Symptomatic spontaneous celiac and hepatic artery dissection is a rare condition. It is not known which treatment modalities are the most appropriate. Here, the case of a 64-year-old man who presented to us with a several-month history of epigastralgia is reported. Computed tomography (CT) revealed a fusiform dilated dissection of the celiac and hepatic arteries with a flap. Because of the size of the dissection and the refractory symptoms, an endovascular stent implantation was performed. Eight months after the procedure, CT scans showed a new aneurysmal formation at the proper hepatic artery near the distal edge of the stent. The dissection was isolated by coil packing. This case suggests that endovascular treatment can be feasible in symptomatic patients with isolated spontaneous celiac and hepatic artery dissection.
A 56-year-old man presenting with abdominal pain had an elevated serum immunoglobulin 4 (IgG4) concentration. Computed tomography angiography revealed a celiacomesenteric trunk aneurysm with wall. After admission, the celiacomesenteric trunk aneurysm grew rapidly along with wall thinning. Emergency transcatheter arterial embolization was completed using detachable coils. After transcatheter arterial embolization, the patient's abdominal pain disappeared completely. Steroid administration, which continues to the present day, was started 1 month after the transcatheter arterial embolization. No clinical symptoms associated with recurrent arteritis or other IgG4-related disease have been confirmed.
A 44-year-old man fell off a cliff and was taken to a community hospital. He was a non-responder and was transferred to our tertiary care hospital. Contrast-enhanced computed tomography images revealed a right renal vein injury and a massive retroperitoneal hemorrhage. Angiography of the right renal artery showed extravasation during the venous phase; therefore, the artery was immediately embolized with N-butyl cyanoacrylate and coils. Subsequently, nephrectomy was performed. Arterial embolization of the renal artery for a renal vein injury in a patient with hemodynamic instability may be effective as a damage-control interventional radiology bridge to emergency nephrectomy.
We report a case of successful treatment of an intractable large biloma induced by transcatheter arterial chemoembolization with beads for hepatocellular carcinoma. First, percutaneous drainage was performed for the biloma but the volume of discharge continued at > 300 ml per day for 12 days. We were unable to approach the proximal bile duct from the biloma. We performed sclerosis of the biloma with ethanolamine oleate, after which the volume of drained bile was markedly decreased. After this sclerotherapy, we were able to advance the catheter into the proximal bile duct from the biloma. Subsequently, internal drainage with a metallic stent was successful, and the biloma was resolved. The patient's course has been uneventful for the 2 years since the stent placement.
Two patients with life-threatening spontaneous hemopneumothorax had developed transpleural, nonbronchial, systemic collaterals from branches of the subclavian artery. It was thought that the collaterals had ruptured due to a collapsed lung and pneumothorax. Transarterial embolization of these arteries was performed, and hemostasis was obtained with no complications. A 37-year-old man underwent embolization of branches of the left internal thoracic artery and the left ascending cervical artery using gelatin sponges and metallic coils. A 33-year-old man underwent artery embolization for extravasation from a branch of the right thyrocervical trunk using n-butyl cyanoacrylate mixed with Lipiodol. Transarterial embolization of a transpleural, nonbronchial, systemic artery provided effective hemostasis in life-threatening spontaneous hemopneumothorax.
A 50-year-old woman with liver dysfunction complained of back pain. Computed tomography showed multiple fusiform aneurysms in the right and left hepatic arteries. As she was hemodynamically stable, antihypertensive therapy was selected to reduce the risk of rupture. During hospitalization, spontaneous and progressive thrombosis formation of multiple hepatic artery aneurysms was observed. She was diagnosed with segmental arterial mediolysis based on her clinical course and imaging findings, and she was discharged after 48 days. One year following discharge, computed tomography showed complete recovery and patent, normal hepatic arterial branches. Segmental arterial mediolysis should be considered as a condition that can cause multiple hepatic artery aneurysms, which can be treated successfully with antihypertensive therapy and careful follow-up observation with imaging when the patient's hemodynamic state is stable.
Malecot catheters have been widely accepted for use during nephrostomy, abscess drainage, and with gastrostomy tubes. Malecot catheters may occasionally be resistant to extraction because of tissue entrapment. Although entrapped catheters are typically removed using traction, this method may be unsuccessful in a few cases, which therefore become difficult to manage. We present 3 cases of entrapped Malecot catheters and discuss the interventional techniques used to treat these patients.