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Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. In most cases, the disorder may be asymptomatic. The objective of endovascular AVM treatment is set individually for each case upon consultations with a neurosurgeon and a neurologist. The endpoint of the treatment should consist in prevention of AVM bleeding in a management procedure characterized by a significantly lower risk of complications as compared to the natural history of AVM. Endovascular interventions within AVM may include curative exclusion of AVM from circulation, embolization adjuvant to resection or radiation therapy, targeted closure of a previously identified bleeding site as well as palliative embolization. Onyx was first described in the 1990s. It is a non-adhesive and radiolucent compound. Onyx-based closure of the lumen of the targeted vessel is obtained by means of precipitation. The process is enhanced peripherally to the main flux of the injected mixture. This facilitates angiographic monitoring of embolization at any stage. The degree of lumen closure is associated with the location of the vessel. Supratentorial and cortical locations are most advantageous. Dense and plexiform structure of AVM nidus as well as a low number of supplying vessels and a single superficial drainage vein are usually advantageous for Onyx administration. Unfavorable factors include nidus drainage into multiple compartments as well as multiarterial supply of the AVM, particularly from meningeal arteries, en-passant arteries or perforating feeders. Onyx appears to be a safe and efficient material for embolization of cerebral AVMs, also in cases of intracranial bleeding associated with AVM. Curative embolization of small cerebral AVMs is an efficient and safe alternative to neurosurgical and radiosurgical methods. Careful angiographic assessment of individual arteriovenous malformations should be performed before each Onyx administration.

Hereditary hemorrhagic telangiectasia (HHT), known as well as Osler-Weber-Rendu syndrome (ORW disease) is autosomal dominant inheritance disease with the worldwide prevalence of 1 case per 5000-10000 population. The pathophysiology of the disease consists of disorders in the growth and migration of endothelial cells, which leads to telangiectasias and arterio-venous malformations (AVM) development. Vascular abnormalities can form in various organs. The most frequent locations are nose and mouth mucous membranes, as well as the rest of GI tract, skin, lungs, urinary system and central nervous system. The most common symptom is reccurent epistaxis (80-90% of patients). Advanced stage disease can result in extensive bleeding with dicrease in hemoglobin levels. Unfortunately, the only available treatment options for Osler-Weber-Rendu syndrom fight the symptoms, not the essential cause, and because of the rarity of the disease there are no guidelines for effective therapy. We are presenting a case of a patient suffering from recurrent episodes of nose bleeding due to hereditary hemorrhagic telangiectasia, who was successfully treated using low-invasive, intravascular arterial embolisation in interventional radiology department.

Vein of galen malformation (VOGM) is a very rare disease which affects blood vessels of the brain. In general population the incidence is estimated at 1%. Treatment of choice is transluminal embolization. We present the case of five-month-old child with low degree heart failure, hydrocephalus and significantly delayed psychomotor development. MR examination reveals a vein of Galen malformations, wall type (type I according to Yasargil) 6 cm in diameter, with venous drainage to the sinus rectus. The enlarged vein filled with thrombus. It causes brain stem compression. Angiography shows one feeder leading to the VOGM, from right posterior brain artery. Lesion was treated with two embolic materials: 5 coils and 2 ml of ONYX. Angiography confirmed total exclusion of the fistula and the circulation in the vein of Galen. One of the most important elements of treatment is to perform a proper diagnosis and evaluation of lesions morphology. With proper technique, high skills and proper equipment, intravascular embolization of vein of Galen malformation is an effective treatment.

Ureteric stricture is the cause of urinary retention above the stricture level and obstructive nephropathy development with progressive renal parenchyma destruction leading to the renal failure. In the management of ureteric stricture, apart from surgery, less-invasive methods of recanalization are applied: transurethral (retrograde) double J stent implantation or, if the above method is unsuccessful, percutaneous (antegrade) double J stent implantation. In this paper we present 2 cases of percutaneous double J stent implantation: in patient after cystoprostatectomy with ureteric stricture at the level of uretero-ileostomy and in patient after renal transplantation with ureteric stricture at the level of ureterovesicostomy.

A case of 21-year-old woman with postraumatic giant direct carotid-cavernous fistula, successfully treated by endovascular embilisation with cyanoacrylate glue, is presented. Stent-assisted coils placement is the method of choice for the treatment of patients with carotid-cavernous fistulas, but closure of direct fistula with cyanoacrylate glue can be alternative, safety and efficient technique especially in cases in which standard interventions offer increased risk or in which other methods have failed.

