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Objective: Benign Prostatic Hyperplasia (BPH) affects patients' quality of life negatively. We aimed to examine the results of prostate artery embolization (PAE) treatment for BPH in the elderly patients with high comorbidity. Materials and methods: in the present study, we evaluated the patients with lower urinary tract symptoms (LUTS) due to BPH and applied endovascular embolization treatment, who were admitted to our hospital radiology department, between February 2017 and February 2019. Patients with a high risk for surgical operation with an American Society of Anesthesiologists (ASA) score of 3 or above, International Prostate Symptom Score (IPSS) >20 and MR (Magnetic Resonance) prostate volume (PV)>70 cm3 were included in this study. In addition, maximum flow rate Qmaximum (Qmax), MRI PV and IPSS values were recorded in all patients in our clinic before PAE, and the 12th months after PAE. Results: in our study, 15 patients, who had a history of transurethral resection (TUR), and 57-82 years old (mean 73.8), participated. PAE treatment was administered to the patients who were admitted to our hospital with the diagnosis of BPH in patient high comorbidity, LUTS and high risk for open prostatectomy. In our series, Qmax, IPSS, MRI and digital subtraction angiography (DSA) findings were presented. The findings showed that pre-PAE and post-PAE at 12th month, IPSS value 25,13 +/- 1,92 and 11,4 +/- 6,51 (p=0,001), Qmax; 7,61 +/- 3,19 and 16,51 +/- 9,56 (p=0,001), MRPV; 135,47 +/- 76,48 and 83,27 +/- 43,53 (p=0,001) and also all parameters were statistically significant. Conclusion: PAE is a novel treatment modality which is increasingly being used in patients with BPH, and it is an important and effective treatment option since it is much less invasive compared to open surgery, does not require hospitalization after the procedure. / Amaç: Benign Prostat Hiperplazisi (BPH) yaşam kaltisini olumsuz etkileyen bir durumdur. Çalışmamızda BPH tanılı ve komorbitesi yüksek yaşlı hastalarda Prostat arter embolizasyonu tedavisinin sonuçlarını gözden geçirmeyi amaçladık. Yöntem: Şubat 2017-Şubat 2019 tarihleri arasında hastanemize Benign Prostat Hiperplazisine (BPH) bağlı alt üriner sistem semptomları (AÜSS) nedeniyle başvurup prostat arter embolizasyon (PAE) tedavi işlemi uygulanan hastaları retrospektif olarak inceledik. Çalışmaya Amerikan Anestezistler Derneği (ASA) skoru 3 ve üzerinde olan cerrahi operasyon açısından yüksek riskli, Uluslararası Prostat Semptom Skoru (IPSS) >20, MR (Manyetik Rezonans) ile prostat volümü (PV) >70 cm3 olan hastalar dahil edildi. Bunun dışında hastalarda PAE öncesi ve PAE sonrası 12. ayda, maksimum akım hızı Qmaksimum (Qmaks), MRG PV ile IPSS değerleri kaydedildi. Bulgular: çalışmamızda komorbitesi yüksek, alt üriner sistem semptomları devam eden ve açık prostatektomi için yüksek riskli 57-82 yaş arası (ort. 73,8) daha önce bir tanesi transüretral rezeksiyon (TUR) operasyonu geçirmiş olmak üzere toplam on beş hastaya prostat arter embolizasyon (PAE) işlemi yapıldı. Serimizde hastaların Qmaks, İPSS, MR ve dijital subtraksiyon anjiyografi (DSA) bulguları sunulmuştur. PAE öncesi ve 12. ayda total IPSS sırasıyla 25,13±1,92 ve 11,4±6,51 (p=0,001), Qmaks; 7,61±3,19 ve 16,51±9,56 (p=0,001), MRPV; 135,47±76,48 ve 83,27±43,53 (p=0,001) olup değerleri kayıt altına alındı. Sonuç: PAE BPH olan hastalarda giderek artar sıklıkta kullanılmakta olan yeni bir tedavi yöntemi olup özellikle komorbiditesi yüksek grupda TUR ile açık cerrahiye göre çok daha az invaziv olması, işlem sonrası hastanede yatış gerektirmemesi ve basit sedasyon ya da lokal anestezi altında yapılabilir olması ile önemli alternatif bir seçenektir., NA

