Sinus Occlusion Research Articles

Complications of Sigmoid Sinus Transvenous Occlusion for the Endovascular Treatment of Dural Arteriovenous Shunts with Emphasis on Inner Ear Dysfunction

Embolization of cranial dural sinus arteriovenous fistulae with transvenous occlusion of the involved sinuses is an established strategy when the collateral brain drainage allows it. We aimed to investigate the frequency and types of complications after endovascular occlusion of the sigmoid sinus. From our database, we detected 52 endovascularly treated consecutive cases of cranial dural arteriovenous shunts involving the sigmoid sinus. The cases treated through the transvenous approach alone or combined with the transarterial one were analyzed retrospectively. Previously reported series and cases were reviewed and critically analyzed. In 15 cases, a transvenous approach was used and in 4 combined a transvenous approach with a transarterial approach. Two patients (13.3%) both treated with the transvenous approach alone presented postoperatively with vertigo and hearing loss. In the first case, the sinus occlusion involved the whole sigmoid sinus, whereas in the second case the occlusion was restricted to a parallel channel posteriorly to the proximal segment of the sigmoid sinus. Magnetic resonance imaging and ear, nose, and throat investigations failed to elucidate the cause and pathomechanism of these symptoms. No other complications occurred. Although the transvenous occlusion of the sigmoid sinus generally is a safe therapeutic option for the treatment of dural arteriovenous fistulae, inner ear dysfunction is still a possible complication. The combined analysis of the reported and our cases did not allow a plausible explanation of this complication and its pathomechanism remains obscure.

Selective Transvenous Embolization Combined with Balloon Sinoplasty for the Treatment of Intracranial Dural Arteriovenous Fistulas with Sinus Occlusion

Selective Transvenous Embolization Combined with Balloon Sinoplasty for the Treatment of Intracranial Dural Arteriovenous Fistulas with Sinus Occlusion

Intraluminal Magnetic Resonance (MR) Findings of Dural Sinuses: Evaluation in Patients having Dural Arteriovenous Fistulas with Sinus Occlusion for Implications of Transvenous Embolization

Intraluminal Magnetic Resonance (MR) Findings of Dural Sinuses: Evaluation in Patients having Dural Arteriovenous Fistulas with Sinus Occlusion for Implications of Transvenous Embolization

TCT-9 Early PICSO preserves LVEF in porcine acute myocardial infarction

A major determinant of mortality and morbidity is the extent of myocardial necrosis after STEMI, and strategies to limit infarct size may therefore improve prognosis. As recently demonstrated in human studies, pressure-controlled intermittent coronary sinus occlusion (PICSO) may enhance myocardial

Severe Edema and Venous Congestion Following Sphenoorbital Meningioma Resection in a Meningiomatosis Case: Importance of Predicting Venous Disturbances

To achieve local disease control, radical removal is the best option for sphenoorbital meningiomas. Preservation of the venous system is crucial during the resection of skull base meningiomas. This vascular injury represents a major risk both for life and neurologic function. We present a case of a severe postoperative frontotemporal venous disturbance and cerebral edema following the radical removal of a giant sphenoorbital meningioma in a patient with meningiomatosis and occlusion of the superior sagittal sinus. The anatomical, radiologic, and surgical aspects are reviewed and discussed, with the aim of preventing such a serious complication.

Sensitivity and Specificity of Double-Track Sign in the Detection of Transverse Sinus Stenosis: A Multicenter Retrospective Study.

