Microcoil Embolization Research Articles

Exploring the Prospects of Antenatal Microcoil Embolization of Giant Placental Chorioangioma: Case Report and Review of Literature

AbstractGiant placental chorioangiomas, which measure more than 4 cm, are associated with adverse maternal, fetal, and neonatal outcomes, with an estimated perinatal mortality of 30 to 40%. Early diagnosis, close prenatal surveillance, intrauterine intervention, and timely delivery would play a vital role in improving pregnancy outcomes. Using conventional treatment options like amniodrainage to reduce intrauterine pressure and intrauterine blood transfusion to correct fetal anemia fails to tackle the underlying pathophysiology. Interventions aimed at devascularizing the tumor, such as injection of alcohol or surgical glue, use of bipolar cautery, placement of vascular clips, interstitial laser, and radiofrequency ablation, have had mixed results due to their invasive nature and associated complications. In this case report, we discuss a minimally invasive, percutaneous, extraamniotic method of focal occlusion accomplished by microcoil embolization of the feeding vessel. The combination of slow blood flow and endothelial vessel damage due to the presence of coils stimulates thrombogenic mechanisms, contributing to the formation of a clot and leading to the cessation of blood flow to the chorioangioma, thereby treating the primary pathology.

Rare Occipital Artery Pseudoaneurysm After Radical Neck Dissection.

Pseudoaneurysm formation in the occipital artery, post radical neck dissection, leading to a bulging mass, is a rare but potentially fatal occurrence. The authors treated a patient with pseudoaneurysm of occipital artery, post radical neck dissection, presenting with pain and swelling after 17 days of surgery. A pseudoaneurysm involving occipital artery was revealed by digital subtraction angiography and treated by endovascular micro-coil embolization.

Catheter-directed hemorrhoidal embolization for rectal bleeding due to hemorrhoids (Goligher grade I-III): prospective outcomes from a Spanish emborrhoid registry.

To evaluate the safety and efficacy of catheter-directed hemorrhoidal embolization (CDHE) by microcoil embolization for rectal bleeding due to hemorrhoids classified as Goligher grade I-III. Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively. All patients had symptomatic bleeding hemorrhoids. All patients were classified according to Goligher classification: grade I (13.7%), grade II (71.1%), grade III (15%), and no grade IV were recruited in this study. In all cases, microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred. Follow-up evaluation (1, 3, 6, and 12 months) included clinical examination and anoscopy. A questionnaire was conducted to determine improvement regarding bleeding, quality of life before, and the degree of patient satisfaction of each participant. Technical success was achieved in 100% of the cases. Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization. VAS and QL improved 4 points and 1.5 respectively after embolization. A total of 25/80 (31.3%) had a recurrence in rectal bleeding. Seventeen (21.3%) patients underwent a second embolization, and four patients (5%) were treated with open hemorrhoidectomy. No major complications were observed. Sixteen participants had minor complications. Subjective post-treatment symptom and QL surveys showed significant differences from the baseline survey. Likewise, the degree of satisfaction in the telephone survey at 12 months revealed a high degree of patient satisfaction (8.3±1.1). The present study demonstrates that CDHE is a feasible, well-tolerated, ambulatory, anal sphincter-sparing procedure for the treatment of internal hemorrhoids. CDHE is a simple procedure, well tolerated and accepted by patients, that preserves the anal sphincter and presents few complications when metal devices or microspheres are used as embolic agents. • The technical success rate of CDHE, defined as the closure of all the SRA in their distal segment, was achieved 100% of all patients. However, a second embolization treatment was required since 21.25% of the patients experienced rectal bleeding. • Overall, CDHE's safety profile is acceptable. After the procedure and 1 year of follow-up, no significant complications were observed. • Encouraging clinical outcomes have demonstrated CDHE in individuals with hemorrhoids and mild prolapse Goligher grades I-III with persistent rectal bleeding.

