American Journal of Interventional Radiology

1-7

Authors: Isabelle Dupuis, Reza Forghani, Huy Le

Objective: The objective of this study was to assess whether the placement of a needle more lateral to the pedicle while using a transpedicular approach compared to the conventional technique yields comparable or better vertebral body filling. Methods: Retrospective review of 134 thoracic and lumbar unipedicular vertebroplasties performed by a single radiologist (110 lateral and 24 classic). Vertebral bodies were divided into eight voxels on computed tomography and the percent of coverage was documented. 50% and 75% cement filling thresholds were defined as “efficient.” Complications were retrospectively collected. Chi-square (?2) was used to compare the filling efficacy and rates of extravertebral cement leakage between the approaches. Bivariate analysis was performed to assess variables potentially influencing the efficacy. Results: There was no significant difference between the two approaches for 50% coverage (classic; n = 21 [87.5%] vs. lateral; n = 98 [89.1%], p = 0.8228). There was more efficient coverage >75% using the lateral approach (classic; n = 4 [16.7%] vs. lateral; n = 46 (41.8%), p = 0.0210). Vertebral body level (50.8% thoracic vs. 26.0% lumbar, p = 0.0031) and fracture type (45.6% pathological vs. 29.2% osteoporotic, p = 0.0444) were associated with 75% coverage. Three classic cases (12.5%) had extravertebral cement leakage versus 34 lateral cases (30.9%), which was not statistically significant (p = 0.0676). Other complications included one asymptomatic lung embolization using both approaches, one pedicular fracture using the classic approach, and one overnight admission for analgesia using the lateral approach. Conclusion: A modified lateral approach proved to be as safe and more effective in achieving 75% or more vertebral filling in treating compression fractures compared to the conventional approach.

1-4

Authors: Rami Sartawi

Transection injuries of the axillary artery are rare and typically involve surgical repair. This case describes an emergent endovascular treatment option, using a stent graft, in a patient that was deemed as high risk for open surgery.

1-11

Authors: Andrew C. Clark

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.

1-11

Authors: Richard Brill

Purpose: Regarding genital lesions, the incidence of male external genitalia vascular anomalies is circa 3%, thereof one-tenth tumors and nine-tenth malformations according to the International Society for the Study of Vascular Anomalies classification. Image-guided percutaneous sclerotherapy in male external genitalia vascular malformations has rarely been described. Therefore, a retrospective analysis of sclerotherapy in a series of eight patients was conducted. Materials and Methods: The study was IRB approved. Two radiologists reviewed angiographic reports and analyzed interventionally treated male patients with external genitalia vascular malformations between February 2, 2014, and November 11, 2017, at an interdisciplinary tertiary care Vascular Anomalies Center. Inclusion criteria were a slow-flow malformation of the male external genitalia and no interventional treatment before. Operations longer than 1-year past were no exclusion criteria. Patients suffered from lymphatic and/or venous malformations and received percutaneous sclerotherapy. Malformations were treated with polidocanol, ethanol in gel form or OK-432. Patients answered a questionnaire regarding symptoms with repeat after follow-up. The initial state and post-treatment results were compared. Magnetic resonance imaging pre- and post-intervention was assessed. Complications were reported standardized. Results: Eight patients with a mean age of 21.6 years suffered from genital swelling, bleeding, thrombophlebitis, lymphorrhea, skin changes, pain, and functional genitourinary symptoms and were treated with sclerotherapy. All patients reported clinical improvement of symptoms during the average follow-up period of 30 months. No complications ensued. Conclusion: Sclerotherapy seems to be a safe and effective treatment of slow-flow malformations of the male external genitalia. Due to the low incidence of the disease, multicenter studies are necessary to assess a larger number of cases.

1-5

Authors: Pranav Sharma

Spontaneous retroperitoneal hemorrhage (RPH) is a rare but serious complication of polyarteritis nodosa (PAN) and must be considered in patients presenting with RPH as their first presentation. Renal infarctions, liver infarctions, and ruptured microaneurysms are all complications of PAN. We present two cases presenting with abdominal and back pain. The first patient’s abdominal computed tomography (CT) scan revealed fractured right kidney with retroperitoneal pericapsular hematoma and multiple hepatic and splenic infarcts. The digital subtraction angiography (DSA) demonstrated large areas of devascularization of the right kidney and right renal arterial wall irregularity with multifocal areas of stenosis, dilatations, and microaneurysms without active extravasation of IV contrast. She was treated conservatively and started on a pulsed dose of steroids and cyclophosphamide. The second patient’s abdominal CT angiography revealed multiple visceral aneurysms and focal areas of stenosis in branches of celiac axis and superior mesentery artery without active contrast extravasation. The DSA demonstrated multifocal areas of irregularity and narrowing in celiac and intrahepatic arteries as well as a 9 mm pseudoaneurysm in the inferior pancreaticoduodenal artery which was embolized with metallic coils. PAN has a vague clinical presentation and is clinically occult. Patients may be diagnosed while getting investigated for some other causes of abdominal pain. The emergency physician and the radiologist should be aware of the findings and should be able to correlate with pathology to prevent life-threatening complications. Angiography plays a crucial role, not only in diagnosis but also in appropriate management.