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Park JH, Woo HY, Min SK. Huge Pseudoaneurysm at the Aortic Bifurcation Misdiagnosed as a Mesenchymal Tumor: A Case Report. Vasc Specialist Int 2024; 40:3. [PMID: 38303149 PMCID: PMC10835026 DOI: 10.5758/vsi.230096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
Aortic pseudoaneurysms (PA) vary in size and may remain asymptomatic. PAs may be caused by vascular injury, such as trauma or surgery, or other non-traumatic causes, such as Bechet disease, infection, or penetrating atherosclerotic ulcers. The diagnosis of PAs may have been delayed for decades. We present a case of a PA detected incidentally in a male patient who experienced traumatic bowel perforation due to blunt abdominal trauma 30 years before presentation. Computed tomography (CT) displayed a 9.2 cm mass in the pelvis, initially considered a neoplasm of small bowel origin. Further analysis of the CT images suggested a thrombosed PA at the aortic bifurcation, which was confirmed via surgical exploration. Graft interposition was performed using a Dacron 16-8 mm graft and the patient recovered without any complications. This case highlights the importance of a high index of suspicion for the diagnosis of a thrombosed aortic PA.
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Affiliation(s)
- Jae Hyun Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Young Woo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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2
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Abatzis-Papadopoulos M, Karamanos D, Papoutsis I, Tigkiropoulos K, Stavridis K, Lazaridis I, Saratzis N. Obstructive Jaundice Caused by a Large Intact Abdominal Aortic Aneurysm. Case Report and Literature Review. Ann Vasc Surg 2021; 79:442.e1-442.e7. [PMID: 34656713 DOI: 10.1016/j.avsg.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obstructive jaundice caused by abdominal aortic aneurysm (AAA) is an extremely rare clinical presentation. We present an 85-year-old male with a large intact AAA causing obstructive jaundice and review the relevant literature. METHODS AND RESULTS The patient was referred to our hospital with jaundice and a palpable pulsatile abdominal mass. Computerized tomography (CT) angiogram and magnetic resonance cholangiopancreatography (MRCP) revealed an infrarenal AAA with maximal diameter of 8.5 cm compressing the pancreatic head and common bile duct, causing obstructive jaundice with elevated levels of total, and direct bilirubin. The patient was subjected to endovascular aneurysm repair (EVAR). Blood bilirubin gradually decreased to normal levels. No complications were reported during the immediate postoperative and at 3-month follow up period. Literature review suggests that our case is one of the largest intact AAAs which have been reported to cause biliary obstruction. CONCLUSIONS AAAs causing secondary obstructive jaundice is an uncommon clinical presentation requiring high clinical suspicion during differential diagnosis, so that patients can receive proper and early diagnosis and treatment.
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Affiliation(s)
- Manolis Abatzis-Papadopoulos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece.
| | - Dimitrios Karamanos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Ioakeim Papoutsis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Tigkiropoulos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Kyriakos Stavridis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Ioannis Lazaridis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - Nikolaos Saratzis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
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Nabati C, Yee S, Hanna P, Wessner S, Madlinger RV. Pseudoaneurysm of the Abdominal Aorta at the Celiac Trunk After Penetrating Trauma. Cureus 2021; 13:e17111. [PMID: 34527494 PMCID: PMC8433046 DOI: 10.7759/cureus.17111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
We report the case of a 33-year-old man who had received multiple gunshot wounds to the abdomen; consequently, he was diagnosed with a traumatic dissection of the abdominal aorta at the level of the superior mesenteric artery (SMA) extending to just below the renal arteries with a posterior pseudoaneurysm of the aorta. He had wounds in the right upper quadrant and in the left lower back. He demonstrated signs of peritonitis for which he was taken to the operating room for exploratory laparotomy. A right common iliac to SMA bypass with a 7-mm ringed polytetrafluoroethylene (PTFE) graft was created. The celiac trunk was then ligated, and through the right groin sheath, a thoracic endograft stent (Cook Medical, Bloomington, IN) was inserted at the level of the thoracic aorta with resolution of the blood flow to the aorta, visceral and iliac arteries, as well as retrograde flow into the bypass graft. The literature on traumatic abdominal aortic pseudoaneurysm was reviewed, and based on that, we believe this report describes a unique case of a traumatic aortic pseudoaneurysm at the level of the celiac trunk, as well as our operative approach.
