Objective: To evaluate the feasibility and safety of bronchial artery embolization (BAE) as a first-line endovascular treatment in patients presenting to the clinic with massive hemoptysis. Methods: In this retrospective single-center study, 43 patients (mean age: 55.6 ± 17.6 years) who underwent BAE for massive hemoptysis between 2016 and 2022 were analyzed. Patient demographics, indications, angiographic findings, embolization materials used, procedure success rates, recurrence rates (early and late), complications, and mortality rates were evaluated during a mean follow-up period of 24 months (range: 6-72 months). Results: Technical success was achieved in 97% of patients, while early clinical success was observed in 95.3%. Early recurrence occurred in 7.1% of cases and late recurrence in 16.2%. The most common etiologies in recurrent cases were recanalization and systemic collaterals. The complication rate was 18.6% and the most common complication was transient chest pain; 1 patient had transient paraplegia. The mortality rate was 7%. Conclusion: Bronchial artery embolization appears to be an effective and relatively safe intervention for the management of massive hemoptysis, demonstrating high technical and clinical success rates with acceptable complication and recurrence rates. Identification and management of non-bronchial systemic collaterals and selection of embolic agents on a case-by-case basis are important to minimize recurrence and improve long-term outcomes. Cite this article as: Öncü F, Yaylı N, Akhan BM, Akkan K, Önal B, Ilgıt E. Bronchial artery embolization for massive hemoptysis: single-center experience. Cerrahpaşa Med J. 2026, 50, 0073, doi: 10.5152/cjm.2026.25073.

AIM:To evaluate the feasibility, safety, and outcomes of n-butyl-cyanoacrylate (nBCA) embolization in patients with iatrogenic femoral arteriovenous fistulas (AVFs). MATERIALS AND METHODS:This retrospective study included 22 patients (13 men, 9 women; mean age 63.6 ± 8.0 years) who underwent nBCA embolization for femoral AVFs. Diagnosis was confirmed by Doppler ultrasound. Procedures involved selective catheterization and injection of an nBCA and ethiodized oil mixture under angiographic guidance. Follow-up was performed with Doppler ultrasound at 1 and 12 months. Technical success was defined as angiographic elimination of early venous filling without the need for additional treatment. Group comparisons used the Mann-Whitney U test, and the impact of tract length on outcomes was evaluated by ROC analysis. Effect size (Cohen's h) and post-hoc power analysis were performed. RESULTS:Technical success was achieved in 19 of 22 patients (86.3 %). The median fistula tract length was 13.5 mm (range: 6-36 mm). Success rates were significantly higher for tracts >6.5 mm (94.7 % vs. 33 %; p=0.035, Cohen's h ≈ 1.51). ROC analysis showed an AUC of 0.886 (95 % CI: 0.710-1.000), with 94.7 % sensitivity and 66.7 % specificity at a 6.5 mm cut-off. Post-hoc power was 76 %. Two patients required stent-graft placement for incomplete closure. One case of asymptomatic partial venous glue migration occurred, with no clinical sequelae. No major complications or recurrences were observed. CONCLUSION:nBCA embolization is a safe and effective treatment for iatrogenic femoral AVFs, especially with sufficient tract length. It is a promising alternative to surgery or stent-graft placement.

PURPOSE:Pseudoaneurysms (PAs) arise from the disruption of the arterial wall, resulting in extravasation of blood into the surrounding tissue. Iatrogenic sources are a leading cause of PA formation. There is an upward trend in the incidence of PAs due to the growing number of endovascular procedures. This study identifies the risk factors associated with the failure of Ultrasound-guided compression repair (UGCR) and evaluates the efficacy of vascular closure devices (VCDs) in the percutaneous treatment of iatrogenic femoral artery PAs. There are case reports in the literature, with a few cases reporting the use of VCDs for PA treatment. The aim is to contribute to the literature with a larger patient group. MATERIALS AND METHODS:Out of 107 patients with femoral PAs, 21 patients were treated with VCDs. All patients underwent preprocedural color Doppler ultrasonography to assess PA characteristics such as origin, diameter, extension, and neck size. The risk factors associated with the failure of UGCR were statistically analyzed. The VCD treatment involved using a 21G micropuncture needle, microwire, and appropriate vascular sheath (5-8 F) if necessary, followed by deploying a plug based VCD to induce thrombosis. Postprocedural ultrasonography control was performed for all patients to confirm the thrombosis and to see plug at the neck. All patients were summoned 1 week and 3 months later to undergo follow-up Doppler ultrasonography. RESULTS:Postprocedural ultrasonography confirmed successful treatment. The results demonstrated that VCDs were effective in the treatment of almost all cases (except one failure), suggesting this technique as a viable, minimally invasive option for managing iatrogenic femoral artery PAs in interventional radiology. CONCLUSION:This method can be successfully used for iatrogenic femoral PAs with a neck smaller than 5 mm. It is an alternative method when other techniques fail.

