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Japanese Journal of Radiology Mar 2023Pelvic fractures are common in cases of blunt trauma, which is strongly associated with mortality. Transcatheter arterial embolization is a fundamental treatment... (Review)
Review
Pelvic fractures are common in cases of blunt trauma, which is strongly associated with mortality. Transcatheter arterial embolization is a fundamental treatment strategy for fatal arterial injuries caused by blunt pelvic trauma. However, vascular injuries due to blunt pelvic trauma can show various imaging findings other than arterial hemorrhage. We present a pictorial review of common and uncommon vascular injuries, including active arterial bleeding, pseudoaneurysm, arteriovenous fistula, arterial occlusion, vasospasm, and active venous bleeding. Knowledge of these vascular injuries can help clinicians select the appropriate therapeutic strategy and thus save lives.
Topics: Humans; Vascular System Injuries; Pelvis; Hemorrhage; Embolization, Therapeutic; Arteriovenous Fistula; Wounds, Nonpenetrating
PubMed: 36350523
DOI: 10.1007/s11604-022-01355-1 -
Current Problems in Diagnostic Radiology Nov 2018Pulmonary arteriovenous malformations (PAVM) are an uncommon entity that interventional radiologists may face in their clinical practice. Many of these lesions are... (Review)
Review
Pulmonary arteriovenous malformations (PAVM) are an uncommon entity that interventional radiologists may face in their clinical practice. Many of these lesions are treated successfully using endovascular techniques with satisfactory long-term results. However, some PAVMs respond poorly to initial interventional techniques. This article reviews the signs and symptoms of persistent PAVMs, illustrates different imaging modalities used to diagnose these lesions, and outlines mechanisms by which these lesions may persist. The article highlights techniques and embolic agents used for percutaneous transcatheter embolotherapy of persistent PAVMs and discuss the outcomes of these interventions.
Topics: Arteriovenous Fistula; Embolization, Therapeutic; Female; Humans; Male; Pulmonary Artery; Pulmonary Veins; Treatment Outcome
PubMed: 29103837
DOI: 10.1067/j.cpradiol.2017.09.006 -
Journal of Ultrasound in Medicine :... Jan 2022To analyze and classify arterial supply and venous drainage of postcatheterization femoral arteriovenous fistulas (AVFs). (Review)
Review
OBJECTIVE
To analyze and classify arterial supply and venous drainage of postcatheterization femoral arteriovenous fistulas (AVFs).
METHODS
A review of extremity Doppler reports identified 77 femoral AVFs in 75 patients. Doppler exams were reviewed retrospectively. Fistulas were classified as above or below the common femoral artery bifurcation and subclassified based on the location of arterial inflow and venous outflow.
RESULTS
Arterial inflow originated above the femoral bifurcation in 32 cases. The communication was between the common femoral artery and the superficial circumflex iliac vein in 25 of 32 cases and between a branch of the common femoral or external iliac artery and the common femoral or external iliac vein in 4 of 32 cases. In 3 of 32 cases, AVFs arose from the common femoral artery, but the venous outflow was not determined. Arterial inflow originated from the superficial femoral artery in 23 cases. Venous outflow originated from the common femoral vein in 10 of 23 cases, the femoral vein in 7 of 23 cases, and the lateral circumflex femoral vein in 6 of 23 cases. Arterial inflow originated from the deep femoral artery in 12 cases. Venous outflow originated from the common femoral vein in 6 of 12 cases and from the lateral circumflex femoral vein 6 of 12 cases. In 8 cases, the AVF originated below the bifurcation, but the arterial inflow was not classified. In 2 cases, it was impossible to determine if the AVF originated above or below the bifurcation.
CONCLUSIONS
Iatrogenic femoral AVFs arise above the femoral bifurcation more often than previously recognized. Classification based on the arterial inflow and venous outflow provides a straightforward means of describing these fistulas.
