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Objective: Subarachnoid hemorrhage (SAH), which can cause mortality and severe morbidity, is a serious condition whose underlying cause must be determined. We aimed to compare 2D digital subtraction angiography (2DDSA), rotational angiography (RA) and 3D volume rendering digital subtraction angiography (3DVRDSA) for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage. Materials and Methods: After an initial diagnosis of SAH with computed tomography, 122 patients (52 males and 70 females with a mean age of 47.77 ± 12.81 ranging between 20 and 83 years) underwent 2DDSA imaging, RA and 3DVRDSA imaging for detection of aneurysms. The location of the aneurysm, the best working angles, the dome/neck ratios, the largest diameter of the aneurysm, the shape of the aneurysm, the presence of spasms or pseudostenoses, and the relationship to the neighboring arteries were recorded. Results: 2DDSA missed 15.6% of the aneurysms that had a mean size of 2.79 ± 0.74 mm. RA was superior to 2DDSA for detecting aneurysm neck, and 3DVRDSA was superior to RA for detecting aneurysm neck. 3DVRDSA conclusively depicted the shape of the aneurysms in all patients. 3DVRDSA imaging was superior to 2DDSA and RA in the detection of the aneurysm relationship to neighboring arteries. The sensitivity and specificity of 3DVRDSA imaging for the detection of vasospasms were 100 and 84%, respectively. Conclusions: 3DVRDSA imaging is superior to 2DDSA and RA for detecting intracranial aneurysms and their morphological properties, especially those of small, ruptured aneurysms. However, 2DDSA should not be neglected in cases of vasospasm. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the primary patency rate at three years for the infra-aortic peripheral arterial pathologies treated with polytetrafluoroethylene-covered stent-grafts., Methods: Patients treated with self-expandable polytetrafluoroethylene-covered stent-grafts for infra-aortic peripheral arterial aneurysms, pseudo-aneurysms, and arterio-venous fistulas were evaluated retrospectively. A total of 48 patients (35 male, 13 female; mean age: 53.8 ± 13.5) were included with 29.0 ± 16.5 months (median 27, range 4-70) mean follow-up period. The primary objective was to determine the primary patency rate at three years. The secondary objectives were to compare type and localization of pathology, and length and diameter of the stent-grafts with primary patency rate. Kaplan-Meier test was used as the main statistical method., Results: Overall mean primary patency rate at three years was 77.10%. Polytetrafluoroethylene-covered stent-graft implantation in aneurysms had worse primary patency rate than pseudo-aneurysms and arterio-venous fistulas (66.6%, P  = 0.03; 76.9%, P  = 0.03; 88.2%, P  = 0.01, respectively). Stent-graft location, length, and diameter are not associated with primary patency rate ( P  > 0.05) but stent diameter is associated with better primary assisted and secondary patency rates ( P <  0.05)., Conclusions: Pathology of the lesion is associated with the long-term primary patency rate of polytetrafluoroethylene-covered stent-grafts but not the stent-graft location, length, or diameter. Stent diameter is associated with primary assisted and secondary patency rates.

Purpose: To investigate the safety, efficacy and long-term results of bronchial artery embolization with microsphere particles (Embosphere ® Microspheres, BioSphere Medical, Rockland, MA) 700-900 µm in size for massive hemoptysis., Methods: One hundred and seventy-four patients (94 female, 80 male; mean age 39.4 ± 5.7) who had bronchial artery embolization for massive hemoptysis between January 2010 and October 2015 were incorporated in the study. Patients had hemoptysis with a mean volume of 525 ± 150 mL (median 500 mL, range 300-1200 mL) over a 24-h period. Underlying pathologies included bronchial artery hypertrophy due to bronchiectasis (56.3% [98/174]), lung cancer (29.9% [52/174]), tuberculosis (10.3% [18/174]) and the rest remained idiopathic (3.4% [6/174]). Mean bronchial artery diameter before the intervention was 3.8 ± 1.5 mm (median 4 mm, range 3.1-7.5 mm). Median follow-up period was 56 months (range 10-82 months). Primary objectives were the technical and clinical success., Results: Technical success was 100%. Clinical success for preventing massive hemoptysis was 91.9% (160/174). There was no procedure-related mortality or morbidities. Minor complications such as chest pain were observed in nine patients (5.0%). Recurrent hemoptysis (8.1%) was observed within 6 months in 14 patients, ten of whom were treated with a second embolization session and the remaining four with a total of three embolization sessions., Conclusion: Bronchial artery embolization for massive hemoptysis with Embosphere particles 700-900 µm in size is a safe and effective method with high technical and clinical success rates. Long-term results are excellent.

