1/23. Arterial embolization in the treatment of post-traumatic priapism.priapism is a prolonged penile erection not associated with sexual arousal. Two types of priapism have been described: the more common one is the "veno-occlusive" priapism and can be frequently observed as the consequence of an intracavernosal injection of vaso-active drugs for the treatment of erectile dysfunction. The less common type of priapism is known as "high flow" priapism and usually follows perineal or direct penile trauma. The clinical presentation in case of high flow priapism is quite typical: hystory of recent penile or perineal trauma followed, by the onset of a painless, incomplete and constant erection of the penis. A color-flow Doppler sonogram should be performed as first diagnostic step: this examination allows to identify the presence of patent cavernous arteries and prominent venous drainage with focal area of high flow turbulence along the pathway of one or both the cavernous arteries. An arterial blood sample taken from the corpora will confirm the diagnosis. At first, conservative therapeutical attempts can be suggested, with mechanical external compression of the perineum, the use of ice packs, corporeal aspiration and irrigation with saline. Besides, intracorporeal administration of alpha-agonists and methylene blue should be performed. Unfortunately, these conservative measures often result unsuccessful, and more invasive approaches must be considered. The radiological superselective transcatheter embolization of the proximal artery supplying arterial-lacunar fistula should be the present treatment of choice in these cases of high-flow priapism refractory to conservative and medical treatments. The first successful management of high flow priapism by selective arterial embolization was reported by Wear and coworkers in 1977. Autologous clots and gelatine sponge have been extensively used and become very popular as the embolic agent. More recently, platinum microcoils have been proposed with the aim to achieve more precise and selective embolization. In our single-case-experience on the treatment of high flow priapism by arterial embolization, we used the recently introduced tungsten microcoils. At the time of the follow-up, 2 months later, patient reported satisfactory intercourse with an approximately 75% of penile rigidity. By comparison with microsurgical ligature of the damaged vessel, selective embolization is, at least theoretically, a less invasive procedure, particularly with reference to the trauma caused to the erectile tissue. High-flow priapism is a fairly rare urological pathology which does not require immediate and emergency treatment (as is the case, instead, with venous-occlusive priapism), since the risk of post-ischaemic fibrosis is excluded thanks to the fact that oxygen is supplied to the cavernous tissue. Once the diagnosis has been established with certainty, therefore, the specialist has the necessary time at disposal to arrange for the most appropriate therapeutic steps. When, as is frequently the case, conservative measures prove ineffective, the current treatment of choice for cases of fistula of the cavernous artery would appear to be superselective embolization of the artery, provided same can be performed at specialized centres and by experienced personnel.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/23. Intraoperative localisation and management of coronary artery fistula using transesophageal echocardiography.Coronary artery fistula is a rare congenital malformation that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, coronary aneurysm and sudden death. Clinical symptomatology depends upon the underlying anatomy and the size of the fistulous connection between the left or right side of the heart. We report the successful management of a giant right coronary artery with fistulization into the right atrium. Intraoperative transesophageal echocardiography with colour flow Doppler was used for precise location of the fistulous communication, selective demonstration of vessels feeding the fistula and documentation of abolition of fistulous flow all without the need for cardiopulmonary bypass. Furthermore the effect of shunt occlusion on regional wall motion was documented which facilitated the successful ligation of the fistula.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/23. Left coronary artery-left ventricular fistula with acute myocardial infarction, representing the coronary steal phenomenon: a case report.A 59-year-old man presented with a left anterior descending coronary artery to left ventricular fistula manifesting as myocardial infarction, representing the coronary steal phenomenon. electrocardiography showed poor R progression in leads V1 through V3. The biochemical markers of myocardial injury were elevated. creatine kinase level was 509 IU/l, creatine kinase MB isoenzyme (CK-MB)47 IU/l, cardiac troponin t 0.62 ng/ml, myosin light chain 6.1 ng/ml, and myoglobin 142 ng/ml. thallium-201 myocardial perfusion imaging with dobutamine stress showed a dobutamine-induced perfusion deficit of the anteroseptal wall of the left ventricle with 0.1 mV ST-segment depression in II, III, aVF, V5, and V6. The mean left anterior descending blood flow measured with the Doppler guidewire was increased from 211 to 378 ml/min. Selective coronary arteriography showed dominant left coronary artery with the contrast medium streaming into the left ventricle via a maze of fine vessels from the distal left anterior descending coronary artery. No critical stenosis of the left anterior descending coronary artery was observed. Administration of acetylcholine 100 micrograms into the left coronary artery did not induce vasoconstriction of that artery. The fistula terminating in the left ventricle was ligated surgically and the patient became free of chest pain. thallium-201 myocardial perfusion imaging with dobutamine stress revealed no perfusion deficit of the anteroseptal wall of the left ventricle. The presence of coronary steal phenomenon was detected by dobutamine stress myocardial imaging.