Objective: Published data describing scintigraphic evaluation of perfusion changes in patients with cerebral arteriovenous malformations (AVMs) after embolization are very scarce. The aim of our study was to evaluate these changes by using Tc-ethyl cysteinate dimer single photon emission computed tomography., Materials and Methods: The examinations were performed in 20 patients before and after the treatment. Voxel-based analysis was used for semiquantitative assessment of single photon emission computed tomography. Hypoperfusion in basal single photon emission computed tomography was diagnosed when asymmetry index was higher than 10% in a cluster volume (CV) greater than 10.0 ml. The change of perfusion between basal and control studies was considered significant when relative difference (RD) was higher than 10% in a CV greater than 10 ml., Results: Obliteration of AVMs was total or nearly total in 12 patients and partial in 8 patients, No serious complications were observed after the procedure. Before embolization hypoperfusion in the region of an AVM was seen in 17 cases, perfusion defects in areas distant from an AVM were found in 12 patients. After embolization, perfusion around an AVM deteriorated in 11 patients (CV=10.7-68.7 ml, mean 28.6+/-18.4, RD=14-26%, mean 17.8+/-4.5). Improvement was seen in three cases (CV=13.7-17.7 ml, mean 16+/-2, RD=16.5-20.1%, mean 18.2+/-1.8). Perfusion deterioration in areas distant from AVMs was found in nine cases, improvement in three cases., Conclusion: The changes of perfusion caused by endovascular embolization of AVM can rely on both deterioration and improvement, and occur in the parenchyma surrounding the AVM and in the distant regions of the brain. Although deterioration of perfusion indicated that more frequent follow-up was necessary, it was not related with serious complications in our group of patients.

Background and Purpose: The purpose of this study was to demonstrate scintigraphic evaluation of cerebral perfusion in patients with intracranial hemangiomas., Material and Method: The examination was carried out in 12 patients aged from 12 to 67 years. In all the patients cerebral angiomas were previously diagnosed and all of them were qualified for intravascular embolization. Brain scintigraphy was performed after IV injection of 99mTcECD and included the dynamic phase with images obtained every 2 seconds for 1.5 minutes and SPECT imaging. The semiquantitative analysis of regional cerebral blood flow was based on the comparison between activity in two symmetrical regions of interest. Cerebral angiography combined with intravascular embolization followed the scintigraphic examination., Results: Based on angiograms, the size of the nidus was estimated at 1.0 to 9.0 cm. In 8 patients the dynamic study showed an increased tracer accumulation in the region of angioma. On SPECT images the nidus was visualized as focally decreased perfusion in all cases. A decreased tracer accumulation in the area adjacent to the nidus was detected in 8 patients. The ratio of activity in the region of angioma to activity in normally perfused tissue calculated using the semiquantitative analysis was 52% to 89%., Conclusions: SPECT images and dynamic phase of cerebral perfusion scintigraphy allow perfusion changes caused by the presence of intracranial angiomas to be identified.

Background: Arteriovenous malformations (AVM) markedly alter the distribution of the regional cerebral blood flow, as they consist of abnormal arteries and veins with no resistance vessels between them. The aim of this study was to the evaluate diagnostic utility of cerebral perfusion scintigraphy (dynamic phase and SPECT) in patients with AVM., Material and Methods: Nineteen patients were examined. All the patients had been previously diagnosed with AVM and qualified for intravascular embolization. Brain scintigraphy was performed with 99mTc-ECD and included dynamic phase and SPECT imaging. The regional blood flow was evaluated visually and semi quantitatively, based on comparison between the activity in the two symmetrical regions of interest. Differences higher than 10% were considered significant. Cerebral angiography combined with intravascular embolization was carried out after a scitigraphic examination., Results: Based on angiograms, the diameter of the AVM nidus was estimated and varied from 1.0 cm to 9.0 cm. In 13 cases, AVM were visible in the dynamic scintigraphy as areas of increased tracer activity. In each case, SPECT images showed the AVM nidus as a region of decreased tracer accumulation. Hypoperfusion in the brain tissue adjacent to the nidus was seen in 15 subjects. In one patient cerebellar diaschisis was present. The average ratio of activity in the region of AVM to activity in the normally perfused tissue calculated by semiquantitative analysis was 77.5 +/- 10.9%., Conclusion: Cerebral perfusion scintigraphy (SPECT images and dynamic scintigraphy) allows one to identify perfusion disturbances caused by the presence of intracranial AVM.

Purpose: This study presents the case history of a 58-year-old woman with a diagnosed spontaneous carotid-cavernous fistula on the left side and mild hypertension., The First Signs of This Disease Were: Headache, double vision, proptosis, ptosis of the left upper lid, paresis of the left abducens nerve, conjunctival edema, dilatation and tortuosity of the vessels in conjunctiva and episclera. In the course of this disease a massive central retinal vein occlusion occurred in the left eye. The angiography demonstrated carotid-cavernous fistula on the left side with pathological blood flow. Embolization of the fistula was attempted, but it was not successful. During 6 months of follow up, the signs of central retinal vein occlusion and other manifestations disappeared., Conclusions: A spontaneous carotid-cavernous fistula should be considered as one of the contributing factors of the central retinal vein occlusion, particularly in menopausal women with concomitant arterial hypertension. The significant reduction of neurological and ophthalmological symptoms and signs may suggest, that arteriovenous shunt is closed.

