Coil Migration Research Articles

Surgical and endovascular treatment of pelvic venous disorder: Results of a multicentre retrospective cohort study

ObjectiveIn the present study, we investigated the clinical outcomes after gonadal vein resection (GVR) and gonadal vein embolization (GVE) with coils in patients with pelvic venous disorder (PeVD). We also assessed the rates of procedural complications and disease recurrence. MethodsOur multicenter retrospective cohort study included 361 female patients with PeVD-related chronic pelvic pain (CPP) and gonadal vein reflux who underwent GVR (n = 184) or GVE with coils (n = 177) from 1999 to 2020. The clinical outcomes (ie, presence and severity of CPP, procedural complications, disease recurrence) were assessed at 1 month and 1, 3, and 5 years after intervention. The pain intensity before and after treatment was assessed using a visual analog scale. All the patients underwent duplex ultrasound after GVR and GVE, and those with persistent CPP and suspected perforation of the gonadal vein by the coils were also evaluated by multiplanar pelvic venography. ResultsGVR and GVE was associated with the reduction or elimination of CPP at 1 month after treatment in 100% and 74% of patients and postprocedural complications in 14% and 37% of patients, respectively (Р < 0.01 for both). The most common complication after either GVR or GVE was pelvic vein thrombosis (11% and 22% patients, respectively; P < .01 between groups). GVE was associated with postembolization syndrome in 20%, coil protrusion in 6%, and coil migration in 1% of patients. The long-term recurrence rate after GVR and GVE was 6% and 16%, respectively (P < .01). ConclusionsBoth GVR and GVE were found to be effective in treating patients with PeVD. However, GVR was associated with better efficacy in the relief of CPP and lower rates of procedural complications and disease recurrence.

OUTCOME EVALUATION OF FLOW DIVERTER STENT PLACEMENT IN TREATMENT OF RUPTURED AND UNRUPTURED CEREBRAL ANEURYSMS

Background: Cerebral aneurysms affect about 5% of the population and are associated with high mortality rates and severe complications for families and society. Complex aneurysm types include giant aneurysms, wide - necked aneurysms, blister - like aneurysms, recurrent aneurysms, fusiform aneurysms, and multiple aneurysms, which are difficult to manage with conventional endovascular or surgical methods due to complications such as coil migration and high rates of re - rupture. The development of flow diverter stents has been a breakthrough in recent decades and has been demonstrated to be safe and effective in treating aneurysms. The aim of this study was to evaluate the outcomes of flow diverter stent placement in the treatment of ruptured and unruptured cerebral aneurysms. Methods: This was a descriptive prospective study that followed up on 23 patients diagnosed and treated for cerebral aneurysms with flow - diverter stent intervention at the Stroke Department of Hue Central Hospital from 6/2020 to 6/2022. The follow - up data after 6 months and 12 months were recorded. Results: There were 23 patients (9 males, 14 females) with 28 cerebral aneurysms, with a mean age of 51.7 ± 9.9 years. Aneurysms were predominantly located in the anterior circulation (85.7%) and 14.3% in the posterior circulation. The most common aneurysm type was fusiform (75%), followed by dissecting (17.9%) and blister - like (7.1%). Most aneurysms had wide necks, with a neck - to - dome ratio &lt; 1.5, accounting for 82.1%. Flow diverter stent placement was successfully performed in 91.3% of patients, with 27 stents used. Stents were properly positioned, well - expanded in 88.9%. The complication rate after intervention was 4.3%. Complete aneurysm occlusion rates at 6 to 12 months were 92.9% and 96.4%, respectively. The rate of mild in - stent stenosis without clinical symptoms was 4.3%. The good outcome rate (mRS 0 - 2) was 91.3%. Conclusion: Flow diverter stent is effective and safe with high rate of successful and low procedural complications in the treatment of complex cerebral aneurysms.