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/23. Laparoscopic cholecystectomy and the Peter Pan syndrome.We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy (LC). This condition was due to the rupture of a pseudo-aneurysm of the right hepatic artery in the common bile duct, probably caused by a clip erroneously fired during LC on the lateral right wall of the vessel. It also caused the formation of multiple liver abscesses and the onset of sepsis. This life-threatening complication led to melena, fever, epigastric pain, pancreatitis, liver dysfunction, and severe anemia, requiring urgent hospitalization and operation. In the operating theater, the fistula was closed, the liver abscesses drained, and a Kehr tube inserted. Thereafter, the patient's general condition improved, and she is now well. LC is often considered to be the gold standard for the management of symptomatic cholelithiasis. However, recent data have undermined that opinion. The apparent advantages offered by LC in the short term (less pain, speedier recovery, shorter hospital stay, and lower costs) have been overwhelmed by the complications that occur during long-term follow-up. When the late downward trend in the bile duct and the vascular injury rate are taken into consideration, the learning curve is prolonged. Therefore, LC should be regarded as the surgical equivalent of a modern Peter Pan-i.e., it is like a young adult who should make definitive steps toward becoming an adult but does not succeed in doing so. We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy. Based on the facts in this case, we argue that the endoscopic procedure still needs to be perfected and cannot yet be considered the gold standard for selected cases of gallstone disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/23. Left anterior descending coronary artery to right ventricular fistula complicating coronary stenting.Coronary artery perforation is a rare complication of percutaneous transluminal coronary angioplasty (PTCA) and coronary stenting, most commonly creating a communication between the coronary artery lumen and the pericardial space. We report a case where vessel rupture following stent deployment led to the development of a fistula between the left anterior descending coronary artery and the right ventricle.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/23. Fistulae of the internal thoracic vessels: report of two cases.Arteriovenous fistulae involving the internal thoracic vessels are extremely rare. The multiple causes, variable clinical presentation, and inconsistent delay of onset of clinical symptoms in addition to their rarity make their diagnosis difficult. However, the complications of untreated internal thoracic fistulae are potentially fatal, emphasizing the need to make a prompt and correct diagnosis. Once the diagnosis is made and the investigational workup complete, treatment consists of either surgical ligation and excision or percutaneous transcatheter embolization. We report two cases of patients with internal thoracic fistulae: one arising as a complication of a tube thoracostomy and the other following an anterior thoracotomy. The second case report describes a rupture of the internal thoracic fistulae, a complication not reported earlier.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
7/23. Late-term myocardial infarction after surgical ligation of a giant coronary artery fistula.A case is presented of a patient with recurrent myocardial infarctions after surgical treatment of a giant coronary artery fistula. The etiology was due to thrombus development in a large blind pouch, with propagation into more proximal vessels. Stenting of the proximal vessel provided temporary benefit, but recurrence eventually required surgical closure of the blind pouch.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
8/23. Endovascular repair of aortojejunal fistula.A 64-year-old male with vascular occlusive disease involving multiple vessels is presented with a history of aortobifemoral bypass grafting and bilateral femoral false aneurysm surgery. More recently, he had cystectomy for bladder carcinoma and repeated urinary stents and sepsis. Gastrointestinal bleeding developed due to the aortic graft anastomotic false aneurysm eroding into the distal jejunum. Endograft placement stabilized the critical situation and served as a bridge to a safer, more elective resection of the previous graft, the false aneurysm, and the endograft with closure of the jejunum.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/23. radiation-induced aortoesophageal fistula: an unusual case of massive upper gastrointestinal bleeding.Aortoesophageal fistula (AEF) is an unusual cause of massive upper gastrointestinal bleeding. Thoracic aortic aneurysm is the most common etiology of primary AEF followed by, respectively, foreign body ingestion, esophageal malignancy, and postsurgical fistulization. radiation-induced damage to the great vessels is well recognized and some authors in the past have suggested that AEF may be caused by radiotherapy. However, previous case reports of radiation-induced AEF involved patients who received radiotherapy for esophageal carcinoma, and precise histopathologic differentiation between AEF secondary to esophageal malignancy and that induced by radiation was difficult. We present here the unique case of a patient with a non-esophageal carcinoma who received radiotherapy before the development of an AEF, thus providing further evidence for the role of radiation injury in the development of this condition. As well, we discuss current opinion regarding etiology, clinical presentation, diagnosis, and management of this entity.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/23. An unusual epistaxis.The case of a man who presented complaining of epistaxis is reported. He had coarctation repair 18 years previously. Subsequent investigation revealed an aortobronchial fistula resulting from false aneurysm formation distal to the original vessel anastamosis. This was repaired at surgery, the patient suffering a minor stroke, before rehabilitation and good recovery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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