Background: The aim of the study was to determine the safety and effectiveness of Atrium Advanta V12 large diameter stent-graft applications for infrarenal abdominal aortic pseudoaneurysms (due to Behcet disease [BD])., Methods: Data of Advanta V12™ (Atrium Europe B.V, Mijdrecht, the Netherlands) applied 12 female patients (mean age 30.5 ± 6.3, range 26-44) with infrarenal abdominal aortic pseudoaneurysms were analyzed retrospectively. All Advanta V12 large diameter stent grafts were implemented from right or left sided 12F femoral sheaths. Stent grafts with 12-16 mm in size and 29-61 mm in length were utilized. Technical success rate, procedure-related mortality and morbidity, and primary patency rate at 4 years were evaluated., Results: Technical success rate was 100%. Neither procedure-related mortality nor morbidity was determined. The mean aortic diameter was 14.0 ± 0.8 mm for pseudoaneurysmatic abdominal aortas. The mean follow-up period was 46.5 ± 40.3 months (range 18-75). During follow-ups, only one recurrent aneurysm has evolved at the stenting site due to patients' withdrawal of immunosuppressive treatment. The advent of a new aneurysm proximal or distal to the stent-graft region or at the femoral access localization was not observed. There were no stent occlusions. Primary patency rate at 4 years was 100%. Complete aneurysm exclusion was achieved 100% at 48 months., Conclusions: The use of Advanta V12 large diameter stent grafts for infrarenal abdominal aortic pseudoaneurysms (due to BD), especially in female patients with small aortic diameter, is safe and efficient. Primary patency rate of the stent grafts at 4 years is excellent., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background and Aims: Magnetic compression anastomosis is a rescue technique for recanalization of complete biliary strictures. Here, we present magnetic compression anastomosis with novel through-the-scope magnets in patients with complete duct-to-duct anastomosis obstruction after liver transplantation., Methods: The magnets were 2 and 2.4 mm in diameter, with a hole at the center for inserting a guidewire. One of the magnets was advanced through the scope up to the distal site of the stricture by using a 7F pusher. The other magnet was pushed percutaneously through the 10F sheath. The procedure was terminated when the magnets were approximated or properly aligned. Recanalization was followed by percutaneous cholangiography. Patients underwent multiple plastic stenting after recanalization was achieved., Results: Nine patients with a stricture length of less than 1 cm, a stump in the donor bile ducts close to the stricture, and proper positioning of the bile duct stumps, underwent magnetic compression anastomosis. Seven patients had a live donor-related liver transplantation. The mean stricture time was 24.1 ± 17.1 months. The mean stricture length was 4.0 ± 1.2 mm. Recanalization was achieved in 7 patients (77%) after a mean recanalization time of 8.1 ± 4.7 days. There was no recurrence after 4.8 ± 3.8 months of stent-free follow-up. No adverse events were observed., Conclusions: The through-the-scope magnet procedure was effective in the recanalization of complete anastomotic biliary obstructions after liver transplantation in a selected group of patients with a short stricture length and an appropriate anatomy., (Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the long-term results of percutaneous transluminal angioplasty (PTA) for a complete membranous obstruction of the suprahepatic inferior vena cava., Methods: Patients (n = 65) who were referred to the interventional unit for PTA for a complete membranous obstruction of the suprahepatic inferior vena cava between January 2006 and October 2014 were included in the study. Thirty-two patients (18 males, 14 females, mean age 35 ± 10.7, range 20-42 years) were treated. The patients presented with symptoms of ascites (88 %), pleural effusion (53 %), varicose veins (94 %), hepatomegaly (97 %), abdominal pain (84 %), and splenomegaly (40 %). Transjugular liver access set and re-entry catheter were used to puncture and traverse the obstruction from the jugular side. PTA balloon dilations were performed. The mean follow-up period was 65.6 ± 24.5 months. The objective was to evaluate technical success, complications, primary patency, and clinical improvement in the symptoms of the patients., Results: The technical success rate was 94 %. In two patients, obstruction could not be traversed. These patients underwent cavoatrial graft bypass surgery. There were no procedure-related complications. Clinical improvements were achieved in all patients within 3 months. The primary patency rate at 4 years was 90 %. There was no primary assisted patency. There was no need for metallic stent deployment in the cohort. The secondary patency rate at 4 years was 100 %., Conclusions: Percutaneous transluminal angioplasty for a complete membranous obstruction of the suprahepatic inferior vena cava is safe and effective, and the long-term results are excellent.