Long-term volume reduction in renal angiomyolipomas embolized by gelatin sponge particles with or without supplementary microcoil embolization

To examine the effect of supplementary microcoil embolization on the long-term progression of angiomyolipomas embolized using gelatin sponge particles (GSPs). This retrospective study included 29 unruptured angiomyolipomas in 25 patients, treated by complete embolization and radiological follow-up for ≥3 years. Embolization was performed using GSPs and supplementary microcoils. Supplementary microcoil embolization affecting >90% of the tumor vasculature was defined as microcoil embolization. Tumor volumes pre- and post-embolization were measured by computed tomography or magnetic resonance imaging. Eleven tumors received supplementary microcoil embolization and 18 tumors did not. Relative tumor reduction at >3 years post-embolization was significantly greater in tumors with supplementary microcoil embolization compared with tumors without microcoil embolization (81% ± 8% vs. 55% ± 29%). Fourteen tumors tended to show volume regrowth and the volumes of the remaining 15 tumors continued to decline. Tumors without supplementary microcoil embolization were more likely to show volume regrowth during follow-up than tumors with supplementary microcoil embolization (78% vs. 0%, respectively). When using a combination of GSPs and microcoils, supplementary microcoil embolization should be carried out to ensure maximum long-term reduction in tumor volume in patients with angiomyolipomas.

Embolization of Renal Pseudoaneurysm Following Partial Nephrectomy of Localized Tumour and Preserving Renal Function: Clinical Case and Review of Literature

Surgical procedures in highly vascularized renal parenchyma sometimes can cause iatrogenic vascular complications. Although incidence renal pseudoaneurysms after partial nephrectomy is low, around 1%, clinical presentation of these patients can be quite severe – hematuria, lumbar pain, dizziness, weakness. Prompt and precise diagnostics and treatment are essential. Ultrasound and Computed Tomography are two most common diagnostic approaches for the assessment of pseudoaneurysms or arteriovenous fistulas following partial nephrectomy. Endovascular selective microcoil embolization is a safe and effective kidney-preserving procedure for treating iatrogenic vascular complications. Although when embolizing renal arteries some of renal parenchyma loses perfusion and becomes fibrotic, no significant decrease in renal function in early post-embolization period was noted. Comparing open surgery to endovascular treatment of pseudoaneurysms, latter one allows shorter average hospital stay and less frequent cardiac and peripheral vascular complications. The article discusses a case of a patient that had developed renal pseudoaneurysm after partial nephrectomy. During a routine check-up of a middle-aged woman a presumable renal cyst was found. On more throughout examination the cyst was ruled as a tumour and partial nephrectomy was performed. After 12 days from surgery patient was admitted to hospital complaining macrohematuria, lower abdomen pain, episodic right-side ache. Urgent contrast enhanced computed tomography was performed, which confirmed that patient was bleeding from the operated kidney. Patient was admitted to interventional radiology departament and perform embolization of bleeding vessel. After embolization of pseudoaneurysm, bleeding was controlled and patient was completely treated.

Arterial Embolisation of Paediatric Mesenteric Pseudoaneurysm Secondary to Blunt Abdominal Trauma

IntroductionRuptured post-traumatic pseudoaneurysms of the superior mesenteric artery (SMA) are potentially life threatening and rarely reported in the paediatric population. The purpose of this report is to highlight the potential of endovascular treatment in this age group.ReportA 16 year old male presented to the emergency department (ED) with seizure like activity. He was hypotensive and tachycardic with worsening abdominal distension. Past medical history was significant for a motor vehicle accident 16 days previously for which he was hospitalised and underwent emergency surgery. During the previous hospitalisation the patient was found to have liver and renal lacerations, haemoperitoneum, and small and large bowel serosal injuries. At surgery, haemostasis of liver lacerations was achieved, a traumatic anterior abdominal wall hernia was repaired, and short segment small and large bowel resections with primary anastomoses were performed. The patient was discharged uneventfully from the outside hospital eight days prior to presentation. Computed tomography in the ED at presentation identified haemorrhage from a ruptured 2 cm SMA pseudoaneurysm. This was successfully treated by transcatheter microcoil embolisation. The patient was discharged uneventfully and was without abdominal complaints at the 29 month clinic follow up.DiscussionPost-traumatic SMA pseudoaneurysms in the paediatric population are rare; endovascular management may be a successful alternative or adjunct to surgical repair.

