A male in his seventy’s had been incidentally diagnosed with a large arteriovenous malformation (AVM) of the right kidney of the high-flow type. We tried to embolize this large aneurysmal type AVM by arterial and venous occlusion with dual balloon catheters. However, the patient developed a shock state immediately after inflation of the dual balloon catheters. CT immediately after this event showed massive hemorrhage in the perirenal space. TAE using detachable coils and N-butyl cyanoacrylate with Lipiodol was used rapidly and the patient recovered.
The intraprocedural rupture might be caused by a sudden arterial flow into the aneurysm blocked the outflow by the balloon via the venous approach due to the migration of the inflated balloon via arterial approach.
We discussed about the treatment strategy of the large aneurysmal type AVM of the Kidney.

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Recently, endovascular treatment of visceral aneurysm has become popular. In most cases, recurrence following sac packing of visceral aneurysm is attributed to coil compaction; however aneurysm regrowth has also been proposed as a potential mechanism. We report a rare case of aneurysm regrowth after sack packing of renal artery aneurysm. After embolization, regrowth of aneurysm adjacent to the neck of the aneurysm occurred. Additional embolization of the parent artery as well as sack packing was performed.

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We report two cases of symptomatic arteriovenous malformations (AVMs) with dominant outflow veins (DOV), categorized as type-II AVM, according to the Cho classification. The first case was a large posterior thigh AVM involving the hamstring, mainly biceps femoris muscle. In the prone position, several DOVs were embolized by direct needle puncture using pushable fibered coils in combination with n-butyl cyanoacrylate or ethanol. After two sessions, angiography revealed disappearance of the AVM. The second case was an AVM in the left pelvic cavity. The DOV was embolized retrogradely by transvenous approach using detachable coils and ethanol. AV shunting was significantly reduced, and pain relief was obtained shortly after wards. We consider that symptomatic type-II AVM of the extremity and trunk can be successfully treated by appropriate anatomical assessment, embolization approach and choice of embolic agents.

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A woman in her thirties with renal arteriovenous fistula was pointed out by medical health checkup. Contrast enhanced CT (CECT) revealed a huge renal venous sac (7cm in diameter) along the left renal vein due to an arteriovenous fistula. Percutaneous embolization was chosen by consensus among the patient, urologists and radiologists. The embolization was simply completed by plug and coils. After the embolization, heparin was administered due to extremely slow flow in the left renal vein sac. On day 1 post embolization, the patient complained of back pain. Therefore US Doppler was performed. During the US exam, the patient became unconsciousness and developed shock. CECT showed massive pulmonary embolization and huge thrombus in the left renal vein sac. After a tPA injection, the patient immediately recovered. Then the renal venous reefing and thrombectomy were conducted. However, the renal venous thrombus recurred and heparin induced thrombocytopenia type II was diagnosed. Finally, total nephrectomy was undertaken. The postoperative course was uneventful.

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Here we describe a rare case of an external iliac arterial injury with a pseudoaneurysm due to a pelvic fracture sustained in a traffic accident. Although the external iliac arterial injury was treated by the placement of a covered stent, which preserved the native blood flow, this arterial blood flow was occluded by a pseudoaneurysm. The cause of the occluded external iliac artery was partially demonstrated by an extravascular placement of the covered stent. The occluded external iliac artery was additionally treated by an external iliac-common femoral arterial bypass surgery following internal iliac artery embolization for contrast extravasation. One of the treatment options for an external iliac arterial injury is the placement of a covered stent. The advantages of this procedure are that it preserves native arterial blood flow and is minimally invasive. However, a covered stent placement should be used with care and precision, especially when the injury is to the external iliac artery adjacent to the common femoral artery. In addition, an external iliac arterial injury only occasionally occurs after a pelvic fracture.

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Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between the pulmonary arteries and veins without any intervening capillary beds, and cause hypoxemia, cyanosis, dyspnea, and neurologic complications consisting of trans ischemic attack, stroke, and brain abscess. Thus, treatment for PAVMs is justified even for asymptomatic ones, and recently transcatheter embolization has become a common procedure. Meanwhile, complications can occur during embolization such as chest pain, cerebral infarction, and migration of the embolic material. Furthermore, persistence after the successful embolization is also an important issue. However, there are some other pitfalls. Herein, we introduce two complex cases of embolization for PAVM.

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Many organs are tightly located within the pelvis, and vascular lesions such as arteriovenous malformation or large aneurysm located within the pelvis can potentially involve the surrounding organs which may aggravate the complexity of the lesion. Surgical option in this field can be highly invasive, and therefore, endovascular management based on embolization is an alternative option. However pelvic vascular lesions can be large and complex and they often necessitate a dedicated treatment strategy from the long-term standpoint. Here we present two cases of complicated vascular lesions treated by embolization. One is a case of arteriovenous malformation, and another is a large aneurysm of the internal iliac artery with arteriouterine fistula. Both case were successfully treated with special attention in the complicated vascular anatomy of the pelvis.

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We report a case of recurrent renal artery aneurysm after endosaccular packing with coils. A 60-year-old female incidentally diagnosed with left renal artery aneurysm was referred to our department. Post contrast CT revealed a wide-neck aneurysm at the ventral branch of the left renal artery. The upper polar branch was involved by the dome of the aneurysm. Endosaccular packing of the aneurysm was performed while preserving the parent artery and upper polar branch, which resulted in minimal dome filling on the renal angiography immediately after embolization. Two years after embolization, coil compaction and reperfusion of the dome of the aneurysm were detected on MR angiography. A second endosaccular embolization was performed using balloon-assist technique, and complete occlusion was achieved while preserving the parent artery and upper polar branch. No recurrent aneurysm was observed during the 4-year follow-up period.

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