PURPOSE:The present study aims to (1) assess the technical success and limb salvage rates of endovascular therapy in patients with critical limb-threatening ischemia (CLTI) and infra-popliteal Trans-Atlantic Inter-Society Consensus (TASC) C/D lesions according to the updated 2015 TASC II classification and (2) to present our institutional experience. METHODS:A single-center retrospective study was conducted on patients with TASC C/D CLTI who underwent endovascular treatment between 2012 and 2017. The follow-up protocol consisted of Doppler ultrasound conduction every 3 months for the first year unless patients showed symptoms of CLTI. Patients with at least 1 year of follow-up data were included in the study, and if applicable their 3-year results were evaluated in terms of primary patency, absence of amputation, amputation-free survival, and overall survival. RESULTS:A total of 248 patients and 287 limbs (238 TASC D lesions and 49 TASC C lesions) were treated via infra-popliteal percutaneous transluminal angioplasty. The overall technical success was 87%, the primary patency rate was 41.5% in the first year, and the freedom from amputation rates were 80.8% in 1 year and 67.7% in 3 years. CONCLUSION:In patients with infra-popliteal arterial occlusive diseases, endovascular treatment methods demonstrate a high rate of technical success and favorable outcomes in limb preservation.

Background and Objectives: Donor hepatectomy for living related liver transplantation (LRLT) has been using widely worldwide, particularly in countries that face a shortage of deceased donors. In this study, the outcomes and safety of donor hepatectomy were aimed to be examined. Methods: Total of 69 donor hepatectomies have been performed between 2006 and 2020. All data were collected retrospectively from hospital charts. Donor evaluation starts with whole blood tests, viral load, blood group analysis. Later, all donors evaluated by the transplantation surgery, gastroenterology, pulmonary, cardiologic and psychiatric teams. Results: Of the 69 living liver donors, 28 (41%) were female, 41 (59%) were male, 39 (57%) for pediatric and 30 (43%) for adult recipient, respectively. The mean age of the donor was 35 +/- 10.5 years (range, 2160). Among the donors, 25 (36%) donors underwent to right lobectomy without middle hepatic vein, 28 (41%) left lobectomy and in 16 (23%) left lateral (LL) lobectomy. Totally 8 (12%) surgical complications were seen (n=6 early, n=2 late complication) in median 100 months (range 44-205) follow-up period. Conclusion: Our study demonstrates favorable outcomes and safety profiles of donor hepatectomy for LRLT at our center. The meticulous evaluation process, comprehensive surgical planning, and multidisciplinary approach contribute to the success of the procedure.

Our aim was to develop a prediction model based on a simple score with clinical, laboratory, and imaging findings for the subtype diagnosis of primary aldosteronism (PA). The contribution of adrenal volumetric assessment to PA subtyping was also investigated. Thirty-five patients with adequate cannulation in adrenal venous sampling (AVS) were included. Laboratory data, the saline infusion test (SIT), and the AVS results of patients with PA were retrospectively evaluated. Volumetric assessment was performed using magnetic resonance imaging (MRI) and the ratio of adrenal volumes was calculated after adjusting for gender- and side-specific mean reference values of both adrenal glands. The AVS was consistent with unilateral PA in 49

Although age determination by radiographs of the hand and wrist before the age of 18 is an area where there is a lot of radiological knowledge and many studies are carried out, studies on age determination for adults are limited. Studies on adult age determination through sternum multidetector computed tomography (MDCT) images using artificial intelligence algorithms are much fewer. The reason for the very few studies on adult age determination is that most of the changes observed in the human skeleton with age are outside the limits of what can be perceived by the human eye. In this context, with the dual-channel Convolutional Neural Network (CNN) we developed, we were able to predict the age groups defined as 20-35, 35-50, 51-65, and over 65 with 73% accuracy over sternum MDCT images. Our study shows that fusion modeling with dual-channel convolutional neural networks and using more than one image from the same patient is more successful. Fusion models will make adult age determination, which is often a problem in forensic medicine, more accurate.