Endovascular interventions in management of renal artery aneurysm.

Renal artery aneurysm (RAA) is a rare disease. With modern non-invasive imaging modalities, the disease is being increasingly diagnosed. It is a slow-growing aneurysm with high mortality in the event of rupture; especially in pregnant females for in which case patients were treated surgically. With advances in endovascular therapy, numerous techniques have been employed to manage complex RAA in artery bifurcation, branch and segmental arteries with excellent technical and clinical success. The various recent techniques include the use of flow diverter stents, remodelling with stent-assisted coil embolization (SACE), balloon-assisted coil embolization (BACE), selective embolization with coils-sac packing, inflow occlusion and coil trapping and selective embolization with liquid embolic agents-hystroacril and onyx. A combination of stent-graft with liquid embolization and liquid with microcoil embolization has been advocated with success. The most common complication encountered is renal infarction. This is mostly without impairment of renal function and secondary to embolization. Endovascular therapy has shorter operative time, less blood loss, shorter intensive care stay, done under conscious sedation and is associated with lesser postoperative morbidity compared to surgery. Reduction in hypertension, improvement of renal function and symptoms has been seen in most studies. Endovascular management of RAA has become the management of choice even with complex anatomy and technically challenging lesions.

Successful Endovascular Management of Large Traumatic Anterior Tibial Artery Pseudoaneurysm

Traumatic tibial artery pseudoaneurysms are rare entities. There are various treatment modalities described in literature. We describe a case of traumatic anterior tibial artery pseudoaneurysm successfully managed by Endovascular microcoil embolisation. Keywords: Anterior Tibial Artery Pseudoaneurysm, Trauma, Endovascular Management, Microcoil Embolisation.

Surgical treatment of patients with neurosurgical pathology combined with COVID-19

The objective is to present first-hand experience of microsurgical operations in patients with neuro-oncological diseases, vascular pathology and COVID-19 in the absence of unified standards of work during the pandemic, as well as summarize literature data on this problem. Clinical cases. Five cases of surgical interventions in patients with moderate COVID-19 pneumonia are presented: 1) microsurgical clipping of a saccular aneurysm of the posterior communicating artery which caused massive basal subarachnoid hemorrhage with bleeding into the IV ventricle; 2) microsurgical resection of glioblastoma of the right temporal lobe; 3) resection of an intracerebral hematoma in the right temporal, occipital and parietal lobes with total volume of 100 cm3 which caused transverse brain dislocation up to 10 mm to the left; 4) micro coil embolization of a ruptured aneurysm of the posterior communicating artery; 5) microcoil embolization of a ruptured aneurysm of the right middle cerebral artery. All surgeries were performed in personal protective gear and FFP3 masks. In 3 patients, positive pneumonia dynamics were observed; in 2 patients (with glioblastoma and subarachnoid hemorrhage from an aneurysm of the right middle cerebral artery), dynamics were negative. Among 5 patients, 4 were discharged in stable condition, 1 case ended in death (despite the absence of coagulopathy, massive brain ischemia with hemorrhagic transformation developed, probably due to endothelial cell dysfunction, high vascular permeability of cerebral arteries in conjunction with coronavirus effect on angiotensin transforming enzyme receptors). Literature analysis . Summarizing experiences of other researchers, the following changes in organization of neurosurgical practice during the pandemic can be recommended: 1) all patients should be considered potentially infected; 2) emergency surgeries should be performed under local anesthesia and/or in separate operating rooms; 3) in emergency cases of vascular pathology of the brain, endovascular interventions are the preferred approach; 4) surgeries should be performed in FFP2/FFP3 masks, protective goggles, two pairs of gloves, protective suits and shoe covers; 5) the number of personnel in the operating room should be minimized; 6) manipulations that can potentially lead to increased formation of aerosol (craniotomies, coagulations) should be performed with special care, craniotome rotation speed should be decreased to minimize formation of bone particles, opening of paranasal sinuses and mastoid cells should be avoided if possible; 7) negative pressure (—5 Pa) should be maintained in the operative room, frequency of interruption of the artificial lung ventilation machine circuit should be minimized, patients’ nose and mouth should be covered with wet wipes; 8) the personnel should be divided into several teams working in turns; 9) personnel older than 65 years should be isolated; 10) planned surgeries should be postponed indefinitely and patients should be consulted by phone, hospitalized only if their condition worsens; 11) during admission, patients should be placed in observation rooms, where thermometry, computed tomography of the lungs and pharyngeal swab for SARS-CoV-2 should be performed; 12) regardless of the SARS-CoV-2 analysis result, patients after surgery should be quarantined for 14 days. Conclusion . Our experience shows that patients with concomitant COVID-19 infection can receive neurosurgical help. Compliance with the guidelines leads to low risk of infection for the personnel and sufficient quality of medical care.