Surgical clipping has been considered for years a "golden standard" in the treatment of middle cerebral artery (MCA) aneurysms. The recent development of materials and endovascular techniques has permitted the use of embolization for the treatment of intracranial aneurysms regardless of their locations and size. In 30 patients with 32 MCA aneurysms (group I) the endovascular approach with GDC-10 coils was used, while in other 30 patients with 31 aneurysms (group II) surgical clipping was performed. On completion of the diagnostic process the patients were randomly assigned either to the endovascular or microsurgical treatment. Group I: 21 (70%) embolization procedures were carried out, while in 9 (30%) cases with 10 aneurysms embolisation was impossible or regarded as too risky due to various causes. The total occlusion of aneurysm SAC was achieved in 17 (77%) aneurysms, subtotal in 5 (23%). The morbidity rate was 8%, mortality-0%. Group II: Microsurgical clipping was performed in 27 (90%) cases, 3 (10%) patients were disqualified from treatment due to their poor clinical status. An excellent technical result was achieved in 24 (86%) patients, in 4 (14%) cases the neck remnant was observed in control angiography. The morbidity rate was 14%, mortality-0%.

A giant, unclippable right ICA aneurysm located partially intracavernously is reported with neck deriving at C3 level. The aneurysm caused optic chiasm compression, progressive left eye vision loss and exophthalmus as well as persistent headache. The presence of the aneurysm was first found in CT and confirmed by angiography. After having performed the temporary occlusion test of right ICA the ICA was permanently occluded with a detachable balloon. Control angiography showed complete occlusion of right ICA and no opacification of the aneurysm sac from vertebral and left carotid arteries.

We describe a cervical congenital paraspinal arteriovenous malformation (AVM) drained by paraspinal and epidural ectatic veins, which caused massive erosion of the C6 and C7 vertebral bodies, threatening the cervical stability and necessitating treatment. During the first session, six arterial embolizations were performed to reduce the size and the flow of the AVM. Two months later, a venous approach was used to occlude the remnant venous exit of the AVM and achieve a complete cure. All embolizations were performed using N-butylcyanoacrylate.

Purpose: To present a case of 59-year-old woman with the symptoms of redness, proptosis of her left eye and temporary bruit in her head., Methods: Basic ophthalmological examination, measurement of proptosis, tonometry, visual field examination (Humphrey 30-2 threshold) CT, MRI and carotid angiography were performed., Clinical Signs: Proptosis of the left eye, dilatation of the episcleral vessels, fundus examination--optic disc normal, enlarged and engorged venous vessels, intraretinal haemorrhages in posterior pole. Tonometry--13 mm Hg--right eye, 24 mm Hg--left eye. Perimetry--general reduction of sensitivity. CT scan--abnormal structure (0.9 x 0.4 cm) in the medial part of the left orbit, without enhancement after applying contrast. MRI examination--enlargement of extraocular muscles of the left eye. Carotid artery angiography revealed indirect carotid--cavernous fistula., Conclusion: Special investigations like CT and MRI showed different picture, final diagnosis could be based upon the clinical picture and confirmed by angiography.

Background: Pulsating mass located close to peripheral arteries is usually considered as a result of arterial wall injury. Clinically important is to distinct pseudoaneurysm from haematoma and also to evaluate proximal and distal arterial bed for the assessment of the injury extent. A few previous reports claim good results of duplex Doppler US diagnosis of iatrogenic (post-catheterization) femoral artery injuries. This paper presents diagnostic findings of arterial injuries caused by accidental trauma., Patients and Methods: A retrospective analysis of 49 patients with post-traumatic pulsating mass close to peripheral artery was performed. The diagnostic results of both sonography and angiography were reviewed. All the patients underwent B-mode and duplex Doppler US examination using PW-, color- and power Doppler imaging techniques., Results: 34 pseudoaneurysms were diagnosed correctly with typical B-mode, color/power Doppler images and PW-Doppler spectral waveforms. The lack of flow signal and distinctive B-mode images enabled proper diagnosis of 13 haematomas. In 2 patients duplex Doppler US misdiagnosis occurred, because of secondary pseudoaneurysm formation, primary diagnosed as haematoma. The 47 correct US findings gave 96% efficacy in distinguishing pseudoaneurysm from haematoma, which compares well with the other studies. In 20 patients suffering from peripheral ischemia, US examination, in spite of proper distinction between pseudoaneurysm and haematoma was unable for precise estimation of proximal and distal arterial damage. Thus, it was successfully supported with angiography before surgical decision making. Angiography was also necessary in 8 patients with severe injuries of carotid, subclavian and palmar arch arteries, hardly accessible for ultrasound penetration., Conclusions: We conclude that duplex Doppler US is essential for noninvasive, unequivocal distinction between pseudoaneurysm and haematoma but it could not completely replace contrast angiography in the evaluation of post-traumatic pulsating mass caused by severe, extensive trauma, frequently complicated with peripheral ischemia or located in regions with poor access for ultrasound penetration.