Purpose: To compare outcomes of endovascular aneurysm repair (EVAR) using the Endurant-I stent-graft system between patients who have ruptured abdominal aortic aneurysms (rAAAs) with normal and hostile anatomy., Materials and Methods: Patients with rAAAs who underwent EVAR between January 2008 and March 2014 were included in the study. There were 21 (70%) men and 9 (30%) women with a mean age of 70 years. Multidetector computed tomography (CT) angiography findings of the rAAA were classified according to the "Classification based on CT findings," and imaging planning was performed according to the Society of Interventional Radiology Guideline. Primary outcome measures (POM) were procedure-related mortality, 30-day mortality, and survival rate at 1 year. Secondary outcome measures (SOM) were technical success, open surgical conversion, complications, survival, relationship between size-severity of the rAAA and mortality, procedure time, hospital stay., Results: The periprocedural-EVAR mortality rate was 33%. The overall mortality rate without prehospital phase deaths was 40.0%. Seventy three percent of the patients with rAAAs had hostile anatomy. There were no statistically significant differences between the groups in POMs and SOMs (except mean hospital stay). Mean hospital stay was shorter in the normal anatomy group. The mortality rate was higher in patients with hematoma in both sides of the aorta and free intraperitoneal hematoma., Conclusion: EVAR of rAAAs with hostile anatomy is feasible and off-label use of Endurant-I endografts could be expanded., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To compare doxorubicin-loaded HepaSphere transarterial chemoembolization versus conventional transarterial chemoembolization in terms of survival, time to recurrence, acute reversible hepatotoxicity, postembolization syndrome, and chemoembolization-related mortality and morbidity., Materials and Methods: One hundred twenty-six patients (103 men, 23 women; mean age, 64.3 y) with unresectable hepatocellular carcinoma (HCC) who underwent conventional chemoembolization between January 2007 and March 2011 or drug-eluting embolic (DEE) chemoembolization (after the protocol change) between March 2011 and October 2014 were included in a retrospective analysis. Primary outcome measures were survival and time to recurrence. Secondary outcome measures were frequency of recurrence, technical success, acute reversible hepatotoxicity, postembolization syndrome, and chemoembolization-related mortality and morbidity., Results: The technical success rate was 97.1%. There were no significant differences between the conventional and DEE chemoembolization groups with regard to mean survival duration (39.0 vs 37.4 mo), recurrence (32.9% vs 39.6%), postembolization syndrome (90% vs 89%), and chemoembolization-related mortality (5.5% vs 1.9%) and morbidity (9.6% vs 9.4%; P > .05). The time to recurrence was shorter in DEE chemoembolization-treated patients than in conventional chemoembolization-treated patients (5.0 vs 11.5 mo; P = .006), and acute reversible hepatotoxicity occurred more frequently after conventional chemoembolization (P = .019)., Conclusions: Conventional chemoembolization and DEE chemoembolization were safe and effective interventions for unresectable HCC. DEE chemoembolization was not better than conventional chemoembolization in terms of survival and was associated with a shorter time to recurrence. Acute reversible hepatotoxicity occurred more frequently after conventional chemoembolization., (Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To analyze the long-term results of endovascular treatment of large pulmonary arteriovenous malformations (PAVMs) using the AMPLATZER vascular plug (AVP; AGA Medical Corp, Golden Valley, Minnesota)., Materials and Methods: Between May 2007 and April 2011, 18 patients with 24 large PAVMs, defined as PAVMs that had a feeding artery with a diameter of ≥ 8 mm, were treated with AVP I or AVP II. A single AVP device was used for each PAVM. Aneurysmal sac diameters, sac perfusion, sac shrinkage, and complete resolution before and after the intervention were analyzed. Complete histories, laboratory values, physical examinations, and multidetector computed tomography images were reviewed. The mean occlusion time for AVP I and AVP II and the mean arterial oxygen saturation (SaO2) before and after the intervention were compared., Results: The mean diameter of the feeding artery was 11.46 mm ± 2.18 (range, 8-13.3 mm). The mean occlusion time was 7.34 minutes ± 1.23 for AVP I and 6.25 minutes ± 1.12 for AVP II (P = .11). The mean SaO2 before and after the intervention was 63.71% ± 8.10% (range, 51%-76%) and 96.28% ± 0.49% (range, 96%-97%), respectively (P = .045). No major periprocedural complications were observed. The mean follow-up duration was 36.33 months ± 10.63 (range, 28-56 mo). During the follow-up period, there were no persistent sac perfusions, migration of the AVPs, major complications, or recanalizations., Conclusions: Treatment of large PAVMs with AVPs is an effective method for obtaining excellent long-term results. Embolization of large feeding arteries can be accomplished with AVPs without major complications., (Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.)

