Arab Cadriovascular Journal

PULSATILITY INDEX AS A PREDICTOR OF SIGNIFICANT ILIAC DISEASE

AbdulRahman AlBlooshi, Sudhir Nagpal — Sat, 22 Dec 2012 00:00:00 +0000

Objective: To study the correlation between Pulsatility Index (PI) and the presence of significant (>50%) stenosis of inflow vessels.
Design: Single centre, Retrospective study.
Patients: Between Jan 04 May, 05 all patients who had Doppler arterial studies followed by diagnostic angiograms were analyzed. N=176, 352 limbs.
Results: Using Logistic Regression, Smoking and PI were found to be significant indicators of >50% stenosis of the inflow vessels. PI < 2 correlated with > 50% inflow disease (p<.0001). Furthermore, PI < 3 correlated with > 50% inflow disease (p<.0001). Theses results were verified for Left and Right sides independently.
Conclusions: Pulsatility Index is a good method to detect significant (>50%) inflow disease. Use of Duplex U/S is recommended in all patients undergoing peripheral angiograms/Endovascular procedures to facilitate proper time and resource allocation in cases that might need concomitant intervention either in the Angio suite or the OR.

ENDOVASCULAR MANAGEMENT OF MAY-THURNER SYNDROME

Wael Ibrahim, Zakareya Al Safran, Hosam Hasan, Wael Abu Zeid — Tue, 25 Dec 2012 00:00:00 +0000

May-Thurner syndrome or iliac vein compression syndrome is deep vein thrombosis resulting from chronic compression of the left iliac vein against lumbar vertebrae by the overlying right common iliac artery. Historically, the treatment for patients with iliac vein compression syndrome has been anticoagulation therapy. When given alone, however, this therapy can be problematic because it prevents the propagation of the thrombus without eliminating the existing clot. Furthermore, it does not treat the underlying mechanical compression. Consequently, when deep vein thrombosis is treated with anticoagulation therapy alone, there is a significant chance that the patient will develop recurrent deep vein thrombosis or post thrombotic syndrome or both. Recently, both retrospective and prospective studies have suggested that endovascular management should be front-line treatment; endovascular management actively treats both the mechanical compression with stent placement and the thrombus burden with chemical dissolution. We report our case of 53y old male patient with May Thurner syndrome managed by endovascular treatment.

TREATMENT OF SYMPTOMATIC UTERINE FIBROIDS WITH UTERINE ARTERY EMBOLIZATION

Wael Ibrahim, Zakareya Al Safran, Hosam Hasan, Wael Abu Zeid — Sun, 25 Nov 2012 00:00:00 +0000

Uterine fibroids are the most common solid tumors of female genital tract ;they develop in 20%–40% of women of childbearing age [1] . The true prevalence of uterine fibroids is unknown, because more than 50% of these tumors are asymptomatic [2] .
Twenty percent to 30% of hysterectomies are performed to treat uterine fibroids that cause bleeding, pelvic pain, and/or refractory anemia [3] .However, therapeutic alternatives to hysterectomy exist for patients with these neoplasms. A primary
alternative is treatment with gonadotropin-releasing hormone agonists, alone or in combination with more conservative surgical treatments, such as myomectomy or myolysis. Gonadotropin-releasing hormone agonists have not been proven to be a definitive solution [4] . Uterine artery embolization (UAE) was introduced in 1995 [5].since that time it has been described as an alternative to hysterectomy for the management of non-acute uterine hemorrhage caused by fibroids [6]0 . The aim of our
study is to evaluate the efficiency of uterine artery embolization in treatment of symptomatic uterine fibroids.

INTERVENTIONAL RADIOLOGICAL MANAGEMENT OF EX- TREMITIES ARTERIOVENOUS MALFORMATION

Wael Ibrahim, Hana Mohamed Bassurrah — Mon, 26 Nov 2012 00:00:00 +0000

Arteriovenous malformations represent a direct connection between the arterial and the venous systems. AVMs are usually present at birth but may not be clinically evident. They become evident in childhood and are often exacerbated during puberty or pregnancy.Closer examination reveals increased temperature, dilated veins, and a thrill that is usually noted at palpation. These lesions can be dangerous when they are in evolution. Cutaneous ischemia with ulceration or infection and haemorrhage are the most common local complications. If the malformation is extensive, high-output cardiac failure can be seen. Vascular malformations of the extremities present a difficult therapeutic challenge. Ligation of feeding vessels may lead to tissue necrosis and limb loss and can make subsequent attempts at transcatheter therapy impossible. The purpose of this study was to review our results with transcatheter and percutanous embolization therapy in symptomatic extremities vascular malformations in 30 patients seen at our interventional unite.

