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Superselective arterial embolization of pseudoaneurysm and arteriovenous fistula caused by transurethral resection of the prostate.

Celtikci P, Ergun O, Tatar IG, Conkbayir I, Hekimoglu B - Pol J Radiol (2014)

Bottom Line: The most common cause is traumas including those of iatrogenic origin.It was successfully treated with coil embolization.Minimally invasive endovascular methods provide safe and efficient treatment and today should be considered as the first line of choice.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.

ABSTRACT

Background: Pelvic vascular lesions such as pseudoaneurysms and arteriovenous fistulas associated with the internal pudendal artery are uncommon. The most common cause is traumas including those of iatrogenic origin. Surgical treatment is complicated due to location of the lesions and endovascular approach is usually the first choice among the treatment options.

Case report: A 79-year-old patient was admitted with massive hematuria following transurethral resection of prostate for benign prostatic hyperplasia. Doppler US and angiography revealed a pseudoaneurysm and arteriovenous fistula originating from the right internal pudendal artery. It was successfully treated with coil embolization.

Conclusions: Arteriovenous fistulas and pseudoaneurysms concerning internal pudendal artery may occur as complications of prostate operations. Minimally invasive endovascular methods provide safe and efficient treatment and today should be considered as the first line of choice.

No MeSH data available.


Related in: MedlinePlus

A control angiogram of the right internal pudendal artery showed no evidence of pseudoaneurysm or AVF.
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f4-poljradiol-79-352: A control angiogram of the right internal pudendal artery showed no evidence of pseudoaneurysm or AVF.

Mentions: A 79-year-old male patient with a history of benign prostatic hyperplasia was admitted to urology outpatient clinic with globe vesicale. The patient was hospitalized for internal ureterotomy and transurethral resection of the prostate. One week after the operation, while the patient was still in hospital due to his other chronic conditions, he had gross hematuria. Diagnostic cystoscopy showed intravesical heamatoma. Penile color Doppler ultrasonography (CDUS) revealed high flow velocity in both cavernozal arteries and spongiosal artery with a pseudoaneurysm formation of 3×1.5 centimeters in size, adjacent to the right side of the penis root and urethra, approximately 3.5 centimeter deep in the perineum. Both of the cavernosal arteries were adjacent to the pseudoaneurysm. At the same day, following CDUS, the patient was referred to our interventional radiology unit for further investigation of the related arterial and venous structures with the defined pseudoaneurysm. Both internal iliac arteries were selectively catheterized. There were no abnormal findings after injection in the left internal iliac artery. Injection of the right internal iliac artery revealed a pseudoaneurysm approximately 2 centimeters in diameter with venous filling during the early arterial phase, located at the distal portion of the right internal pudendal artery suggesting AVF (Figure 1A, 1B). The right internal pudendal artery was catheterized superselectively with a 2.7 French microcatheter (Progreat Coaxial Microcatheter System®, Terumo Medical, Somerset, NJ, USA) (Figure 2) and the distal portion was embolized with multiple microcoils (Barricade Helical Fill Endovascular Embolization Coil®, Blockade Medical, Irvine, CA, USA) (Figure 3). Unfortunately, quite a long segment of the right internal pudendal artery had to be embolized due to continuation of pseudoaneurysm filling. A total number of eight microcoils (three 3×40 mm, three 4×60 mm and two 5×80 mm microcoils) were used for embolization. After embolization, control angiograms showed no evidence of pseudoaneurysm or arteriovenous fistula while the perineal blood flow remained sufficient (Figures 4 and 5). After the procedure, the patient had no hematuria.


Superselective arterial embolization of pseudoaneurysm and arteriovenous fistula caused by transurethral resection of the prostate.

Celtikci P, Ergun O, Tatar IG, Conkbayir I, Hekimoglu B - Pol J Radiol (2014)

A control angiogram of the right internal pudendal artery showed no evidence of pseudoaneurysm or AVF.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4199465&req=5

f4-poljradiol-79-352: A control angiogram of the right internal pudendal artery showed no evidence of pseudoaneurysm or AVF.
Mentions: A 79-year-old male patient with a history of benign prostatic hyperplasia was admitted to urology outpatient clinic with globe vesicale. The patient was hospitalized for internal ureterotomy and transurethral resection of the prostate. One week after the operation, while the patient was still in hospital due to his other chronic conditions, he had gross hematuria. Diagnostic cystoscopy showed intravesical heamatoma. Penile color Doppler ultrasonography (CDUS) revealed high flow velocity in both cavernozal arteries and spongiosal artery with a pseudoaneurysm formation of 3×1.5 centimeters in size, adjacent to the right side of the penis root and urethra, approximately 3.5 centimeter deep in the perineum. Both of the cavernosal arteries were adjacent to the pseudoaneurysm. At the same day, following CDUS, the patient was referred to our interventional radiology unit for further investigation of the related arterial and venous structures with the defined pseudoaneurysm. Both internal iliac arteries were selectively catheterized. There were no abnormal findings after injection in the left internal iliac artery. Injection of the right internal iliac artery revealed a pseudoaneurysm approximately 2 centimeters in diameter with venous filling during the early arterial phase, located at the distal portion of the right internal pudendal artery suggesting AVF (Figure 1A, 1B). The right internal pudendal artery was catheterized superselectively with a 2.7 French microcatheter (Progreat Coaxial Microcatheter System®, Terumo Medical, Somerset, NJ, USA) (Figure 2) and the distal portion was embolized with multiple microcoils (Barricade Helical Fill Endovascular Embolization Coil®, Blockade Medical, Irvine, CA, USA) (Figure 3). Unfortunately, quite a long segment of the right internal pudendal artery had to be embolized due to continuation of pseudoaneurysm filling. A total number of eight microcoils (three 3×40 mm, three 4×60 mm and two 5×80 mm microcoils) were used for embolization. After embolization, control angiograms showed no evidence of pseudoaneurysm or arteriovenous fistula while the perineal blood flow remained sufficient (Figures 4 and 5). After the procedure, the patient had no hematuria.

Bottom Line: The most common cause is traumas including those of iatrogenic origin.It was successfully treated with coil embolization.Minimally invasive endovascular methods provide safe and efficient treatment and today should be considered as the first line of choice.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.

ABSTRACT

Background: Pelvic vascular lesions such as pseudoaneurysms and arteriovenous fistulas associated with the internal pudendal artery are uncommon. The most common cause is traumas including those of iatrogenic origin. Surgical treatment is complicated due to location of the lesions and endovascular approach is usually the first choice among the treatment options.

Case report: A 79-year-old patient was admitted with massive hematuria following transurethral resection of prostate for benign prostatic hyperplasia. Doppler US and angiography revealed a pseudoaneurysm and arteriovenous fistula originating from the right internal pudendal artery. It was successfully treated with coil embolization.

Conclusions: Arteriovenous fistulas and pseudoaneurysms concerning internal pudendal artery may occur as complications of prostate operations. Minimally invasive endovascular methods provide safe and efficient treatment and today should be considered as the first line of choice.

No MeSH data available.


Related in: MedlinePlus