Comparison of Fibered versus Nonfibered Coils for Venous Embolization in an Ovine Model

PurposeTo compare nylon fibered (F) with nonfibered (NF) coils for embolization in an ovine venous model. Materials and MethodsFour- to 8-mm-diameter, 0.035-inch F and NF coils were deployed in 24 veins in 6 sheep. The number of coils, total length of the coils, and length of implanted coil pack required to achieve complete stasis were recorded, as were vessel diameter, radiation dose, ease of packing, damage to embolized vessel, and time to stasis. Venography at 1 and 3 months was used to assess the migration and durability of vessel occlusion. Veins were harvested at 3 months. ResultsF and NF coils were deployed in 24 veins, and stasis was achieved, without immediate coil migration or vessel damage. The mean numbers of F and NF coils per vein were 5 and 8.75, respectively (P = .007). The vessel diameter between the groups was not statistically different. The total coil length (F, 70 cm vs NF, 122.5 cm; P = .0007), coil pack length (F, 29.3 mm vs NF, 39.4 mm; P = .003), time to stasis (F, 5.3 minutes vs NF, 9.0 minutes; P = .008), and radiation dose (F, 25.3 mGy vs NF, 34.9 mGy; P = .037) were significantly different between the groups. Challenges with the animal model prevented conclusive long-term results. Migration occurred with 8 of 11 (72%) coil packs in the femoral veins and 0 of 13 (0%) coil packs in the internal iliac and deep femoral veins. Venography demonstrated that of 16 remaining coil packs, 11 were occluded at 1 month and 10 remained occluded at 3 months. ConclusionsFibers allow for significantly fewer coils to achieve immediate venous occlusion.

Coil Embolization of True, Common and Proper, Hepatic Artery Aneurysms: Technique, Safety and Outcome.

To retrospectively assess the safety and efficacy of coil embolization for catheter-directed true common and proper hepatic artery aneurysm exclusion. Nine consecutive patients (2005-2021) in two university centers presenting with true common and proper hepatic artery aneurysms (> 2cm in diameter) were treated with 'frontdoor-backdoor' coil embolization. Patients presenting with a hepatic artery pseudoaneurysm, mycotic aneurysm or patients with small (< 2cm diameter) aneurysms and followed up by imaging were excluded. Technical and clinical success was defined as complete coil-exclusion of the aneurysm on completion angiography and absence of post-embolization adverse events, in particular mass effect or hemorrhage, respectively. Patient characteristics, technical and clinical success, liver function tests and follow-up results were assessed based on the patients' electronic medical records. Technical and 30-day clinical success was achieved in all procedures (100%). No major procedural complications were reported. Liver function test values were available in 6/9 patients, showing transient elevation of bilirubin in one patient. No end organ ischemia was reported. The mean clinical follow-up period of the study patients was 72months (12-168months). Long-term stable occlusion of the hepatic aneurysms was achieved in 9/9 patients (100%). One patient showed late complication (3years) with coil migration into a bulbar ulcer, without aneurysm recanalization, however with fatal outcome. Coil embolization for the endovascular exclusion of true common and proper hepatic artery aneurysms is safe and effective.

Abstract No. 26 Two Year Cumulative Patency Following Creation of Endovascular Arteriovenous Hemodialysis Fistulas with the WavelinQ Device