We aimed to describe the technical aspects and outcomes of the retrograde tibial approach and balloon predilation for recanalization of complex infrainguinal arterial occlusions and determine the efficacy of this approach in minimizing failure rates.Between September 2006 and April 2011, antegrade revascularization failed in 22 limbs with complex total occlusions within the infrainguinal arterial territory. For each of these antegrade failure cases in 22 patients, a retrograde tibial puncture had been attempted. Percutaneous recanalization and predilation were initially performed through tibial access, and final balloon dilatation or stent placement was performed from antegrade femoral access. The patients were followed up for functionality and wound healing.Access from the tibial artery was successfully obtained for all patients (100%). Successful recanalization was obtained in 18 patients (82%). Retrograde access was performed from the anterior tibial/dorsalis pedis artery in 12 patients and posterior tibial artery in 10 patients. One major and one minor complications were documented.Retrograde tibial recanalization technique in the infrainguinal complex arterial occlusion safely increases the success rates of percutaneous recanalization in the failed traditional approach and is a feasible endovascular option to avoid more invasive, time-consuming, and high-risk procedures.

This study retrospectively evaluated ultrasonography-guided (US-guided) percutaneous thrombin injection for the treatment of postcatheterization femoral and brachial artery pseudoaneurysms.Fifty-five patients with postcatheterization femoral artery (n = 53) or brachial artery (n = 2) pseudoaneurysms were treated using US-guided human thrombin (500 IU/mL) injection. Pseudoaneurysm size, thrombin dose, therapy outcome, and complications were documented. Follow-up color Doppler US was performed 7 and 30 days after treatment. Short-duration supplemental compression was applied to six patients at the first week follow-up examination after a reinjection of thrombin had failed.Mean pseudoaneurysm volume was 20.3 ± 18.7 cm(3). The mean injected thrombin dose was 478 ± 238 IU. Thirty-eight (69.1%) of the 55 pseudoaneurysms were thrombosed with a single injection, and 11 of 17 pseudoaneurysms were thrombosed after a second injection. All (100%) of the 41 pseudoaneurysms that were diagnosed within the first two weeks of postcatheterization were successfully treated. The overall primary success rate was 89.1% (49 of 55 pseudoaneurysms). Supplemental compression promoted thrombosis in four of the six patients who had treatment failure with thrombin injection. The secondary success rate was 96.4% (53 of 55 pseudoaneurysms). There were no complications.US-guided thrombin injection was most successful within the first two weeks, and the supplemental compression might aid in the closure of partially thrombosed pseudoaneurysms.

Evaluation and management of peritonsillar masses require specific attention because of their relationship to vital neighboring anatomical structures. A 57-year-old woman developed pseudoaneurysm of the internal carotid artery following a biopsy taken at another center from a mass in the left tonsillar region. She was treated by a multidisciplinary approach and an endovascular covered stent was implanted under local anesthesia in the left internal carotid artery. No recurrence was detected in the neck and the patient was asymptomatic in the postoperative second year.

To evaluate magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) findings in popliteal artery entrapment syndrome.Seven limbs of 6 patients (5 men and 1 woman; mean age, 36 +/- 12 years) with popliteal artery entrapment syndrome were evaluated retrospectively. Both MRI and DSA were performed on each affected limb.MRI findings established the diagnosis of type-3 popliteal artery entrapment syndrome in 4 limbs, and type-2 in 3 limbs. Abnormal MRI findings included popliteal artery thrombosis with aneurysm in 2 limbs (29%), popliteal artery thrombosis without aneurysm in 1 limb (14%), aberrant fibrous band in 3 limbs (43%), aberrant thick muscle bundle in 1 limb (14%), insertion anomaly of medial head of the gastrocnemius muscle (MHG) in 3 limbs (43%), lateral deviation of the MHG in 4 limbs (57%), hypertrophy of the MHG in 1 limb (14%), and atrophy of the MHG in 2 limbs (29%). Deviation of the popliteal artery in 4 limbs (57%) and distal crural embolic occlusions in 2 limbs (29%) were detected with both angiography and MRI imaging. DSA was diagnostic in 2 limbs of 1 patient, and MRI was diagnostic in all limbs examined.Popliteal artery entrapment syndrome should be considered in patients younger than 50 years of age with isolated popliteal artery stenosis or occlusion. MRI is the preferred imaging modality for diagnosis of entrapment syndrome, and may obviate the use of DSA.