BackgroundTransverse sinus stenosis (TSS) is common among patients with cerebral venous sinus thrombosis. No previous studies have reported on double-track sign detected on axial Gd-enhanced T1WI in TSS. This study aimed to determine the sensitivity and specificity of the double-track sign in the detection of TSS.MethodsWe retrospectively reviewed medical records of 383 patients with transverse sinus thrombosis (TST) and 30 patients with normal transverse sinus from 5 participating hospitals in china from January 2008 to June 2014. 167 feasible transverse sinuses included in this study were categorized into TSS (n = 76), transverse sinus occlusion (TSO) (n = 52) and transverse sinus normal (TSN) groups (n = 39) according to imaging diagnosis on digital subtraction angiography (DSA) or magnetic resonance venography (MRV). Double-track sign on axial Gd-enhanced T1WI was compared among the three groups. Sensitivity and specificity of double-track sign in detection of TSS were calculated, with final imaging diagnosis of TSS on DSA or MRV as the reference standard.ResultsOf 383 patients with TST recruited over a 6.5-year period, 128 patients were enrolled in the study, 255 patients were excluded because of insufficient clinical data, imaging finding and delay time, and 30 matched patients with normal transverse sinus were enrolled in the control group. Therefore, double-track sign assessment was conducted in 167 available transverse sinuses of 158 patients. Of the 76 sinuses in TSS group, 51 had double-track sign. Of the other 91 sinuses in TSO and TSN groups, 3 had a false-positive double-track sign. Thus, double-track sign on axial Gd-enhanced T1WI was 67.1% (95% CI 55.3–77.2) sensitive and 96.7% (95% CI 89.9–99.1) specific for detection of TSS.ConclusionsThe double-track sign on axial Gd-enhanced T1WI is highly specific and moderate sensitive for detection of TSS. Nevertheless, it could be a direct sign and might provide an early clue for TSS.

Spontaneous Recanalization of Traumatic Transverse Sinus Occlusion despite Persistence of Depression Fracture

A 7-year-old boy was admitted to the emergency department after a closed head injury. Physical examination revealed no neurological disturbances or scalp laceration. Computed tomography revealed depressed skull fracture on the right occipital bone with multiple fracture lines over the right transverse sinus. Magnetic resonance imaging revealed right transverse sinus thrombosis, and magnetic resonance venography identified total occlusion of the right transverse sinus due to bone compression. Despite the presence of venous sinus injury secondary to a depressed skull fracture, surgery was not indicated for this patient. Despite persistence of a right occipital depression fracture identified during a three-dimensional cranial computed tomography performed in the third month following the trauma, the patient's magnetic resonance venography showed spontaneous recanalization of the right transverse sinus. It was demonstrated that venous sinus occlusion secondary to a depressed fracture could heal spontaneously and independently of bone pathology. With such characteristics, this report represents an extremely rare case.

The application of Y-shaped self-expandable covered metal stents in the thoracostomach-airway fistula: a single center, 11 years experience

To investigate the clinical feasibility and efficacy of Y-shaped self-expandable covered metal stents (Y-stents) in the management of thoracostomach-airway fistula. Retrospective analysis was performed for 108 patients treated for thoracostomach-airway fistula with Y-shaped self-expandable coated metal stents between April 2003 and October 2014. Y-stents were designed based on the dimensions of trachea and bronchus and sites of the fistula and then were inserted under DSA monitoring. There were 65 cases with single big Y-stent placement, 26 cases with single small Y-stent placement, 23 cases with double Y-stents placement, and 1 case with 3 Y-stents placement. Stent implantation was successfully accomplished with single manipulation in all patients. Complete occlusion of the fistula was obtained in 104 patients after the primary manipulation, and 4 patients required a secondary manipulation where a double Y-stents was inserted because of failure of primary manipulate. Ninety-two patients completed the follow-up , while 16 were lost. Fifty-nine patients died while 33 were alive with marked improvement in their quality of life. The placement of Y-stents can effectively occlude the thoracostomach-airway fistula in patients who had had the esophageal tumors resected. The technique is not only feasible but reliable to improve the quality of life of the patients.

Pressure-Lowering Effect of Fistula Occlusion in a Patient with Secondary Glaucoma Due to an Intracranial Arteriovenous Fistula.

IntroductionThis case report presents the pressure-lowering effect of transluminal fistula occlusion in a patient suffering from secondary glaucoma due to carotid cavernous fistula (CCF).Case ReportA 76-year-old Caucasian woman presented with dilated epibulbar vessels with elevated intraocular pressure (IOP, >30 mmHg) as well as glaucomatous excavations of the optic disc in both eyes. Cerebral digital subtraction angiography revealed a CCF with bilateral orbital communication. Preoperative diurnal pressure profiling showed an average IOP of 25.8 mmHg (right eye) and 26.6 mmHg (left eye). Transluminal intervention and fistula occlusion led to a decrease in IOP of about 9 mmHg. A post-operative oculomotor nerve palsy regressed spontaneously.ConclusionSecondary glaucoma due to CCF might be affected by fistula occlusion. Therefore, it should be considered before any surgical glaucoma interventions are performed. Diurnal pressure profiling is an effective tool for monitoring therapeutic success.Electronic supplementary materialThe online version of this article (doi:10.1007/s40123-015-0036-0) contains supplementary material, which is available to authorized users.

