1/5. arteriovenous fistula after injury of the left internal mammary artery during extraction of pacemaker leads with a laser sheath.The left internal mammary artery was severed and an arteriovenous fistula created during extraction of pacemaker leads with a laser sheath.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/5. Arteriovenous fistulae complicating cardiac pacemaker lead extraction: recognition, evaluation, and management.Transvenous pacemaker lead extraction has become a commonly performed procedure that is associated with a small but significant risk. We report two cases where lead extraction was complicated by arteriovenous fistulae between branches of the aortic arch and the left brachiocephalic vein. Presenting signs and symptoms included severe chest or back pain, persistent or copious bleeding from the venous puncture site, unexplained hypotension or anemia, superior vena cava syndrome, and signs of central venous hypertension or acute heart failure. One patient whose injury was not recognized immediately and who did not undergo repair died rapidly, whereas the other patient who was diagnosed quickly underwent successful repair. Immediate diagnosis with arteriography and rapid intervention with surgery or percutaneous techniques are indicated and may prevent mortality.- - - - - - - - - - ranking = 1.2keywords = extraction (Clic here for more details about this article) |
3/5. Management of arterial injuries caused by laser extraction of indwelling venous pacemaker and defibrillator leads.The use of laser technology for the removal of pacemaker and defibrillator leads has decreased the lead extraction time and improved the success rate for complete lead removal when compared to traditional techniques. However, this extraction method may be associated with significant complications. This report documents two cases of iatrogenic arteriovenous fistula created by laser lead extraction. Endovascular repair of these fistulas provides an effective and less invasive alternative to open repair.- - - - - - - - - - ranking = 1.4keywords = extraction (Clic here for more details about this article) |
4/5. Catheter-aided extraction of a steel coil accidentally lodged in the right ventricle.In one case a steel coil similar to the Gianturco coil accidentally lodged in the outflow tract of the right ventricle during the embolization of a pulmonary arteriovenous fistula. Extraction of the coil with an intravascular foreign body retrieval set (Cook Inc., Bloomington Ind.) was unsuccessful because the extraction wire broke. An improvised device was then employed, using a Cordis 8 French multipurpose catheter and a single stainless steel wire designed for surgical osteosynthesis. The steel coil was successfully caught by the device and pulled out via the femoral vein.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/5. Hemodynamic and metabolic disturbances in patients with intracranial dural arteriovenous fistulas: positron emission tomography evaluation before and after treatment.In patients with intracranial dural arteriovenous fistulas (AVFs), clinical symptoms and angiographic findings vary. The relevance of disturbed venous drainage to clinical symptoms and prognosis has been recognized. However, the roles of cerebral hemodynamics and metabolism, which are impaired by shunt flow or disturbed venous drainage, have not been fully evaluated. The authors studied the cerebral hemodynamic and metabolic status in 10 patients with intracranial dural AVFs using positron emission tomography (PET) scanning. Ten patients with dural AVFs underwent a PET study before treatment. The regional cerebral blood flow (rCBF), regional oxygen extraction fraction (rOEF), regional cerebral metabolic rate of oxygen (rCMRO2), and regional cerebral blood volume (rCBV) were measured using the 15O-labeled gas inhalation steady-state method The PET parameters that were obtained were analyzed and compared with the patients' neurological and angiographic findings. In six of the 10 patients, a PET study was also performed after treatment. Before treatments, all four patients with cerebral symptoms showed a severe reduction in rCBF and a mild elevation in the rOEF. The areas showing reduced rCBF corresponded with areas in which retrograde venous drainage into the cortical veins and delayed parenchymal circulation were seen on angiograms. In another two patients with occlusion of the affected sinus and/or retrograde drainage into the cortical veins, mild abnormalities were demonstrated in rCBF mapping. In the remaining four patients, all PET parameters except rCBV were within normal limits and venous flow was not impaired on the angiograms. In four patients who underwent surgical excision or transvenous embolization of the affected sinus, the cerebral hemodynamics and metabolism were improved, as were the clinical symptoms. In two patients who underwent transarterial embolization of the feeding vessels only or craniotomy, no hemodynamic improvement was achieved. Our results indicate that hemodynamic insufficiency detected by the PET study corresponded well with cerebral symptoms and angiographic findings of retrograde venous drainage into the cortical veins and delayed parenchymal circulation, but not with sinus occlusion or arterial blood supply. Eradication or prevention of retrograde venous drainage from the affected sinus into the cortical veins should be a treatment goal in patients with dural AVFs.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |