Coil Migration Research Articles

Radiological and clinical outcomes of endovascular coiling of proximal A1 aneurysms

Aneurysms of the proximal anterior cerebral artery (A1) are rare. Of these A1 aneurysms, proximal A1 aneurysms are among the most challenging for endovascular coiling. This study aimed to evaluate the angiographic features and radiological and clinical outcomes of endovascular coiling of proximal A1 aneurysms. We recruited 38 patients with 38 proximal A1 aneurysms treated with endovascular coiling between September 2005 and April 2016. Baseline patient characteristics, aneurysm morphology, endovascular treatment techniques, immediate post-procedural radiological outcome, and follow-up clinical and radiological outcomes were evaluated, as were risk factors for recurrence. Sixteen proximal A1 aneurysms ruptured (42.1%). Six procedural complications (15.8%), including 5 thromboembolisms and 1 coil migration, were noted. There was no procedural morbidity or mortality. Immediate post-procedural radiological outcomes showed complete occlusion in 23, residual necks in 12, and residual sacs in 3 lesions. Follow-up angiographic outcomes were possible for 28 lesions (73.7%). Follow-up angiography showed sac recurrence in 3 (10.7%) and neck recurrence in 3 (10.7%) lesions. Retreatment was performed in 4 lesions (14.3%); all were treated by endovascular coiling. The presence of aneurysmal ruptures was only significant regarding recurrence in univariate logistic regression analysis. In our study, endovascular coiling of proximal A1 aneurysms was associated with a relatively high rate of procedural complications but not with procedural morbidity and mortality. The recurrence and retreatment rates of endovascular coiling of proximal A1 aneurysms were relatively high, and presence of rupture was significant for recurrence.

Calyceal migration of vascular embolization coils used to treat massive hemorrhage following percutaneous nephrolithotomy: an endoscopic finding during repeat percutaneous nephrolithotomy.

Calyceal migration of vascular embolization coils used to treat massive hemorrhage following percutaneous nephrolithotomy: an endoscopic finding during repeat percutaneous nephrolithotomy.

Migrated Pelvic Coil Causing Pulmonary Infarct in an Adult Female

Purpose: The migration of endovascular coils is a relatively rare complication, with few cases reported in patients with pelvic congestion syndrome. Additionally, the coil retrieval process has not been well described. Case report: A 39-year-old female with recent coil embolization of her left internal iliac and ovarian veins for pelvic congestion syndrome presented with one month of rightsided chest pain and dyspnea. Chest radiograph and computed tomography (CT) imaging revealed a migrated pelvic coil in the patient’s right main pulmonary artery with associated pulmonary infarcts and a small right pleural effusion. Interventional radiology successfully removed the coil piecemeal via a bilateral femoral access approach, resulting in significant symptom improvement and only a small piece of coil left in situ. Conclusions: Careful history should be obtained in patients presenting with chest pain or dyspnea, including recent procedures. Endovascular retrieval of the migrated coil was a successful and safe intervention in this patient, resulting in symptom resolution without the requirement of long-term anticoagulation or monitoring. The patient was also spared a more invasive open surgical procedure, which could lead to prolonged recovery times and increased complication risk.

Ethanol embolization of lingual arteriovenous malformations: Positive experience in 52 patients during 11 years

ObjectiveLingual arteriovenous malformations (AVMs) are extremely rare in clinical practice, which has limited comprehensive research to find standard treatment protocols. This study summarizes the clinical features of lingual AVMs and assesses the safety and efficacy of ethanol embolotherapy in the management of these lesions. MethodsOur study group was composed of 52 patients with lingual AVMs treated by ethanol embolization, all of whom received general anesthesia. The optimal access to the nidus of the AVM was by direct puncture, transarterial catheterization, transvenous catheterization, and a combination of these routes. Pure ethanol was manually injected into the nidus of the AVMs. The observed major or minor complications related to ethanol embolization were analyzed, and periodic follow-up of the patients was performed. The devascularization of the lingual AVMs between baseline and final angiography and the clinical outcomes of symptoms and signs after ethanol embolization were evaluated. ResultsThere were 171 embolization procedures (mean, 3.3; range, 1-20) including 166 ethanol embolizations performed; the average volume of ethanol injected in a single ethanol embolization session was 29.8 mL (range, 1-65 mL). Therapeutic outcomes were complete response in 17 patients (33%), partial response in 33 patients (63%), and no response in 2 patients (4%). The effective therapeutic outcomes were gained in 96% of the patients with lingual AVMs treated with ethanol embolization; 25 (48%) of the patients had 83 complications, which were necrosis, infection, hemorrhage of the puncture point, transient hemoglobinuria, postoperative irritability, airway constriction, and coil migration, occurring in 78 procedures (46%). Regular follow-up of all the patients was performed, with the average follow-up period of 37.9 months (range, 1-125 months) after the last treatment. ConclusionsEthanol embolization of lingual AVMs is safe and efficacious and is recommended to be the potential preferred method in the treatment of these complicated lesions.

Utility of Coil-Assisted Retrograde Transvenous Obliteration II (CARTO-II) for the Treatment of Gastric Varices.

PurposeTo investigate the technical feasibility, safety and clinical outcomes of coil-assisted retrograde transvenous obliteration II (CARTO-II) for gastric varices (GV).Materials and MethodsThirty-six consecutive patients who had undergone CARTO-II between June 2016 and April 2018 were included in the study. In the CARTO procedure, coil embolization of the drainage vein is performed “before” injection of the sclerosant to replace the use of balloon catheter. In the CARTO-II procedure, coil embolization of the drainage vein was performed “after” injection of the sclerosant to prevent migration of the sclerosant. CARTO-II was performed with ethanolamine oleate iopamidol, and the balloon catheter was immediately removed after coil placement. Technical and clinical success rates, number of coils used, presence or absence of severe complications, timing of the procedure, and rate of GV recurrence after the procedure were analyzed retrospectively.ResultsIn all patients, GV sclerosis, coil placement and removal of the balloon catheter were successfully completed. The technical success rate was 100%. No patients experienced severe complications such as coil migration or pulmonary embolization. The mean number of metallic coils used per procedure was 3.36. Mean length of the procedure was 132.8 min. Contrast-enhanced computed tomography after CARTO-II confirmed complete variceal thrombosis in all cases. The recurrence rate of GV during follow-up was 2.8% (mean follow-up, 207 days).ConclusionCARTO-II was feasible and safe and could be performed relatively quickly. The number of coils used and the rate of GV recurrence were both low. CARTO-II may have an important role to play in the management of GV.

Injectable and Radiopaque Liquid Metal/Calcium Alginate Hydrogels for Endovascular Embolization and Tumor Embolotherapy.

Improved endovascular embolization can contribute to assistant treatment for patients. However, many traditional embolic materials, such as metal microcoils or liquid embolic agents, are associated with limitations of coil migration or recanalization. Herein, as the first trial, an injectable and radiopaque liquid metal/calcium alginate (LM/CA) hydrogel is introduced and fabricated as a candidate for endovascular embolization and tumor embolotherapy through developing LM droplets as radiopaque units into biocompatible calcium alginate cross-linked network. The adoption of LM droplets makes hydrogels radiopaque under X-ray and CT scan, which significantly facilitates the tracking of material location during surgical vascular operation. In addition, in vitro and in vivo experiments prove that such smart hydrogel could convert from liquid to solid rapidly via cross-linking, showing pretty flexible and controllable functions. Benefiting from these properties, the hydrogel can be performed in blood vessels through injection via syringes and then served as an embolic material for endovascular embolization procedures. In vivo experiments demonstrate that such hydrogels can occlude arteries and block blood flow until they ultimately lead to ischemic necrosis of tumors and partial healthy tissues. Overall, the present LM/CA hydrogels are promising to be developed as new generation embolic materials for future tumor embolotherapy.

