Case
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Dr. Javier Irurzun - Alicante
Spain
66 years old
Arterio-venous fistula of the mesenteric artery
Endovascular treatment Selective catheterization of the mega-inferior mesenteric artery, with hydrophilic guide wire and positioning of the 4Fr catheter tip in the joining segment between artery and vein, making the progressive release of AZUR HydroCoil 0.035” (two 8mm x 20cm and two 6mm x 15cm) to get the occlusion, as confirmed by CT angiography control. It also displays left colic artery, until now hidden. Progressive clinical improvement, also accompanies the procedure, was discharged at 27 days after admission
Medical history 66 years old man was admitted to the emergency room for severe abdominal pain, elevated CRP, anemia, leukocytosis, rectal bleeding and hypovolemic shock. Rx with diffuse intestinal dilatation images.Left colectomy, performed 17 years ago.Tac and arteriography is performed to confirm the presence of arterio-venous fistula between the inferior mesenteric artery and vein with partial thrombosis of superior mesenteric vein.
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Case
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Dr. Fernando Sánchez - Alicante
Spain
34 years old
Pseudoaneurysm of Gastroduodenal artery
Treatment Placement of Cobra catheter 4Fr in the superior mesenteric artery. Placement of Progreat 2.8 Fr microcatheter further to the pseudoaneurysm. Performing release of AZUR Hydrocoil 0.018”, first of 3mm x 50mm, positioning immediately after another 4mm x 100mm, we finish before the pseudoaneurysm without covering any collateral branch. The verification study confirmed the exclusion of the pseudoaneurysm and good patency of side branches.
Medical history 34 years old male admitted for emergency after traffic accident with multiple injuries, being treated for fractured middle third of left clavicle and left periastragalina dislocation A week later, after performing abdominal-pelvic CT scan for pain and suspected hematoma with pseudoaneurysm, send him to study arteriography and embolization if required.
Arteriography and embolization Arteriography of the celiac trunk compression by arcuate ligament, with hypertrophy of the gastroduodenal arcade, with upward flow from the superior mesenteric artery. Study conducted selective extravasation of contrast is displayed with jejunal branch pseudoaneurysm. We assess the embolization, confirming the presence of collateral circulation that would allow the segment of artery embolization before and after the pseudoaneurysm.
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POST EMB (fig. 4)
Arteriography
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10`POST EMB (fig. 5)
Case
8
Dr. Pedro de la Iglesia - Alicante
Spain
63 years old
Thoracic saccular aneurysm
Treatment - Via right humeral (only possible). To access: 4Fr Simmons II catheter, placement of Progreat 2.8Fr microcatheter getting the sac of the aneurysm and slide safely, five AZUR HydroCoil 0.018”, one 10mm x 20cm, two 20cm x 8mm and two 6mm x 10cm, with result after ten minutes waiting time: complete exclusion of the leak, with progressive disappearance of symptoms and discharged after seven days.
Medical history 63 years old, ex-smoker, hypertension, DLP.Thoracic aortic endograft for saccular aneurysm in 2000.Bypass Fem-Fem in 2005, by Right iliac occlusion.AAA stent graft treated with aortouniiliac graft in 2010.May 2012 chest pain and vegetative box ANGIOTAC-. Thoracic saccular aneurysm, high-density material inside, consistent with active extravasation at the proximal of the thoracic endoprothesis (Leak I). Small pericardial effusion and left pleural effusion compatible with hematic content.
ENDOVASCULAR TREATMENT
ANGIOTAC CONTROL 2011
FINAL RESULTS
PREVIOUS ANGIOTAC 2012
DIAGNOSTIC ANGIOGRAPHY
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Case
8
Dr. Alvarez Luque - Madrid
Spain
36 years old
RENAL ARTERY ANEURYSM
Interest of the case Framing coils leads to a great and safe comfortable HydroCoil delivery. It gets easily adjusted to the sac allowing a very nice HydroCoil packing. (Images 3 and 4)
Clinical history Female 36 years Old Microscopic Hematuria. Incidentally new discovered renal artery aneurysm in a routine US exam . Angiography depicts a medium size (18mm) renal artery aneurysm (Images 1 and 2).