PURPOSE Thoracic endovascular aortic repair (TEVAR) is a safe and effective treatment method for a variety of thoracic aortic pathologies. We aimed to investigate the mortality and complication outcomes and associated factors of TEVAR treatment in Turkey. METHODS In this single-centered retrospective study, patients with thoracic aorta pathologies treated with TEVAR at Gazi University School of Medicine, Department of Radiology, between January 2009 and January 2020 were included. Perioperative, early, and late mortality, complications, and technical success were the outcomes. RESULTS The sample comprised 58 patients with 68 TEVAR interventions. Eleven (16.2%) patients were female, the mean age was 60.1 ± 13.4 years. Emergent TEVAR was required in 20.7% of the patients. The main indications of TEVAR were intact descending aorta aneurysms in 37.9% of the sample, 31.0% Stanford type-B dissection, and 12.1% traumatic transections. The technical success rate of primary and secondary interventions was 98.3% and 100%, respectively. The mortality rate in the first 30 days was 8.6%. Seventeen (29.3%) cases had at least 1 complication related to TEVAR treatment. The most common complication was type-1A endoleak (10.3%). Having acute symptoms, stroke, and acute renal failure were significantly associated with mortality (P=.020, .049, and .009, respectively). CONCLUSION This study reported the outcomes of TEVAR treatment from a tertiary medical center in Turkey over a decade. Patients presenting with acute symptoms and who developed stroke and acute renal failure after the procedure should be carefully followed up as these factors were found to be associated with mortality.

PURPOSE:Clinical studies conducted in different geographic regions using different methods to compare transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) have demonstrated discordant results. Meta-analyses in this field indicate comparable overall survival (OS) with TACE and TARE, while reporting a longer time to progression and a higher downstaging effect with TARE treatment. In terms of isolated procedure costs, treatment with TARE is 2 to 3 times more, and in some countries even more, expensive than TACE. However, relevant literature indicates that TARE is more advantageous compared to TACE regarding the need for repeat procedures, costs of complication management, total hospital stay and quality of life. Heterogeneity of hepatocellular carcinoma (HCC) patients as well as the shortcomings of clinical classifications, randomized clinical trials and cost-effectiveness studies make it difficult to choose between treatment alternatives in this field. As in other countries, these challenges lead to differences in treatment choice across different centers in Turkey.METHODS:The present expert panel used two round modified Delphi method to investigate the resources and clinical parameters referenced while selecting patients for drug-eluting beads (DEB)-TACE and TARE treatment modalities in Turkish clinical practice. The cost-effectiveness parameters and comparisons of these treatments have also been evaluated at a prediction level.RESULTS:The panelists stated that they most commonly use the BCLC staging system for the management of HCC patients in Turkey. However, they did not find any of the staging systems or treatment guidelines sufficient enough for their clinical practice in terms of covering the down-staging intent of treatments. Since living donor transplant preference is higher in Turkey than the rest of the Western countries, down-staging treatments are thought to be more prioritized in Turkey than that in other Western countries. The panelists reached a consensus that TARE may provide improved OS and reduce the number of repeat procedures compared to DEB-TACE in intermediate-stage patients with a single tumor spanning a diameter above 5 cm who experience recurrence after previous treatment with TACE and most TACE-naïve patient groups in intermediate stage.CONCLUSION:Based on the consensus on OS and the number of procedures, the panelists assumed that TARE would be more cost-effective than DEB-TACE in most groups of TACE-naïve patients in intermediate stage and in those with a single tumor spanning a diameter above 5 cm. It was also stated that the predicted cost-effectiveness advantage of TARE could be more pronounced in patients with a tumor diameter greater than 7 cm.