Embolization using hydrogel-coated coils for pulmonary arteriovenous malformations

PurposeTo prospectively evaluate the efficacy and safety of embolization using hydrogel-coated coils for the treatment of pulmonary arteriovenous malformations (PAVMs). Materials and methodsThe outcomes of 21 PAVMs in 19 patients (3 men and 16 women; mean age, 58.8±15.2 [SD] years; age range 14–78 years) treated by venous sac embolization (VSE) with additional feeding artery embolization were prospectively evaluated. For VSE, using one or more 0.018-inch hydrogel-coated coils was mandatory. Recanalization and/or reperfusion were evaluated by pulmonary arteriography 1 year after embolization. ResultsThe mean feeding artery and venous sac sizes were 4.0mm and 8.5mm, respectively. Embolization was successfully completed in 20/21 PAVMs, yielding a technical success rate of 95%. The feeding artery was also embolized in 17/20 successful PAVMs (85%). A technical failure occurred in one PAVM, where embolization was abandoned because of migration of one bare coil to the left ventricle. The mean numbers of hydrogel-coated coils and bare platinum detachable coils used for VSE were 3.3±2.1 (SD) (range, 1–8) and 4.4±3.9 (SD) (range, 1–17), respectively. The mean percentages of hydrogel-coated coils in number, length, and estimated volume were 42.9%, 33.3%, and 72.7% respectively. One patient with one PAVM was lost to follow-up after 3 months. Neither recanalization nor reperfusion was noted in the remaining 19 PAVMs (success rate, 19/19 [100%]). One grade 4 (coil migration) adverse event occurred, and it was treated without any sequelae. ConclusionVSE using hydrogel-coated coils with additional feeding artery embolization is a safe and effective treatment for PAVM.

Development of hybrid shape memory polyurethane composites for endovascular applications

Interventional radiology technique (IRT) is being increasingly used to embolize the blood vessels or prevent the flow of blood into the diseased part of a blood vessel in a human body. Shape memory polyurethane (SMPU) has been identified as an alternate embolic agent for IRT, which can overcome vital issues such as non-target embolization, incomplete occlusion, coil migration, and others. However, its inherent lack of radiopacity and bioinertness restrict potential applications of it in IRT. The objective of the present work is to study the effect of combining SMPU and radiopaque filler materials on the mechanical, thermal, shape recovery characteristics, and radiopacity. Hybrid composite materials having Barium sulphate (BaSO4) nanoparticles and hydroxyapatite (HaP) nanoparticles in the SMPU matrix are fabricated using a twin-screw extruder, and their properties are compared with that of the composites containing only single filler. The addition of the filler in SMPU is not found to affect its shape-holding characteristics. However, the shape recovery characteristics of the hybrid composites are decreased by 20–30% during the 1st cycle, which was then recovered to more than 90% during the 2nd recovery cycle. It is observed that the shape recovery rate of the SMPU can be fine-tuned by changing its programming temperature. It is also noted that the tensile strength of composites is decreased with an increase of filler concentration due to their agglomeration and voids in the composites. In case of 10 wt% hybrid composites, the reduction of tensile strength is found to be in the range of 24–28% irrespective of individual filler concentration, and it showed better mechanical properties than individual filler at the same concentration. The radiopacity of the composites is observed to be increased with filler concentration, where BaSO4 played a dominant role in comparison to that of hydroxyapatite nanoparticles. Hence, the developed SMPU hybrid nanocomposites can be explored as embolic agents for IRT due to their suitable mechanical properties, actuation profiles, and enhanced radiopacity.

Coil migration during or after endovascular coiling of cerebral aneurysms

BackgroundCoil migration is a complication of endovascular coiling of cerebral aneurysms that has not been well studied.ObjectiveTo report the frequency, risk factors, management strategies, and outcomes of coil migration.MethodsThis was...

