Behandlung eines bilateralen Aneurysmas der Arteria iliaca communis mittels unilateraler potentiell-reversiblen Ballonembolisation und sekundärer Y-Endoprotheseneinlage

Bilateral common iliac artery (CIA) aneurysms are rare, but more frequently symptomatic than abdominal aortic aneurysms (AAA). In elderly patients with coexisting medical problems, transluminal and/or endovascular procedures are preferred to avoid the risk of morbidity and mortality associated with further general anesthesia and surgery. However, bilateral internal iliac artery (IIA) occlusion during endovascular repair might be associated with significant morbidity, including gluteal claudicatio, and ischemia of the sigmoid colon and perineum. In the presented case report we describe the successful repair of bilateral CIA aneurysms by a total transluminal and endovascular approach. The potentially reversible embolisation of the less diseased IIA with detachable latex balloons preceded the implantation of a bilateral endovascular Y-stent. Both CIA aneurysms were successfully excluded from circulation. No complications were noted and the patient could be discharged four days after surgery. Probationary detechable balloon embolisation of the IIA followed by implantation of an endovascular bifurcated stentgraft is a safe technique. It allows clinical monitoring of acute ischemic complications before bilateral IIA occlusion by the stentgraft. In comparison to coil embolisation these balloons may be easier to remove if for instance, an external-internal iliac artery bypass is needed. Percutaneous balloon puncture might be another option to reverse acute ischemia.

Post-Traumatic Cavernous Fistula Fed by Persistent Trigeminal Artery: Treatment by GDC Embolisation

A case of traumatic persistent primitive trigeminal artery (PPTA) cavernous sinus fistula treated with GDC embolisation is reported. Because of the small lumen of PPTA, posteriorly directed course and flow contribution from the posterior circulation, balloon embolisation via the carotid system was not considered appropriate. The fistula was successfully closed by GDC embolisation.

Extracavernous Arteriovenous Fistulae

We report five cases of arteriovenous fistulae (AVFs) of the carotid system. Two were traumatic non penetrating injuries and involved the subarachnoid, extracavernous part of the intracranial internal carotid artery; two were spontaneous and involved the internal carotid artery in its extracranial portion; one was a spontaneous AVF of the ascending pharyngeal artery. All the symptoms due to these AVFs were not related to the location of the fistula, but to the congestive venous drainage. The revealing symptoms regressed and/or improved after transarterial detachable balloon embolisation that led to complete occlusion of the AVFs.

Treatment of a Small Hole Post-Traumatic Carotid-Cavernous Fistula with a Non-Detachable Balloon Catheter

Transarterial detachable balloon embolisation has become a well established primary treatment of post-traumatic carotid cavernous fistula (CCF). However, in some instances due to the complexity of the fistula, the treatment can be difficult or impossibile. A simple and useful technique using a non-detachable balloon catheter to easily navigate the microcatheter into the fistula via the transarterial route is discussed in this paper. The non-detachable balloon catheter allows easy navigation of the microcatheter into the small hole fistula, and complete occlusion of the fistula was obtained using one interlocking detachable coil (IDC) in the draining veins. The method of using a non-detachable balloon catheter to navigate a microcatheter into a fistula is relatively easy via the transarterial route.