Topics: Arteriovenous Fistula; Femoral Artery; Humans; Iatrogenic Disease; Iliac Vein; Retrospective Studies
PubMed: 33720458
DOI: 10.1002/jum.15696 -
Neurology Sep 2023In this review, we describe the pathophysiology, diagnosis, and treatment of spinal dorsal intradural arteriovenous fistulas (DI-AVFs), focusing on novel research areas.... (Review)
Review
In this review, we describe the pathophysiology, diagnosis, and treatment of spinal dorsal intradural arteriovenous fistulas (DI-AVFs), focusing on novel research areas. DI-AVFs compose the most common subgroup of spinal arteriovenous lesions and most commonly involve the thoracic spine, followed by lumbar and sacral segments. The pathogenesis underlying DI-AVFs is an area of emerging understanding, thought to be attributable to venous congestion and hypertension that precipitate ascending myelopathy. Patients with DI-AVFs typically present with motor, sensory, or urinary dysfunction, although a wide swath of other less common symptoms has been reported. DI-AVFs can be subdivided by spinal region, which in turn is associated with 4 distinct clinical phenotypes: craniocervical junction (CCJ), subaxial cervical, thoracic, and lumbosacral. Patients with CCJ and lumbosacral DI-AVFs have particularly interesting presentations and treatment considerations. High-value diagnostic findings on MRI include flow voids, missing-piece sign, and T2-weighted intramedullary hyperintensity. However, digital subtraction angiography is the gold standard for diagnosis and localization of DI-AVFs and for definitive treatment planning. Surgical disconnection of DI-AVFs is almost universally curative and frontline treatment, especially for CCJ and lumbosacral DI-AVFs. Endovascular techniques evolve in promising ways, such as improved visualization, distal access, and liquid embolic techniques. The pathophysiology of DI-AVFs is better understood using newly identified radiologic diagnostic markers. Despite new techniques and devices introduced in the endovascular field, surgery remains the gold-standard treatment for DI-AVFs.
Topics: Humans; Spinal Cord; Arteriovenous Fistula; Spine; Spinal Cord Diseases; Magnetic Resonance Imaging; Central Nervous System Vascular Malformations
PubMed: 37185123
DOI: 10.1212/WNL.0000000000207327 -
Texas Heart Institute Journal Mar 2023
Topics: Humans; Veins; Radial Artery; Arteriovenous Fistula; Catheterization; Arteriovenous Shunt, Surgical
PubMed: 36972538
DOI: 10.14503/THIJ-22-7995 -
Portuguese Journal of Cardiac Thoracic... May 2024
Topics: Humans; Iatrogenic Disease; Arteriovenous Fistula; Brachiocephalic Veins; Male; Female; Middle Aged
PubMed: 38743521
DOI: 10.48729/pjctvs.382 -
Operative Neurosurgery (Hagerstown, Md.) Jun 2020Spinal dural arteriovenous fistulas (AVFs) have been categorized on the basis of the Anson and Spetzler classification into 4 types. Type I is the most common type and...
Spinal dural arteriovenous fistulas (AVFs) have been categorized on the basis of the Anson and Spetzler classification into 4 types. Type I is the most common type and describes an abnormal connection between a radicular artery at the nerve root sleeve and an intradural draining vein. This communication results in progressive dilatation and mass effect from the draining vein experiencing arterial pressures without intervening arterioles. In this patient, preoperative angiography showed a type I dural AVF. A laminoplasty was performed to provide dural exposure, and a midline durotomy was performed. Indocyanine green (ICG) angiography was used to visualize flow within the fistula. This dorsal dural AVF demonstrated the characteristic slow venous flow. Pressure recordings were obtained and confirmed the elevated venous pressure observed in these lesions. Bipolar coagulation of the fistulous point was performed, and the vessel was removed at the site of the root entry zone to permit pathologic confirmation of the arteriovenous interface. Intraoperative ICG angiography findings confirmed disconnection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Topics: Angiography; Arteriovenous Fistula; Central Nervous System Vascular Malformations; Humans; Spine; Vascular Surgical Procedures
PubMed: 32107554
DOI: 10.1093/ons/opaa031 -
Vascular and Endovascular Surgery Nov 2022Penetrating injuries of the neck involving major vessels are associated with high morbidity and mortality. A traumatic arteriovenous (AV) fistula can provide a...