2386 Shock Liver: A Complication of Gastroduodenal Artery Embolization

INTRODUCTION: PUD is the most common cause of acute upper GI bleeding. Duodenal ulcers are 4x more likely to bleed than gastric ulcers. Posterior duodenal ulcers, are more likely to erode into the gastroduodenal artery (GDA) resulting in massive bleeding requiring intervention. Liver failure is a known complication of gastroduodenal artery embolization due to inadvertent embolization of the main hepatic artery [1,2]. CASE DESCRIPTION/METHODS: A 71 year old lady presented with a hemoglobin of 5.7 g/dL with a baseline of 10.7 g/dL. She was resuscitated with pRBCs and fluids to a hemoglobin of 8.7 g/dL. EGD showed an active 3 cm bleeding ulcer at the duodenal bulb with a visible vessel and adherent clot. Hemostasis was achieved with epinephrine, two hemoclips and gold probe cautery. On POD# 5, she had two melenic stools and an acute drop in hemoglobin reaching a nadir of 6.4 g/dL which prompted a repeat EGD. An ulcerated area on the posterior wall of the bulb was bleeding, hemostasis with epinephrine and three hemoclip deployment failed. Subsequently, she underwent gastroduodenal artery coiling. During the embolization, the coil was partially protruding into the hepatic artery. Coil repositioning failed. POD# 1, AST and ALT trended up to 2814 IU/L and 1375 IU/L from a baseline of 14 IU/L and 10 IU/L on admission, respectively. INR trended up from 1.23 to 1.8, she developed encephalopathy, was diagnosed with shock liver and transferred to outside liver transplant center. DISCUSSION: Technical success rates of transcatheter arterial embolization are extremely high (>90%) while clinical success rates vary from 60%-90% [3]. This difference may be attributed to multiorgan failure, coagulopathy, and bleeding from trauma or invasive procedures [4]. A lack of understanding of the factors that influence clinical outcome also plays a role. Transcatheter therapeutic embolization has a very high rate of success and should be considered as an alternative to surgery in high-risk populations. [1,2]. Endoscopic embolization usually has a low rate of complications of rebleeding, infarction, and rarely coil migration [3,5,]. Coil migration has been described after embolization of the GDA, but infrequently been reported to be fatal. Our patient had movement of the sheath used to protect the hepatic artery and the catheter resulting in partial migration of the coils into the hepatic artery which led to shock liver. To our knowledge, few cases of coil migration inducing hepatic failure have been reported in the literature.

1884 Migration of Embolization Coil in a Crohn’s Patient With NSAID-Induced Peptic Ulcer Disease

INTRODUCTION: Peptic ulcer-related bleeding has a high mortality rate if not controlled. If endoscopic interventions fail, interventional radiology or surgical intervention is often considered. We report a case of rare complication of Transcatheter Arterial Embolization (TAE) for bleeding duodenal ulcer in a patient with Crohn’s Disease. CASE DESCRIPTION/METHODS: A 69-year-old female with a previous medical history of Crohn's colitis (on prednisone taper for active Crohn’s disease/pending initiation of biologic therapy) presented to the emergency department for generalized weakness, nausea, non-bloody, non-bilious emesis and melena. No prior history of gastrointestinal bleeding, antiplatelet or anticoagulation use was reported. Medications includes: Prednisone 20mg and Naproxen 400mg (BID or TID). Hemoglobin was 6.0 (11.0-16.2 g/dL), BUN 46 (8-26mg/dL), Cr 1.54 (0.44 – 1.00 mg/dL). Upper GI bleed was suspected with the initiation of Pantoprazole 80mg IV, 3 units of pRBC and Intravenous fluids. Endoscopy performed post-resuscitation revealed LA Grade D esophagitis, large non-bleeding duodenal bulb ulcer with extension into the sweep. No endoscopic therapy was performed. Twenty hours later, the patient became hemodynamically unstable requiring massive transfusion. As ulcer was not amenable to endoscopic therapy, Interventional radiology was consulted who TAE with the placement of two coils in the gastroduodenal artery (GDA). The patient tolerated the procedure well without any recurrence of bleeding. A follow-up endoscopy four weeks later, showed improvement in ulceration with only a 3-4 mm area of non-bleeding, healing ulcer with a coil protruding from ulcer site. The coil was left in place without any manipulation to the area. The patient was advised to discontinue NSAIDs and continue Pantoprazole 40 mg BID. In the interim, the patient was started on Vedolizumab (Entyvio) with improvement in CRP and abdominal pain. DISCUSSION: Embolization of GDA is safe and effective in patients with high surgical risk. Complications such as duodenal ischemia, hepatic artery embolization, duodenal stenosis do exist. Migration/Erosion of coil into lumen can occur, especially in a patient with active Crohn’s disease. Ulceration surrounding the coil can occur with a consequence of bleeding, which would require surgical intervention if endoscopic hemostasis is unable to be achieved.