PURPOSE: To evaluate carotid artery lesions with B-flow sonography and compare the findings with color, power Doppler sonography and digital subtraction angiography (DSA). MATERIALS AND METHODS: Forty-Three patients (30 male, 14 female; mean age 64±9.2; age range: 42-81) with 61 carotid artery lesions were involved in the study. The lesions were evaluated with color, power Doppler and B-flow sonography. All images were reviewed and graded independently by two radiologists for surface delineation, plaque morphology and overall image quality. The grades for each technique were compared with Friedman and Wilcoxon tests. Simple regression analysis was used to compare the percentage of stenosis calculated with different sonographic techniques and DSA for lesions causing more than 60 % stenosis. RESULTS: Statistical analysis with Friedman test revealed that B-flow is superior to other sonographic techniques for all three parameters (plaque surface delineation, plaque morphology and overall image quality). Wilcoxon test also showed B-flow is superior to other methods for the evaluation of plaque surface delineation and plaque morphology (p=0.000); while no significant difference was found between B-flow and power Doppler imaging for the evaluation of overall image quality (p=0.09). Kappa scores reflected moderate to good interobserver correlation (0.297-0.659). The percentage of stenosis calculated with both B-flow and power Doppler sonography correlated with DSA significantly (p=0.000). CONCLUSION: B-flow sonography is a technique that provides direct visualization of the blood echoes and the morphology of the surrounding vessel wall simultaneously. This technique maintains more efficient evaluation of carotid artery lesions by eliminating artifacts such as aliasing and overwriting.

Purpose: This study evaluated the hemodynamic effects of carotid artery stenting (CAS) on cerebral blood flow velocity (CBFV) in patients with carotid artery stenosis, before, 3 d, and 3 months after the procedure using transcranial Doppler ultrasound (TCD). Methods: The study included 36 patients with atheromatous carotid artery stenosis. Cerebral computed tomography (CT) or magnetic resonance imaging (MRI) was performed in every patient, and carotid stenosis was evaluated using duplex sonography, CT, and MRI angiography before the procedure. To obtain baseline values, the CBFV was evaluated 1 d before CAS. Follow-up TCD evaluations were performed 3 d and 3 months postoperatively. Results: The median degree of internal carotid artery (ICA) stenosis in the participants was 90% (range 50%–99%). The median CBFV at the anterior cerebral artery (ACA) was significantly lower on the ipsilateral side than on the contralateral side before stenting; however, there were no significant differences in CBFV in the ipsi and contralateral middle cerebral artery (MCA). The median CBFV in the ipsilateral MCA increased significantly 3 d after the procedure and remained higher than the basal values after 3 months. Conclusions: We observed significant increases in the median CBFV and pulsatility index (PI) in the MCA bilaterally, especially on the stented side, measured 3 d and 3 months after stenting in patients with severe ICA stenosis.

OBJECTIVE. The purpose of this study was to assess the reproducibility and validity of quantitative perfusion parameters derived from dynamic volume perfusion CT in patients with critical limb ischemia (CLI) and to evaluate perfusion parameter changes before and after endovascular revascularization. SUBJECTS AND METHODS. Patients with CLI referred for unilateral extremity endovascular arterial recanalization were enrolled in this study. CT examinations obtained 1-3 days before the procedure and then within 1 week after the treatment were evaluated at two reading sessions. Blood flow (BF), blood volume (BV), and time to peak (TTP) were measured on color-coded maps and compared statistically. Intraobserver agreement was assessed using intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS. Endovascular treatment was technically successful for all 16 patients. The posttreatment BF and BV showed a statistically significant increase in both dermal and muscle areas (p < 0.05). The posttreatment TTP shortened at a statistically significant level (p < 0.05). In the 3-month clinical follow-up period, the limb salvage rate was 81% and the percentage change in BF and BV of patients with poor response to treatment had no statistically significant increase after treatment, consistent with the clinical assessment. The percentage change in BF and BV correlated well with the improvement of the clinical condition (r = 0.673-0.901). ICC values showed excellent agreement in the range of 0.95-0.98. CONCLUSION. As a reproducible method, dynamic volume perfusion CT of the foot may enable quantitative evaluation of the perfusion of soft tissues and also provide a novel approach to assessing response to endovascular recanalization in CLI.

We aimed to report the long-term outcomes of osteoid osteoma patients and to determine CT and dynamic contrast-enhanced MR imaging characteristics of radiofrequency ablation (RFA) treatment related changes of osteoid osteoma between follow-up periods.

