Peter T. Kennedy

The Use of Direct Thrombin Injection to Treat a Type II Endoleak Following Endovascular Repair of Abdominal Aortic Aneurysm

This report describes the use of thrombin to treat a type II endoleak which was causing continued abdominal aortic aneurysm expansion in a patient who had undergone endovascular repair. A small quantity of thrombin was injected into the leak by a percutaneous approach directly into the aneurysm sac using color doppler ultrasound. The procedure was successful and required only a few minutes to perform. We believe this procedure is an alternative to some of the more complex and technically challenging means of treating this lesion.

Successful exclusion of a high internal carotid pseudoaneurysm using the Wallgraft endoprosthesis.

AbstractA 43-year-old woman presented with a several-month history of transient ischemic attacks 7 years following surgery for a malignant carotid body tumor. Angiography revealed a pseudoaneurysm at the distal vein graft anastomosis and a stenosis related to the proximal anastomosis. Due to the extensive previous surgery an endovascular approach was advocated and the pseudoaneurysm was successfully excluded using a covered stent (Wallgraft). This is, to our knowledge, the first time such an approach has been used following carotid body tumor excision.

Anchoring a migrating inferior vena cava stent with use of a T-fastener.

An attempt to treat symptomatic stenosis of the inferior vena cava in a patient with metastatic liver disease was complicated by migration of a Wallstent into the right atrium. Effective palliation was achieved by insertion of a second stent, which was anchored by transhepatic insertion of a T-fastener into the intracaval stent. This anchoring maneuver was performed safely under sonographic and fluoroscopic guidance.

ADJUVANT UROKINASE THERAPY IN PERCUTANEOUS DRAINAGE OF A MULTILOCULATED SPLENIC ABSCESS

Ian M. G. Kelly, MRCPI, FRCR SPLENIC abscess is an uncommon monthly Gold injections (intramusChristopher S. Boyd, BSc, condition that is usually associated cular sodium aurothiomalate) and FRCS with sepsis and immunosuppreshad intraarticular corticosteroid Peter T. Kennedy, FRCSI, sion, and may be drained safely and knee injections as recently as a FRCR effectively by percutaneous methods week before this presentation. She (1,2). However, the use of adjuncalso had an endometrial polyp (adetive intracavitary fibrinolysis in nofibroma) removed 6 weeks before

Treatment of a Persistent False Lumen with Aneurysm Formation Following Surgical Repair of Type A Dissection

We describe the case of a 68-year-old man who developed aneurysmal dilatation of the proximal descending thoracic aorta 8 years after repair of a type A dissection. The aneurysm was due to an anastomotic leak at the distal end of the previous repair in the ascending aorta with antegrade perfusion of the false lumen. Surgical repair of the anastomotic leak partially obliterated the false lumen and computed tomography scan demonstrated thrombosis in a large proportion of the false lumen aneurysm. Follow-up with surveillance scans showed persistent filling of this aneurysm due to retrograde flow of blood within the false lumen. Coil embolization of the false lumen within the thoracic aorta was performed which successfully thrombosed the aneurysm with a reduction in diameter. Late aneurysm formation may complicate type A dissection repairs during follow-up due to a persistent false lumen, especially if there is an anastomotic leak. This case report describes a strategy to deal with this difficult clinical problem.

Transosseous Access for Decompression of an Obstructed Pelvic Kidney

Abstract We report a case of an obstructed pelvic kidney which was decompressed using a transosseous access route. The patient presented with obstructive uropathy and fever, necessitating decompression. Initial access was gained to the kidney by traversing the ilium, allowing subsequent retrograde placement of a double-J ureteric catheter.

Re: Double Coaxial Microcatheter Technique for Transarterial Aneurysm Sac Embolization of Type II Endoleaks after Endovascular Abdominal Aortic Repair

http://dx.doi.org/10.1016/j.jvir.2014.07.028 None of the authors have identified a conflict of interest. who sustained a more permanent complication from a similar technique. An 85-year-old woman who underwent endovascular aortic aneurysm repair 3 years earlier was found to have an aneurysm sac increasing in size secondary to a type II endoleak from a lumbar vessel. She was admitted for elective embolization via a left iliolumbar approach. The left internal iliac artery and the left iliolumbar artery were selectively catheterized, and a definite endoleak was identified. A microcatheter was advanced to a suitable position within the endoleak to maximize the chance of achieving embolization of inflow and outflow vessels. A 2:1 ratio of ethiodized oil (Lipiodol; Guerbet, Aulnaysous-Bois, France) to N-butyl cyanoacrylate glue was injected in a standard fashion. At the time of injection, the glue also opacified L4 lumbar arteries on the right via a common origin and other associated collaterals (Fig a). Shortly after injection, the patient complained of severe localized right-sided lumbar pain. Both femoral pulses were present, the feet were well perfused, and the patient was hemodynamically stable. Intravenous fentanyl was administered for pain relief. Lumbar and right-sided leg pain still persisting 6 hours later led to computed