1/14. natural history of congenital arteriovenous fistula.There is no more difficult lesion to manage than congenital arteriovenous fistula. The advanced lesions are extremely vascular and unless they lend themselves to total excision, prompt recurrence is the rule. For the same reason, embolization is not successful and as the major feeding vessels are occluded, access to the tumor becomes more and more limited. In order to obliterate the tumor, it must be destroyed at the microvascular level. So far, only ethanol has proved effective in this regard, and this agent must be used conservatively to avoid excessive destruction of normal tissue and systemic damage.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/14. Vascular complications in lumbar spinal surgery: percutaneous endovascular treatment.Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery. In two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula. We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.- - - - - - - - - - ranking = 0.4keywords = fistula (Clic here for more details about this article) |
3/14. Fatal fungal infection complicating aortic dissection following coronary artery bypass grafting.The case of a 52-year-old man with severe coronary atheroma/ischaemic heart disease, who underwent successful triple vessel coronary artery bypass grafting is described. One month later this was complicated by aortic dissection arising at the aortic cannulation site. An emergency resection and Dacron graft placement were performed. Five weeks later he represented with haemoptysis. Despite inconclusive investigations the patient went on to suffer a massive fatal haemoptysis. autopsy revealed candida infection of the graft with a secondary aortobronchial fistula.- - - - - - - - - - ranking = 0.2keywords = fistula (Clic here for more details about this article) |
4/14. Recurrent hemoptysis following a systemic-to-pulmonary anastomosis in a child with a complex congenital cardiomyopathy.A 14-year-old boy with a history of congenital cardiopathy is presented. At age 4, a left systemic-to-pulmonary fistula was performed, using a tubular prosthesis to anastomose the left subclavian artery to the left pulmonary artery. Following this procedure, he developed recurrent episodes of hemoptysis, cough, and left upper lobe consolidation. Treatment resulted in clinical but no radiologic resolution. At age 6, a new right systemic-to-pulmonary anastomosis was needed, as the left one was no longer functioning. After placement of the second shunt, the hemoptysis disappeared. At age 14, flexible bronchoscopy revealed a foreign body granuloma at the left secondary carina. Rigid bronchoscopy and laser photoresection showed it to be the left vascular prosthesis, placed 10 years before. Surgery failed to remove it.- - - - - - - - - - ranking = 0.2keywords = fistula (Clic here for more details about this article) |
5/14. Tracheo-innominate fistula after initial percutaneous tracheostomy.We report a tracheo-innominate fistula formation after tracheostomy in a 68-year-old man with guillain-barre syndrome. The initial percutaneous tracheostomy had to be revised surgically after the tube dislodged from its insertion site in the trachea. Three days later, massive bleeding occurred and emergency surgery revealed a fistula. This was surgically repaired but subsequently re-bled with a fatal outcome. The post mortem report found an aneurysmal ectatic innominate artery with a fistula involving the anterior tracheal wall. The aetiology, diagnosis and management of tracheo-innominate fistula are discussed.- - - - - - - - - - ranking = 1.6keywords = fistula (Clic here for more details about this article) |
6/14. Migration of steel-wire coils into the stomach after transcatheter arterial embolization for a bleeding splenic artery pseudoaneurysm: report of a case.Transcatheter arterial embolization (TAE) represents the primary, and often definitive, mode of therapy for bleeding splanchnic artery pseudoaneurysms (PSA). Nevertheless, a number of complications associated with this procedure have been described. We report herein the case of a 59-year-old man with chronic pancreatitis who was referred to us with hematemesis and hemorrhagic shock. Computed tomography revealed a splenic artery PSA bleeding into a pancreatic pseudocyst, and TAE was performed using steel-wire coils, placed inside the aneurysmal cavity, which resulted in the immediate cessation of bleeding. However, several weeks later some of the coils were found to have dislodged through a gastropseudocystic fistula. Furthermore, an early gastric cancer was incidentally found proximal to the fistula. We finally performed open surgery to treat both disorders; primarily for the gastric cancer, but also for the pseudocyst and fistula, with the intermittent discharge of the steel-wire coils. To our knowledge, migration into the stomach of steel-wire coils after TAE has not been described before. It is generally believed that the embolization procedure should occlude normal portions of the artery both distal and proximal to the PSA with embolization materials. By occluding the PSA in this way, the subsequent migration of steel-wire coils into the pseudocyst and stomach might have been prevented in our patient.- - - - - - - - - - ranking = 0.6keywords = fistula (Clic here for more details about this article) |