S1517 Evaluating Obscure GI Bleeding in Pancreatitis

INTRODUCTION: Pancreatic pseudoaneurysm is a rare complication of pancreatitis and occurs in as many as 10% of cases and has a mortality rate ranging from 11-50%. In pancreatitis, pancreatic enzymes cause a necrotizing arteritis of surrounding vessels. Weakened arterial vessel architecture can result in bleeding into a pseudocyst causing rupture and subsequent massive bleeding into the gut lumen or peritoneal cavity. Herein we describe a case involving pancreatitis with pseudocyst complicated by a splenic artery pseudoaneurysm presenting with abdominal pain, anemia, and GI bleeding. CASE DESCRIPTION/METHODS: A 50 year old woman was transferred to our hospital system with acutely worsening abdominal pain and anemia. Her medical history was significant for morbid obesity and recent pancreatitis complicated by necrotizing pancreatitis with large pseudocyst and a right sided pleural effusion. On admission, vitals revealed BP 148/74, HR 79 bpm, RR 20 resp/min, T 36.6 °C, SpO2 100% on room air. Labs revealed WBC 6.58g k/uL, hgb 6.9 g/dL, plts 47, t bili 1.4, alk phos 107, ALT 18, AST 13. CT redemonstrated a moderately sized acute necrotic collection of the pancreas head and neck with no clearly defined wall enclosing the area. A repeat CT scan in 2 weeks was ordered to ensure maturity of the walled off necrosis prior to EUS guided drainage. Shortly after admission the patient developed hematemesis and maroon colored stools. EGD was positive only for moderate edema, erythema, and friability of the entire duodenum, however, a fistula between the pancreatic collection and the stomach/duodenum was not excluded. Ongoing hematemesis prompted an emergent CTA which was notable for a 1.4 cm distal splenic artery pseudoaneurysm (Figure 1). IR performed a successful coil embolization of the splenic artery (Figure 2 A-B). The patient tolerated the procedure well with no complications. DISCUSSION: There is significant mortality associated with rupture of a splenic artery pseudoaneurysm. A high index of suspicion for ruptured splenic artery pseudoaneurysm resulting in GI bleeding through fistulation is required in patients with acute and/or chronic pancreatitis who experience worsening abdominal pain, anemia, and/or overt GI bleed. Early identification and intervention of these pseudoaneurysms is paramount and can be emergently managed with arterial embolization or surgery to prevent life threatening complications.Figure 1.: CT angiogram showing a splenic artery pseudoaneurysm near tail of pancreas.Figure 2.: IR embolization. A) Pseudoaneurysm of the distal splenic artery. B) Successful microcoil embolization of a splenic artery across a pseudoaneurysm with no evidence of active extravasation after embolization with stasis of flow in the splenic artery.

Hepatic Flow Redistribution is Feasible in Patients with Hepatic Malignancies Undergoing Same-Day Work-Up Angiography and Yttrium-90 Microsphere Radioembolization.