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After 25 minutes there was no evidence of blood flow within the sac. Interlobular artery was permeable. (Image 5). 5
Despite the artifact caused either by the framing and HydroCoil, Angio-CT is a good option in the post-treatment follow up. A 3 months Angio-CT follow up image is shown on image 6 and 7. 1
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Treatment Selective Embolization of the aneurysm sac without damaging the inferior interlobular branch. Material: 1 Framing Coil, 5 Hydrocoils (0,018“) in diameters of 15mm and 2 in diameters of 10mm. The length was 15 cm in all of them. Microcatheter: Terumo Progreat®. 7
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Case
8
Dr. Bravo - Madrid
Spain
58 years old
TITRE TEXTE
Gastroduodenal embolization Clinic history Stage IV rectal adenocarcinoma NATIVE KRAS. (Hepatic) (May 2009). Neoadjuvant XELOX-RT. Liver metastases resection (October 2009). Primary tumor resection (November 2009). Breast Reconstruction transit (November 2009). XELOX-Avastin adjuvant * 4 (end February 2010). Relapse liver (July 2010). FOLFIRI preop * 3. Liver metastasis resection(27/09/2010).
Intrarterial reservoir fixation in gastroduodenal artery
Placement is requested of local QT reservoir for intra-arterial hepatic.
Treatment Procedure: Digestive visceral arteriography (identify extra hepatic vessels dependent on hepatic artery and embolization of the same).Fixing the gastroduodenal artery catheter reservoir to prevent dislocation of the catheter and the resulting distribution of treatment in arterial branches unwanted
Final result, after intrarterial reservoir fixation in gastroduodenal artery
Hydrocoils used: - Detachable AZUR HydroCoil 0.018” 3mm x 5cm (1) - Detachable AZUR HydroCoil 0.018” 4mm x 10cm (3)
Reservoir removed after 6 months One month control. permeable reservoir without dislocation and gastroduodenal artery embolized Detachable AZUR HydroCoil 0.018” 3mm x 5cm 14
Post embolization control
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Case
8
Dr. Bustamante and Dr. Jordá - Santander
Spain
43 years old
Left pulmonary arterio-venous malformation embolization
Microcatheter was then advanced into the remaining artery detaching 4 AZUR HydroCoil 0.018” (8 mm x 10 cm, 6 mm x 20 cm and 2 measuring 4 mm x 15 cm ) (Image 3). Ten minutes after last coil placement angiographic control was performed showing complete occlusion of both feeding branches immediately proximal to the “nidus”, preserving blood flow of branches feeding normal lung (Image 4).
Clinical history Male 43 years old. Hereditary hemorrhagic telangiectasia (HHT). Multiple facial telangiectasias. Frequent episodes of epistaxis. Contrast Echocardiography Grade 4 indicating severe shunt. CT revealed a large pulmonary arterio-venous malformation (PAVM) with 2 feeding arteries in the superior lobe of the left lung.
Treatment In June 2012 pulmonary angiography was performed and once PAVM was located (Image 1 and 2) a Progreat® microcatheter was advanced into the largest artery detaching 5 AZUR HydroCoil 0.018” (10 mm x 20 cm, 8 mm x 20 cm, 8 mm x 10 cm , 6 mm x 20 cm and 4 mm x 15 cm).
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Interest In our opinion AZUR HydroCoil is suitable not only for little PAVM but also for those with greater feeding arteries. High precision detachment allows exact placement of the coils, preserving most of the feeding artery supplying blood flow to normal lung parenchyma.
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Case
8
Dr. Crespo - Madrid
Spain
58 years old
ANEURYSM EMBOLIZED WITH DETACHABLES HYDROCOILS
Treatment Laparoscopic emergency appendectomy Endovascular treatment of the bigger aneurysm with AZUR Framing coil 14x34 + 4 Hydrocoils, one month later
Clinical history Woman 58 y.o. No allergic reactions No relevant medical history No previous surgeries Current status: Right iliac fossa pain from previous day, fever and alteration in the analytic (leucocytes and acute phase reactants) Retrocecal purulent appendicitis. Aneurysm dependent of the right renal artery, proximal to the bifurcation with 1.9 diameter, 5 mm neck( range less than 1/3) There is another small aneurysm 6mm dependent of a lower polar branch. Hepatic hydrated cyst
Framing coil placement
Final Result
Control TC 3 days after the procedure
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Case
8
Dr. Gómez - La Fé
Spain
55 years old
Portal Vein Embolization (PVE)
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Image 1: Both main branches of the portal vein are permeable. Image 2: Direct portography showing the portal tree anatomy and confirming their permeability. Images 3: Three minutes after AZUR HydroCoil were placed a new direct portography is taken. Late images reveal slow flow with partial patency of the embolized branches but no parenchyma staining
Clinical history Woman 58 y.o. No allergic reactions No relevant medical history No previous surgeries Current status: Right iliac fossa pain from previous day, fever and alteration in the analytic (leucocytes and acute phase reactants) Retrocecal purulent appendicitis. Aneurysm dependent of the right renal artery, proximal to the bifurcation with 1.9 diameter, 5 mm neck( range less than 1/3) There is another small aneurysm 6mm dependent of a lower polar branch. Hepatic hydrated cyst
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Procedure Portal vein embolization of the right liver Material: Terumo 4 Fr Radifocus introducer sheath, Terumo 4 Fr Glidecath Simmons I. Bead Block Polyvinyl alcohol hydrogel microspheres in 100-300 and 300-500 μm. Three Hydrocoils (0.035“) in diameters of 10 (two of them) and 12 mm and a length of 20 cm.
