P. Shukla

Ethylene Vinyl Alcohol Copolymer (Onyx) Embolization for Acute Hemorrhage: A Systematic Review of Peripheral Applications

PURPOSE To evaluate the endovascular use of ethylene vinyl alcohol (EVOH) copolymer (Onyx; ev3 Endovascular, Inc, Plymouth, Minnesota) for the treatment of acute peripheral nonneurologic hemorrhage. MATERIALS AND METHODS MEDLINE and PubMed databases were searched for articles published in English from 1946 to August 2014 describing patients treated for hemorrhage with EVOH copolymer outside of its usual neurovascular applications. Additional cases were collected from the bibliographies of relevant articles. Full-text articles were obtained. Demographic data, clinical presentation, underlying etiology, culprit vessel, endovascular treatment, outcomes, and follow-up times were obtained. RESULTS The literature search yielded 19 relevant articles. Cases of 131 patients (87 men, 44 women; mean age, 61 y ± 19.2) describing the treatment of 151 lesions were reviewed. The most common categories of arterial lesions were gastrointestinal (n = 53) and bronchial (n = 40) in origin. In 14 cases, EVOH copolymer was employed after failure or rebleeding following the use of a different embolic agent. Average follow-up time was 12.0 months. EVOH copolymer was the sole embolic agent used in 105 patients. Rebleeding after treatment with EVOH copolymer occurred in 10 patients. There were 2 technical failures. One patient died of multiorgan failure in the setting of persistent hemoptysis. Complications included 2 nerve injuries and 2 minor strokes. CONCLUSIONS Embolization of acute hemorrhage in the peripheral vasculature was safe and effective with EVOH copolymer.

The MILLER banding procedure as a treatment alternative for dialysis access steal syndrome: a single institutional experience ☆,☆☆

OBJECTIVE To describe a single institutional experience with minimally invasive limited ligation endoluminal-assisted revision (MILLER) for treatment of dialysis access steal syndrome (DASS). MATERIALS AND METHODS Twenty patients were retrospectively identified that underwent 30 MILLER band procedures for DASS at our institution from March 2010 to December 2014. Technical success was defined by successful creation of MILLER band with preservation of flow for hemodialysis. Clinical success was defined as complete resolution of signs and symptoms with preservation of dialysis access in a 1-month postprocedural period. Primary MILLER band patency, postintervention-assisted primary access patency, and postprocedure secondary access patency are reported. RESULTS Technical success was achieved in all patients. Clinical success was achieved in 75% of patients after one banding procedure and in 95% of patients after two banding procedures. One patient experienced access thrombosis following the initial banding procedure which was subsequently treated and did not lead to loss of access. MILLER band patency was 83% at 1 month and 77% at 6 months. Postintervention-assisted primary patency was 95%, 93%, and 92% at 3 months, 6 months, and 1 year, respectively. Postintervention secondary patency was 86%, 68%, and 59% at 3 months, 6 months, and 1 year, respectively. CONCLUSIONS MILLER banding offers a less-invasive alternative to surgical therapy that appears to be safe and permits preservation of dialysis access.

No catheter angiography is needed in patients with an obscure acute gastrointestinal bleed and negative CTA

PURPOSE To evaluate the negative predictive power of computed tomography angiography (CTA) for the identification of obscure acute gastrointestinal (GI) bleeding (GI bleeding not visualized/treated by endoscopy) on subsequent mesenteric angiography (MA) with the intention to treat. MATERIALS AND METHODS A retrospective chart review of patients was performed who underwent mesenteric angiography for the evaluation/treatment of acute GI bleeding between November 2012 and July 2016. Patients with negative CTA examinations that proceeded to MA were identified. Negative predictive value (NPV) was calculated. RESULTS 20 patients (14 male, 6 female; average age: 73.1±12.8years) underwent 20 negative CTA examinations for the evaluation and treatment of GI bleeding followed by mesenteric angiography. Eighteen of 20 patients had negative subsequent MA (negative predictive value, NPV=90%). Both false negative cases were upper GI bleed (vs 0 lower GI bleed); this difference was significant (p<0.05). CONCLUSIONS The high NPV of CTA for the evaluation of GI bleeding suggests utility for excluding patients that are unlikely to benefit from MA and subsequent endovascular therapy. CTA may be considered for the first line diagnostic study for the evaluation of obscure GI bleeding.

Endovascular Treatment of a Dorsalis Pedis Artery Pseudoaneurysm.

Pseudoaneurysm of the dorsalis pedis artery (DPA) is an extremely rare entity that most commonly occurs secondary to trauma or surgery. All reported cases describe surgical treatment. We illustrate a case of enlarging DPA pseudoaneurysm causing pain and disability in a 49-year-old woman who was treated with transcatheter embolization and pseudoaneurysm aspiration resulting in near-immediate resolution of symptoms.

Percutaneous Embolization of an Intrahepatic Portal Vein Aneurysm

http://dx.doi.org/10.1016/j.jvir.2016.01.132 None of the authors have identified a conflict of interest. patient’s serum prostate-specific antigen level decreased to 5.42 ng/dL. Ischemic complications in the penis are rare and may result from trauma, inadvertent administration of vasoactive drugs, diabetes, vasculitis, circumcision, penile strangulation, foreign bodies, spider bite, or other uncommon conditions (1). In the present case, the penis ischemia was a consequence of nontarget embolization as a result of reflux of microspheres into the APA with distal migration and occlusion of small arteries in the penis. Accessory or aberrant pudendal arteries are present in 4%–75% of all men, and they may be solely responsible for arterial blood supply to the corpora cavernosa (2). This variation in the prevalence of accessory pudendal arteries is related to the modality used for their identification. These arteries have been found to provide the primary blood supply to the corpora cavernosa in 3.2% of patients (3). In the present case, coil embolization of the APA before delivery of the embolic material in the PA might have prevented distal migration of the spheres with nontarget embolization. However, the safety of this maneuver has not been demonstrated to our knowledge. In addition, some surgeons advocate that the preservation of this vessel during radical prostatectomy is mandatory to avoid erectile dysfunction caused by penile artery insufficiency (2). The present case highlights that even careful delivery of embolic materials in such small vessels may result in inadvertent reflux with nontarget embolization. Therefore, if flow-redistribution maneuvers cannot be achieved, interruption of the procedure should be considered. REFERENCES