2191 EUS-Directed Transgastric ERCP (EDGE) for Removal of Cystic Duct Coils: A Novel Application of an Emerging Technique

INTRODUCTION: Presence of obesity as well as sudden weight loss, both predispose to gallstone disease. Post roux-en-y gastric bypass (RYGB) anatomy creates additional challenges for endoscopy and surgery. We present a captivating case of post-RYGB complicated gallbladder (GB) surgery, which eventually ends with coiling of cystic duct. The coil formed a nidus for infection and biliary obstruction, and the novel technique of EUS directed trans-gastric ERCP (EDGE) comes to the rescue. CASE DESCRIPTION/METHODS: A 27-year-old male with morbid obesity underwent RYGB. Over next 6 months, he lost 130 lbs (35% of total body weight). Three years after RYGB, he presented with acute calculous cholecystitis; requiring laparoscopic-converted to open cholecystectomy due to gangrenous GB and extensive adhesions. Postoperatively, a large cystic duct leak developed, requiring percutaneous transhepatic biliary drainage. Due to persistent leak IR-guided coil embolization of the cystic remnant was successfully done.After three years he presented again with RUQ pain, nausea and fever. CT showed cystic duct coil migration into the CBD with upstream dilation. An EDGE procedure with a 20 mm lumen apposing metal stent was performed with successful biliary sphincterotomy and biliary stones and sludge removal. The migrated coils were removed with a rotating action of the biopsy forceps advanced intraductally which facilitated wrapping of the coils around the forceps, and then removed with a snare. DISCUSSION: Obesity pauses high risk for cholelithiasis due to change in fat metabolism, hormonal regulation and GB motility. Significant weight loss further leads to gallstone formation. Our patient presented with acute calculous cholecystitis. Cholecystectomy was complicated by bile leak and led to percutaneous biliary (PTC) drainage. Lap-assisted ERCP could not be performed due to high risk of morbidity in this patient. Instead of PTC and coil placement, EDGE may have been a better option at that point. Patient ended up requiring EDGE due to development of cholangitis associated with biliary obstruction due to migrating cystic duct coils. In this complicated young patient with abdominal adhesions, EGDE was a saving grace, as the alternative may be to live with PTC drain lifelong.

1914 A Rare Complication of Interventional Radiology-Guided Arterial Embolization of Gastroduodenal Artery in the Setting of an Acute GI Bleed-Migrated Coils in the Duodenum

INTRODUCTION: Interventional radiology guided (IR) embolotherapy can be lifesaving when an acute gastrointestinal (GI) bleed cannot be controlled with endoscopic therapy. However, IR embolization can lead to various complications and herein we present a complication which has been published. CASE DESCRIPTION/METHODS: A 91-year-old male presented to the emergency room with hemodynamically significant upper gastrointestinal bleeding manifesting as hematemesis. After medical optimization, the patient underwent an upper GI endoscopy (EGD) which showed large amount of frank blood in the duodenum interfering with the visualization and treatment of the bleeding site. Hence, the patient underwent an urgent IR guided arteriogram and embolization of the gastroduodenal artery by placement of vascular coils. An EGD was done 48 hours later which showed a giant non-bleeding cratered duodenal ulcer with a visible vessel and vascular coils partially protruding into the duodenal bulb lumen. No active bleeding was noted from the ulcer. Patient had no further evidence of bleeding post embolization and was discharged. The patient presented 3 months later with abdominal pain. CT abdomen showed multiple liver abscesses. IR-guided drainage of abscesses was performed and the culture grew Streptococcus Intermedius. MRCP, ERCP and barium enema were unremarkable. The patient was treated with prolonged course of IV antibiotics and recovered without any further issues. DISCUSSION: IR guided arterial embolization can be life-saving in cases where GI bleeding cannot be controlled endoscopically, however it can lead to serious complications including endovascular coil migration into GI lumen. Endovascular coil migration can occur immediately or several years later which can result in fatal bleeding and infection. Endoscopic removal of the migrated coil with hot biopsy forceps has been reported however in most cases this complication has been conservatively followed by endoscopy. The best approach to prevent and manage migrated endovascular coils in GI lumen remains unclear.

