Abstract:

Article describes a rare case of iatrogenic arterial priapism, which was the result of inadequate surgical tactics in treatment of recurrent venous priapism.

Aim: was to formulate an algorithm of examination and treatment of patients with various forms of priapism.

Materials and methods: treatment of patient with iatrogenic arterial priapism, which developed as a result of inadequate surgical tactics in treatment of venous priapism, was analyzed step by step.

Results: reasons for development of arterial priapism in surgical treatment of venous priapism were identified. Achieved success in arresting arterial priapism by selective embolization a. pudenda interna.

Conclusion: angiography and subsequent selective embolization is a highly effective and safe method of arresting arterial priapism.

Abstract:

This review is devoted to critical upper limb ischemia in patients with hemodialysis vascular access. Possible etiological causes of critical ischemia and diagnostic aspects of this pathology are considered. Contemporary approaches of treatment of critical ischemia in this group of patients are demonstrated; indications and contraindications for methods of treatment are discussed. Particular attention has been paid to endovascular method of revascularization of hand, which can become the method of choice in treatment of patients with critical ischemia of the upper limb caused by occlusive lesions of arteries in patients with hemodialysis vascular access.

References

1.     Vennesland JB, S?reide K, Kval?y JT, et al. A Population-Based Study of Incidence, Presentation, Management and Outcome of Primary Thromboembolic Ischemia in the Upper Extremity. World J Surg. 2019; 43(9): 2320-2327.

https://doi.org/10.1007/s00268-019-05023-w

2.     Thibaudeau S, Serebrakian AT, Gerety PA, Levin LS. An algorithmic approach to the surgical treatment of chronic ischemia of the hand: а systematic review of the literature. Plast Reconstr Surg. 2016; 137: 818-828.

3.     Huber TS, Larive B, Imrey PB, et al. Access-related hand ischemia and the Hemodialysis Fistula Maturation Study. J Vasc Surg. 2016; 64(4): 1050-1058.

https://doi.org/10.1016/j.jvs.2016.03.449

4.     Horst VD, Nelson PR, Mallios A, et al. Avoiding hemodialysis access-induced distal ischemia. The Journal of Vascular Access. 2020. https://doi.org/10.1177/1129729820943464

5.     Mohamed AS, Peden EK. Dialysis-associated steal syndrome (DASS). The Journal of Vascular Access. 2017; 18(1): 68-73.

https://doi.org/10.5301/jva.5000684

6.     Stolic RV, Trajkovic GZ, Miric DJ, et al. Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis. World J Nephrol. 2013; 2(2): 26-30.

https://doi.org/10.5527/wjn.v2.i2.26

7.     Cheun TJ, Jayakumar L, Sideman MJ, et al. Upper extremity arterial endovascular interventions for symptomatic vascular access-induced steal syndrome. J Vasc Surg. 2019; 70 (2): 1896-1903.

8.     Sedov VM, Karpov SA, Alfyorov SV, Grinyov KM. Phenomenon of ischemic steal syndrome in patients with different arteriovenous fistulas for hemodialysis and its surgical correction. Grekov's Bulletin of Surgery. 2013;172(6): 051-055 [In Russ].

9.     Vaes RHD, Wouda R, Teijink JAW, Scheltinga MR. Venous side branch ligation as a first step treatment for haemodialysis access induced hand ischemia: effects on access flow volume and digital perfusion. Eur J Vasc Endovasc Surg. 2015; 50: 810-814.

10.   Tordoir JHM, Dammers R, van der Sande FM.мUpper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg. 2004; 27: 1-5.

11.   Gurkov A, Lobov G, Gurevich K. Blood flow in the large vessels of the forearm and in the microvessels of the hand in patients on programmed hemodialysis. The Doctor. 2012; 6: 64-67 [In Russ].

12.   Cheun TJ, Jayakumar L, Sheehan MK et al. Outcomes of upper extremity interventions for chronic critical ischemia. J Vasc Surg. 2018; 69 (1): 20-128.

13.   Tursunov BZ, Usmanov HH, Temirov SN. Balloon angioplasty of the radial artery in critical hand ischemia. Angiology and Vascular Surgery. 2018; 24: 64-69 [In Russ].

14.   Guerra A, Raynaud A, Beyssen B, et al. Arterial percutaneous angioplasty in upper limbs with vascular access devices for haemodialysis. Nephrol Dial Transplant. 2002; 17: 843-851.