Single center experience with treatment of spinal dural arteriovenous fistulas.

Spinal dural arteriovenous fistulas (SDAVFs) are rare pathologies with a yearly incidence of 5-10 new cases/million, constituting 60-80% of spinal arteriovenous malformations. Clinical symptoms include progressive paraparesis, paresthesias, bladder, and bowel disturbances. The pathophysiology of SDAVFs is not well elucidated. Microneurosurgery and endovascular techniques are established treatment modalities for permanent fistula occlusion, which are oftentimes accompanied by an amelioration of neurological deficits in the long run. Here, we report our interdisciplinary neurosurgical/neuroradiological management strategy of SDAVFs in 32 patients who were evaluated retrospectively. We focused on clinical presentation, microneurosurgical and interventional technique, early, and late neurological results. Quality of life (QoL) was additionally assessed in 12 patients at last follow-up. We discuss the results against the background of the current literature. Our series and the literature indicate that clinical outcome after treatment of SDAVF is favorable in general. Both neurosurgical and neurointerventional therapies appear to be safe and effective, but short-term neurological deterioration after the intervention constitutes an as-of-yet unsolved problem. Beyond age and preoperative neurological state, presence of comorbidities had a significant influence on neurological outcome in our study sample. Self-assessed physical and mental QoL at long-term follow-up was reduced in quite a number of patients and was associated with a poorer neurological result as well as presence of comorbidities. The patients' perspective in terms of QoL was first investigated in this study, but further research on QoL and psychosocial impairment of SDAVF patients is needed to enable individualized counseling and rehabilitation strategies.

Urinary Tract Fistulas: Transrenal Reversible Ureteral Occlusion With Detachable Semicompliant Balloons

To evaluate transrenal reversible ureteral occlusion with detachable balloons in patients with treatment-refractory urinary tract fistulas. From September 2009 to September 2013, reversible occlusion of 18 ureters (7 men, 3 women; 27-74years) with treatment-refractory urinary leakage mostly because of tumor disease or iatrogenic surgical injury was performed. Nephrostomy was exchanged fluoroscopically into an 8F or 9F sheath, which was introduced into the ureter to the point of intended balloon inflation. The prepared semicompliant balloon on a special microcatheter was introduced into the sheath, inflated, and detached. A nephrostomy tube was placed in the pelvicalyceal system. After healing of the fistulas, urinary flow was restored by transureteral removal or computed tomography-guided percutaneous puncture of the balloons. Hundred percent successful placement of the balloons and initial urinary fistula occlusion was achieved (18 of 18 ureters). One patient was lost during follow-up. Six of the remaining 9 patients needed reocclusion because of balloon dislocation or deflation (secondary technical success 83%; 5 of 6 ureters). A z-shaped ureter made reocclusion unsuccessful. Mean duration of ureteral occlusion was 74days (5-250days). After healing of the fistulas, intentional ureteral recanalization by percutaneous puncture or transureteral balloon removal was feasible. Anterograde urination was achieved in 5 of 9 patients (clinical success rate 55%). Four fistulas did not heal. Two patients died from their underlying disease. Transrenal reversible off-label ureteral occlusion with semicompliant detachable balloons is feasible with a high technical success rate. Long-term ureteral occlusion can be achieved in nearly all patients with a moderate clinical success rate in heavily diseased patients.

Trombólisis supraselectiva en trombosis extensa de los senos venosos durales: reporte de caso y revisión de la literatura

Cerebral venous sinus thrombosis is considered one of the sub-types of vascular brain disease. Congenital or acquired thrombophilias are its main etiology. Thrombolysis has been proposed as an alternative treatment, but management lysing the clot by anticoagulation remains the cornerstone of treatment.Thrombolysis with or without thrombectomy, and despite having no controlled clinical trials, is a treatment option for accelerating recanalization of the occluded venous sinus, being able to shorten the ICU stay.A review of the literature up to the present was performed, and the case of a patient aged 31 with extensive thrombosis of the dural venous sinus is presented. This patient progressed to super selective thrombolysis of venous sinus due to persistent headaches and drowsiness despite anticoagulation management. The patient made excellent progress after complete recanalization of them.

