Segmental artery injury during transforaminal percutaneous endoscopic lumbar discectomy:Two case reports

BACKGROUND Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus,percutaneous endoscopic lumbar discectomy(PELD)has been developed.The branch of the segmental artery around the neural foramen may be damaged during PELD using the transforaminal approach.We report 2 rare cases in which segmental artery injury that occurred during PELD was treated with emergency embolization.CASE SUMMARY In case 1,a 31-year-old man was transferred to our emergency department with left lower quadrant abdominal pain after PELD at a local hospital.Lumbar spine magnetic resonance imaging after the surgery showed a hematoma of the left retroperitoneal area and the psoas muscle area.Under suspicion of vascular injury,arteriography was performed.Pseudoaneurysm and blood leakage from the left 4th lumbar segmental artery into the abdominal cavity were identified.Emergency transarterial embolization was performed using fibered microcoils for bleeding of the segmental artery.In case 2,a 75-year-old woman was transferred to our emergency department with low blood pressure,right flank pain,and drowsy mental status after PELD at a local hospital.When the patient arrived at the emergency room,the blood pressure decreased from 107/55 mmHg to 72/47 mmHg.Low blood pressure persisted.Under suspicion of vessel injury,arteriography was performed,and the right 4th lumbar segmental artery rupture was confirmed.Emergency transarterial embolization was performed for bleeding of segmental artery.CONCLUSION We were able to find the bleeding focus by angiography and treat the injury of the segmental artery successfully through emergency transarterial embolization.

Ruptured gastric artery aneurysm:An uncommon manifestation of microscopic polyangiitis

Gastric artery aneurysm is a rare and lethal condition,and is caused by inflammatory or degenerative vasculopathies.We describe herein the clinical course of a patient with a ruptured gastric artery aneurysm associated with microscopic polyangiitis.Absence of vasculitic changes in the aneurysm resected and negative results of autoantibodies interfered with our diagnostic process.We should have adopted an interventional radiology and initiated steroid therapy promptly to rescue the patient.

Treatment of Dissection at the Ophthalmic Segment of Internal Carotid Artery

Objective Intracranial internal carotid artery dissection is a rare case. The purpose of this study was to report the treatment of intracranial internal carotid dissection and the radiologic and clinical result.Material And Method A 67 year-old female patient admitted for lower leg fracture at the outside university hospital. After 6 days later, she presented with left hemiparesis, verbal disturbance and visual disturbance. She transferred to our hospital and evaluated with MRI and Angiography. Angiography show stenosis with ulceration and pseudoaneurysm at the internal carotid artery. The stenosis rate was 63%. At the lesion, ophthalmic artery was poor visualized. Results The intracranial lesion was treated with angioplasty and stenting. After stenting, angiography showed good ophthalmic artery flow. Patients improved visual acuity just after stenting. Conclusions Intracranial angioplasty and stenting will be a good treatment option in a highly selected case.

A Case of A1 Wide-necked Aneurysm Embolization via the Front Communicating Artery

With the development of radiography,especially digital subtraction cerebrovascular angiography,which is widely used in clinical practice,interventional embolization of intracranial aneurysms has become more and more popular due to its advantages of minimal invasiveness,high efficiency,and rapid postoperative recovery.The choice of patients,often we have to formulate an unconventional and individualized treatment plan based on the specific conditions of each patient’s blood vessel.This case is a segment A1 aneurysm of the right anterior cerebral artery.Due to its special location and wide diameter,in order to reduce the difficulty and risk of the operation during the operation,a bilateral internal carotid artery approach was developed to complete the stent-assisted procedure and special treatment plan for aneurysm embolization.

A diagnostic dilemma:acute abdomen presenting as segmental arterial mediolysis masked by a ruptured hepatocellular carcinoma

A 65-year-old male was brought to our hospital with right upper abdominal fullness sensation and recent body weight loss of about 3 kg.The patient had developed episodes of melena following progressive abdominal muscular guarding and drop of haemoglobin level to 6.3 g/dL.An abdominal computed tomography scan disclosed a ruptured hepatocellular cell carcinoma.A segmental arterial mediolysis was found on the superior mesenteric artery in the process of repairing the ruptured right hepatic artery with the assistance of angiography.Transarterial embolization was carried out and permanent haemostasis was achieved.