To assess two-year cumulative patency of endovascular arteriovenous fistulas (endoAVF) created with the WavelinQ device. Patients who had fistulas created at a single center from December 2019 to December 2020 were included in this retrospective study. Data points collected included patient demographics, location of fistula creation, interventions performed and brachial artery flows pre and post creation. Two-year cumulative patency was assessed with Kaplan Meir method and variables that affected patency were examined using the Cox proportional hazards model. Forty-three patients underwent endoAVF creation. (22 females, 21 males). Technical success was 95% (41/43) and in 2 patients the fistula did not mature for dialysis use. For the remaining 39 patients where the endoAVF matured, two-year cumulative patency was 94.8% (SE 3.6%). Mean follow up was 665.7 days with no patients lost to follow-up. There were 15 censored events with two patients undergoing renal transplantation and 13 patients passing away. No examined variables including location of the fistula, brachial flow pre/post creation, and patient demographics significantly impacted patency. Number of interventions per patient year was 0.38 where 8 were maturation procedures (5 surgical vein elevations/transpositions and 3 coil embolizations) and 21 angioplasties for maintenance of fistula patency. 25 were ulnar/ulnar fistulas and 10 were radial/radial fistulas with remaining cases created between the interosseous artery and ulnar or interosseous vein. Mean brachial artery flow pre and post creation was 69 mL/min and 1008 mL/min respectively. One major complication occurred with coil migration to the heart with successful retrieval at the time of the procedure. A high two-year patency following endoAVF creation with the WavelinQ device was observed in this single-center experience.

Preoperative liver arterial conditioning in patients scheduled for a Mayo Clinic class Ia distal pancreatectomy: embolization or ligation?

BackgroundLiver ischemia may occur during intraoperative common hepatic artery ligation in Mayo Clinic class I distal pancreatectomy with en bloc celiac axis resection (DP-CAR). Preoperative liver arterial conditioning could be used to avoid this outcome. This retrospective study compared arterial embolization (AE) or laparoscopic ligation (LL) of the common hepatic artery before class Ia DP-CAR. MethodsFrom 2014 to 2022, 18 patients were scheduled for class Ia DP-CAR after neoadjuvant FOLFIRINOX treatment. Two were excluded due to hepatic artery variation, six underwent AE, ten underwent LL. ResultsTwo procedural complications occurred in the AE group: an incomplete dissection of the proper hepatic artery and a distal migration of coils in the right branch of the hepatic artery. Neither complication prevented surgery. The median delay between conditioning and DP-CAR was 19 days; decreased to five days in the last six patients. None required arterial reconstruction. Morbidity and 90-day mortality rates were 26.7% and 12.5%, respectively. No patient developed postoperative liver insufficiency after LL. ConclusionPreoperative AE and LL seem comparable in averting arterial reconstruction and postoperative liver insufficiency in patients scheduled for class Ia DP-CAR. However, serious complications that may arise during AE led us to prefer the LL technique.

Retrograde Intrarenal Surgery for Nephrolithiasis with Partially Migrated Renal Artery Embolisation Coil: A Case Report

Transcatheter renal artery embolisation is an effective and minimally invasive treatment option for acute renal bleeding. However, it is associated with a variety of complications, which can be classified as early or late according to the time of presentation. Coil migration leading to renal calculi formation is a late complication of transcatheter or percutaneous renal arterial embolisation. A 47- year-old diabetic male patient presented with a recurrent right renal staghorn calculus. Four years ago, the patient underwent a right Percutaneous Nephrolithotomy (PCNL). Following the procedure, he had to undergo a renal arterial embolisation for postoperative haemorrhage. The patient this time did not consent for repeat PCNL, therefore a staged right Retrograde Intrarenal Surgery (RIRS) was performed. Complete clearance of stone and extraction of the migrated coil was achieved in a three-staged procedure. Embolisation coils in the proximity of the pelvi-calyceal system, can migrate into the system, and form a nidus for stone formation. These stones and the migrated coil can be managed effectively and safely with RIRS.