Brainstem edema caused by traumatic carotid-cavernous fistula: A case report and review of the literature.

Brainstem edema caused by traumatic carotid-cavernous fistula (TCCF) is rare, and there is little information available regarding its clinical characteristics. The present report describes the case of a 51-year-old man with TCCF, who presented with right exophthalmos and intracranial bruit for 1 week. One month prior to admission at hospital, he fractured the frontal and ethmoid sinuses. Digital subtraction angiography confirmed the diagnosis of TCCF, and magnetic resonance imaging (MRI) suggested edema on the right side of the pons. Five days after admission, the patient exhibited left hemiparesis, and MRI revealed aggravation of the brainstem edema. Following treatment with transarterial balloon embolization, the clinical symptoms, including hemiparesis, were relieved; at the 1-month follow-up, the brain edema had disappeared. The patient was normal at the 6-month follow-up. Following the report of the present case, we reviewed six additional cases previously reported in the literature and discussed the potential mechanisms of TCCF-associated brainstem edema. We conclude that occlusion of the superior petrosal sinus may contribute to brainstem edema caused by TCCF. Relief of the brainstem edema and brainstem edema-associated clinical symptoms can be achieved with transarterial coil or balloon embolization of the TCCF to reduce the drainage pressure in the brainstem veins.

Pectoralis Major Myocutaneous Flap in Primary and Salvage Head and Neck Cancer Surgery

To analyze the oncologic, functional, and esthetic results of using the pectoralis major myocutaneous flap (PMMF) from November 2001 to April 2012 at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana (Ljubljana, Slovenia). Patients with squamous cell carcinoma of the head and neck (SCCHN) who underwent tissue defect reconstruction with a PMMF were identified from a prospective database. Medical and surgical records were reviewed for information on clinical characteristics, treatment, and outcome and specifically for indications for the PMMF, wound healing, flap vitality, functional results, and esthetics. Forty PMMFs were used in 39 patients with SCCHN. With respect to previous therapy and prognosis, patients were sorted into a primary surgery group (19 patients) and a salvage surgery group (20 patients with recurrent disease). Statistically better locoregional control and disease-free survival were observed in the first group. Wound healing was completed in 32 patients (median time from surgery, 22 days). Three cases exhibited partial PMMF necrosis. Functional results, occlusion of pharyngocutaneous fistula, speech intelligibility, upper limb dysfunction, and esthetic outcome did not differ between the 2 groups. The PMMF is a reasonable choice for primary head and neck cancer surgery and in salvage procedures. Its use is characterized by vitality, a reasonably short recovery time, and a favorable esthetic outcome at the donor site in most patients.

Application effect of situational experience health education with psychological counseling for maintenance hemodialysis patients

Objective To explore the application effect situational experiencing health education with psychological counseling in maintenance hemodialysis patients. Methods A total of 80 patients, who had the final stage of renal failure and treated by maintenance hemodialysis in Tongde Hospital of Zhejiang Province in January 2013 to February 2014, were selected and randomly divided into observation group and control group on average. The patients of control group received conventional health education, while the patients of observation group were on the basis of conventional health education, received health education market environment and simultaneously experiencing psychological counseling. We compared the patients′ general information such as the age, and utilized concise health SF-36 quality of life questionnaire and self-rating anxiety scale (SAS) and self-rating depression scale (SDS) to questionnaire. Results The difference between the patient′s age and other general information were not statistically significant (P>0.05). Scores of observation group were higher than these of the control group in vitality, physical function, social function, bodily pain, mental health, physical function, role emotional and general health aspects of eight dimensions (t=6.102, 4.484, 5.311, 5.268, 5.339, 3.939, 7.885, 6.952; P<0.01). After nursing intervention, the score of SAS acquired (53.7±9.1), higher than (58.9±11.0) of control group (t=4.621, P<0.01). The score of SDS improved significantly compared the score of control group (45.4±6.8) vs. (54.6±7.6), which had statistical significance between two group (t=5.623, P<0.01). The complication incidences of observation group patients were apparently lower than those the control group including high blood pressure, low blood pressure, low blood glucose, and fistula occlusion (χ2=6.023, 7.352, 5.364, 5.964; P<0.05). Conclusions The situational experience health education with psychological counseling can improve maintenance hemodialysis patients′ quality of life and mental health. Key words: Situational education; Experiential learning; Health education; Maintenance hemodialysis