Iliac vein compression syndrome (IVCS), also known as May-Thurner syndrome, is the result of compression of the left common iliac vein between the right common iliac artery and overlying vertebrae. The most common clinical presentation is left lower extremity deep vein thrombosis. Rarely, a patient with IVCS can present with obstruction of venous outflow, without deep vein thrombosis. Iliac vein compression, with or without thrombosis, should be treated if symptomatic. We present a patient with IVCS that was initially diagnosed with transabdominal ultrasonography (US), and then confirmed with computed tomography and venography with pressure measurements. We believe this is the first report of an IVCS patient diagnosed with US.

The aim of this study was to determine the types, prevalence rates, and clinical implications of portal vein (PV) variations using routine abdominal multidetector computed tomography (MDCT).The study included 1384 retrospectively evaluated patients (721 males, 663 females) that had undergone routine abdominal MDCT. Portal phase CT scans (2.5 mm collimation, table speed/rotation time, 12.5 mm/0.5 s) were acquired 60 s after contrast material injection. Two radiologists interpreted the images and reached a consensus on all findings. Types and frequencies of PV variations were noted.Normal PV branching patterns were observed in 1005 (72.6%) of the patients. PV variants and anomalies were identified in 379 patients (27.4%). Normal main PV branching patterns were noted in 1087 (78.5%) of the patients. Main PV branching variations were seen in 297 (21.5%) of the patients. The most frequent types of these variations were trifurcation (n = 154, 11.1%) and right posterior PV as the first branch of the main PV (n = 134, 9.7%). Right PV variation was identified in 42 (3.9%) of the 1087 patients with type 1 anatomy. Variation of the origin of the segmental PV that traversed the interlobar boundary was identified in 55 (4%) of the 1384 patients.The prevalence of PV variations was high in patients that underwent abdominal CT, and routine abdominal MDCT demonstrated these abnormalities very well. Clinically relevant PV variants should be reported in routine CT evaluations.

Acute portal vein thrombosis (PVT) is a rare clinical condition that can cause portal hypertension and bowel infarction. Early diagnosis and treatment of PVT is crucial for the restoration of portal venous flow and reduction of morbidity and mortality. We report a successful treatment of acute PVT which was seen following splenectomy, utilizing catheter directed transhepatic thrombolysis. No complication was encountered related to the procedure. Thrombolytic therapy via transhepatic route proved to be a safe and effective method in the treatment of PVT.

Popliteal artery entrapment syndrome is a rare but potentially limb threatening peripheral vascular disease occurring predominantly in young adults. We report a case of a 17-year-old boy who presented with intermittent claudication on the right side. Digital subtraction angiography revealed bilateral, focal narrowing of the popliteal arteries. Magnetic resonance imaging displayed compression of the arteries by the medial head of the gastrocnemius muscles. The mechanism, presentation, imaging findings, and management of this rare disease are discussed.

Atherosclerotic stenosis of the vertebrobasilar system most commonly occurs at the vertebral artery origin. Stenting of these stenotic lesions in combination with antithrombotics with or without anticoagulants is a safe and effective treatment method. The purpose of this study is to present the results of vertebral artery origin stenting in 14 high-risk patients.Significant vertebral artery origin stenosis was treated with primary stenting in 14 patients, aged between 58 and 74 years (mean, 66+/-5.3 years). Eleven patients were male, and three were female. Vertebral artery stenosis was detected in eight patients prior to coronary artery surgery, and in six patients after a posterior system stroke or during evaluation of a vertebrobasilar insufficiency. All stenosis were successfully treated with stent placement. Except one patient who had a left posterior cerebral artery infarction, all patients had an uneventful procedure without any complication. Third-month and sixth-month clinical and color Doppler follow-up examinations were available in ten patients, and 12th-month control angiography performed in three patients did not show stent restenosis. None of the patients had new neurologic deficit during the follow-up.Vertebral artery origin stenoses are one of the most common causes of vertebrobasilar stroke. In the presence of concomitant cerebral artery stenosis or systemic disorders, patients are under high risk even if they are on medical therapy. Primary stenting combined with medical treatment is a safe and effective treatment modality.

In recent years a characteristic subcapsular and periligamentous fatty infiltration of the liver has been reported in diabetic patients on intraperitoneal insulin treatment by continuous ambulatory peritoneal dialysis. The finding is unique to these patients on continuous ambulatory peritoneal dialysis and has not been defined in diabetics using subcutaneous insulin. We present characteristic US and CT findings in two such patients with focal subcapsular fatty infiltration of the liver.