To assess the feasibility of performing same-day vascular flow redistribution and Yttrium-90 radioembolization (90Y-RE) for hepatic malignancies. From November 2015 to February 2019, patients undergoing same-day hepatic flow redistribution during work-up angiography, 99mTechnetium-labeled macroaggregated albumin (99mTc-MAA) SPECT/CT and 90Y microsphere-RE, were recruited. Within 18h following the delivery of 90Y resin microspheres, an 90Y-PET/CT study was performed. According to patients' vascular anatomy, flow redistribution was performed by microcoil embolization of extrahepatic branches (group A), intrahepatic non-tumoral vessels (group B) and intrahepatic tumoral arteries (group C). The accumulation of 99mTc-MAA particles and microspheres in the redistributed areas was qualitatively evaluated using a 5-point visual scale (grade 1 = < 25% accumulation; grade 5 = 100% accumulation). Differences in the distribution of microspheres among groups were assessed with Mann-Whitney U test. Twenty-two patients were treated for primary (n = 17) and secondary (n = 5) hepatic malignancies. The MAA-SPECT/CT showed uptake in all the redistributed areas. Regarding the accumulation of microspheres within the redistributed segments in all the groups, perfusion patterns were classified as 2 in 1 case, 4 in 6 cases and 5 in 15 cases. No statistically significant differences were observed between groups A and B-C (U value = 34, p = 0.32) and between groups B and C (U value = 26, p = 0.7). Mean predicted absorbed doses by the tumoral and normal hepatic tissues were 163.5 ± 131.2Gy and 60.4 ± 69.3Gy, respectively. Mean total procedure time (from work-up angiography to 90Y delivery) was 401 ± 0.055min. Performing same-day redistribution of the arterial hepatic flow to the target and 90Y-microsphere delivery is feasible in the treatment of liver tumors. Clinical Trials Registry NCT03380130.

Posttraumatic Arterial Priapism Treated with Superselective Embolization: Our Clinical Experience and a Review of the Literature.

To present 12 cases of arterial priapism treated by superselective embolization and propose our management algorithm for this condition. Between February 2013 and May 2018, 12 cases of arterial priapism caused by blunt trauma were treated by superselective embolization. The mean age of patients was 36years (25-47years). All of the patients had normal sexual capability before priapism (IIEF-5 scores 24-25). All patients were treated with superselective embolization after more than 3weeks of simple conservative treatment had failed. All cases but one used a gelatin sponge as embolic agent. A microcoil was added in one case in which the gelatin sponge failed to occlude the pseudoaneurysm. After superselective embolization, ice pack and "observation" treatments continued. The sexual capability of the patients was evaluated by IIEF-5 scores at 6months and 12months postoperatively. The mean follow-up period was 27.2months (13-48months). Three patients achieved complete detumescence immediately. Nine cases needed 2-17days to return to a flaccid nonpainful state. No patient underwent a second embolization. The time needed to improve erectile function was from 7days to 4months. There has been no recurrence. Eleven patients treated with gelatin sponge have normal erectile function, while one patient treated with additional microcoil embolization had mild erectile dysfunction. Superselective embolization of the fistula is an effective option for arterial priapism. Absorbable agents should be used. Superselective arterial embolization should be considered after 3weeks of conservative treatment. Patients should undergo another 3weeks of "observation" treatment before repeated intervention.

Evaluation of thromboprophylaxis after highly advanced Hepatobiliary-Pancreatic surgery

Background: For most major abdominal operations, routine post-operative venous thromboembolism (VTE) chemoprophylaxis has been proven to be both safe and effective, and is now considered the international standard of care for cancer surgery. Hepatopancreatobiliary (HPB) surgeons have frequently withheld VTE chemoprophylaxis owing to the perceived risk of peri-operative haemorrhage. Methods: From 2012 – 2016, 140 patients were underwent high-level hepato-biliary pancreatic surgeries. For VTE prevention, four thousand international units per day of enoxiaparin were administered for all patients from two days to fourteen days after surgery. We analyzed the rates of postoperative bleeding events and morbidity to evaluate the safety and efficacy of postoperative thromboprophylaxis. Results: 60 patients were underwent hepatectomy. Bleeding event were not admitted in all cases of hepatectomy. 80 patients were underwent pancreatectomy. Pseudoaneurysmal bleeding after pancreatoduodenectomy due to pancreatic fistula were admitted 3 patients and underwent with microcoil embolization. 1 patient, a cerebral hemorrhage was admitted early after operation and cancel administer an enoxiaparin. The case of VTE with symptom was not admitted. Postoperative complication with enoxaparin were not observed. Conclusion: Prevention of VTE in our institution is feasible. Cemical thromboprophylaxis did not increase the risk of hemorrhage and can be safely used even after high-level hepato-biliary pancreatic surgeries.