INTERVENTIONAL RADIOLOGY MANAGEMENT OF HEPATOCELLULAR CARCINOMA

Wed, 01 May 2019 00:00:00 +0000

The purpose of this article is to present the early results of single centre trial using drug eluting beads loaded with chemotherapeutic agents for transarterial chemoembolization (TACE) in patients with un-resectable hepatocellular carcinoma. From December 2006 to March 2011, 50 patients (33 male and 17 female), with mean age 67.8 years (45-82) were treated by selective TACE using drug eluting beads (DEB) loaded with doxorubicin. The diameter of the treated lesions ranged from 3.5 to 11.5 mm (mean 52.5mm; maximum of 4 tumor nodules). Tumor response was evaluated by either multiphasic computed axial tomography (CT) or MRI according to the European Association for the Study of the Liver criteria. All of the procedures were technically successful, and there were no major complications. At 1-month follow-up, objective response was observed in 62%, then increased to 75% and 80% after second and third session of embolization. TACE with (DEB) loaded with doxorubicin was successfully repeated twice in 20 patients, whereas 5 patients underwent the procedure 3 times. Our initial single centre experience retrospective analysis demonstrates that TACE using (DEB) is feasible, is well tolerated, has a low complication rate, and is associated with promising tumor response. When complete tumor response in not achieved, additional treatments can be performed without difficulties.

EMBOLISATION OF A LEAFLET OF A PROSTHETIC MITRAL VALVE TO THE RIGHT COMMON ILIAC ARTERY

Ahmed Mohamed Taher Ghanem — Tue, 20 Nov 2012 00:00:00 +0000

I NTRODUCTION : The embolisation of prosthetic heart valve is an extremely rare condition and when occurred is considered as a surgical emergency.
Presentation of the Case: In this report, we describe a 38 year old female patient presented to the hospital with carcinogenic shock. Exclusion of arrhythmias and myocardial infarction was done. Also, pulses were equal on both lower limbs. The
medical history of the patient showed surgical replacement of the mitral valve with a prosthetic one since two years. Echocardiography showed a malfunctioning mitral valve. CT scan showed presence of a leaflet of the mitral valve in the right common iliac artery. The mitral valve was re replaced, and then escaped leaflet was retrieved surgically.
Discussion: The embolisation of part of mitral valve was reported previously a rare surgical emergency. The extraction of the embolised valve was described.
Conclusion: In this paper, we document with medical imaging a rare case of prosthetic mitral valve embolisatio. The importance of echocardiography and CT scan in the diagnosis has been emphasised. The urgent management of the case including the retrieval of the mitral leaflet from the right coronary artery is described.

ENDOVASCULAR MANAGEMENT OF GIANT SPLENIC ANEURYSM WITH ARTERIOVENOUS FISTULA

Wael Ibrahim, Hana Basourah — Sun, 25 Nov 2012 00:00:00 +0000

Although splenic artery aneurysm is the commonest visceral and third most common intra abdominal aneurysm after aorta and iliac artery, aneurysm of splenic artery along with aneurysm of splenic vein and arteriovenous fistula is a rare entity. Most of them are <3 cm in diameter. Giant true splenic artery aneurysms are rare and very few lesions >10 cm have been reported. We report a case of an 11 cm x 8 cm size splenic artery and vein aneurysm with arteriovenous fistula. To the best of our knowledge, this is the 1st case of giant splenic aneurysm with arteriovenous fistula managed by endovascular treatmen.

MANAGEMENT OF POST-TRAUMATIC PRIAPISM BY SUPERSELECTIVE EMBOLIZATION

Wael Ibrahim, Hana Basourah — Sun, 25 Nov 2012 00:00:00 +0000

Priapism is a prolonged penile erection not associated with sexual arousal. Two types of priapism have been described: the more common one is the "veno-occlusive" priapism and can be frequently observed as the consequence of an intracavernosal
injection of vaso-active drugs for the treatment of erectile dysfunction. The less common type of priapism is known as "high flow" priapism. The most frequent cause of high-flow priapism is penile or perineal closed trauma with laceration of the
cavernous artery and the formation of an arterial-lacunar fistula. We present a 23 year old male with high-flow priapism due to closed perineal trauma and damage to the right cavernous artery which was completely resolved following super-selective angiography and embolization treatment