S urgical clipping of MCA aneurysms is usually preferred to EVT. This preference is largely the result of a relatively easy surgical access and unfavorable endovascular approach due to the complex branching pattern of the MCA. As of this writing, no direct comparison between results of endovascular and surgical treatment of MCA aneurysms has been published in the literature, leaving the optimal treatment strategy unclear and choices depending mainly on the practice at the different centers. We therefore considered it important to study procedure-related risks as well as the immediate and midterm angiographic and clinical results after EVT of MCA aneurysms. MethodsFrom October 1992 to October 2001, a total of 940 patients with 1120 cerebral aneurysms were seen in our institute. Of these 940 patients, 202 (21.5%) were found to have MCA aneurysms (a total of 238 [21.3% of all identified aneurysms]). The closing date was chosen to have more than 5 years of follow-up data.Since the first use of detachable coils in our department in October 1992, data pertaining to all patients referred for EVT has been prospectively recorded. These data include: patients' demographic characteristics, mode of presentation, aneurysmal angiographic features, angiographic outcome at immediate post-EVT and follow-up examinations, procedure-related complications, and clinical status, using Hunt and Hess grading (in case of hemorrhage) on admission and GOS scores upon discharge Object. The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution.Methods. The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered.Results. At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years.Conclusions. Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identi...

Endovascular treatment of renal artery aneurysms is an adequate treatment and can be proposed, if feasible, as first step.

No abstract

Conservative therapy is safe and effective when the renal artery is patent and blood pressure is controlled: we propose it as the first line of treatment, reserving interventional management for refractory cases.

Objectives: Anterior vaginal wall slings (AVWS) have been used for decades in the treatment of female stress urinary incontinence (SUI). The main drawback of using the vaginal wall as a sling is its tendency to weaken and stretch over the course of years. The use of synthetic tapes for the treatment of SUI is effective but costly. For patients who cannot afford synthetic tapes, we describe the preliminary results of a modi and III. Patients and Methods: In this series, a modification of the AVWS was applied in 35 female patients with SUI. A fortified and rolled urethra. The vaginal mucosal surface of the across it. The flap is then rolled on itself with a running 2/0 vicryl suture. Two sutures attached to both ends are passed retropubically to the anterior abdominal wall and tied over the rectus sheath. Results: All 35 female patients had type II/III SUI. After a median follow up of 43 months, 91% of the patients were dry or used 0-1 pad per day. Only one patient suffered from transient retention for one week post-operatively. Conclusion: This is a simple method to reinforce vaginal wall effective option for the treatment of SUI in patients who can not afford synthetic tapes. Long-term follow up is required to evaluate the durability of the procedure.