Endovascular treatment of «mirror» aneurysms of the middle cerebral artery

Objective ‒ to analyze the results of endovascular treatment of the «mirror» MCA aneurysms.Materials and methods. A retrospective analysis of the 172 patients with multiple cerebral aneurysms, who were treated between the period from April 2016 to February 2022 at Scientific and Practical Center of Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine was conducted. «Mirror» MCA aneurysms were found in 20 (11.6 %) patients. Twenty patients had 54 aneurysms (8 patients had 12 aneurysms except MCA and 2 patients had 2 MCA aneurysms at one side). In one patient, a combination of «mirror» aneurysms of MCA and internal carotid artery was found. The group included 8 (40 %) men and 12 (60 %) women. The average age of the patients was (47.11 ± 11.73) years; range 23‒64 years. 8 (40 %) patients had subarachnoid hemorrhage due to MCA aneurysm rupture, in another 3 (15 %) patients another aneurysm was the cause of rupture, and 9 (45 %) of patients underwent surgery for unruptured aneurysms. The choice of treatment strategy and its staging, peri-procedural (bleeding, migration of coils, thrombus formation) and postoperative complications and the result of the treatment at the time of discharge and 3–6 months after the final treatment were analyzed. Qualitative assessment of aneurysm occlusion was performed intraoperatively and during follow-up angiographic examinations according to the modified Raymond‒Roy scale.Results. Of all 54 aneurysms in 20 patients, 49 aneurysms (40 MCA aneurysms and 9 aneurysms in other localization) were excluded endovascularly, 1 MCA aneurysm was clipped, and 4 aneurysms due to their small size were left for observation with regular follow-up examinations due to the low risk of rupture. Bilateral one-session endovascular occlusion of the «mirror» MCA aneurysms was performed in 11 patients, and staged procedure was performed in 9. Among 40 surgically treated «mirror» MCA aneurysms, 24 (60 %) were excluded with only coiling, 7 (17.5 %) with stent assistance coiling, 7 (17.5 %) with balloon assistance coiling, 1 aneurysm (2.5 %) was treated with parent artery occlusion, and 1 aneurysm (2.5 %) was clipped. Intraoperative complications occurred in 2 patients. One patient had an intraoperative rupture of an ICA aneurysm combined with «mirror» MCA aneurysms, which could not be stopped and ICA sacrifice was performed. In another, the coils migrated into the artery. In the first patient, the course of the disease was complicated with brain infarction in the left ICA region. Another patient was prescribed antiplatelet therapy in postoperative period, which was uneventful. Follow-up angiography studies were available in 16 patients. At the follow-up examination, significant recanalization of one of the MCA aneurysm was detected in two patients, who were successfully occluded during the second procedure without negative clinical outcome. In 15 patients at the control examination, the evaluation of the result according to the mRS was 1 – 2 points, and in 1 patient ‒ 3 points.Conclusions. Our series demonstrates that the outcomes of endovascular treatment of the «mirror» MCA aneurysms have comparable risks of periprocedural and post-procedural complications, with the general population of patients with both ruptured and unruptured MCA aneurysms. Best treatment strategy must be individualized with careful planning, considering which aneurysm should be excluded first, the possible sequence of treatment, depending on the clinical presentation, type of intervention, age, patient preference and available options. It is also necessary to assess the traumatic nature of treatment methods. In our opinion, endovascular interventions have obvious advantages over bilateral craniotomies or extended combined unilateral approaches, which in turn has the potential to improve the results of treatment, both in the short and long term, and to reduce its duration and cost.

Coil and n-butyl-2-cyanoacrylate migration into the stomach after TIPS for gastroesophageal variceal bleeding: a case report and literature review.

Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established therapeutic option for the management of variceal hemorrhage in patients with cirrhosis. The simultaneous migration of the coil and n-butyl-2-cyanoacrylate (NBCA) is an extremely rare but significant complication after TIPS. Because of its rare presentation, there are currently no definitive recommendations for the management of this condition. A 46-year-old man with hepatitis B cirrhosis underwent TIPS placement for uncontrolled gastroesophageal varix (GEV) bleeding secondary to portal hypertension in August 2018. During the procedure, large GEVs were embolized using a coil and NBCA. After a year, coil and NBCA migration into the stomach was observed. Attempts to remove the coil using biopsy forceps during esophagogastroduodenoscopy failed. The patient refused further intervention on the coil to prevent further complications and received conservative therapy instead. Close surveillance with endoscopy is recommended for detecting coils and varices. The present case reports an extremely rare but significant complication after TIPS, which highlights the management and follow-up recommendation for such rare complications. Our experience may provide guidance for the management of future similar cases and stimulate discussion about treatment methods of similar patients.