Coil Migration After Endovascular Closure of a Coronary Artery Fistula

Abstract Coronary artery fistula is a rare congenital anomaly of coronary vessels. Acquired form of coronary artery fistula is very rare and may be due to trauma secondary to surgery or cardiac catheterizations. The incidence of congenital form ranges from 0.1 to 0.2% of all congenital heart diseases. Majority of the fistulae are asymptomatic and diagnosed incidentally. Symptomatic patients may present with shortness of breath, palpitations, chest pain, and fatigue. It is managed with endovascular coiling or surgical closure. We report a case of surgical closure of coronary sinus fistula after failed endovascular coiling.

P.085 Perioperative endovascular procedure utilization in transsphenoidal surgery patients at two tertiary-care academic centres

Background: Utilization of endovascular procedures in the perioperative management of patients undergoing transsphenoidal surgery is uncommon but plays a critical role in preventing and treating potentially life-threatening vascular complications. Methods: We performed a retrospective review of all patients over a 10-year period who underwent transsphenoidal surgery at two tertiary-care institutions and identified all pre-operative and post-operative endovascular procedures performed. Results: 18 perioperative endovascular procedures were performed including 9 pre- and 9 post-operative. Pre-operative procedures included balloon-test occlusion (n=4), aneurysm coiling (n=4), and parent artery occlusion (n=1). One aneurysm coiling was complicated by coil migration requiring coil retrieval with a snare device and one balloon-test occlusion was complicated by pituitary apoplexy. Pituitary apoplexy following balloon-test occlusion has not been reported and the potential pathophysiology is reviewed. Post-operative procedures included embolization for epistaxis (n=2) and embolization with or without parent artery sacrifice for carotid and anterior cerebral artery vascular injury (n=7). Arterial vascular injury was managed with coil embolization and/or with detachable balloons. Review of anatomical features predisposing to vascular injury are discussed. Conclusions: Patients undergoing transsphenoidal surgery should be managed with a multidisciplinary team ensuring that endovascular treatment options are made available during the perioperative period.

Selective Trans-Catheter Coil Embolization of Cystic Duct Stump in Post-Cholecystectomy Bile Leak.

Percutaneous drainage is a first-line treatment for bilomas developed post-cholecystectomy in the setting of bile leak from the cystic duct stump. Percutaneous drainage is usually followed by surgical or endoscopic treatment to address the leak. This study aimed to evaluate outcome of selective coil embolization of the cystic duct stump via the percutaneously placed drainage catheters in patients with post-cholecystectomy bile leak. Seven patients with persistent bile leak after laparoscopic cholecystectomy who underwent percutaneous catheter placement for biloma/abscess formation in the region of the gallbladder fossa were followed. These patients underwent selective trans-catheter cystic duct stump coil embolization from Feb 2013 to Feb 2019. Procedural management, complications, and success rates were analyzed. All patients underwent placement of a percutaneous catheter for drainage of biloma formation in the gallbladder fossa post-cholecystectomy. Selective coil embolization of the cystic duct was performed through the existing percutaneous tract on average 3.5weeks after percutaneous catheter placement, resulting in resolution of the biloma. All bile leaks were immediately closed. None of the patients showed recurrent bile leak or further clinical symptoms. Coil migration to the common bile duct was diagnosed in a single case, after 2.5years, with no bile leak reported. Selective trans-catheter coil embolization of the cystic stump is a feasible and safe procedure, which successfully seals leaking cystic duct stumps and can circumvent the need for repeat surgical or endoscopic intervention in selected patient populations.

Feasibility and efficacy of coil embolization for middle cerebral artery aneurysms.

