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 transient ischemic attack, stroke, and brain abscess. Thus, treatment for PAVMs is justified even for asymptomatic ones, and recently transcatheter embolization is a common procedure. However, recurrence can occur after the embolization, and attributed to recanalization, pulmonary-to-pulmonary reperfusion, incomplete primary treatment and systemic-to-pulmonary reperfusion. The recurrence may induce neurologic complications, and so it is necessary to perform transcatheter embolization without recurrence. Recanalization is the most frequent recurrence and tight packing is important to prevent it.
Prediction of postoperative cerebral infarction after cardiovascular surgery is difficult. The present study investigated whether quantitative evaluation of preoperative cerebral blood flow used in the Japanese EC-IC Bypass Trial (JET) study is useful for the prediction of postoperative cerebral infarction after cardiovascular surgery. First, patients were divided into two groups based on preoperative cerebral blood flow. In an evaluation using preoperative imaging, patients with good or mildly decreased preoperative cerebral blood flow, divided into clinical stage I or II by quantitative evaluation showed no postoperative cerebral infarction. However, 24% of patients with poor cerebral blood flow who were categorized as clinical stage II, experienced postoperative cerebral infarction. The incidence rate was not statistically significantly different when the groups were compared. Second, patients were divided into two groups based on the anatomical area of the brain affected corresponding to clinical stage II. Patients with a 10% and greater brain involvement had a significantly higher incidence of postoperative cerebral infarction (38%) compared to others (0%, p<0.01). This method may be useful for the prediction of postoperative cerebral infarction after cardiovascular surgery, but a further prospective study is needed.
Extracorporeal shock wave lithotripsy (ESWL) is widely used for ureteric and renal calculi. Complication rates associated with ESWL are low. We report a case of abdominal aortic pseudoaneurysm due to ESWL. A 70-year-old man had received ESWL treatment for ureteral stone eight years ago. He was referred with abdominal aortic aneurysm. Computed tomography revealed a 30 mm mass lesion which was adjacent to abdominal aorta. We performed open repair. The mass was pulsatile. There was a hole in posterior wall of aorta. We diagnosed it as a pseudoaneurysm. He had no history of trauma, inflammation or operation except ESWL.