The treatment strategy and the correct incidence of near occlusion (NO) of the internal carotid artery (ICA) is still controversial. In routine radiological imaging NO can easily be misdiagnosed as complete occlusion and there is no consensus on the standard treatment strategy.

AIM: We report our experience with flow diverter devices in the treatment of intracranial aneurysms arising from the anterior circulation with mid- and long-term follow-up. MATERIAL and METHODS: Seventy-eight aneurysms in 61 patients (range 25-81 years, 13 male, 48 female) were treated with flow diverter devices. Forty (51.3%) aneurysms were treated with a pipeline embolization device (PED), 24 (30.8%) aneurysms were treated with a SILK stent, 12 (15.4%) aneurysms were treated with a flow redirection endoluminal device (FRED) and two aneurysms were treated with a P64 Flow Modulation Device (P64). Angiographic follow-up data at six months and one year were recorded and the occlusion degrees of the aneurysms were evaluated according to the scale developed by Kamran et al. RESULTS: At six-month follow-up, the complete occlusion (grade 4) rate was 60.8% and at one-year this rate had increased to 74.3%. Statistical analysis revealed a significant difference (p=0.002) between six-month and one-year follow-up results but there was no significant association (p=0.531, p=1.000) between aneurysm occlusion rate and aneurysm diameter. Two patients (3.2%) died due to hemorrhagic complications. CONCLUSION: Endovascular treatment of intracranial anterior circulation aneurysms with flow diverters is a safe and effective treatment option. A high rate of stable occlusion is achieved at long-term follow-up.

Abducens palsy is the most common isolated cranial nerve palsy due to its long peripheral course. Multiple anatomical relationships, particularly within the cavernous sinus and orbita, make the nerve vulnerable. 67 year-old female patient was admitted with worsened headache and lateral gaze restriction of the left eye, which appeared recently. She had no prior history of trauma. Prominent appearance of the left cavernous sinus on cranial magnetic resonance imaging, raised the need of digital substraction angiography which revealed the presence of bilateral type D dural arteriovenous fistula of cavernous sinuses. Cavernous sinus pathologies, which are usually known to manifest with multiple ocular motor palsies because of the close relationship between 3rd, 4th and 6th nerves inside, might rarely present with isolated abducens palsy. The clinician should pay particular attention to headache in such kind of patients and dural carotid-cavernous fistula should be taken into account, even in the absence of previous trauma history.

This study was designed to present our preliminary experience with the Roadsaver® double-layer micromesh (DLM) stent in the endovascular treatment of supra-aortic and visceral aneurysms and to utilize the flow-diverting effect of this new design in the treatment of these aneurysms.

Introduction The knowledge of anatomic variations of the cerebral arterial circulation may be important to decide on the safest surgical or endovascular treatment method. Variations in the middle cerebral artery (MCA) territory seems to be less frequent than the other intracranial arteries. During the embryonic stage the primitive MCA is hypothesized to be made up of arterial twigs and these twigs will generate the definitive MCA at the end of the development stage. As in our cases, an early interruption in this period will prevent the evolution of MCA normally and a plexiform arterial network will create the M1 segment of MCA which is the so-called extremely rare unfused or twig-like (Uf/Tw) MCA variation. Our aim is to define and evaluate the angiographical features of Uf/Tw MCA. Methods The diagnosis of Uf/Tw MCA was evaluated in a total of 4855 diagnostic cerebral catheter angiograms, retrospectively. The coexisting intracranial pathologies were also interpreted with former radiological examinations. A review of the literature is provided. Results A total of six cases of Uf/Tw MCA was identified on angiograms accompanying ipsilateral internal carotid artery (ICA) occlusion and contralateral ICA supraclinoid segment aneurysm in one case, and cingulate gyrus AVM in the other. In two different cases, CT or MRI examinations revealed coexisting subarachnoid hemorrhage and misdiagnosis of forniceal AVM in one case, and temporal arachnoid cyst and parenchymal hematoma in the other. Conclusion Lack of data and knowledge about the Uf/Tw MCA variation may cause misdiagnosis and unnecessary treatment attempts.

The present report describes a patient with bilateral occipital arteries of internal carotid origin, which is an extremely rare variation, and left vertebral artery ostial stenosis diagnosed by selective catheterization and digital subtraction angiography.