BackgroundThe anatomy of middle cerebral artery (MCA) aneurysms has been noted to be unfavorable for endovascular treatment. The purpose of this study was to assess the feasibility and efficacy of coiling for MCA aneurysms.MethodsFrom January 2004 to December 2015, 72 MCA aneurysms (38 unruptured and 34 ruptured) in 67 patients were treated with coils. Treatment-related complications, clinical outcomes, and immediate and follow-up angiographic outcomes were retrospectively analyzed. ResultsAneurysms were located at the MCA bifurcation (n=60), 1st segment (M1, n=8), and 2nd segment (M2, n=4). Sixty-nine aneurysms (95.8%) were treated by neck remodeling techniques using multi-catheter (n=44), balloon (n=14), stent (n=8), or combination of these (n=3). Only 3 aneurysms were treated by single-catheter technique. Angiographic results were 66 (91.7%) complete, 5 (6.9%) remnant neck, and 1 (1.4%) incomplete occlusion. Procedural complications included aneurysm rupture (n=1), asymptomatic coil migration to the distal vessel (n=1), and acute thromboembolism (n=10) consisting of 8 asymptomatic and 2 symptomatic events. Treatment-related permanent morbidity and mortality rates were 4.5% and 3.0%, respectively. There was no bleeding on clinical follow-up (mean, 29 months; range, 6-108 months). Follow-up angiographic results (mean, 26 months; range, 6-96 months) in patients included 1 major and 3 minor recanalizations.ConclusionCoiling of MCA aneurysms could be a technically feasible and clinically effective treatment strategy with acceptable angiographic and clinical outcomes. However, the safety and efficacy of this technique as compared to surgical clipping remains to be ascertained.

Coil Embolization of an Iatrogenic Arteriovenous Fistula between the Superior Mesenteric Artery and Vein: A Case Report

Superior mesenteric arteriovenous fistulae are rare. A 32-year-old woman presented with abdominal pain. The angiography showed that the superior mesenteric vein was aneurysmal. The patient underwent coil embolization, during which a balloon catheter was inflated before the fistula for the protection of coil migration with a high blood flow. After the balloon inflation, one 8-mm and two 7-mm coils were deployed at the fistula site. The final angiography showed successful embolization with no visualization of the fistula and the aneurysmal vein.

Empiric Transcatheter Arterial Embolization for Massive or Recurrent Gastrointestinal Bleeding: Ten-year Experience from a Single Tertiary Care Center.

PurposeIn patients with massive or recurrent gastrointestinal bleeding (GIB) which is not amenable to endoscopic therapy, angiographic interventions are often employed. We report our ten-year experience of empiric transcatheter arterial embolization (TAE) for patients with massive or recurrent GIB.MethodsAll patients who had undergone empiric TAE at our hospital between March 2004 and June 2015 were identified using the institutional radiology information system. A retrospective chart review was performed using a structured pro forma. Technical success rate, 30-day clinical success rate, 30-day mortality rate, and rate of procedural complications were computed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.ResultsA total of 32 patients had undergone empiric TAE for GIB during the study period. The median age of subjects was 56 years and two-thirds of them were male (68.7%). Gastroduodenal (n=24), ileocolic (n=3), left gastric (n=2), right gastroepiploic (n=1), and branches of superior and middle rectal arteries (n=1) were embolized using microcoils (n=25), polyvinyl alcohol particles (n=25), and gelatin sponge (n=3)--either alone or in combination. Technical and 30-day clinical success rates were 96.9% (31/32) and 71.9% (23/32), respectively. The 30-day mortality rate for our cohort was 21.9% (7/32). One patient developed re-bleeding at two days after the initial procedure and required repeat embolization. Coil migration (n=3) and access site hematoma (n=1) were the observed procedural complications.ConclusionEmpiric TAE can be a useful treatment option for selected patients with massive or recurrent GIB that is not amenable to endoscopic therapy.

Transvenous salvage of coil migration with intraprocedural pulmonary circulation protection and successful transvenous coil embolization for the treatment of giant high-flow renal arteriovenous fistula.

Transcatheter embolization is a well-established treatment for renal arteriovenous fistula (AVF) in selected cases. Transarterial approach has been the conventional route of access of the AVF. In large arteriovenous shunts, however, transarterial approach inherits the risk of distal migration of embolization material with subsequent pulmonary embolism. We report a case of giant high-flow renal arteriovenous fistula treated with coil embolization. Arterial approach was attempted with double catheter technique, however complicated with coil mass dislodgement. We have retrieved the coil mass via transvenous route with simultaneous pulmonary circulatory protection and subsequent successful transvenous coil embolization with complete obliteration of the AVF was performed.