Holmium Laser Enucleation of the Prostate and Iatrogenic Arteriovenous Fistula Treated by Superselective Arterial Embolization

Asimakopoulos, Anastasios D; Dutto, Lorenzo; Preziosi, Paolo; Spera, Enrico; Micali, Francesco; De Carolis, Andrea; Iorio, Beniamino

doi:10.1155/2016/4918081

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Holmium Laser Enucleation of the Prostate and Iatrogenic Arteriovenous Fistula Treated by Superselective Arterial Embolization

case-report

Author(s): Anastasios D. Asimakopoulos ¹ ^, ^* , Lorenzo Dutto ² , Paolo Preziosi ³ , Enrico Spera ¹ , Francesco Micali ⁴ , Andrea De Carolis ⁴ , Beniamino Iorio ¹

Publication date (Electronic): 28 February 2016

Journal: Case Reports in Urology

Publisher: Hindawi Publishing Corporation

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Abstract

Iatrogenic pelvic pseudoaneurysm with concomitant arteriovenous fistula has been described as a rare and challenging complication, which may occur during transurethral resection of the prostate. We provide the first report of this complication after holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia. The attempt to control the bleeding by conversion to open surgery and placement of haemostatic stitches into the prostatic fossa failed. Angiography with superselective arterial embolization proved to be a modern, quick, safe, and efficient treatment of this uncommon complication.

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Most cited references 12

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Transcatheter embolization of complex pelvic vascular malformations: results and long-term follow-up.

B. H. J. Hofstee, Caron Rockman, Thomas Riles … (2000)

Vascular malformations of the pelvis are rare and present a difficult therapeutic challenge. Surgical treatment is notoriously difficult and carries a high likelihood of recurrence. Surgical proximal ligation of a feeding vessel may in fact be contraindicated, because it can make subsequent transcatheter therapy impossible. The purpose of this study was to review our results with transcatheter embolization therapy in symptomatic complex pelvic vascular malformations in 35 patients. A retrospective review was conducted of a prospectively compiled database of all patients undergoing transcatheter therapy of a pelvic vascular malformation at our institution. The mean age of the patients was 34 years (range, 16 months-66 years), and 51% were male. The most common presenting symptoms included pain (59%), a visible or palpable lesion (62%), associated palpable pulsation or thrill (44%), hemorrhage (27%), congestive heart failure (18%), and symptoms due to mass effect (35%). A significant number of patients had undergone previous, unsuccessful attempted surgical treatment of the lesion (32%). The most common type of lesion noted on arteriography was arteriovenous shunting (89%). Patients required a mean of 2.4 embolization procedures (range, 1-11 procedures) over a mean period of 23.3 months (range, 1-144 months). The most common agents used were rapidly polymerizing acrylic adhesives. The most common vessels involved and treated were branches of the hypogastric artery (82%). More than one procedure were performed in 20 patients (53%). Seven were planned as staged embolizations, whereas 13 were due to residual or recurrent symptoms. Adjunctive surgical procedures were performed subsequent to embolization therapy in five patients (15%). Eighty-three percent of patients were asymptomatic or significantly improved at a mean follow-up of 84 months (range, 1-204 months). Pelvic vascular malformations are difficult to eradicate completely, and recurrences are common. Many patients require multiple therapeutic interventions. However, most of these difficult cases have good results in the long term. Transcatheter embolization plays a significant role in, and may be the treatment of choice for, symptomatic pelvic vascular malformations.

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Diagnosis of clinically unsuspected posttraumatic arteriovenous fistulas of the pelvis using CT angiography.

Jennifer Chen, Pamela T. Johnson, Elliot Fishman (2007)

Traumatic arteriovenous (AV) fistulas present with a variety of clinical manifestations and may prove difficult to detect. The clinical sequelae of undiagnosed AV fistulas are significant and include dilatation of the vessels, venolymphatic trophic complications, and heart failure. In this article, we report two rare cases involving long-standing noniatrogenic AV fistulas of the pelvis that were detected using 64-MDCT angiography (CTA) 14 and 20 years after a trauma.

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Spontaneous thrombosis of hepatic posttraumatic pseudoaneurysms: sonographic and computed tomographic features.

Diana Gaitini, Monica Epelman, Michalle Soudack (2002)

Hepatic artery pseudoaneurysms are rare complications of blunt abdominal trauma. In the past, surgical ligation was the recommended treatment; today, it is embolization. We report a case of a child involved in a motor vehicle collision who had liver lacerations with subsequent development of hepatic artery pseudoaneurysms. In this case, embolization was not performed, and the pseudoaneurysms regressed spontaneously. Spontaneous regression has been reported previously, but its true prevalence is unknown. Our report includes full sonographic and partial computed tomographic (CT) documentation of the lesions during the course of their regression. To the best of our knowledge, this is the first report in the English literature with sonographic depiction of spontaneous thrombosis of a hepatic posttraumatic pseudoaneurysm in a child.

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Author and article information

Journal

Journal ID (nlm-ta): Case Rep Urol

Journal ID (iso-abbrev): Case Rep Urol

Journal ID (publisher-id): CRIU

Title: Case Reports in Urology

Publisher: Hindawi Publishing Corporation

ISSN (Print): 2090-696X

ISSN (Electronic): 2090-6978

Publication date (Print): 2016

Publication date (Electronic): 28 February 2016

Volume: 2016

Electronic Location Identifier: 4918081

Affiliations

¹Department of Experimental Medicine and Surgery, UOC of Urology, University of Rome Tor Vergata, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy

²Department of Urology, Prostatazentrum Nordwest, Möllenweg 22, 48599 Gronau, Germany

³Department of Radiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy

⁴Department of Urology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy

Author notes

*Anastasios D. Asimakopoulos: tasospao2003@ 123456yahoo.com

Academic Editor: Sung Kyu Hong

Author information

Anastasios D. Asimakopoulos http://orcid.org/0000-0002-7230-579X

Article

DOI: 10.1155/2016/4918081

PMC ID: 4789036

PubMed ID: 27022498

SO-VID: dffe6ce9-7302-4d28-94d8-62257fc43448

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.