Spinal dural arteriovenous fistulas (SDAVF) account for about 70% of all spinal AV shunts. We re-port on a 56-year-old male patient with progressive neurological symptoms. Pre- and post-contrast MR imaging of the spin...Spinal dural arteriovenous fistulas (SDAVF) account for about 70% of all spinal AV shunts. We re-port on a 56-year-old male patient with progressive neurological symptoms. Pre- and post-contrast MR imaging of the spine, including contrast-enhanced MR angiography was done on a 1.5 T MR scanner. In addition a special (pre-contrast) 3D turbo-spin-echo sequence with variable flip angle evolution (SPACE) was performed providing a slice thickness of 0.9 mm. T2-weighted images showed extensive widened and tortuous vascular structures with typical flow voids intradurally due to dilated pial veins. The origin of the spinal dural arteriovenous fistula was found to be the radiculomeningeal artery at level D10/11 on the left side, visualized by the T2-weighted 3D SPACE sequence and CE MRA. After imaging the patient was referred to an interventional neuroradiology department for therapy. With the detailed information from MR imaging concerning the fistula level the interventional radiologist was able to find the fistula immediately and consequently treated it successfully by endovascular therapy. Interpreting the MR images of this obvious case of a SDAVF, SPACE sequence after post processing with 3D MPR software directly led to the location of the AV shunt at D10/11 on the left side, better than 3D contrast-enhanced MR angiography did. Therefore, SPACE can be a useful adjunct in further evaluation of spinal dural arteriovenous fistula and especially in defining fistula level.展开更多
BACKGROUND In the modern era of endovascular surgery percutaneous interventions are being widely used to treat a number of vascular disorders including arteriovenous fistulas(AVF).Still,patients with hostile anatomy o...BACKGROUND In the modern era of endovascular surgery percutaneous interventions are being widely used to treat a number of vascular disorders including arteriovenous fistulas(AVF).Still,patients with hostile anatomy or complicated cases such as large post-traumatic AVFs may be successfully treated using conventional vascular surgery.CASE SUMMARY This paper presents state-of-the-art treatment options in subjects with posttraumatic AVFs and a case-report of a successful open surgical approach in a patient with a 25 year old history of a post-traumatic AVF between the common femoral artery and common femoral vein.CONCLUSION Open surgery is still a great option to treat patients with post-traumatic arteriovenous fistulas with hostile anatomy or in complicated cases.Concomitant conditions and complications should be addressed promptly.展开更多
Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of<1%.This is due to the advancements and wide availability of ultrasound to gu...Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of<1%.This is due to the advancements and wide availability of ultrasound to guide its insertion.Formation of arteriovenous fistula after arterial puncture is an unexpected complication.Till date,only five cases(including this case)of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture.The present case is a 26-year-old man sustained traumatic brain injuries,chest injuries and multiple bony fractures.During resuscitative phase,attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery.Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula.The catheter was removed successfully and common carotid artery was repaired.Postoperatively,the patient recovered and clinic visits revealed no neurological deficits.From our literature review,the safest method for removal is via endovascular and open surgical removal.The pull/push technique(direct removal with compression)is not recommended due to the high risk for stroke,bleeding and hematoma formation.展开更多
文摘Spinal dural arteriovenous fistulas (SDAVF) account for about 70% of all spinal AV shunts. We re-port on a 56-year-old male patient with progressive neurological symptoms. Pre- and post-contrast MR imaging of the spine, including contrast-enhanced MR angiography was done on a 1.5 T MR scanner. In addition a special (pre-contrast) 3D turbo-spin-echo sequence with variable flip angle evolution (SPACE) was performed providing a slice thickness of 0.9 mm. T2-weighted images showed extensive widened and tortuous vascular structures with typical flow voids intradurally due to dilated pial veins. The origin of the spinal dural arteriovenous fistula was found to be the radiculomeningeal artery at level D10/11 on the left side, visualized by the T2-weighted 3D SPACE sequence and CE MRA. After imaging the patient was referred to an interventional neuroradiology department for therapy. With the detailed information from MR imaging concerning the fistula level the interventional radiologist was able to find the fistula immediately and consequently treated it successfully by endovascular therapy. Interpreting the MR images of this obvious case of a SDAVF, SPACE sequence after post processing with 3D MPR software directly led to the location of the AV shunt at D10/11 on the left side, better than 3D contrast-enhanced MR angiography did. Therefore, SPACE can be a useful adjunct in further evaluation of spinal dural arteriovenous fistula and especially in defining fistula level.
文摘BACKGROUND In the modern era of endovascular surgery percutaneous interventions are being widely used to treat a number of vascular disorders including arteriovenous fistulas(AVF).Still,patients with hostile anatomy or complicated cases such as large post-traumatic AVFs may be successfully treated using conventional vascular surgery.CASE SUMMARY This paper presents state-of-the-art treatment options in subjects with posttraumatic AVFs and a case-report of a successful open surgical approach in a patient with a 25 year old history of a post-traumatic AVF between the common femoral artery and common femoral vein.CONCLUSION Open surgery is still a great option to treat patients with post-traumatic arteriovenous fistulas with hostile anatomy or in complicated cases.Concomitant conditions and complications should be addressed promptly.
文摘Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of<1%.This is due to the advancements and wide availability of ultrasound to guide its insertion.Formation of arteriovenous fistula after arterial puncture is an unexpected complication.Till date,only five cases(including this case)of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture.The present case is a 26-year-old man sustained traumatic brain injuries,chest injuries and multiple bony fractures.During resuscitative phase,attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery.Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula.The catheter was removed successfully and common carotid artery was repaired.Postoperatively,the patient recovered and clinic visits revealed no neurological deficits.From our literature review,the safest method for removal is via endovascular and open surgical removal.The pull/push technique(direct removal with compression)is not recommended due to the high risk for stroke,bleeding and hematoma formation.