Interest of the case
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Hydrocoils demonstrated to have an excellent safety profile and control in detachability to safely occlude the proximal portion of the liver branches Despite using just 1 AZUR HydroCoil, slow flow was seen after direct portography. CT control for volumetry showed left liver volume increase and complete occlusion of the branches embolized by means of AZUR HydroCoil
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Image 4: CT 3 weeks after portal vein embolization complete occlusion of portal branches. Images 5 and 6: Left main portal branch patency with right portal branches occlusion with coils. Right liver lobe atrophy and left liver lobe hypertrophy
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Case
8
Dr. García - La Fé
Spain
69 years old
Nonfunctioning Renal Allograft Embolization
Treatment Selective Embolization of renal graft artery and parenchyma (image 3). Material: PVA spherical (Bead Block) in either the 300-500 and 500-700 μm. One HydroCoil (0.035“) in diameter of 6 mm and a length of 20 cm (image 4 and 5)
Clinical history Male 69 years Old Membrano-proliferative glomerulonephritis (MPGN) and hemodialysis since 2007 . Kidney transplant in 2010. Renal graft artery stenosis with stent placement (images 1 and 2). Impaired kidney function with proteinuria in 2011. Persistent hematuria with graft intolerance syndrome in 2012.
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Interest of the case Hydrocoils combined with PVA embolic microspheres has demonstrated to be a good and safety element for embolization of the non functioning renal graft artery. After only 15 minutes there was no evidence of flow in renal graft artery. (Image 6).
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Case
8
Dr. Van Den Berg - Lugano
Switzerland
49 years old
False Aneurysm between the celiac trunk and the superior mesenteric artery
Case description After a common femoral artery access a 4Fr introducer was placed. With a 4Fr Cobra diagnostic catheter (0.038” lumen) the false aneurysm was cannulated. With the use of a coaxial technique (and a Y-connector) a 2.7Fr Progreat® microcatheter was advanced through the diagnostic catheter, into the false aneurysm. Diagnostic angiography confirmed the absence of side-branches originating from the aneurysm and the vicinity of the neck to the origin of the celiac trunk and superior mesenteric artery. A detachable 0.018” AZUR HydroCoil (diameter 10 mm, length 10 cm) was placed under fluoroscopic guidance (in a 15o anterior oblique projection in order to visualize any protrusion of the coil beyond the neck of the false aneurysm into the aortic lumen.
Medical history A 49 years old female patient, presented with acute abdominal and thoracic pain, highly suggestive of an acute aortic syndrome. A CT-angiography was performed that demonstrated an intramural hematoma of the aorta that extended from the origin of the left subclavian artery to the infrarenal abdominal aorta. A small contrast extravasation (considered to be the entry tear) was seen at the level between the origin of the celiac trunk, and the origin of the superior mesenteric artery. The patient was treated conservatively (anti-hypertensive therapy). A followup CT scan that was performed after 3 months showed complete regression of the intramural hematoma, and persistence of the contrast extravasation, that now appeared like a wide-neck false aneurysm (diameter aneurysm 7 mm x 12 mm, neck diameter 7 mm), originating between the celiac trunk and superior mesenteric artery.
A surgical reconstruction was considered to be impossible, mainly due to the location of the false aneurysm, and therefore it was decided to perform an endovascular procedure.
After placement of a single coil a control angiography using cone beam CT demonstrated absence of filling of the aneurysm. Hemostasis was obtained with manual compression. The patient was discharged without complications on the same day.
Case description The detachable 0.018” AZUR HydroCoil can be precisely and reliably placed in cases of wide neck false aneurysms. Due to its compatibility with 4Fr catheters (using a coaxial microcatheter) the detachable 0.018” AZUR HydroCoil allows for treatment on an outpatient basis, without requiring arterial closure devices.
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