Neuroform atlas stent-assisted coiling of tiny wide-necked intracranial aneurysms.

To investigate the safety and efficacy of Neuroform Atlas stent-assisted coiling for the treatment of tiny wide-necked intracranial aneurysms and evaluate risk factors associated with procedure-related complications. We retrospectively examined 46 patients with 46 tiny wide-necked aneurysms who were treated using Atlas stent-assisted coiling at our institution from August 2020 to May 2022. Patient and aneurysm characteristics, procedural details, procedure-related complications, and angiographic and clinical outcomes were analyzed. A total of 10 patients presented with aneurysmal rupture. Atlas stent placement was successful in all patients. Angiography immediately after the procedure showed complete occlusion in 38 patients (82.6%), neck remnant in 7 (15.2%), and partial occlusion in 1 (2.2%). The mean angiographic follow-up was 8.4 months (range, 6-16). At the last follow-up, angiography showed complete occlusion in 41 patients (89.1%) and neck remnant in 5 (10.9%). No aneurysm recurrence or in-stent stenosis occurred. Incidence of procedure-related complications was 10.8% (intraprocedural aneurysm rupture, two cases; acute thrombosis, two cases; and coil migration, one case); only one patient (2.2%) experienced procedural neurological morbidity. The mean clinical follow-up was 9.7 months. A favorable outcome was achieved in 45 patients (97.8%). In univariate logistic regression analysis, aneurysm size (odds ratio, 4.538; P = 0.045) was significantly associated with procedure-related complications. However, multivariate analysis found no independent risk factors. Atlas stent-assisted coiling of tiny wide-necked intracranial aneurysms is feasible and effective. Outcomes and occlusion rates are favorable and morbidity is low. The complication rate may be higher in larger tiny aneurysms.

Anterior superior pancreaticoduodenal artery pseudoaneurysm after distal pancreatectomy with en bloc celiac axis resection successfully treated with balloon-assisted coil embolization

Bleeding is a fatal complication after pancreatectomy. Although coil embolization is a widely accepted treatment option, ischemia of the remaining organs should be prevented. This study reports the successful treatment of intra-abdominal hemorrhage following distal pancreatectomy with en bloc celiac axis resection (DP-CAR) using balloon-assisted coil embolization (BACE). A 59-year-old man was diagnosed with locally advanced pancreatic cancer. The tumor involves the common hepatic artery, splenic artery, and celiac artery. After four cycles of treatment with gemcitabine/nab-paclitaxel, the soft-density masses, surrounding the artery, shrunk. DP-CAR and R0 resections were performed. A minor postoperative pancreatic fistula occurred. Six months postoperatively, the computed tomography showed delayed asymptomatic bleeding from an anterior superior pancreaticoduodenal artery (ASPDA) pseudoaneurysm located near the gastroduodenal artery confluence. BACE was performed by placing a microballoon catheter in the region of confluence of the ASPDA and posterior superior pancreaticoduodenal artery (PSPDA) to prevent coil migration. After inserting the microballoon catheter, coil embolization was performed in the ASPDA. Hepatic blood flow was maintained from the PSPDA. BACE is a useful technique to preserve blood flow to the remnant organs when performing coil embolization for bleeding following a distal pancreatectomy, especially following a DP-CAR.