7/14. Visceral artery pseudoaneurysms following pancreatoduodenectomy.Pancreatic and biliary fistulas and delayed gastric emptying are the most common complications after pancreatoduodenectomy. The development and bleeding of visceral arterial pseudoaneurysms are rare phenomena and pose diagnostic and treatment dilemmas. We describe 5 recent patients who developed bleeding from visceral artery pseudoaneurysms after pancreatoduodenectomy. These patients all had "herald" bleeding from their abdominal drains. Subsequent angiography and therapeutic embolizations were successfully performed.- - - - - - - - - - ranking = 0.2keywords = fistula (Clic here for more details about this article) |
8/14. Occlusion of an intraluminal endovascular stent graft after treatment of a ureteral-iliac artery fistula.Ureteral-arterial fistulas are rare causes of intermittent and often massive hematuria. We report the case of a patient presenting with massive hematuria and shock caused by a ureteral-iliac fistula initially treated with a covered endovascular stent graft. Eight months after deployment, the stent occluded, and the patient required a femoral-femoral bypass. This is the first known case of endovascular stent graft occlusion when used for this purpose.- - - - - - - - - - ranking = 1.2keywords = fistula (Clic here for more details about this article) |
9/14. ehlers-danlos syndrome type IV and recurrent carotid-cavernous fistula: review of the literature, endovascular approach, technique and difficulties.We report the follow-up of a previously published case (Forlodou et al. Neuroradiology 38:595-597, 1996) of carotido-cavernous fistulas (CCFs) in a patient presenting with type IV ehlers-danlos syndrome (EDS 4) that were successfully treated twice by an endovascular approach. Initial treatment with a detachable balloon was in 1994 for a right CCF, and, 8 years later, a left CCF was treated by selective transarterial occlusion of the cavernous sinus with coils. Unfortunately, the patient suffered from a spontaneous post-operative intracranial haemorrhage in the left hemisphere and died. review of the literature, technical considerations for bilateral CCF and complication are discussed.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
10/14. Unusual late vascular complications of sagittal split osteotomy of the mandibular ramus.Intraoperative or early postoperative vascular complications are not uncommon problems in sagittal split osteotomies of the mandibular ramus; however, reports of late complications are considerably rarer. Here, we present two patients who sustained late vascular complications after the sagittal split osteotomy. The first patient had a delayed bleeding, which presented itself as a rapidly expanding swelling of the left cheek from the left external carotid artery 18 days postoperatively. During exploration, a 2 mm laceration of the external carotid artery located just proximal to the bifurcation of the internal maxillary artery and the superficial temporal artery was successfully repaired. The prominent bony spike of the cut end of medial cortex of the set-back mandibular ramus was found against the arterial wall and could possibly have caused the progressive necrosis of the wall with subsequent spontaneous rupture. The second patient suffered from a mild noise in the right ear 2 weeks after the initial surgery; however, a pre-auricular arteriovenous fistula between the right external carotid artery and the external jugular vein was discovered 1 year postoperatively. The diagnosis was confirmed by angiography, and the lesion was treated successfully by therapeutic embolization at that time. To avoid vascular injury, sufficient protection of the soft tissue during exposure of the mandibular ramus is mandatory. In addition, the direction of the cut of medial cortex is suggested to avoid the cranialward inclination that creates a sharp, bony end against the artery. awareness of the possible late vascular complications to facilitate early detection and management is also important.- - - - - - - - - - ranking = 0.2keywords = fistula (Clic here for more details about this article) |
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