Four-dimensional computed tomography angiographic evaluation of cranial dural arteriovenous fistula before and after embolization

PurposeThis study aimed to evaluate the usefulness of four-dimensional CTA before and after embolization treatment with ONYX-18 in eleven patients with cranial dural arteriovenous fistulas, and to compare the results with those of the reference standard DSA. Patients and MethodsEleven patients with cranial dural arteriovenous fistulas detected on DSA underwent transarterial embolization with ONYX-18. Four-dimensional CTA was performed an average of 2 days before and 4 days after DSA. Four-dimensional CTA and DSA images were reviewed by two neuroradiologists for identification of feeding arteries and drainage veins and for determining treatment effects. Interobserver and intermodality agreement between four-dimensional CTA and DSA were assessed. ResultsForty-two feeding arteries were identified for 14 fistulas in the 11 patients. Of these, 36 (85.71%) were detected on four-dimensional CTA. After transarterial embolization, one patient got partly embolized, and the fistulas in the remaining 10 patients were completely occluded. The interobserver agreement for four-dimensional CTA and intermodality agreement between four-dimensional CTA and DSA were excellent (κ=1) for shunt location, identification of drainage veins, and fistula occlusion after treatment. ConclusionFour-dimensional CTA images are highly accurate when compared with DSA images both before and after transarterial embolization treatment. Four-dimensional CTA can be used for diagnosis as well as follow-up of cranial dural arteriovenous fistulas in clinical settings.

Recurrence Rates After Surgical or Endovascular Treatment of Spinal Dural Arteriovenous Fistulas: A Meta-analysis.

There is an increasing tendency to treat spinal dural arteriovenous fistulas (SDAVFs) endovascularly despite the lack of clear evidence favoring embolization over surgery. To compare the initial failure and recurrence rates of primary treatment of SDAVFs by surgery and endovascular techniques. A meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard was performed. All the English literature from 2004 onward was evaluated. From each article that compared the 2 treatment modalities, the odds ratio (OR) was calculated. Combined ORs were calculated with Review Manager 5.3 of The Cochrane Collaboration. A total of 35 studies harboring 1112 patients were assessed. Initial definitive fistula occlusion was observed in 588 of 609 surgical patients (96.6%; 95% confidence interval [CI], 94.8-97.8) vs 363 of 503 endovascularly treated patients (72.2%; 95% CI, 68.1-75.9; P < .001). The combined OR from 18 studies that assessed both treatment modalities (730 patients) was 6.15 (95% CI, 3.45-11.0) in favor of surgical treatment. Late recurrence (13 studies, 480 patients) revealed an OR of 3.15 (95% CI, 1.66-5.96; P < .001) in favor of surgery. In a subgroup, recurrence was reported in 10 of 22 patients (45%) treated with Onyx vs 8 of 35 (23%) treated with n-butyle-2-cyanoacrylate (OR, 2.51; 95% CI, 0.75-8.37; P = .13). Although hampered by inclusion of poor quality studies, this meta-analysis shows a definite advantage of primary surgical treatment of SDAVF over endovascular treatment in initial failure rate and late recurrences. The often-used argument that endovascular techniques have improved and therefore outweigh surgery is not supported by this meta-analysis.