S1702 Coil-Angitis: A Rare Case of Coil Migration into the Biliary Tree

Introduction: Embolization coils are commonly used to manage hemorrhage after liver injury; however, migration into the biliary tree is uncommon. When this occurs, symptoms of biliary obstruction might develop such as jaundice, cholangitis, stone formation and pancreatitis. Physicians may not be aware of this potential risk, resulting in a delay in diagnosis and an increased morbidity and mortality risk. Herein, we present the case of a patient with history of liver laceration requiring bile duct embolization, and concurrent bile leak, presenting >3 years later with ascending cholangitis. Case Description/Methods: A 27-year-old male with remote history of motor vehicle accident complicated by a liver laceration presented to the ED with one-week onset of right upper quadrant (RUQ) pain, vomiting, and fever. Evaluation at admission was notable for fever of 100.3F, RUQ tenderness, White blood cell count of 13.000/mL. Liver chemistries with bilirubin of 5.0mg/dL, ALT 405U/L, AST 217U/L, ALP 200U/L, consistent with obstructive pattern. Computed tomography showed sequela of liver laceration and bile duct embolization in segment 8, with an unfolded portion of the embolization coil extending inferiorly to the common bile duct, and a dilated bile duct to 15mm (Figure A). The patient was started on antibiotics and underwent urgent ERCP with findings of a coil bundle in the common bile duct with adherent stone and cast material surrounding the coil cast (Figure B). The wire bundle was successfully removed using the extraction balloon and an endoscopic forceps. A significant amount of stone, sludge and pus was also removed from the duct (Figure C). The final cholangiogram demonstrated no further evidence of intraductal embolization coils or other filling defects (Figure D). His pain was relieved, and he was discharged with a common bile duct stent and outpatient follow-up. Discussion: Cholangitis due to biliary coil migration represents an unusual, delayed complication from endovascular embolization. The migrated coil serves as a nidus for stone formation, leading to choledocholithiasis and cholangitis. Our patient was managed successfully with ERCP allowing coil extraction with a favorable outcome. Similar cases of this possible complication have been rarely described in the literature. Our case highlights an uncommon cause of life-threatening cholangitis, warranting a high degree of suspicion and need for detailed documentation of prior interventions.Figure 1.: A. CT showing an unfolded portion of the embolization coil extending inferiorly to the common bile duct. B. Cholangiogram showing a coil bundle in the common bile duct with multiple filling defects suggestive of stones. C. Significant amount of stone, sludge, and coils were removed from the biliary tree. D. Cholangiogram with complete removal of the coil bundle and no further filling defects. The second coil seen in theright upper quartrant were in the liver parenchyma or intra-vascular as confirmed by fluoroscopy.

Early Distal Coil Migration Requiring Surgical Treatment

Coil migration is a rare but devastating endovascular complication that can lead to severe neurological deficit. There are only 11 cases reported in the literature, with the majority located within the middle and anterior cerebral arteries.

Coil migration during pressure-cooker technique for cerebral AVM

Introduction: In recent decades, the endovascular treatment of cerebral arteriovenous malformations (AVMs) has advanced. However, it still carries risks of unanticipated complications. Coil migration is a reported complication of aneurysmal coiling procedures. Herein, we report a case of early intraprocedural coil migration during pressure cooker technique embolization of right thalamic AVM, discussing the management and potential explanations. The literature showed no report of coil migration after the pressure cooker technique in the form of coil-augmented Onyx injection technique (CAIT). Case description: An otherwise healthy 26-year-old female suddenly developed a severe headache with no loss of consciousness. Computed tomography (CT) scan of the head illustrated intraventricular haemorrhage. Magnetic resonance imaging (MRI) showed the bag of worms' sign in the right thalamic area. The size and location of the AVM prompted the decision for multistage endovascular embolization using onyx. In the anterior circulation, the right A5 arterial feeder has a high flow which indicates the pressure cooker technique embolization in the form of CAIT. In the procedure, early detachment and migration of the coil occurred in the medial prefrontal branch through the anterior cerebral artery. No intervention to retrieve the coil was carried out because the detachment piece is small and lodged distally. Onyx was injected directly without the coil because of the risk of radiation to the patient. Otherwise, the intraprocedural and postprocedural courses went uneventful. Conclusion: This is the first report of coil migration during the pressure cooker technique with CAIT for the right thalamic AVM.

Complications Following Splenic Embolization for Trauma: Have Things Changed Over Time?

