611/1992. Neonatal cavernous carotid artery aneurysm: case report. Neonatal intracranial aneurysms are rare. The authors report the case of a 4-week-old girl who presented with left-eye ptosis and proptosis. Computerized tomography scanning and magnetic resonance imaging demonstrated a mass involving the left cavernous sinus and middle cranial fossa. cerebral angiography revealed a large complex left cavernous carotid artery (CA) aneurysm. The patient underwent endovascular treatment in which detachable coils and N-butyl cyanoacrylate glue were used to achieve complete obliteration of the aneurysm. To the authors' knowledge, this is the first reported neonatal intracranial aneurysm originating from the cavernous CA and treated endovascularly. The authors review the literature on neonatal intracranial aneurysms. ( info) |
612/1992. Detachable balloon embolization of an arterioportal fistula following liver biopsy in a liver transplant recipient: a case report and review of literature. We report a case of an intrahepatic arterioportal fistula in a 61-year-old female liver transplant recipient. The patient presented with massive ascites 7 months after a percutaneous liver biopsy. A large fistula between the right hepatic artery and the right portal vein was diagnosed on color Doppler ultrasound and confirmed on arteriography. The fistula was successfully embolized with the detachable balloon technique and the ascites resolved. Symptomatic intrahepatic arterioportal fistula in a liver transplant recipient following percutaneous biopsy is rare. Clinical manifestations, surgical or endovascular therapy, and outcome are discussed. The literature on this subject is reviewed. ( info) |
613/1992. Post-traumatic thoracic arteriovenous fistulas. Post-traumatic arteriovenous fistulas (AVF) between vascular structures in the thorax rarely occur. We present an unusual case of the delayed diagnosis of two post-traumatic thoracic AVF in a 70-year-old male. He had abnormal communications between an intercostal artery and an intercostal vein as well as an intercostal artery and a pulmonary vein. He has remained asymptomatic and has not developed a complication from these abnormal vascular structures in a three-year follow up. ( info) |
614/1992. Cerebral arteriovenous fistulas induced by dural arteriovenous shunts. Dural arteriovenous shunts and pial arteriovenous fistulas are uncommonly associated. Their etiology, pathogenesis, and natural history are still unclear and are likely different. We present three cases of high-flow dural arteriovenous shunts associated with pial arteriovenous fistulas and discuss their pathogenesis, anatomic association, and angioarchitecture. We propose that venous steal effect in the dural sinus secondary to the high-flow dural arteriovenous shunt induced the pial arteriovenous fistulas. Treatment of the high-flow dural arteriovenous shunts and the induced pial arteriovenous fistulas are discussed. ( info) |
| PURPOSE: To assess the effectiveness, initial and long term, of embolization using polyvinyl alcohol particles (PVA) particles in patients with spinal dural arteriovenous fistulas (SDAVF). methods: The initial treatment in 14 patients with SDAVF was embolization with PVA particles. Postembolization occlusion of the SDAVF was documented angiographically in all cases. RESULTS: All 14 patients initially showed an improvement in clinical symptoms, but the neurologic status of 11 patients subsequently deteriorated. Of the 11 patients who had recurrence of symptoms, nine had angiographically proven recurrences of their SDAVF while two had negative follow-up of spinal angiography. PVA embolization is ineffective for the treatment of SDAVF and is not without risk. CONCLUSION: On the basis of a literature review of the other two alternative treatments (operation or liquid adhesive embolization) available for SDAVF and our preliminary experience with N-butyl cyanoacylate (NBCA) embolization, we suggest that NBCA embolization be the initial treatment of choice for SDAVF; if that procedure is not possible, or is unsuccessful, then operation is recommended. ( info) |
616/1992. Congenital circumflex coronary arteriovenous fistula with aneurysmal termination in the pulmonary artery. Coronary arteriovenous fistula is a rare congenital anomaly that is seen in 0.1 % to 0.2% of coronary angiograms. Aneurysmal formation in the fistula is even rarer. We report a case of congenital circumflex arteriovenous fistula with aneurysmal formation just near its termination in the pulmonary artery, associated with atherosclerotic left anterior descending coronary artery. The anomaly was successfully repaired. ( info) |
617/1992. Posterior "nutcracker" phenomenon: hemodynamic relevant aorto-retroaortal renal vein fistula leading to fatal right heart failure. A rare complication of an aneurysm of the abdominal aorta is the so-called "posterior nutcracker phenomenon", which describes compression of a retroaortal renal vein between the abdominal aorta and the vertebral column. The clinical presentation is flank pain and hematuria, which are usually caused by a renal (respectively ureteral) calculus or neoplasia. Another rare differential diagnosis for these very common clinical symptoms is an aorto-left renal vein fistula (ALRVF), which is a spontaneous vascular fistula, usually also associated with an aortic aneurysm, infrequently a result of abdominal trauma. ( info) |
618/1992. Aneurysmal dilatation of the right renal vein for arterovenous fistula as a late consequence of open renal surgery. We report a case of right renal arterial-venous (A-V) fistula, probably related to injury of renal blood vessels during open surgery for renal stones performed eight years ago, presenting with symptoms of congestive heart failure and chronic renal failure. On physical examination a palpable abdominal pulsatile mass in the right upper quadrant, associated with a continuous thrill was appreciated. The computed tomographic (CT) scan and the selective renal angiography showed the shunt between the renal vessels and the subsequent aneurysmal dilatation of right renal vein. Prompt and significant improvement of congestive heart and chronic renal failure was documented after right nephrectomy. ( info) |
619/1992. Angiosarcoma arising in an arteriovenous fistula site in a renal transplant patient: a case report and literature review. Angiosarcoma in the setting of immunosuppressed renal transplant recipients is exceedingly rare. In this report, we describe the occurrence of angiosarcoma arising at an arteriovenous fistula site of a 39-year-old renal transplant recipient that clinically mimicked a thrombosed aneurysm. These tumors are histologically high-grade and clinically aggressive malignancies. They have a predilection for arteriovenous fistula sites. The literature on this uncommon entity is reviewed and possible histogenesis is discussed. ( info) |
620/1992. Cavernous aneurysm and pituitary adenoma: management of dual intrasellar lesions. A 53-year-old female with a functioning pituitary adenoma was found to also have an unruptured asymptomatic aneurysm in the cavernous sinus portion of the internal carotid artery on MRI. The adenoma had a suprasellar extension with optic chiasm compression and extended into the right cavernous sinus. An aneurysm-like flow-void adjacent to the left internal carotid artery in the sella and embedded in the adenoma was also found. The aneurysm was confirmed by conventional angiography. We used a right fronto-pterional approach to clip the aneurysm and to remove the pituitary tumor in a one-stage procedure. The outcome was good on long-term follow-up. It is important to thoroughly evaluate the anatomic relations around the sella turcica prior to procedures with limited exposure, including transsphenoidal surgery, to avoid unrecognized complications and morbidity. ( info) |