Evaluation of thromboprophylaxis after highly advanced hepatobiliary-pancreatic surgery

Background: For most major abdominal operations, routine post-operative venous thromboembolism (VTE) chemoprophylaxis has been proven to be both safe and effective, and is now considered the international standard of care for cancer surgery. Hepatopancreatobiliary (HPB) surgeons have frequently withheld VTE chemoprophylaxis owing to the perceived risk of peri-operative haemorrhage. Methods: From 2012 to 2016, 140 patients were underwent high-level hepato-biliary pancreatic surgeries. For VTE prevention, four thousand international units per day of enoxiaparin were administered for all patients from two days to fourteen days after surgery. We analyzed the rates of postoperative bleeding events and morbidity to evaluate the safety and efficacy of postoperative thromboprophylaxis. Results: 60 patients were underwent hepatectomy. Bleeding event were not admitted in all cases of hepatectomy. 80 patients were underwent pancreatectomy. Pseudoaneurysmal bleeding after pancreatoduodenectomy due to pancreatic fistula were admitted 3 patients and underwent with microcoil embolization. 1 patient, a cerebral hemorrhage was admitted early after operation and cancel administer an enoxiaparin. The case of VTE with symptom was not admitted. Postoperative complication with enoxaparin were not observed. Conclusion: Prevention of VTE in our institution is feasible. Cemical thromboprophylaxis did not increase the risk of hemorrhage and can be safely used even after high-level hepato-biliary pancreatic surgeries.

Case Report: A Rare Case of Coronary-Bronchial Fistula Associated with a Large Lung Bullae and Bronchiectasis Presenting as Dyspnea

Coronary artery fistulas (CAF) are rare but hemodynamically significant anomalies. Although asymptomatic, they can be associated with several cardiorespiratory conditions. Coronary to bronchial fistulas (CBF) account for 0.5% to 0.61% of coronary artery fistulas, with fistulas arising from the right coronary artery being exceedingly rare. These fistulas are known to be associated with bronchiectasis but not lung bullae. The following paper reports a rare case of a coronary to bronchial fistula associated to bronchiectasis and lung bullae. The patient presented for dyspnea and was found to have a large lung bullae, bronchiectasis and a coronary to bronchial artery fistula arising from the right coronary artery and terminating into the left bronchial artery. The CBF was successfully managed first with percutaneous microcoil embolization then the bullae was resected thoracoscopically three days later. However, more case reports are mandatory in order to further understand the etiology and pathophysiology of these fistulas, elucidate their relationship to other pathologies such as bronchiectasis and lung bullae and determine the optimal therapeutic measures.

TCTAP C-122 Successful Treatment for Guidewire-induced Coronary Perforation with Micro-coil Embolization

### Patient Initials or Identifier Number B.T.600015644 ### Relevant Clinical History and Physical Exam 75 year-old, male, HT, smoking, presented with acute chest pain, onset for 4 hrs to the first rural hospital (estimated referral time 3 hrs). BP 145/95 mmHg, HR 98 /min/irregular, RR 22 /min

Hemosuccus Pancreaticus: A Potentially Life-threatening Cause of Gastrointestinal Bleeding