Endovascular treatments for cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially fatal condition. CVST usually occurs young adults with a female predominance. The current mainstay for treating CVST is anticoagulation with heparin. However, more aggressive interventions, endovascular treatment as an example, may be indicated in selected patients who are non-responsive to heparin and other anticoagulants. Endovascular approaches include catheter-based local chemical thrombolysis, balloon angioplasty and mechanical thrombectomy, all of which may rapidly recanalize the occluded venous sinus, restore the blood flow, reduce the increased intracranial pressure, and subsequently relieve the corresponding symptoms. However, as an invasive strategy, endovascular procedures per se may cause complications, such as intracranial hemorrhage, vessel dissection and pulmonary embolization, which may substantially decrease the benefit-risk ratio of the treatment. Due to the rareness of the condition and the limited indication of this invasive strategy, safety and efficacy of endovascular procedures in treating CVST are less feasible to be evaluated in large randomized clinical trails. Therefore, the evidences for justifying this treatment strategy are largely derived from case reports, cohort studies and clinical observations.

Surgical treatment for occlusion of graft arteriovenous fistula in patients undergoing hemodialysis.

BackgroundMaintenance of adequate vascular access for hemodialysis is important in patients with end-stage renal disease. Once arteriovenous fistula (AVF) occlusion occurs, the patient should be treated with rescue therapy. This study was performed to evaluate the results of a rescue therapy for AVF occlusion.MethodsFrom January 2008 to December 2012, 47 patients who underwent surgical rescue therapy for AVF occlusion after graft AVF formation, were enrolled in this study. The patients were divided into two groups, namely the graft repair group (group A, n=19) and the thrombectomy group (group B, n=28). Postoperative results of both groups were analyzed retrospectively.ResultsThere were no statistically significant differences in the clinical characteristics between the two groups. In terms of the duration of AVF patency after the first rescue therapy, group A showed a longer AVF patency duration than group B (24.5±21.9 months versus 17.7±13.6 months), but there was no statistically significant difference (p=0.310). In terms of the annual frequency of AVF occlusion after the rescue therapy of group A was lower than that of group B (0.59 versus 0.71), but there was no statistically significant difference (p=0.540). The AVF patency rates at 1, 2, 3, and 5 years after the first rescue therapy in group A were 52.6%, 31.5%, 21.0%, and 15.7%, respectively, and those in group B, they were 32.1%, 25.0%, 17.8%, and 7.14%, respectively. There was no statistically significant difference (p=0.402).ConclusionGraft repair revealed comparable results. Although there was no statistically significant difference, the patent duration and annual frequency of AVF occlusion of group A were better than those of group B. Therefore, graft repair is considered as a safe and useful procedure for maintaining graft AVF.

Percutaneous Rheolytic Thrombectomy of Thrombosed Autogenous Dialysis Fistulas

Purpose: To retrospectively analyze the technical and clinical outcome of percutaneous rheolytic thrombectomy with the use of the AngioJet device in thrombosed autogenous arteriovenous dialysis fistulas. Methods: A cohort of 38 consecutive patients (24 men; mean age 70.7±13.8 years) presenting with 59 thrombotic events in 39 autogenous dialysis fistulas were retrospectively analyzed. The AngioJet rheolytic thrombectomy device was used in all cases. Adjunctive therapies, as well as procedure-related complications, were noted. Primary, assisted primary, and secondary patency of the autogenous fistulas was assessed along with factors potentially influencing patency. Results: Initial technical success to recanalize the efferent vein was 100% (n=59), and a successful postprocedure dialysis session was possible in 97% (n=57) of cases. Adjunctive procedures included percutaneous thromboaspiration (n=4, 7%), balloon angioplasty (n=59, 100%), and stent placement (n=16, 27%). Complications related to thrombectomy occurred in 3 (5%) procedures (distal arterial embolus). Primary, assisted primary, and secondary patency rates at 12 months were 56.1% (95% CI 42.8% to 75.2%), 61.6% (95% CI 48.6% to 74.7%), and 86.2% (95% CI 74.9% to 97.5%), respectively. Risk factors for early fistula occlusion were greater patient age (p=0.045), the age of the fistula (p=0.045), previous stent insertion (p=0.019), and an upper arm fistula (p=0.047). Conclusion: Percutaneous rheolytic thrombectomy of autogenous dialysis fistulas is effective in restoring patency and allowing subsequent hemodialysis. The complication rate is acceptably low, and the large majority of the fistulas are still used for hemodialysis at 1-year follow-up. Older fistulas and upper arm fistulas are at higher risk for early rethrombosis.