15.   Oprea A, Molnar A, Scridon T, Mircea PA. Digital pressure in haemodialysis patients with brachial arteriovenous fistula. Indian J Med Res. 2019; 149(3): 376-383.

16.   Tolba M, Maresch M, Kamal D. Distal radial artery ligation for treatment of steal syndrome associated with radiocephalic arteriovenous fistula. J Surg Case Rep. 2020; 2020(9): rjaa314.

https://doi.org/10.1093/jscr/rjaa314

17.   Alie-Cusson FS, Bhat K, Ramchandani J, et al. Distal Revascularization and Interval Ligation for the Management of Dialysis Access Steal Syndrome. Ann Vasc Surg. 2021; 74: 29-35.

https://doi.org/10.1016/j.avsg.2021.01.102

18.   Scali ST, Chang CK, Raghinaru D, et al. Prediction of graft patency and mortality after distal revascularization and interval ligation for hemodialysis access-related hand ischemia. Eur J Vasc Endovasc Surg. 2013; 45:195.

19.   De Caprio JD, Valentine RJ, Kakish HB, et al. Steal syndrome complicating hemodialysis access. Cardiovasc Surg. 1997; 5: 648-653.

20.   Sheaffer WW, Hangge PT, Chau AH, et al. Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER): A Review of the Available Literature and Brief Overview of Alternate Therapies in Dialysis Associated Steal Syndrome. J Clin Med. 2018; 7(6): 128.

21.   Kordzadeh A, Garzon LAN, Parsa AD. Revision Using Distal Inflow for the Treatment of Dialysis Access Steal Syndrome: A Systematic Review. Ann Vasc Dis. 2018; 11(4): 473-478.

22.   Vaes RHD, van Loon M, Selma MM, et al. One-year efficacy of the RUDI technique for flow reduction in high-flow autologous brachial artery-based hemodialysis vascular access. J Vasc Access. 2015; 16(9): 96-101.

23.   Shaikh FA, Siddiqui N, Shahzad N, et al. Operative Techniques to Prevent Dialysis Access-associated Steal Syndrome in High-risk Patients Undergoing Surgery for Hemodialysis Access: A Systematic Review. Cureus. 2019; 11(11): 6086.

24.   Schaffer D. A prospective, randomized trial of 6-mm versus 4-7-mm PTFE grafts for hemodialysis access in diabetic patients. In: Vascular Access for Hemodialysis, 5th. ed., edited by Henry ML, Ferguson RM, Tucson, WL. Gore and Associates, Inc., and Precept Press, 1997; 91-94.

25.   Scholz H. Arteriovenous Access Surgery. New-York: Springer-Verlag Berlin Heidelberg. 2015.

26.   Patel MS, Davies MG, Nassar GM, Naoum JJ. Open repair and venous inflow plication of the arteriovenous fistula is effective in treating vascular steal syndrome. Ann Vasc Surg. 2015; 29(5): 927-933.

https://doi.org/10.1016/j.avsg.2014.12.042

27.   Zamani P, Kaufman J, Kinlay S. Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis. Vascular Medicine. 2009; 14: 371-376.

28.   Leake AE, Winger DG, Leers SA, et al. Management and outcomes of dialysis access-associated steal syndrome. J Vasc Surg. 2015; 61(3): 754-760.

29.   Misskey J, Yang C, MacDonald S, et al. A comparison of revision using distal inflow and distal revascularization-interval ligation for the management of severe access-related hand ischemia. J Vasc Surg. 2016; 63(6): 1574-1581.

30.   Shakarchi JA, Stolba J, Houston JG, et al. Surgical techniques for haemodialysis access-induced distal ischaemia. J Vasc Access. 2016; 17(1): 40-46.

31.   Spinelli F, Benedetto F, Passari G, et al. Bypass Surgery for the Treatment of Upper Limb Chronic Ischaemia. Eur J Vasc Endovasc Surg. 2010; 39: 165-170.

32.   Pederson WC. Revascularization Options for Terminal Distal Ischemia. Hand Clin. 2015; 31: 75-83.

33.   Cornejo A, Neaman KC, Srinivasan RC, et al. In situ venous bypass for chronic hand ischemia. Ann plast surg. 2016; 76(4): 275-279.

34.   Masden LD, Seruya M, Higgins JP. A systematic review of the outcomes of distal upper extremity bypass surgery with arterial and venous conduits. Hand Surg. 2012; 37(A): 2362-2367.

