1/56. Resection of a large arteriovenous fistula of the brain using low-flow deep hypothermic cardiopulmonary bypass: technical case report.OBJECTIVE AND IMPORTANCE: We present the second report in the literature on the use of low-flow hypothermic cardiopulmonary bypass to aide in the surgical resection of a large intraparenchymal arteriovenous fistula. CLINICAL PRESENTATION: The patient was a 46-year-old man who was found to have a left sylvian arteriovenous fistula with a giant varix during a workup for chronic left frontal headaches and was referred to our center for management. A cardiac workup revealed a cardiac output of 9 L per minute. INTERVENTION: Endovascular embolization of the lesion was initially attempted without success because of the high flow within the lesion and the large diameter of the feeding arteries. We then planned combined and staged endovascular and surgical approaches to gradually eliminate the fistula. Endovascular embolization, both transarterial and transvenous, could not be performed because of the high flow in the fistula. Despite the stepwise reduction of flow during the course of several weeks via surgical exposures and arterial ligations, the fistula remained difficult to remove because of its size and the turgor of the varix. Once hypothermic low-flow circulatory bypass was used, however, decompression of the sac allowed access to the afferent vasculature. CONCLUSION: The use of low-flow hypothermic circulatory bypass can facilitate the surgical extirpation of certain large intraparenchymal arteriovenous fistulas.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/56. Coronary arteriovenous fistulas with giant aneurysm: two case reports.Coronary arteriovenous fistulas are rare, particularly in association with coronary aneurysms. Two rare cases of patients with coronary arteriovenous fistulas and giant aneurysmal formation are described. A right coronary fistula that drained into the superior vena cava was demonstrated in one patient. The remaining patient had a documented left coronary fistula that drained into a main pulmonary artery and had evidence of several plexal vessels that transversed through the pulmonary trunk and toward the pericardial reflex. Under cardiopulmonary bypass, the fistulas and plexal vessels were successfully ligated without any injury to the native coronary circulation.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
3/56. arteriovenous fistula with associated aneurysms coexisting with dural arteriovenous malformation of the anterior inferior falx. Case report and review of the literature.This 24-year-old man presented with an unusual case of a high-flow arteriovenous fistula (AVF). This lesion was similar to giant AVFs in children that have been previously described in the literature. In patients in whom abnormalities of the vein of Galen have been excluded and in whom presentation occurs after 20 years of age, a diagnosis of congenital AVF is quite unusual. The fistula in this case originated in an enlarged callosomarginal artery and drained into the superior sagittal sinus via a saccular vascular abnormality. Two giant aneurysmal dilations of the fistula were present. In an associated finding, a small falcine dural arteriovenous malformation (AVM) was also present. Arterial supply to the AVM arose from both external carotid arteries and the left vertebral artery, with drainage through an aberrant vein in the region of the inferior sagittal sinus into the vein of Galen. craniotomy with exposure and trapping of the AVF was performed, with subsequent radiosurgical (linear accelerator) treatment of the dural AVM. Through this combination of microsurgical trapping of the AVF and radiotherapy of the dural AVM, an excellent clinical outcome was achieved.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
4/56. Intractable oesophageal variceal bleeding caused by splenic arteriovenous fistula: treatment by transcatheter arterial embolization.We describe a rare case of splenic arteriovenous fistula and venous aneurysm which developed after splenectomy in a 40-year-old woman who presented with epigastralgia, watery diarrhoea, repeated haematemesis and melaena caused by hyperkinetic status of the portal system and bleeding of oesophageal varices. It was diagnosed by computed tomography and angiography, and obliterated with giant Gianturco steel coils.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/56. Embolization of a giant torcular dural arteriovenous fistula in a neonate.We treated a neonatal infant who presented with heart failure and a giant torcular dural arteriovenous fistula by staged transtorcular embolization with two guidewires, 95 platinum microcoils, and tissue glues through a needle-size craniotomy. blood loss was minimal. The patient was stable without heart failure after a three-staged embolization. The lesion disappeared on the follow-up angiography done at the age of 3 years. This is the first documented case of neonatal giant torcular dural arteriovenous malformation cured by interventional neuroradiology. The dilemma and strategy in managing this patient will be presented and discussed.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