Penetrating injuries of the neck involving major vessels are associated with high morbidity and mortality. A traumatic arteriovenous (AV) fistula can provide a protective effect by decompressing the injured arterial structure and prevent massive blood loss and airway compression. We present a novel description of CCA (common carotid artery) transection with associated protective AV fistula. Protective AV fistulae have been uncommonly described, and to our knowledge, this is the first case involving carotid transection with associated protective AV fistula ultimately allowing lifesaving operative repair.
Topics: Arteriovenous Fistula; Carotid Artery, Common; Humans; Treatment Outcome; Vascular System Injuries
PubMed: 35726740
DOI: 10.1177/15385744221075008 -
Handbook of Clinical Neurology 2017Spinal dural arteriovenous fistulas (dAVF) are the most common subset of the larger group of spinal vascular malformations. In this chapter, we discuss the definition,... (Review)
Review
Spinal dural arteriovenous fistulas (dAVF) are the most common subset of the larger group of spinal vascular malformations. In this chapter, we discuss the definition, epidemiology, clinical presentation, diagnosis, treatment, and outcomes of spinal dAVF. Special attention is given to clinical approach, imaging, and diagnosis with discussion of newer spinal magnetic resonance angiographic techniques. Endovascular management techniques are discussed, including technical and safety considerations for the performance of spinal angiography and various methods of embolization. Embolization media, including liquid embolics, particles, and coils, are introduced. Finally, clinical and imaging outcomes are discussed with attention to the clinical and imaging findings of dAVF recurrence.
Topics: Arteriovenous Fistula; Central Nervous System Vascular Malformations; Embolization, Therapeutic; Endovascular Procedures; Humans; Magnetic Resonance Angiography; Treatment Outcome
PubMed: 28552142
DOI: 10.1016/B978-0-444-63640-9.00019-9 -
Clinical Cardiology Aug 2023Drug-coated balloons (DCBs) have been used in dialysis patients with arteriovenous fistula (AVF) stenosis, but whether DCBs have advantages over ordinary balloons is... (Meta-Analysis)
Meta-Analysis Review
Drug-coated balloons (DCBs) have been used in dialysis patients with arteriovenous fistula (AVF) stenosis, but whether DCBs have advantages over ordinary balloons is still controversial. A meta-analysis was designed to investigate the safety and efficacy of DCBs and common balloons (CBs) in the treatment of AVF stenosis. We searched the PubMed, EMBASE, and China National Knowledge Internet (CNKI) databases for randomized controlled trials that evaluated the comparison of DCB angioplasty versus CB angioplasty for AVF stenosis in dialysis patients and reported at least one outcome of interest. The results showed that the DCB group had a higher first-stage patency rate of the target lesion 6 months [odds ratio, OR = 2.31, 95% confidence interval, CI: (1.69, 3.15), p < .01] and 12 months [OR = 2.09, 95% CI: (1.50, 2.91), p < .01] after surgery. There was no statistically significant difference in all-cause mortality between the two groups at 6 months [OR = 0.85, 95% CI: (0.47, 1.52), p = .58] and 12 months [OR = 0.99, 95% CI: (0.60, 1.64), p = .97]. Compared with CB, DCBs as a new endovascular treatment for AVF stenosis have a higher primary patency rate of target lesions and can delay the occurrence of restenosis. There is no evidence that DCB can increase the mortality of patients.
Topics: Humans; Vascular Patency; Graft Occlusion, Vascular; Constriction, Pathologic; Treatment Outcome; Coated Materials, Biocompatible; Time Factors; Angioplasty, Balloon; Arteriovenous Fistula; Paclitaxel
PubMed: 37417371
DOI: 10.1002/clc.24078