extraction of the retained gallstones was achieved, and in four cases partial extraction combined with passage of small residual fragments to the duodenum was obtained. In one case the extraction attempt was ineffective. Mild haemobilia was observed in two patients. No mortality or major complications were observed. Conclusions Our findings are consistent with literature data and confirm that percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract is an effective and safe treatment method. Although the presented technique is not a novel approach, it can be beneficial in patients unsuitable for open surgery or laparoscopic intervention when ERCP attempt occurs ineffective or there exist contraindications to ERCP.

Endovascular Embolization of Renal Cell Carcinoma in a Patient with Solitary Kidney

Summary Background Kidney tumors account for about 3% of tumors in adults. The primary therapy of renal cancer is the surgical removal. Traditionally, and also modern procedures are performed to remove the kidneys, especially when the tumor involves the entire kidney. In the cases of unresectable tumors embolization is used as a palliative procedure. Case Report The aim of this study is to present the case of endovascular treatment of renal cell carcinoma in patient with solitary kidney. 77-years old patient had an ultrasound examination because of the pain in left lumbar region. MRI confirmed the presence of tumor size 29×45 mm in the left kidney. The right kidney had been removed eight years earlier because of clear cell carcinoma. Histopathological diagnosis was renal clear cell carinoma. The patient did not consent to surgical treatment. Tumor embolization was proceeded as a minimally invasive procedure. Pathological tumor vessels were closed using particles filling the entire vascular tumor. Next, the blood vessels supplying the tumor were closed using a mixture of lipiodolu and glubranu. Control angiographiy of the left renal artery confirmed the effective closure of all vascular pathology. In a recent ultrasound examination which was done 15 months after surgery no evidence of vascular pathology was found. Conclusions Embolization of kidney cancer in particular cases may be an alternative way of treatment and give a good result in the form of stopping the growth of the tumor with simultaneous retaining the remaining parenchyma and renal function.

Is CT still a method of monitoring patients after endovascular treatment of abdominal aortic aneurysms

Introduction. The endovascular treatment of patient with abdominal aorta aneurysms has been a recognized alternative to classic surgery. One of the most common complications is an endoleak developing due to incomplete exclusion of the aneurysmal sac from circulation. Aim. To assess the value of ultrasound contrast agents for the diagnosis of endoleaks in patients with AAA treated by stent graft implantation. Material and methods. One hundred and ninety-eight patients with AAA were treated with stent graft implantation. Follow-up examinations, i.e. preand post-contrast ultrasound and angio-CT, were performed 6 months after treatment in all patients. In each ultrasound examination, colour, power, Bflow options were used before and after contrast injection; additionally, contrast-enhanced ultrasound (CEUS) was performed after contrast administration. Results. During the follow-up examinations after 6 months, pre-contrast ultrasound performed in all options (colour, power, Bflow) revealed 16 endoleaks: 6 type IA, 4 type IB, type 2 IIA and 4 type IIB; in post-contrast ultrasound using CEUS 22 endoleaks were confirmed and additionally 4 endoleaks were diagnosed: 2 type IIA, and 2 type IIB. In angio-CT, 22 endoleaks were diagnosed: 1 type IA, 5 type IB, 4 type IIA, and 7 type IIB. None of the four additional endoleaks observed with CEUS was found in angio-CT. Conclusions. The use of ultrasound contrast media significantly increases the sensitivity of ultrasound in the diagnosis of endoleaks, particularly type II ones. CEUS examinations show the greatest sensitivity in detecting endoleaks, as they disclose the endoleaks unrecognized by other techniques, including angio-CT. Post-contrast ultrasound can replace angio-CT in monitoring patients after stent graft implantations.