Type:
Educational Exhibit
Keywords:
Interventional non-vascular, Interventional vascular, Catheter arteriography, Catheter venography, Fluoroscopy, Angioplasty, Balloon occlusion, Catheters, Education and training, Other
Authors:
A. Ward, G. S. Dulku, H. Hasan
DOI:
10.26044/ranzcr2022/R-0236
Imaging findings OR Procedure details
Case 1: Transvenous, ipsilateral IJV, retrograde approach, balloon-assisted thrombin injection of left brachial artery pseudoaneurysm & concomitant angioplasty (Figure 1 A-C)
- 62-year-old female.
- Traumatic needling of left brachio-basilic arteriovenous fistula (AVF) at hemodialysis.
- Unintentional injury to brachial artery inflow during needling at HD
- Fistulogram (Figure 1A) demonstrates pseudoaneurysm of the mid-brachial artery (red arrow) and juxta-anastomotic outflow venous stenoses (blue arrow).
- Balloon catheter utilized to:
- Occlude the pseudoaneurysm neck (Figure 1B – arrow head) followed by successful ultrasound-guided thrombin injection of the pseudoaneurysm.
- Satisfactory balloon-plasty of the outflow venous limb (Figure 1C).
Case 2: Intra-operative balloon occlusion of the splenic artery for minimisation of blood loss during splenectomy for myelodysplastic syndrome-related massive splenomegaly (Figure2 A-E)
- 52 year old male with myelodysplastic syndrome.
- Chronic left sided portal hypertension and splenomegaly with extensive venous varices (Figures 2A&B).
- Splenectomy to treat portal hypertension and facilitate bone marrow transplant.
- Pre-surgery: Fogarty balloon 5.5Fr occlusion of the proximal splenic artery (Figure 2C – arrow head), via right common femoral artery access.
- Devascularised spleen (Figure 2D) noted at laparotomy. Successful splenectomy (Figure 2E) with minimal intra-operative blood loss.
Case 3: Balloon-assisted endoluminal foreign body retrieval of an endovascular balloon damaged during fistuloplasty (Figure 3 A-C)
- 61 year-old male.
- Right brachiocephalic AVF with recalcitrant mid-humeral venous stenosis (Figure 3A – arrow head).
- Complicated by balloon rupture and endoluminal retention of fractured catheter fragment (Figures 3B&C arrows).
- Open surgical retrieval of the retained catheter fragment (Figure 3D) with a Fogarty balloon assist following failed endovascular snaring.
Case 4: Balloon plasty of in-stent stenosis & in-stent balloon-trawling for recurrent tumour ingrowth and accumulation of debris in ampullary biliary adenocarcinoma (Figure 4 A-D)
- 74 year-old male with ampullary biliary adenocarcinoma.
- Recurrent in-stent biliary obstruction due to tumour ingrowth & accumulation of debris (Figure 4A – arrow head). Failed ERCP.
- In-stent balloon plasty (Figure 4B) followed by in-stent balloon trawling with the same balloon catheter (Figure 4C).
- Recanalized in-stent occlusion and improved in-stent contrast flow, freely draining into the proximal jejunum (Figure 4D).
Case 5: Intraoperative prophylactic balloon occlusion of bilateral internal iliac arteries to assist in caesarean section and hysterectomy for placenta accrete spectrum (Figure 5 A-D)
- 39 year old female with placenta accreta spectrum.
- Planned for caesarean section and hysterectomy.
- Pre-operative 5.5 Fr Fogarty balloon placement in the bilateral internal iliac arteries via contralateral retrograde CFA approach (Figures 5A&B). The balloons were inflated after the delivery of the foetus in the post-partum period, and throughout hysterectomy till satisfactory haemostasis was achieved (Figures C&D – arrow heads).
Case 6: Balloon-assisted IVC filter retrieval for filter strut penetration into the caval walll (Figure 6 A-C)
- 37 year-old female. Background neurosurgery, DVT and PE.
- Right IJV access. Cook Gunther Tulip filter retrieval set utilised.
- Filter was snared uneventfully and easily collapsed but several of the filter struts that penetrated through the cava wall would not disengage (Figure 6A – arrow head).
- Second right IJV access obtained. A 9-French Coda balloon was utilised to successfully disengage most of the filter struts(Figure 6B – arrow head) and the filter was finally retrieved.
- Check cavogram demonstrated suspicion of contrast extravasation. The Coda balloon was inflated for 2 minutes (Figure 6C). No retroperitoneal haematoma on check CT immediately post-procedure.
Case 7: : Recanalisation of a thrombosed brachiocephalic AV fistula in a haemodialysis dependent elderly patient. (Figure7 A-C)
- 82 year old female. Unable to dialyse via right brachiocephalic AVF.
- Fistulogram demonstrates nearly occluded outflow cephalic vein (Figure 7A – arrow heads).
- Successful recanalization of the outflow venous limb following extensive balloon plasty of the vein up to 7 mm (Figure 7B&C).