Splenic artery embolization (SAE) is a routinely used adjunct in the nonoperative management (NOM) of blunt splenic injury (BSI). The purpose of this study was to evaluate the rate and type of adverse events that occur in patients undergoing SAE and to compare this with the previous data. Patients who had SAE for BSI between 2011 and 2018 were identified. Splenic abscess, splenic infarction, and contrast-induced renal insufficiency were considered major complications. Coil migration, fever, and pleural effusions were regarded minor complications. The results were compared with data from a prior study examining similar indices at the same trauma center between 2000 and2010. There were 716 patients admitted with BSI. SAE was performed in 74 (13.3%) of the 557 (78%) NOM patients. The overall complication rate was 33.8%. Major complications occurred in 11 patients (14.9%) and minor in 13 patients (18.9%). There was no association between complications and coil location by logistic regression. SAE continues to be a useful adjunct in the NOM of BSI though complications continue to occur. Fewer minor complications were noted in the period studied compared to past similar studies.

Preoperative liver arterial conditioning in patients scheduled for a mayo clinic class IA distal pancreatectomy: Embolization or ligation?

Patients who undergo intraoperative ligation of the common hepatic artery in Mayo Clinic class I distal pancreatectomy with en bloc celiac axis resection (DP-CAR) might be exposed to liver ischemia. To avoid serious adverse postoperative outcomes related to arterial reconstruction, preoperative liver arterial conditioning by embolization or ligation is used. Here, we report our experience of preoperative liver conditioning by arterial embolization (AE) or laparoscopic ligation (LL) of the common hepatic artery before Class Ia DP-CAR. From 2014 to 2021, 15 patients were scheduled for a Class Ia DP-CAR after neoadjuvant FOLFIRINOX treatment. Six patients underwent AE, while nine underwent LL. Two procedural complications occurred in the AE group: one patient had an incomplete dissection of the proper hepatic artery, and one patient had distal migration of coils in the right branch of the hepatic artery. None of these complications prevented surgery. The median delay between liver conditioning and DP-CAR was 19 days; this delay decreased to 5 days in the last five patients. Arterial reconstruction was not performed. The severe morbidity and 90-days mortality rates were 26.7% and 13.3%, respectively. No patient developed postoperative liver insufficiency. No differences were noted between the groups in terms of the postoperative course. Preoperative AE and LL were comparable in terms of avoiding arterial reconstruction and postoperative liver insufficiency in patients scheduled for class Ia DP-CAR. However, the possible serious complications that may arise during AE led us to prefer the LL technique.

Novel endovascular technique for repair of superior mesenteric arteriovenous fistula with portal vein aneurysm

BackgroundA superior mesenteric arteriovenous fistula (SMAVF) is a rare, aberrant connection between the superior mesenteric artery (SMA) and the superior mesenteric vein (SMV). Management includes either open surgical repair or endovascular repair with embolization coils or covered stents. We report a novel in-stent coil embolization technique successfully used for repair of a challenging SMAVF. Case presentationA 56-year-old man presented with an enlarging SMV and portal vein aneurysm. His history was significant for a small bowel resection of a desmoid tumor 14 years prior. Computed tomography (CT) angiography revealed a high-flow SMAVF in the midsegment of the SMA, and the patient was taken to the operating room for endovascular repair. Embolization was initially attempted with detachable coils, but this approach was aborted as the coils did not have sufficient purchase to anchor securely and would migrate into the portal venous system prior to full release and deployment. Placement of a covered stent in the SMA to exclude the fistulous connection was not feasible due to the presence of multiple adjacent major SMA branches. Therefore, a balloon-expandable covered stent was placed across the fistula and crushed distally to create a blind end into which embolization coils were able to nest without migrating. This was achieved with the use of multiple buddy wires to deploy a VBX balloon-expandable stent graft (WL Gore, Flagstaff, AZ) across the fistulous connection and crush the distal end of the stent with a buddy balloon. The funneled covered stent then served as a backstop for packing with embolization coils, and completion angiography demonstrated complete occlusion of the SMAVF and filling of all SMA branches. Both 6-month and 1-year postoperative surveillance CT scans confirmed continued resolution of the fistula. ConclusionThis case demonstrates a novel endovascular technique to create a funneled covered stent across a high-flow SMAVF as a platform to enable embolization and prevent coil migration. This in-stent coil embolization technique is a viable option for cases in which embolization coils and covered stents fail or are unsuitable.