Both complete transection and accidental ligation of the main bile duct because of a cholecystectomy are the injuries that are not amenable to endoscopic treatment and require an additional surgery. Leaks resulting from the severance of an aberrant bile duct may be treated endoscopically, although such injuries are difficult to be identified, thus resulting in treatment delays. Presented here are the details and follow-up results of 7 cases of patients with postcholecystectomy aberrant bile duct injuries, which were treated by endoscopic treatment.

Purpose: The purpose of this study is to analyze the outcomes of the self-expanding covered metallic stent (SECMS) therapy in the management of the postoperative anastomotic leaks that seen after total gastrectomy-esophagojejunostomy (EJ) operations., Materials and Methods: Contrast radiography and endoscopy revealed EJ fistulas in 14 patients. SECMSs were implanted both fluoroscopically and endoscopically to seal fistulas. Postoperative fistula diagnosis times, postoperative covered stent implantation times, primary success rates, clinical success rates, postinterventional oral feeding beginning times, reduction of the drainage from the surgical drains, procedure-related mortality-morbidity, and mortality related with factors other than the procedure were noted., Results: Technical success rate was 100 %. Clinical success rate was 79 %. Reduction of the fluid from surgical drains was observed in all patients. There were no procedure-related mortality. Recurrent fistula was observed in two patients (14 %) at the third and fifth day after the intervention. In one patient (7 %), stent dislocation was observed at the 10th day after the intervention. Non procedure-related mortality was 21 %. No anastomotic stricture, no in-stent stenosis was observed during the follow up period(11.09 ± 3.21 months)., Conclusion: From the above results we concluded that SECMS treatment for EJ fistulas is a safe, effective and technically easy procedure.

Purpose: To determine the safety, efficacy, and long-term results of percutaneous biliary balloon dilation (PBBD) of benign hepaticojejunostomy strictures and evaluate the necessity of repeated PBBD in this setting., Materials and Methods: PBBD was performed after traversing hepaticojejunostomy strictures in 89 patients (40 male, 49 female; age range, 19-84 y; mean age ± SD, 54.5 y ± 14.0), who were divided into three groups: group I (one satisfactory initial PBBD; n = 41), group II (two or more PBBDs with satisfactory initial PBBD; n = 33), and group III (two or more PBBDs without satisfactory PBBD; n = 15). Groups I and II were randomized. The primary outcome measure was the absence of clinical biliary obstruction symptoms at 24 months. Secondary outcome measures included technical and clinical success, primary and secondary patency, major complications, and mortality. Categoric variables were compared between groups I and II., Results: Procedure-related mortality and major morbidity rates were 0% and 5.6%, respectively. Mean primary and secondary patency durations were 45.3 months ± 2.2 and 71.3 months ± 15.4, respectively. The follow-up period was 36.4 months ± 15.1. The primary outcome measure was achieved in 73% of patients. Technical and clinical success rates (secondary outcome measures) were 97.8% and 84.3%, respectively. Repeated PBBD procedures were not satisfactory in 16.9% of patients. No significant differences in categoric variables were observed between groups I and II., Conclusions: PBBD of benign hepaticojejunostomy strictures is a safe and effective procedure. Repeated PBBD is not required when the first procedure is successful., (Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess the role of multidetector computed tomography (MDCT) with multiplanar reconstruction (MPR) and virtual gastroscopy (VG) for detection and differentiation of gastric subepithelial masses (SEMs) by comparison with endoscopic ultrasonography (EUS)., Methods: Forty-one patients with a suspected SEM were evaluated using EUS and MDCT. MDCT findings were analyzed based on the consensus of two radiologists who were blinded to the EUS findings. The analysis of the CT features included the location, size, and contours of the tumor, the presence of central dimpling, as well as the growth pattern, enhancement pattern, and enhancement degree. The long diameter (LD) and the short diameter (SD) of each lesion were measured and the LD/SD ratios were calculated. EUS and MDCT results were compared with histopathology for the pathologically proven lesions. For the non-pathologically proven lesions, MDCT results were compared with EUS., Results: Among the 41 patients, 34 SEMs were detected using EUS. For the detection of SEMs with MDCT, a sensitivity of 85.3%, a specificity of 85.7%, a positive predictive value of 96.7%, and a negative predictive value of 54.5% were calculated. The overall accuracy of MDCT for detecting and classifying the SEMs was 85.3 and 78.8%, respectively., Conclusions: MDCT with MPR and VG is a valuable method for the evaluation of SEMs. Specific MDCT criteria for various SEMs may be helpful in making an accurate diagnosis.

