CASE PRESENTATION: We present a case of a highly vascular giant SCT in a neonate, which was successfully embolized through an endovascular approach prior to surgery. The femoral artery approach was chosen, with access established using a Micropuncture introducer as a sheath. Embolization was performed using a combination of microcoils, Gelfoam slurry, and polyvinyl alcohol particles. The patient developed femoral artery spasm post-procedure, which resolved with the application of a glyceryl trinitrate patch.
CONCLUSIONS: Performing pre-operative endovascular embolization on a giant sacrococcygeal teratoma presents particular challenges, primarily due to the difficulty in assessing small vessels and the potential complications associated with this procedure. Nevertheless, this technique proves exceptionally valuable in helping the surgeon minimize blood loss during surgery, thereby reducing the risks of morbidity and mortality. Comprehensive planning for the embolization procedure is essential, encompassing the identification of potential vascular access points and alternatives, along with careful selection of the appropriate catheter.
METHODS: We present 2 cases in which we encountered premature intravascular detachment of the microcatheter tip and coil migration while treating a dural arteriovenous fistula and aneurysm, respectively. We used a stentriever to remove the detached microcatheter tip and suction using the reperfusion catheter to remove the migrated coil, both techniques that have not been reported in the literature thus far.
RESULTS: Detached microcatheter tip and migrated coil were successfully retrieved using a stentriever and aspiration catheter.
CONCLUSIONS: These novel techniques could potentially reduce mortality and morbidity associated with neurointervention.
CASE DETAILS: In the present case, the fracture was suspected during the process of removal. The tip of the catheter was notably missing, and an emergency chest radiograph confirmed our diagnosis of a retained fracture of central venous catheter. The retained portion was removed by the interventional radiologist using an endovascular loop snare and delivered through a femoral vein venotomy performed by the surgeon.
CONCLUSION: Endovascular approach to retrieval of retained fractured catheters has helped tremendously to reduce associated morbidity and the need for major surgery. The role of surgery has become limited to instances of failed endovascular retrieval and in remote geographical locations devoid of such specialty.
PATIENT CONCERNS: A 73-year-old Asian gentleman with underlying hypertension, hyperlipidaemia, chronic renal failure, and history of chronic smoking presented to the emergency department with acute left lower limb swelling of 1 day. On examination, the patient was tachycardic (110 beats/minute) and hypertensive (168/84 millimeters mercury (mmHg)). The entire left lower limb was swollen with notable pitting oedema, tenderness, and warmth; left calf swelling was measured to be 4 centimeters (cm).
DIAGNOSES: The patient's Wells score of 4 placed him in the high-risk group for deep vein thrombosis. Serum D-dimer was subsequently found to be elevated at 926 nanograms/milliliter (ng/ml). Compression ultrasonography revealed a thrombus in the left deep femoral vein, confirming the diagnosis of deep vein thrombosis. The ultrasonographic evaluation was extended to the abdominal aorta due to the patient's high risk of abdominal aortic aneurysm, and a 7-cm aneurysm was indeed found. Further computed tomography and magnetic resonance imaging localized it to the infrarenal region, with left common iliac vein compression resulting in stagnant venous return.
INTERVENTIONS: Emergency endovascular repair was performed with insertion of an inferior vena cava filter.
OUTCOMES: The patient was subsequently monitored in the intensive care unit and uneventfully discharged after 2 weeks.
LESSONS: Such clinical presentations of deep vein thrombosis are rare, but physicians are reminded to consider screening for abdominal aneurysms and other anatomical causes before heparinization in patients who seemingly do not have thromboembolic risk factors. This is especially so for the high risk group of male deep vein thrombosis patients aged 65-75 years with a history of smoking who have yet to be screened for abdominal aortic aneurysms, in line with United States Preventive Services Task Force recommendations.
BACKGROUND: BeGraft Aortic stent (Bentley InnoMed, Hechingen, Germany) allows large postdilation diameter up to 30 mm. With availability of lengths of 19-59 mm and lower stent profile, they can be used in native and recurrent CoA in adults and in pediatric patients.
MATERIALS AND METHODS: This is a multicentre retrospective analysis of 12 implanted BeGraft Aortic stents in CoA between May 2017 and April 2019.
RESULTS: Twelve patients aged 7.7-38 years (median 18.3 years) with body weight of 19.9-56 kg (median 45.5 kg). Eight patients (66%) had native juxtaductal CoA while four had recurrent CoA after previous surgical or transcatheter treatments. The stents were implanted successfully in all the patients with no serious adverse events. The length of the stents ranged from 27 to 59 mm and the implanted stent diameter varied from 12 to 18 mm. The median intraprocedural CoA pressure gradient decreased from 25 mmHg (range 16-66 mmHg) to 2 mmHg (range 0-13 mmHg). The mean follow-up duration was 10.2 months. Two patient (16.6%) had residual stent narrowing requiring staged redilation. One patient (8%) had pseudoaneurysm formation at 1 year cardiac CT follow-up.
CONCLUSIONS: The BeGraft Aortic stent may be considered to be safe and effective in the short term in treatment of CoA from childhood to adulthood. Long-term follow-up is needed.
Conclusion: This form of treatment provides a less-invasive option with a more concrete evaluation of the venous abnormality and its drainage during venous aneurysm occlusion.