Hemitruncus arteriosus is a rare congenital heart disease in which the pulmonary artery arises from the aorta. Patients usually present with symptoms of pulmonary hypertension during the neonatal period. A 15-year-old female with no past medical history presented with progressive dyspnea and hemoptysis for 2 months. On admission, the patient was hypoxic (O₂ saturation was 88% on room air). Echocardiogram showed an elevated pulmonary artery systolic pressure (PASP: 90 mm Hg) with a D-shaped left ventricle. Chest computed tomography (CT) angiogram showed the right pulmonary artery arising from the posterior aspect of the ascending aorta ([Fig. 1]) with a 4-mm saccular aneurysm in the right lower pulmonary artery associated with surrounding air space consolidation representing alveolar hemorrhage ([Fig. 2]). Surgical management was considered high risk due to severe pulmonary hypertension. Embolization was done via left brachial artery access. A 5-Fr diagnostic catheter was advanced over a guidewire to the ascending aorta followed by selection of the anomalous right pulmonary artery. Angiogram showed anomalous origin of the right pulmonary artery from the posterior aspect of ascending aorta with a subsegmental pulmonary artery aneurysm ([Fig. 3]). A microcatheter was advanced distal to the aneurysm followed by embolization using Concerto detachable 5 mm × 20 cm micro coils (Medtronic, Minnesota, United States). Postembolization angiogram showed complete exclusion of the aneurysm ([Fig. 4]). The patient was discharged 2 days later with no more hemoptysis, and continued on medical management for pulmonary hypertension. No recurrent episodes of hemoptysis reported at 6-month follow-up. The patient is planned for surgical correction of the hemitruncus arteriosus after controlling the symptoms of pulmonary hypertension and optimization of medical management. Hemitruncus arteriosus develops during the fetal period due to failure or incomplete leftward migration of the right posterior aortic arch that leads to development of the right pulmonary artery from the posterior aspect of ascending aorta. This is eight times more frequent on the right than the left.[1] Hemitruncus arteriosus presents during the early neonatal period by signs and symptoms of elevated pulmonary arterial pressure.[2] Surgical management by correction of these anomalies is the treatment of choice, and survival rate is as low as 30% if left untreated.[3] Late presentation of Hemitruncus arteriosus in adulthood was reported only in 16 cases in the literature.[4] Surgical repair of hemitruncus is done early in the infancy. However, there are reported cases showing effective surgical repair even in late presentation to minimize complications of pulmonary hypertension.[5] The cause of pulmonary artery aneurysm in this case remains unclear, especially with the absence of trauma, pulmonary artery interventions, or documented pulmonary infection. Chronic exposure to high systemic arterial pressure is presumed to be the etiology of this aneurysm. However, none of the previously reported cases of hemitruncus arteriosus was complicated by aneurysmal formation. This case illustrates a rare cause of hemoptysis secondary to hemitruncus arteriosus aneurysm that was treated with trans arterial coil embolization. Article published online: 15 July 2022 © 2022. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

Background/Objectives: Muscle thickness and stiffness near the arteriovenous fistula (AVF) site may influence vascular access function in hemodialysis patients. This exploratory study aimed primarily to describe differences in muscle thickness and stiffness between the AVF-bearing and contralateral limbs, and secondarily to examine whether these parameters were associated with AVF maturation. This study aimed to compare these muscle parameters between the AVF and contralateral sides and to evaluate their relationship with AVF maturation status. Methods: Thirty participants undergoing hemodialysis were included, comprising 22 with mature AVFs and 8 with non-mature AVFs. Ultrasound examinations measured muscle thickness and stiffness using Shear Wave Elastography (SWE) of the biceps brachii and brachioradialis muscles. Volume flow was recorded in the draining vein and feeding artery. Statistical analyses included paired comparisons, group comparisons, Pearson correlations, and multiple linear regression models. Results: Brachioradialis thickness was significantly reduced on the AVF side compared with the contralateral side (p = 0.013, Cohen’s d = –0.95), particularly in forearm (radiocephalic) fistulas (Wilcoxon p = 0.014, Cohen’s d = –0.95), indicating localized muscle atrophy. No significant side-to-side differences were found for biceps brachii thickness or for stiffness in either muscle (all p > 0.1). Comparisons between mature and non-mature AVF groups showed no significant differences in muscle parameters on the AVF side (all p > 0.4). Conclusions: AVF may lead to asymmetric muscle changes, especially a reduction in brachioradialis thickness, regardless of maturation status, which could affect forearm function. Nevertheless, muscle thickness and stiffness do not appear to predict AVF maturity or vascular access success directly.

A novel endovascular technique to occlude high flow direct arteriovenous fistulae is presented, where the distal tip of the microcatheter acts as a nucleus that the operator can grow a plug from a liquid embolic agent. Its advantages (such as cost-saving and distal reachability), disadvantages (such as embolic material instability), and technique are discussed.