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Title: Selective Embolization of Bilateral Arterial Cavernous Fistulas for Posttraumatic Penile Arterial Priapism

Abstract

A 22-year-old man suffered a hiking accident with perineal trauma and developed a nonpainful priapism secondary to bilateral arterial-cavernosal fistulas. To minimize the risk of impotence in this young patient, successive selective embolizations with autologous blood clot were performed to close the fistulas. This led to an uncomplicated full recovery. No fistula was detectable on Doppler ultrasonography at 1-year follow-up. Review of the literature confirms the safety of embolization with autologous clot.

Authors:
; ;  [1];  [2]
  1. Department of Diagnostic Radiology, Lahey Hitchcock Medical Center, 41 Mall Road, Burlington, MA 01805 (United States)
  2. Department of Urology, Lahey Hitchcock Medical Center, 41 Mall Road, Burlington, MA 01805 (United States)
Publication Date:
OSTI Identifier:
21080512
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 19; Journal Issue: 4; Other Information: DOI: 10.1007/s002709900057; Copyright (c) 1996 Springer-Verlag New York Inc; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ACCIDENTS; BLOOD; BLOOD VESSELS; EMBOLI; INJURIES; PATIENTS; ULTRASONOGRAPHY; VASCULAR DISEASES

Citation Formats

Lazinger, Maxwell, Beckmann, Carl F., Cossi, Alda, and Roth, Robert A. Selective Embolization of Bilateral Arterial Cavernous Fistulas for Posttraumatic Penile Arterial Priapism. United States: N. p., 1996. Web. doi:10.1007/S002709900057.
Lazinger, Maxwell, Beckmann, Carl F., Cossi, Alda, & Roth, Robert A. Selective Embolization of Bilateral Arterial Cavernous Fistulas for Posttraumatic Penile Arterial Priapism. United States. doi:10.1007/S002709900057.
Lazinger, Maxwell, Beckmann, Carl F., Cossi, Alda, and Roth, Robert A. 1996. "Selective Embolization of Bilateral Arterial Cavernous Fistulas for Posttraumatic Penile Arterial Priapism". United States. doi:10.1007/S002709900057.
@article{osti_21080512,
title = {Selective Embolization of Bilateral Arterial Cavernous Fistulas for Posttraumatic Penile Arterial Priapism},
author = {Lazinger, Maxwell and Beckmann, Carl F. and Cossi, Alda and Roth, Robert A.},
abstractNote = {A 22-year-old man suffered a hiking accident with perineal trauma and developed a nonpainful priapism secondary to bilateral arterial-cavernosal fistulas. To minimize the risk of impotence in this young patient, successive selective embolizations with autologous blood clot were performed to close the fistulas. This led to an uncomplicated full recovery. No fistula was detectable on Doppler ultrasonography at 1-year follow-up. Review of the literature confirms the safety of embolization with autologous clot.},
doi = {10.1007/S002709900057},
journal = {Cardiovascular and Interventional Radiology},
number = 4,
volume = 19,
place = {United States},
year = 1996,
month = 4
}
  • We report a case of idiopathic priapism that was only identified as high-flow or arterial priapism after drainage of the corpora cavernosa. Following failure of conservative and surgical treatment attempts, two consecutive embolizations of a unilateral penile artery were performed with gelgoam particles.
  • A patient with high-flow priapism was treated by transcatheter embolization of a posttraumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate (NBCA), resulting in complete detumescence. Erectile function has been preserved during a 3-month follow-up. Only two patients with NBCA embolization for high-flow priapism have been reported previously.
  • Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.
  • No abstract prepared.
  • PurposeCranial nerve dysfunction (CND) is not uncommon in patients with cavernous dural arteriovenous fistulas (cDAVFs), and may represent an initial manifestation or a complication after endovascular treatment. This study evaluated the outcome of CND associated with cDAVFs after transvenous embolization (TVE) using Onyx.Materials and MethodsForty-one patients with cDAVFs were treated with TVE in our department between April 2009 and October 2013. For each patient, clinical and radiologic records were retrospectively reviewed and evaluated, with an emphasis placed on evaluating the outcomes of the pre-existing cDAVF-induced CND and the TVE-induced CND.ResultsOf the 41 cases, 25 had a history of preoperative CND.more » Postoperatively, gradual remission to complete recovery (CR) within 8 months was observed in 17 of these cases, transient aggravation in 7, and significant improvement to be better than preoperative function but no CR in 1. All aggravation of CND occurred immediately or within 1 day after TVE and resolved completely within 5 months. Nine patients developed new CND after TVE. New CND occurred during the perioperative period in 8 cases, but all cases resolved completely within 15 days–6 months. Delayed CND was observed in 3 cases with a time lag of 3–25 months after TVE. Two of these completely resolved within 20 days–1 month and the remaining case significantly improved.ConclusionBoth the pre-existing cDAVF-induced CND and the TVE-induced new or aggravated CND completely resolved in almost all cases after embolization with Onyx.« less