6/56. Coronary arteriovenous fistula with a giant aneurysm: role of transesophageal echocardiography.Congenital coronary arteriovenous fistulas are rare anomalies. patients may present with congestive heart failure, ischemic chest pain, or endocarditis. In this case, transesophageal echocardiography provided valuable additional information to that obtained from cardiac catheterization, which was essential for the diagnosis and planning of surgical correction.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
7/56. hepatic artery aneurysm in a patient with Behcets disease and segmental pancreatitis developing after its embolization.Segmental pancreatitis is an unusual form of acute pancreatitis mostly seen in the head of pancreas. We present the CT findings of a segmental pancreatitis in the body and tail of the pancreas developed following endovascular embolization of a giant hepatic artery aneurysm and arterioportal fistula in a patient with Behcet's disease.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
8/56. rupture of a giant saccular aneurysm of coronary arteriovenous fistulas.A 58-year-old Japanese woman was admitted to our hospital because of chest pain. A continuous murmur was detected at the left parasternal area. Electrocardiogram showed ST elevation in leads V2, V3 and V4. Chest computed tomography and echocardiography demonstrated pericardial effusion and a large mass which was adjacent to the pulmonary artery. An abnormal blood flow was detected in the mass by Doppler echocardiography. coronary angiography confirmed that the mass was a giant aneurysm of coronary arteriovenous fistula arising from both the left and right coronary arteries. This patient had no symptoms until rupture of the fistula. rupture of a coronary arteriovenous fistula is very rare but can be a cause of chest pain and pericardial effusion.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
9/56. Resection of a giant intracranial dural arteriovenous fistula with the use of low-flow deep hypothermic cardiopulmonary bypass after partial embolization: technical case report.OBJECTIVE AND IMPORTANCE: To describe the surgical resection of a giant intracerebral arteriovenous fistula with involvement of dura mater and surrounding bone. Intraoperative bleeding was controlled by hypothermic circulatory arrest. CLINICAL PRESENTATION: This 46-year-old woman complained of persistent headache for 1 year; her diagnostic workup revealed the presence of an arteriovenous fistula in the dura mater of the left temporal region fed by the meningeal artery of the external and internal carotid arteries, with normal run-off into Labbe's and Trolard's veins. magnetic resonance imaging depicted a Chiari I malformation that was most likely a result of insufficient cerebral venous drainage. INTERVENTION: In preparation for surgery, staged embolization of feeders from the left meningeal artery and the left occipital artery was performed under controlled hypotension. This procedure failed to achieve a significant reduction in flow because of the immediate recruitment of internal branches of the internal carotid artery and dural branches of the right external carotid artery. Surgical treatment was undertaken without further embolization. Because of involvement of surrounding bone and the high risk of uncontrollable bleeding, the procedure was carried out with the patient under deep hypothermic cardiopulmonary bypass. Forty-five minutes of low flow (1.5 L/min) at 18 degrees C allowed total resection of the involved dura mater and surrounding bone. Postoperative recovery was marked by left brain edema that disappeared within 10 days. Findings on follow-up angiography were normal, and the patient was discharged with no neurological deficit. CONCLUSION: Low-flow deep hypothermic cardiopulmonary bypass can be used to control intraoperative bleeding for surgical excision of a giant intracerebral dural arteriovenous fistula.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
10/56. Successful management of a giant arteriovenous fistula with a combination of selective embolization and excision: report of a case.We experienced a female patient with a giant arteriovenous fistula in her lumbar region, which was successfully managed by a combination of selective embolization and a subsequent total excision. Embolization of the giant arteriovenous malformation resulted in an immediate decrease in the cardiac output and an increase in systemic vascular resistance. Three days after the embolization, a total resection of the lesion was achieved under general anesthesia, with a minimum amount of blood loss. The large skin defect after a total excision of the cutaneous lesion was covered with bilateral latissimus dorsi musculocutaneous flaps.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
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