Outcomes of Wrist-Access Deep Venous Embolization Following Percutaneous Fistula Creation: A Two-Year Single Center Experience

During percutaneous arteriovenous (pAVF) fistula creation, deep venous embolization is recommended to encourage superficial venous flow development. The safety of crossing adjacent to the newly formed fistula from wrist venous access has not been established. The purpose of this study was to evaluate the safety and efficacy of antegrade deep venous embolization after creation of the pAVF. A retrospective analysis was performed of all procedural data related to pAVF creation using the Wavelinq device from October 2019 to November 2021. Patient data from the hospital information systems were collected where the venous access for fistula creation was from the wrist-access (ulnar or radial vein) and where deep venous embolization was performed after forming the fistula and crossing adjacent to the anastomosis. Thirty-nine patients were identified. Twenty pAVFs were created from wrist ulnar vein access and 19 from radial vein access. The accessed veins were used for embolization of the brachial veins central to the newly created anastomosis. No pAVFs were lost by crossing adjacent to the anastomotic area to perform deep venous embolization at time of creation. There were no major complications, specifically bleeding, infection, pseudoaneurysm formation. Rates of minor complications consisted of two coil migrations to the right atrium requiring uneventful retrieval (5%). Follow-up ultrasound data showed no evidence of delayed complications. In this single center experience crossing alongside the anastomosis of a newly formed percutaneous fistula from an antegrade venous approach was safe with no risk of loss of the pAVF.

Intraperitoneal Coil Migration Causing Appendicular Bisection Treated By Laparoscopic Appendectomy: A Call for Alternatives

Objective: To describe the clinical presentation, laparoscopic findings, and management of a case of intraperitoneal migration of a copper coil with appendicular bisection and to highlight alternative approaches to avoid this serious complication. Design: A case report. Setting. Endoscopy Unit of a tertiary University hospital. Patients: A multiparous woman presented with chronic pelvic pain.

Embolisation of an aneurysmal high-flow renal arteriovenous fistula in a paediatric patient: simultaneous arterial and venous approach

BackgroundA large aneurysmal renal arteriovenous fistula (AVF) can cause hypokalaemic hypertension due to activation of renin-aldosterone system due to steal effect from renal parenchyma. In comparison to nephrectomy, endovascular embolisation of renal AVF is minimally invasive and can be nephron sparing, thus preserving renal function. However, such embolisation is technically challenging and can be associated with high risk of embolic migration.Case presentationWe present a case of successful embolisation of a large aneurysmal renal AVF in a 11-year-old girl. The AVF was initially treated with coil embolization via transarterial route, resulting in partial migration of coil into inferior vena cava. After removal of the migrated coil via transvenous snaring, coils were deployed simultaneously via transarterial and transvenous routes to prevent migration. AVF flow dampened but residual flow persisted at 1 month follow up. A second embolization session with additional coil deployment and N-butyl cyanoacrylate (NBCA) injection resulted in successful occlusion of the AVF. At 3 months follow up, the girl’s blood pressure and serum potassium level have normalized without need of antihypertensive agent or potassium supplements.ConclusionEndovascular embolisation can be an effective nephron sparing treatment for large aneurysmal renal AVF. This is particularly important in paediatric patients as most renal function can be preserved with their expected longer life span. Risk of coil migration can be controlled by simultaneous transarterial and transvenous deployment. Complete occlusion of AVF can be aided by additional use of NBCA.