Use of Interventional Neuroradiology Devices (Solitaire AB and Cascade Net) In The Treatment of Complex Renal Aneurysms Through Stent-Assisted Coil Embolisation.

Introduction: The risk of rupture of true renal artery aneurysms is low but when they are bigger than 2 - 2.5 cm it increases significantly, making treatment essential. The need to use alternatives to conventional techniques in order to avoid predictable complications as coil migration is mandatory.Discussion: Routinely-used techniques in interventional neuroradiology such as flow diverters or those assisted with an occlusion balloon or stent have are suitable alternatives for complex aneurysms.Conclusion: Interventional neuroradiology devices such as the Cascade Net stent (Perflow Medical and Grupo Logsa) and Solitaire AB stent retriever (Medtronic) are valid and safe options. We describe the technique of such devices.

479 Penetrating Chest Trauma Causing A Superior Mesenteric Artery-Inferior Vena Cava Fistula and Pancreatic Injury: A Case Report

Penetrating traumatic injuries can present a challenging scenario due to the potential for multisystem involvement requiring swift collaboration between surgical specialities. We present the case of a 66-year-old female who was stabbed in the right posterior chest. CT revealed a diaphragmatic injury, liver laceration involving segments 6/7 with active bleeding, and a posterior superior mesenteric artery (SMA) to anterior inferior vena cava (IVC) fistula. Due to the proximity of the SMA injury to a replaced right hepatic artery origin, the fistulous connection with the suprarenal IVC, and suspected pancreatic and duodenal injuries, a hybrid rather than a purely endovascular approach was taken. A large compliant occlusion balloon was placed percutaneously in the hepatic IVC. Subsequent trauma laparotomy and right medial visceral rotation identified SMA and SMV injuries, which were repaired with temporary supracoeliac aortic clamping. Further kocherisation of the duodenum revealed a 10 cm longitudinal IVC laceration causing sudden large volume venous haemorrhage. This was repaired after control was gained with supracoeliac aortic clamping, infrarenal IVC vessel loop and balloon inflation. An abdominal VAC dressing was applied. Before transfer to ICU, however, 1L of blood was noted in the VAC cannister and a relook laparotomy demonstrated more than 1L of intrabdominal fresh blood. Bleeding vessels around the uncinate process were ligated. After 48 hours, a relook laparotomy revealed no significant bleeding, and the abdomen was closed. A post-operative MRCP demonstrated pancreatic divisum and likely laceration of the aberrant ventral duct. A subsequent peripancreatic collection was managed conservatively.

Management of bleeding with a temporary arterial occlusion balloon in revision total hip arthroplasty

Purpose: Perioperative bleeding is an undesirable surgical phenomenon. An effective way of diminishing bleeding is by use of a temporary arterial occlusion balloon (TAOB) to produce regional hypotension. We analysed TAOB-related complications at our institution occurring with total hip arthroplasties between years 2000 and 2016. We also compared the effect on bleeding for a TAOB group and a matched group during this same time. Patients and methods: 76 consecutive cases had a total hip arthroplasty (THA) combined with a TAOB. In an analysis of all complications connected to the use of TAOB, 48 of them were revision THAs. The matched reference group consisted of 20 patients with revision surgery, but without TAOB. We analysed and compared perioperative bleeding, surgery, and balloon occlusion time for these 2 groups. Results: No thromboembolic complications or other severe complications were recorded. 1 case had bleeding from the insertion site after catheter removal. 3 cases had balloon failure without the consequences of this complication. The TAOB group had significantly less haemoglobin loss, total perioperative bleeding, bleeding per minute, and total transfusion than the matched reference group. Interpretation: The use of TAOB in elective THA surgery is safe and effective in reducing intraoperative bleeding.

Partial Right Atrial Inflow Occlusion for Transient Systemic Hypotension During Deployment of Thoracic Stentgrafts

Purpose Temporary balloon occlusion of the inferior vena cava to lower cardiac output is a relatively infrequently used technique to induce controlled systemic hypotension. In this technical note, we describe the feasibility, reliability, and safety of partial occlusion of right atrial inflow and the effect on systemic blood pressure during the deployment of a thoracic stentgraft. Materials and Methods Twenty consecutive patients undergoing thoracic endovascular aortic repair, with proximal landing in zone 0–3 of the thoracic aorta, were prospectively included. Right atrial inflow occlusion was performed with a compliant occlusion balloon. Results Median time to reach a mean arterial pressure of 50 mmHg was 43 s. Median recovery time of blood pressure was 42 s. Conclusion Partial right atrial inflow occlusion with an occlusion balloon is feasible with reliable results and without procedure-related complications.

Recurrent massive hemoptysis in a patient with cystic fibrosis: balloon assisted Onyx embolization after bronchial artery coil recanalization

Background Although not standard of care, Cystic Fibrosis patients with recurrent hemoptysis occasionally have coil embolization of bronchial arteries. In the event of recanalization of these arteries in this specific subset of patients, the presence of indwelling coils makes the prospect of conventional particle embolization more difficult, preventing both adequate catheterization of the coiled segment and reflux of the particles. Case presentation In this report, we describe a case of bronchial artery embolization of a complex Cystic Fibrosis patient with massive hemoptysis from recanalized coiled bronchial arteries utilizing a Scepter Balloon Catheter® (Microvention Terumo, USA) in administration of the liquid embolic agent Onyx® (Medtronic, USA). Conclusions The Scepter occlusion balloon catheter allowed for careful placement of the tip within the interstices of the pre-existing coils, allowing for Onyx injection directly into the coil mass without reflux, reconfirming the benefits of Onyx embolization in bronchial artery embolization and providing evidence that the Scepter occlusion balloon catheter should be added to the armamentarium of devices used in complex bronchial artery embolization for Cystic Fibrosis patients with massive hemoptysis.

Gastric Artery Embolization: Studying Effects of Catheter Type and Injection Method on Bead Distributions within a Benchtop Arterial Model

Aims: To investigate the effect of catheter type and injection method on microsphere distributions, specifically vessel targeting accuracy. Materials and Methods: The study utilized three catheter types (a standard micro-catheter, a Surefire anti-reflux catheter, and an Endobar occlusion balloon catheter) and both manual and computer-controlled injection schemes. A closed-loop, dynamically pressurized surrogate arterial system was assembled to replicate arterial flow for bariatric embolization procedures. Four vessel branches immediately distal to the injection site were targeted for embolization. Embolic microspheres were injected into the model using three catheter types (a standard micro-catheter, a Surefire anti-reflux catheter, and an Endobar occlusion balloon catheter) and both manual and computer-controlled injections. Results: Across all injection methods, the catheter effect on the proportion of microspheres to target vessels (vs. non-target vessels) was significant (p=0.005). The catheter effect on the number of non-target vessels embolized was significant (p=0.059). Across all catheter types, the injection method effect was not statistically significant for either of two outcome measures (percent microspheres to target vessels: p=0.265, number of non-target vessels embolized: p=0.148). Conclusion: Catheter type had a significant effect on targeting accuracy across all injection methods. The Endobar catheter exhibited a higher targeting accuracy in pairwise comparisons with the other two injection catheters across all injection schemes and when considering the Endobar catheter with the manifold injection method vs. each of the catheters with the manual injection method; the differences were significant in 3 of 4 analyses. The injection method effect was not statistically significant across all catheter types and when considering the Endobar catheter/Endobar manifold combination vs. Endobar catheter injections with manual and pressure-replicated methods.