35.   Hoexum F, Coveliers HM, Lu JJ, et al. Thoracic sympathectomy for upper extremity ischemia. Minerva Cardioangiologica. 2016; 64(6): 676-685.

36.   Zeng W, Hammert WC. Arterialization of the Venous System for Treatment of Chronic Ischemia in the Hand. Plast Reconstr Surg. 2016; 137(4): 1213-1220.

37.   Zatevahin II, Cipciashvili MSh, Gorbenko UF. Тransplantation of omentum major in the treatment of distal lesions of the tibial arteries. Clinical angiology: Manual/Ed. by A.V. Pokrovsky. - Moscow: Medicine Publishers, 2004; 2: 316-325 [In Russ].

38.   Shukla PA, Contractor S, Huang JT, Curi MA. Coil embolization as a treatment alternative for dialysis-associated steal syndrome. Vasc Endovascular Surg. 2012; 46(7): 546-9.

https://doi.org/10.1177/1538574412456435

39.   Davies MG. Management of Arteriovenous Fistula Side Branches: Ligation or Coil Embolization. Journal of Vascular Surgery. 2019: 70(2): 34.

https://doi.org/doi:10.1016/j.jvs.2019.06.041

40.   Kasirajan K. Coil Embolization of Tributaries of Brachiocephalic Fistula is Effective in the Management of Vascular Steal. Ann Vasc Surg. 2021; 72: 307-314.

https://doi.org/10.1016/j.avsg.2020.08.150

41.   Tomoi Y, Soga Y, Fujihara M, et al. Outcomes of Endovascular Therapy for Upper Extremity Peripheral Artery Disease With Critical Hand Ischemia. J Endovasc Ther. 2016; 23(5): 717-22.

https://doi.org/10.1177/1526602816659279

42.   Law Y, Chan YC, Cheng SW. Angioplasty of forearm arteries as a finger salvage procedure for patient with end-stage renal failure. Int J Nephrol Renovasc Dis. 2016; 9: 105-109.

https://doi.org/10.2147/IJNRD.S102257

43.   Gandini R, Angelopoulos G, Da Ros V, et al. Percutaneous transluminal angioplasty for treatment of critical hand ischemia with a novel endovascular approach: the radial to ulnar artery loop technique. J Vasc Surg. 2010; 52: 760-762.

44.   Singh A, Kumar N, Jain AP, et al. Endovascular management of critical hand ischemia by 'palmar arch loop' technique. Vascular. 2021; 29(4): 597-605.

https://doi.org/10.1177/1708538120966939

45.   Bahro A, Igyarto Z, Martinsen B. Critical hand ischemia treatment via orbital atherectomy - A single center observational retrospective analysis. Cardiovascular Revascularization Medicine. 2017; 18: 91-94.

46.   Gandini R, Fabiano S, Morosetti D, et al. Endovascular treatment of below-the-elbow arteries in critical hand ischemia. Minerva Cardioangiol. 2016; 64(6): 662-71.

47.   Yeager RA, Moneta GL, Edwards JM, et al. Relationship of hemodialysis access to finger gangrene in patients with end-stage renal disease. J Vasc Surg. 2002; 36(2): 245-249.

Abstract:

Aim: was to assess the efficacy of surgical treatment of post-traumatic arteriovenous fistula with use of stent-grafts.

Materials and methods: stent-grafts were successfully used in treatment of 4 patients with post-traumatic arteriovenous fistula (AVF). In 2 cases AVF were located in iliac vessels, in 1 case in shin and in 1 case - thigh. In 3 cases, appearance of AVF was a result of gunshot wound, in 1 case - stab wound

Results: technical success was achieved in all cases. In 1 case after endovascular elimination of AVF on the level of iliac vessels, retroperitoneal hematoma with infection was revealed, that leaded to open surgical operation.

Conclusion: the use of stent-grafts in surgical correction of vessel injury can decrease operational trauma, and can achieve better clinical results and good long-term prognosis.  

References

1.    Petrovskij B.V., Milonov O.B. Hirurgija anevrizm perifericheskih sosudov [Surgery of peripheral vessels' aneurysms] M.: Medicina. 1970; 273S [In Russ].

2.    Kugukarslan N.L., Oz B.S., Ozal E.,Yildirim V., Tatar H. Factors affecting the morbidity and mortality of surgical management of vascular gunshot injuries: missed arterial injury and disregarded vein repair. Ulus Travma Acil Cerrahi Derg. 2007;13(1):43-48.

