BACKGROUND AND PURPOSE: Transverse sinus stenosis can lead to pseudotumor cerebri syndrome by elevating the cerebral venous pressure. The occipital emissary vein is an inconstant emissary vein that connects the torcular herophili with the suboccipital veins of the external vertebral plexus. This retrospective study compares the prevalence and size of the occipital emissary vein in patients with pseudotumor cerebri syndrome with those in healthy control subjects to determine whether the occipital emissary vein could represent a marker of pseudotumor cerebri syndrome. MATERIALS AND METHODS: The cranial venous system of 46 adult patients with pseudotumor cerebri syndrome (group 1) was studied on CT venography images and compared with a group of 92 consecutive adult patients without pseudotumor cerebri syndrome who underwent venous assessment with gadolinium-enhanced 3D-T1 MPRAGE sequences (group 2). The presence of an occipital emissary vein was assessed, and its proximal (intraosseous) and distal (extracranial) maximum diameters were measured and compared between the 2 groups. Seventeen patients who underwent transverse sinus stent placement had their occipital emissary vein diameters measured before and after stent placement. RESULTS: Thirty of 46 (65%) patients in group 1 versus 29/92 (31.5%) patients in group 2 had an occipital emissary vein (P Ͻ .001). The average proximal and distal occipital emissary vein maximum diameters were significantly larger in group 1 (2.3 versus 1.6 mm, P Ͻ.005 and 3.3 versus 2.3 mm, P Ͻ .001). The average maximum diameters of the occipital emissary vein for patients who underwent transverse sinus stent placement were larger before stent placement than after stent placement: 2.6 versus 1.8 mm proximally (P Ͻ .06) and 3.7 versus 2.6 mm distally (P Ͻ .005). CONCLUSIONS: Occipital emissary veins are more frequent and larger in patients with pseudotumor cerebri syndrome than in healthy subjects, a finding consistent with their role as collateral venous pathway in transverse sinus stenosis. A prominent occipital emissary vein is an imaging sign that should raise the suspicion of pseudotumor cerebri syndrome. ABBREVIATIONS: OEV ϭ occipital emissary vein; MDCT ϭ multidetector row CT; PTCS ϭ pseudotumor cerebri syndrome; SCTV ϭ subtracted CT venography
Background. Renal arteriovenous fistula (rAVF) is a rare complication after a total nephrectomy, with only 72 cases reported in the last literature review published in 1997. AVF has never been described in a renal transplant recipient, and the possible consequences of hemodetournement on the graft function are unknown. Methods. We hereby reported the first case of rAVF occurring in a renal transplant recipient and analyzed all cases of postnephrectomy rAVF reported between 1997 and 2017. Results. A 75-year-old woman who underwent a right nephrectomy and kidney transplant 16 years earlier, and complaining of mild exercise dyspnea, was discovered with a lumbar continuous murmur. Echocardiography showed a moderate to severe dilatation of the left ventricle, with a decreased ejection fraction. Serum creatinine was slightly raised but returned to normal value with hydration. An injected computed tomography scan demonstrated a communication between the stump of the right renal artery and inferior vena cava. Total occlusion of the rAVF was obtained with Amplatzer plug and coils placed in the distal renal stump, just upstream of rAVF. Exercise dyspnea disappeared immediately, and regression of left ventricular dilatation was objectified at 6-month echocardiography follow-up. Conclusions. Postnephrectomy rAVF is rare, frequently diagnosed late, and may be responsible for high-output heart failure by left-to-right shunt, with abdominal/lumbar bruit being the only manifestation. Renal complications concern 15% of the patients. Endovascular procedure is nowadays the treatment of choice. Occluding rAVF permits cardiac hemodynamic features and heart failure symptoms resolution.
Introduction The presence of median arcuate ligament (MAL) during orthotopic liver transplantation (OLT) may cause a significant reduction in the arterial hepatic flow. The aim of the present study is to investigate the impact of MAL on biliary complications in patients who underwent OLT. Methods We performed a retrospective case‐control study among patients who underwent OLT in Geneva University Hospital between 2007 and 2017, depending on the presence or absence of MAL. The matching was performed according to age, gender, lab‐MELD score at the time of OLT and type of donor (living or dead). The presence of MAL was assessed by an expert liver radiologist on the preoperative CT angiographic evaluation. Results The incidence of MAL was 6.1% (19 patients). Baseline characteristics were comparable between the two groups. No significant difference in biliary complications was found between patients with and without MAL (37% and 24%, respectively). No patient presented hepatic artery thrombosis. After logistic regression, in patients with MAL, the MAL release and gastroduodenal artery preservation compared to no treatment, showed an odds ratio for post‐OLT biliary complications of 1.5 and 1.25, respectively. There was no difference in overall graft survival and in hazard for biliary complications between patients with and without MAL. Conclusion In the present study, we did not find any difference in the prevalence of biliary and arterial complications between patients with and without MAL. The choice of MAL treatment did not influence in a significant way the overall outcome and development of complications. However, if, at the end of arterial reconstruction, the arterial flow is not adequately established, MAL needs to be treated with the least invasive technique.
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