Adult ; Child ; Embolization, Therapeutic ; methods ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male

OBJECTIVES: Hereditary hemorrhagic telangiectasia (HHT) is characterized by the presence of vascular malformations with an absence of capillaries between arteries and veins. One major manifestation site is the nasal mucous membrane where recurrent nosebleeds occur. Our clinical strategy to treat patients with HHT has the aim to reduce nasal bleeding long-term with minimal local and general side effects. METHODS: We describe staged diagnosis and therapy including individual medical treatments of 97 patients with HHT. The success of treatment is monitored with a systematic questionnaire. RESULTS: The neodymium-doped yttrium aluminium garnet (Nd:YAG) laser therapy remains standard treatment of choice with no major side effects despite the need for repeated treatment. In addition new treatment strategies like nasal occlusion, local drug therapy, and nasal septal splinting show initial success. CONCLUSION: Improvement of the quality of life of HHT patients can be achieved by a multimodal concept. Several new treatment strategies like nasal septal splinting and nasal occlusion successfully expand the range of established methods. Further studies have to prove the safety and long-term effectiveness of the described individual medical treatments.
Arteries ; Arteriovenous Malformations ; Bevacizumab ; Capillaries ; Diagnosis ; Drug Therapy ; Epistaxis ; Humans ; Laser Therapy ; Mucous Membrane ; Quality of Life ; Splints ; Telangiectasia, Hereditary Hemorrhagic* ; Vascular Malformations ; Veins ; Yttrium

In recent two years, new reports about concepts, technologies, materials, and especially new clinical trial results for endovascular treatment of cerebrovascular diseases, has provided tremendous promise for further progress. Mechanical thrombectomy becomes a guideline-recommended therapy for acute ischemic stroke patients with large vessel occlusion, which is considered as a landmark event. The superiority of endovascular coiling over neurosurgical clipping has been further proved for intracranial aneurysm. New devices are constantly developing for aneurysm occlusion. For brain arteriovenous malformation, application of detachable-tip microcatheters improves safety of embolization procedure, and successful transvenous embolization has been also achieved in a few cases. Long-term result of carotid stenting for symptomatic patients has been proved to be noninferior to carotid endarterectomy. Meanwhile, some new trials only obtain negative results, for example, endovascular stenting for intracranial or vertebral artery stenosis both show worse outcomes compared with medical therapy alone. More advancements and investigations are needed.
Embolization, Therapeutic ; instrumentation ; Endarterectomy, Carotid ; Humans ; Intracranial Aneurysm ; therapy ; Intracranial Arteriovenous Malformations ; therapy ; Stents ; Stroke ; therapy ; Thrombectomy ; Vertebrobasilar Insufficiency ; therapy

OBJECTIVE: To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy. MATERIALS AND METHODS: This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes. RESULTS: The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n = 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension. CONCLUSION: Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.
Adult ; Aged ; Angiomyolipoma/therapy ; Arteriovenous Malformations/therapy ; Child ; Embolization, Therapeutic/adverse effects/*methods ; Female ; Graft Rejection/therapy ; Hematuria/etiology ; Humans ; Infarction/etiology ; Kidney/blood supply ; Kidney Diseases/surgery/*therapy ; Kidney Failure, Chronic/therapy ; Kidney Neoplasms/therapy ; Male ; Middle Aged ; Nephrectomy/adverse effects/*methods ; *Renal Artery/abnormalities ; Retrospective Studies ; Young Adult

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage, and renal failure. Among the various hemorrhagic complications of HFRS, the spontaneous rupture of an arteriovenous malformation of the testicular vessels with a retroperitoneal hematoma is a rare finding. Here, we report a case of HFRS complicated by a massive retroperitoneal hematoma that was treated with transcatheter arterial embolization.
Adult ; Arteriovenous Malformations/*complications ; Embolization, Therapeutic ; Hematoma/diagnosis/*etiology/therapy ; Hemorrhagic Fever with Renal Syndrome/*complications ; Humans ; Kidney Cortex/blood supply ; Male ; Retroperitoneal Space ; Rupture, Spontaneous ; Testis/blood supply

OBJECTIVETo evaluate the feasibility, efficacy and safety of a new method for distant injection of Onyx for treatment of intracranial arteriovenous malformations (AVMs).

METHODSThe clinical data of 26 patients with AVMs receiving distant injection of Onyx using the new method were retrospectively analyzed. Onyx was injected by the surgeon in the control room through a pressure transmission system.

RESULTSThe 26 patients received a total of 31 embolization procedures, with an average estimated size reduction of AVMs of (61.48 ± 26.85)%. Total obliteration was achieved in 3 AVMs. In one case, Onyx leakage occurred during the operation resulting from a broken microcatheter, and the patient developed hemiparesis after the operation.

CONCLUSIONEndovascular treatment of intracranial AVMs with Onyx embolization using this new distant injection method is feasible, safe and effective. This method minimizes potential radiation exposure of the surgeons without increasing the risks of related complications.

Adolescent ; Adult ; Aged ; Child ; Dimethyl Sulfoxide ; administration & dosage ; therapeutic use ; Embolization, Therapeutic ; methods ; Female ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male ; Middle Aged ; Polyvinyls ; administration & dosage ; therapeutic use ; Retrospective Studies ; Treatment Outcome ; Young Adult

Arteriovenous Malformations ; therapy ; Child ; Female ; Humans ; Pulmonary Artery ; abnormalities ; Pulmonary Veins ; abnormalities ; Septal Occluder Device

Adult ; Arteriovenous Malformations ; therapy ; Embolization, Therapeutic ; methods ; Enbucrilate ; therapeutic use ; Female ; Humans ; Kidney ; blood supply ; Male ; Middle Aged

This report concerns a 4-month-old infant with progressive prominent and redness of his left eye since birth. This report concerns a 4-month-old infant with progressive prominent redness of his left eye since birth. Angiography revealed a congenital pial arteriovenous fistula between the temporal branch of the left posterior cerebral artery and left cavernous sinus through the sphenoparietal sinus, a condition not reported in the literature. The fistula was successfully occluded with two micro-coils by vertebrobasilar approach.
Arteriovenous Fistula/*diagnosis/therapy ; *Cavernous Sinus/radiography ; Embolization, Therapeutic/methods ; Humans ; Infant ; Intracranial Arteriovenous Malformations/*diagnosis/therapy ; Magnetic Resonance Imaging ; Male ; Posterior Cerebral Artery ; Temporal Lobe/blood supply

Pulmonary arteriovenous malformations (PAVMs) are often treated by pushable fibered or non-fibered microcoils, using an anchor or scaffold technique or with an Amplatzer plug through a guiding sheath. When performing percutaneous transcatheter microcoil embolization, there is a risk of coil migration, particularly with high-flow type PAVMs. The authors report on a unique treatment in a patient with a giant high-flow PAVM whose nidus had a maximum diameter of 6 cm. A detachable coil, not detached from a delivery wire (an anchored detachable coil), was first placed in the feeding artery under flow control by balloon occlusion, and then multiple microcoils were packed proximally to the anchored detachable coil. After confirming the stability of the microcoils during a gradual deflation of the balloon, we finally released the first detachable coil. The nidus was reduced in size to 15 mm at one year postoperatively.
Arteriovenous Malformations/*therapy ; Balloon Occlusion/*methods ; Catheterization ; Contrast Media/diagnostic use ; Embolization, Therapeutic/instrumentation/*methods ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pulmonary Artery/*abnormalities ; Pulmonary Veins/*abnormalities ; Tomography, X-Ray Computed