3.    Gavrilenko A.V. Travmaticheskie arteriovenoznye svishhi [Traumatic arteriovenous fistula]. OAO «Izdatel'stvo «Medicina» Klinicheskaja angiologija: Ruk. pod red. A.V. Pokrovskogo. 2004;2: 340-344 [In Russ].

4.    Gavrilenko A.V., Egorov A.A. Tradicionnaja hirurgija sosudov i rentgenjendovaskuljarnye vmeshatel'stva - konkurencija ili vzaimodejstvie, vedushhee k gibridnym operacijam? [Traditional sugery of vessels versus endovascular treatment: competition or cooperation, leading to the hybrid operation?] Angiologija i sosudistaja hirurgija. 2011; 17(4):152-156 [In Russ].

5.    Zotov S.P., Shherbakov A.V., Kugeev A.F., Zajcev S.S., Shakirov R.G., Semashko T.V., Zhabreev A.V., Panov I.O. Klinicheskie osobennosti posttravmaticheskih arterio- venoznyh svishhej [Clinical features of post-traumatic arteriovenous fistula]. Angiologija i sosudistaja hirurgija. 2011; 17(2):133-137 [In Russ].

6.    Li F., Song X., Liu C., Liu B., Zheng Y Endovascular stent-graft treatment for a traumatic vertebrovertebral arteriovenous fistula with pseudoaneurysm. Ann. Vasc. Surg. 2014; 2:489.

7.    Mensel B., Kuhn J.P, Hoene A., Hosten N., Puls R. Endovascular repair of arterial iliac vessel wall lesions with a self-expandable nitinol stent graft system. PLoS One. 2014; 9(8): journal.pone.0103980.

8.    Park H.K., Choe W.J., Koh YC., Park S.W. Endovascular management of great vessel injury following lumbar microdiscectomy. Korean J. Spine. 2013; 4:264-267.

9.    Sin'kov M.A., Murashkovskij A.L., Pogorelov E.A., Golovin A.A., Kalichenko N.A., Haes B.L., Kokov A.N., Heraskov V.Ju., Evtushenko S.A., Popov V.A., Barbarash L.S. Sluchaj uspeshnogo jendovaskuljarnogo zakrytija jatrogennogo arterio-venoznogo soust'ja podvzdoshnoj arterii i veny, projavljajushhegosja venoznym trombojembolicheskim sindromom i pravozheludochkovoj nedostatochnost'ju [Successful endovascular occlusion of iatrogenic arteriovenous fistula of the iliac artery and vein with thromboembolic syndrome and right ventricular insufficiency]. Diagnosticheskaja i intervencionnaja radiologija. 2014; 8(2):98-102 [In Russ].

Abstract:

Intraoperative vascular injury is infrequent complication (0.02-0.06%) during surgical operations on lumbar discs. We report a case of a 44-year-old man with oedema and varicose veins of the right lower limb. Despite an 4-year history of oedema and varicose veins, he appeared to be asymptomatic and could recollect no traumatic injury or surgery that might have caused it. Near the vertebral column, we found a small scar, the result of spinal disk surgery six years before. CT scan showed pseudoaneurysm of the right iliac artery with a 54 mm diameter. Thereafter, we located the suspected arteriovenous fistula by selective angiography of the aorta and its branches: a communication of the right iliac artery with the right iliac vein had resulted in a large shunt. This lesion was repaired by transluminal placement of stent-grafts Aorfix (Lombard Medical, UK). We had to use three stent-grafts due to the large difference in diameter between the common and external right iliac arteries. Hemodynamic improvement was immediate, and the postoperative course was uneventful. At the present time, almost six months postoperatively, the patient is asymptomatic. Sealing of pseudoaneurysm and arteriovenous fistula as a complication of lumbar-disc surgery with a stent graft is simple and is suggested as an excellent alternative to open surgery for iatrogenic vessel injuries. 

References

1.     Canaud L., Hireche K., Joyeux F., et al. Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery. Eur. J. Vasc, Endovasc. Surg. 2011; 42 (2): 167-171.

2.     Papadoulas S., Konstantinou D., Kourea H.P., et al. Vascular injury complicating lumbar disc surgery. A systematic review. Eur. J. Vasc. Endovasc. Surg. 2002; 24 (3): 189-195.

3.     Mulaudzi T., Sikhosana M. Arterio-venous fistula following a lumbar disc surgery. Indian J. Orthop. 2011; 45 (6): 563-564.