The median arcuate ligament is a tendinous arch joining the two medial borders of the diaphragm crura together. In 13-50% of asymptomatic subjects it is responsible for significant angiographic celiac trunk compression. The significance of median arcuate ligament-associated celiac artery compression has been a source of some controversy in the past literature, and the etiology remains unclear. We report here a case series from a family that was diagnosed by the use of multidetector computed tomography. The observation of this syndrome in a family suggests that the responsible anatomic relationships are congenital and may be genetically inherited., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Endoscopic retrograde cholangiopancreatography(ERCP), as with other fluoroscopic procedures, carries the risk of exposure of staff to radiation. However, over the last two decades, only a few studies have investigated this risk., Objective: The aim of this work was to evaluate the dose of radiation exposure to staff participating in ERCP procedures in a busy teaching hospital that performs more than 1,850 procedures annually., Methods: The entire ERCP staff consisted of the experienced endoscopist, the assistant, and two nurses who were responsible for monitoring patients as well as keeping their heads in position during the procedure. RAD DOSE NEB.226 dosimeters, which were provided by the Turkish Atomic Energy Authority, were used for this study., Results: Data on 110 consecutive therapeutic ERCP procedures was recorded. The mean fluoroscopy time was 5.65 ± 4.71 min. The mean fluoroscopy time of the 61 procedures performed by an experienced endoscopist alone was 5.41 ± 4.65 min, whereas the mean fluoroscopy time for the 49 procedures during which an assistant was involved was 5.94 ± 4.81 min (p = 0.56). In terms of median dose of ionizing radiation exposure to the eyes, the dose measurement per procedure in which the primary endoscopist participated alone was 72 microsievert (μSv), compared to 92 μSv when an assistant took part in theproceedings. Considering that the recommended annual equivalent dose limit to the lens of the eye is 150 mSv, by performing 1,850 procedures annually, the primary endoscopist exceeds this limit., Conclusions: Based on our results, taking into consideration the heavy workload in our hospital, it would seem that more experienced endoscopists are required to help provide training in ERCP, and that the use of lead acrylic goggles is required to decrease radiation exposure to the eyes.

Objectives: To compare estimated remnant liver volume (ERLV) ratios among the major main portal vein (MPV) variants., Methods: Eighty-five potential donors underwent multidetector CT examination. Arterial, portal and hepatic venous phase images were obtained. CT volumetric measurements were performed by using summation-of-area method. MPV variants were classified into three groups. In type 1 (group 1), the MPV branches into the right portal vein (RPV) and the left portal vein (LPV). In type 2 (group 2), the MPV trifurcates into the right anterior portal vein (RAPV), right posterior portal vein (RPPV) and LPV. In type 3 (group 3), the RPPV arises from the MPV as a first branch, and the RAPV emerges directly from the LPV., Results: No differences were observed between groups 1 and 2 with respect to ERLV ratios. However, significant differences were discovered between groups 1 and 3 and between groups 2 and 3 (p<0.001 and p<0.05, respectively)., Conclusions: The ERLV proportions in the donors with a type 3 MPV variation were significantly lower than those in the donors with type 1 and type 2 MPV variations and six (31.6%) donors in group 3 presented an ERLV percentage below 30% of the total liver volume., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Hepatic artery aneurysm (HAA) is a rare clinical entity that can lead to potentially life threatening complications. We reported our personal experience of 4 cases, in which we used different procedures., Methods: The first case had a pseudo-aneurysm involving the right hepatic artery. The second case had a pseudo-aneurysm, which was localized distal to the accidentally ligated right hepatic artery from the previous cholecystectomy operation. The third case had multiple aneurysms with accompanying dissecting abdominal aortic aneurysm. The fourth case had a pseudo-aneurysm originating from the proper hepatic artery. A covered stent was successfully placed in the case 1. In the second case, the right hepatic artery was ligated distal to the aneurysm. In the third case, vascular structures were not appropriate for vascular reconstruction, and a covered stent placement and embolization were unsuccessful. In the fourth case, ligation of the proper hepatic artery and cholecystectomy was performed., Results: The third case with multiple aneurysms died from multi-organ failure due to sepsis. The remaining cases (case 1, 2, and 4) are disease free and alive., Conclusion: HAAs are more commonly observed clinical entities, and their treatment should be handled for each patient separately. Computerized tomography-Angiography and intraoperative Doppler ultrasound are useful radio-diagnostics for determination of aneurysm and planning the operative procedure (Fig. 5, Ref. 15).