Hemosuccus pancreaticus (HP) is the least frequent cause of gastrointestinal bleeding (GIB) and even though HP is potentially life threating, it is rarely identified by endoscopy due to its intermittent bleeding and difficulty in obtaining adequate views of the ampulla. We report a case of HP identified by esophagogastroduodenoscopy (EGD) that was successfully treated with microcoil embolization. A 76 year old male with unknown medical history was admitted after being found unresponsive. On initial presentation the patient's vital signs were stable and he was severely anemic with a hemoglobin of 4.5 gm/dl, stools were brown and guaiac positive. CT abdomen was pertinent for chronic calcific pancreatitis with a 2x0.8cm pseudoaneurysm within the body of the pancreas and large stool burden. After transfusion of 3 units of packed red blood cells the patient continued to have worsening of his anemia. EGD was performed and positive for active bleeding coming from the ampulla. Interventional radiology identified the large bleeding pseudoaneurysm at the junction of the dorsal pancreatic and superior pancreaticoduodenal arteries on arteriogram and the patient was treated with microcoil embolization of the transverse pancreatic artery, dorsal pancreatic artery and superior pancreaticoduodenal arteries. HP is defined as bleeding from the pancreas or surrounding structures into the pancreatic duct and ampulla of Vater and occurs approximately once for every 1,500 cases of GIB. HP most commonly occurs from chronic pancreatitis, pancreatic tumors or bleeding of a pseudoaneurysm usually from the splenic artery but approximately 15% will bleed from the pancreaticduodenal artery, as in our case. Due to its location, intermittent bleeding and overall rarity, HP is difficult to identify by endoscopy and must be diagnosed with angiography and treated with surgery or angiographic embolization. Due to the life threating potential of HP, one most thoroughly investigate the ampulla for signs of bleeding and consider HP in the differential diagnosis to allow for early radiologic diagnosis and treatment.Figure: Bleeding from the Ampulla of Vater (Black arrow).

Successful management of cavernosal artery pseudoaneurysm using microcoil embolization

Erectile dysfunction (ED) is a common condition among men and has several causes. Among men under the age of 40, pelvic or perineal trauma is the most common cause of ED. Pelvic or perineal trauma often results in arterial injury as the likely mechanism of ED. We present the case of a 14-year-old male diagnosed with a pseudoaneurysm causing arteriogenic ED secondary to blunt force trauma to the perineum. We successfully managed arteriogenic ED with superselective embolization using microcoils. We also conclude through a review of the literature that microcoil and Gelfoam yield similar outcomes. We believe that it is important for urologists to be familiar with the various treatment techniques used by interventional radiologists in order to properly manage post-traumatic arteriogenic ED.

Transcatheter Microcoil Embolization of an Idiopathic Solitary Pulmonary Artery Aneurysm

Transcatheter Microcoil Embolization of an Idiopathic Solitary Pulmonary Artery Aneurysm

Clinical research of X-ray plain film assessment of recurrence after interventional treatment of intracranial aneurysms

Objective To investigate the clinical application value of using conventional X-ray fluoroscopy follow-up after interventional treatment of intracranial aneurysms. Methods From August 2013 to June 2015, all patients with intracranial aneurysm treated with interventional therapy and followed up with digital subtraction angiography (DSA) at the Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command were analyzed retrospectively. The patients were asked to have both immediately after procedure and reexamination operation position angiograms (all patients took conventional0°/CRAN 30°andLAO 90°/0°angiograms). A total of 86 patients with 102 aneurysms met the demands. The shadowgraphs of the microcoils were collected: the immediately after procedureoperating position, reexaminationoperation position,0°/CRAN 30°, andLAO 90°/0°shadowgraphs. The coil shape documented with the corresponding projection angle were compared in the immediately after procedure and follow-up shadowgraphs and determined whether the coil shape changed or not. Whether the aneurysms recurrence or not were identified according to the DSA result of the same case. Kappa test was used to analyze the consistency. Results In 102 aneurysms using microcoil embolization, 90 coils did not have any change. DSA examination revealed no relapse. Under X-ray fluoroscopy, the coil shape did not have any change in 3 cases, but DSA revealed aneurysm recurrence. Under X-ray fluoroscopy, the coil shape changed in 9 cases, and DSA did not reveal recurrence. Using Kappa test, both methods were highly consistent (K=0.76, P<0.05). Conclusions Observing microcoil shape with X-ray fluoroscopy can well predict whether aneurysms recurrence or not. It has better clinical application value in the follow-up after intracranial aneurysm intervention. Key words: Radiography; Intracranial aneurysm; Embolism; Follow-up studies