4.     Machado-Atias I., Fornes O., Gonzalez-Bello R., Machado-Hernandez I. Iliac arteriovenous fistula due to spinal disk surgery. Causes severe hemodynamic repercussion with pulmonary hypertension. Tex. Heart Inst. J. 1993; 20 (1): 60-64.

5.     Jarstfer B., Rich N. The challenge of arteriovenous fistula formation following disk surgery: A collective review. J. Trauma. 1976; 16: 726-733.

6.     Енькина Т.Н. Состояние сердечно-сосудистой системы у больных с хронической почечной недостаточностью на программном гемодиализе. Автореф. дис. ... канд. мед. Наук СПб. 1999. [En'kina T.N. Sostojanie serdechno-sosudistoj sistemy u bol'nyh s hronicheskoj pochechnoj nedostatochnost'ju na programmnom gemodialize [Condition of cardiovascular system in patients with chronic renal insufficiency on dialysis]. Avtoref. dis. ... kand. med. nauk SPb. 1999]. [In Russ].

7.     Brewster D., Cambria R., Moncure A., et al. Aortocaval and iliac arteriovenous fistulas: Recognition and treatment. J. Vasc. Surg. 1991; 13 (2): 253-264.

8.     Akpinar B., Peynircioglu B., Cil B., et al. Iliac vascular complication after spinal surgery: Immediate endovascular repair following CT angiographic diagnosis. Diagn. Inters. Radiol. 2009; 15 (4): 303-305.

9.     Hans S., Shepard A., Reddy P., et al. Iatrogenic arterial injuries of spine and orthopedic operations. J. Vasc. Surg. 2011; 53 (2): 407-413.

10.   Zajko A., Little A., Steed D., Curtiss E. Endovascular stent-graft repair of common iliac artery-to-inferior vena cava fistula. J. Vasc, Inters. Radiol. - 1995; 6 (5): 803-806 

Abstract:

Successful endovascular occlusion of iatrogenic arteriovenous fistula of the iliac artery and vein with tromboembolic syndrome and right ventricular insufficiency, occurred after surgical intervention on spine (mircodiscectomy of L4-L5, decompression of L5 radix). Disease spreaded under clinic of tromboembolic syndrome with formation of arteriovenous fistula and manifested like thromboembolic syndrome with right ventricular insufficiency.

References

1.     Papadoulas S., Konstantinou D., Kourea H.P, et al. Vascular injury complicating lumbar disc surgery: a systematic review. Eur. J. Vasc. Endovasc. Surg. 2002; 24: 189-195.

2.     Fruhwirth J., Koch G., Amann W., et al. Vascular complications of lumbar disc surgery. Acta Neurochir/ (Wien). 1996; 138: 912-916.

3.     Jarstfer B.S., Rich N.M. The challenge of arteriovenous fistula formation following disk surgery: a collective review. J. Trauma. 1976; 16: 726-733.

4.     Palmon S.C., Moore L.E., Lundberg J., Toung T. Venous air embolism: a review. J. Clin. Anesth. 1997; 9: 251-257.

5.     Goodkin R., Laska L.L. Vascular and visceral injuries associated with lumbar disc surgery: medicolegal implications. Surg. Neurol. 1998; 49: 358-372.

6.     Quigley T.M., Stoney R.J. Arteriovenous fistulas following lumbar laminectomy: the anatomy defined. J. Vasc. Surg. 1985; 2: 828-833.

7.     Jarstfer B.S., Rich N.M. The challenge of arteriovenous fistula formation following disk surgery: a collective review. J. Trauma. 1976; 16: 726-732.

8.     Ewah B., Calder I. Intraoperative death during lumbar discectomy. Br. J. Anaesth. 1991; 66: 721-723.

9.     Brewster D.C., May A.R., Darling R.C., et al. Variable manifestations of vascular injury during lumbar disk surgery. Arch. Surg. 1979; 114: 1026-1030.

10.   Epstein F.H., Post R.S., McDowell M. The effect of an arteriovenous fistula on renal hemodynamics and electrolyte excretion. J. Clin. Invest. 1953; 32: 233-241.

11.   McCarter D.H., Johnstone R.D., McInnes G.C., et al. Iliac arteriovenous fistula following lumbar disc surgery treated by percutaneous endoluminal stent grafting. Br. J. Surg. 1996; 83: 796-797.

12.   Burger T., Meyer F., Tautenhahn J., et al. Percutaneous treatment of rare iatrogenic arteriovenous fistulas of the lower limbs. Int. Surg. 1998; 83, 198-201.