Although percutaneous closure of patent ductus arteriosus is an established safe procedure, protrusion of the device to descending aorta may occur in various degrees during these procedures, especially in small infants. The aim of our study is to evaluate the benefits of balloon-assisted device releasing technique in the era of preventing device protrusion and conditions related to protrusion.

One hundred and fifty-five infants, who underwent patent ductus arteriosus closure with Amplatzer duct occluder I device between January, 2012 and December, 2018, were retrospectively analysed. Balloon-assisted device releasing technique was used in 20 cases (group 1, 12.9%), between January, 2015 and December, 2018. Procedures in which the technique had been used were compared with the remaining ones (group 2, 87.1%, n = 135) with regard to device stabilisation, aortic disc protrusion to the aorta, iatrogenic coarctation, and device embolisation.

There was no significant difference by means of gender, age, weight, and the ductal diameter, whereas the average mean pulmonary artery pressure was significantly higher in group 1. Device protrusion and related complications were significantly higher in group 2; thus, additional catheterisations or surgical interventions were required, while no additional intervention was required in group 1.

The balloon-assisted device releasing technique provides a good device stabilisation and prevents protrusion of the device and related complications during percutaneous patent ductus arteriosus closure in selected cases.

Data regarding long-term outcome after percutaneous closure of left superior caval vein draining into the left atrium are lacking. The aim of the present study was to report the long-term follow-up by using contrast-enhanced CT.

In all, three patients underwent percutaneous closure of left superior caval vein draining into the left atrium between 2005 and 2015. All of them were evaluated clinically and underwent contrast-enhanced CT.

In one patient, the Amplatzer® Septal Occluder was used. In two patients, the Amplatzer® Vascular Plug type-1 was preferred: the device size/LSVC diameter ratio was 1.7 in the child and 1.2 in the adult. There were no early-onset or long-term onset complications. CT was performed 1, 2, and 10 years after the procedure, respectively. Complete occlusion of the vessel was documented in all. After 10 years since the procedure, CT revealed a persistent trivial residual shunt through the accessory hemiazygos vein in one patient, in whom the device was implanted above its drainage into the left superior caval vein. When an Amplatzer® Vascular Plug type-1 is oversized compared with the venous vessel diameter, it immediately assumes a dog-bone shape that disappears early to regain its shape memory and nominal size.

Percutaneous occlusion of left superior caval vein draining into the left atrium has excellent early and long-term outcomes. The optimal implantation of the device is below the drainage of the accessory hemiazygos vein, when present. The device might be oversized compared with the left superior caval vein diameter according to the age of the patient.

Transcatheter device closure has become the established standard of care for suitable atrial septal defects. Device erosion has been a recent focus and has prompted changes in the Instructions for Users documentation released by device companies. We reviewed our entire local experience with atrial septal defect device closure, focussing on the evolution of this procedure in our centre and particularly on complications.

We carried out a retrospective review of 581 consecutive patients undergoing attempted transcatheter device closure of an atrial septal defect in Auckland from December 1997 to June 2014. We reviewed all complications recorded and compared our outcomes with the current literature. We sought to understand the impact of the evolution in recommendations and clinical practice on patient outcomes in our programme.

There were a total of 24 complications (4.1%), including 10 device embolisations (1.7%), nine arrhythmias (1.5%), two significant vascular access-related complications (0.3%), one device erosion (0.2%), one malposed device (0.2%), and one probable wire perforation of the left atrial appendage (0.2%). There was one mortality related to device embolisation. All device embolisations occurred following the change in Instructions for Users after publication of the first device erosion report in 2004. This increase in embolisation rate was statistically significant (p-value 0.015).

In our series, the incidence of device embolisation was higher than that anticipated, with a significant increase following changes to the Instructions for Users. This highlights the need for ongoing data collection on complication incidence and for ongoing review of the impact of changes in clinical practice on complication rates.

To determine the effect of embolisation on endoscopic resection of angiofibroma.

A partially blinded trial was undertaken. Twenty-three patients with angiofibroma (nine embolised and 14 not embolised) underwent endoscopic resection between January 2007 and August 2008 in two tertiary referral centres. Demographic data were collected, the pre-operative tumour extent was assessed by computed tomography, and tumours were staged according to their computed tomography appearance (Radkowski scale). In addition, we evaluated the duration of surgery, amount of haemorrhage, blood pressure during surgery, duration of hospitalisation, complications of surgery and embolisation, cost of treatment, and number of post-operative recurrences, as well as the angiographic characteristics in the embolisation group.

There was no significant difference between the general characteristics of both groups. At the end of the study period, we could find no significant difference between the two groups regarding haemorrhage, number of recurrences or complications. The only significant difference was cost of treatment, which was significantly higher in the embolisation group.

Endoscopic resection is a feasible and safe method for angiofibroma surgery. The current evidence does not support obligatory embolisation in every case of endoscopic angiofibroma resection.

To report the case of a spontaneous arteriovenous malformation involving the auricula, external auditory meatus, middle ear and part of the petrous apex, and also to provide updated information about its management.

A 33-year-old woman presented complaining of accelerated growth of a retro-auricular swelling during her latest pregnancy, together with pain, pulsatile tinnitus and ear discharge. An arteriovenous malformation occupying the right auricula, external auditory canal, mastoid proccess of the temporal bone and the lateral half of the petrous segment was diagnosed, using temporal computerised tomography and magnetic resonance imaging. The lesion was embolised with polyvinyl alcohol particles at angiography. Excision of the arteriovenous malformation nidus was performed. Three years post-operatively, magnetic resonance imaging showed no residual lesion or recurrence at the temporal bone and petrous apex, although a few scanty, serpiginous, vascular remnants had persisted.

In the head and neck, arteriovenous malformations usually occur intracranially; they are rare outside the cranium. To our knowledge, there have been no previously published cases of such an extensive arteriovenous malformation involving the temporal region. Apropos of our case, the definition, clinical findings, diagnostic approaches and therapeutic management of arteriovenous malformations are discussed.