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Affiliation(s)
- Camellia Nabati
- Surgery/Trauma, St. Joseph's University Medical Center, Paterson, USA
| | - Stephanie Yee
- Surgery, St. Joseph's University Medical Center, Paterson, USA
| | - Paul Hanna
- General Surgery, St. Joseph's University Medical Center, Paterson, USA
| | - Scott Wessner
- Trauma/Surgery/Surgical Critical Care, St. Joseph's University Medical Center, Paterson, USA
| | - Robert V Madlinger
- Trauma/Surgery/Surgical Critical Care, St. Joseph's University Medical Center, Paterson, USA
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Spinal Pseudoaneurysms Mimicking an Osteogenic Tumor: A Case Report. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e1900156. [PMID: 33970574 PMCID: PMC7434042 DOI: 10.5435/jaaosglobal-d-19-00156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM This study presents a rare case of pseudoaneurysm mimicking a tumor on the back, with no history of fever, trauma, or surgical intervention. In which no identifiable symptoms or warning signs were present. This pseudoaneurysm arises from intercostal arteries and segmental arteries. Both of which, to the limit of our knowledge, have not been discussed before. METHOD This study was done using chart and literature review. We present a case of a 46-year-old man with a known case of left-sided intracranial hemorrhage due to hypertension and an old cerebrovascular accident. The patient has a positive history of hypertension, which could have attributed to the pseudoaneurysm; however, he has no history of vascular disease otherwise. The patient reports of back swelling and intermittent back pain for the past 3 years. On MRI, the mass showed a pulsating pattern around it. It also showed a layering effect because of different wall thicknesses and enhanced patterns, and the enhancement ratio was increased. In addition, it showed flow artifacts with T1 hyperintense areas because of associated thrombus and blood products. These changes noted on the MRI prompted the team to do a color Doppler study to confirm the presence of an aneurysm and if present, to do a CT angiography. The color Doppler showed a turbulent flow, that is, there was a bidirectional pulsatile flow which further confirms the presence of a pseudoaneurysm. Spine CT with contrast showed a right paraspinal lesion at the T9-T11 level. It had contrast enhancement and flow inside, consistent with a partially thrombosed aneurysm. The CT also showed evidence of bone remodeling in the adjacent thoracic vertebrae. The patient opted for spinal vascular emobilization and vascular sheath removal. The right and left intercostal arteries were selected at the level of left and right T4, left T8, bilateral T9, and bilateral T10. CONCLUSION Differentiating between pseudoaneurysms and osteogenic tumors is essential to target later investigations accordingly. In addition, if pseudoaneurysms are left untreated, they could cause bony erosions of the vertebra, which lead to compression fractures. They can further compress the adjacent neurovasculature, which worsens the morbidity.
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Kayacı S, Cakir T, Dolgun M, Cakir E, Bozok Ş, Temiz C, Caglar YS. Aortic Injury by Thoracic Pedicle Screw. When Is Aortic Repair Required? Literature Review and Three New Cases. World Neurosurg 2019; 128:216-224. [PMID: 31077895 DOI: 10.1016/j.wneu.2019.04.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Aortic injury by pedicle screw is rare but can cause serious complications. It has not been clearly determined when aortic repair is necessary in cases of screw impingement without perforation of the aortic wall. In this article, we review the treatment and clinical course of pedicle screw aortic impingement and attempt to clarify this issue. METHODS Cases of aortic injury during thoracic screw procedures were found using a MEDLINE search and analyzed together with 3 new cases that we present. RESULTS Nineteen cases collected from the literature and 3 new cases were included in the study. In 7 of the cases, aortic impingement by the pedicle screw was detected during postoperative follow-up (day 1) radiologic examinations. In the other cases, time to presentation of aortic impingement ranged between 2 weeks and 60 months after fixation. The main indications for thoracic spinal fixation were post-traumatic vertebral fracture and kyphoscoliosis/scoliosis. Repair of the aortic damage ranged from primary repair to stent and tube graft placement by the thoracic endovascular aortic repair method. CONCLUSIONS In cases in which the screw impinges less than 5 mm into the aortic wall, hardware revision without aortic repair may be sufficient if recognized early and there are no sign of aortic leakage in vascular imaging. However, cases with more than 5 mm of screw impingement should undergo aortic repair first, even in the absence of aortic leakage, following by screw revision.
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Affiliation(s)
- Selim Kayacı
- Department of Neurosurgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey.
| | - Tayfun Cakir
- Department of Neurosurgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Muge Dolgun
- Department of Neurosurgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Ertugrul Cakir
- Department of Neurosurgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Şahin Bozok
- Department of Cardiovascular Surgery, Faculty of Medicine, Usak University, Usak, Turkey
| | - Cüneyt Temiz
- Department of Neurosurgery, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Yusuf Sukru Caglar
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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Freeman BM, Powell BC, Devane AM, Hale AL, Gandhi SS. Traumatic Aorto-Cisterna Chlyi Fistula with Treatment of Aortic Pseudoaneurysm with CT-Guided Thrombin Injection. Ann Vasc Surg 2018; 54:145.e11-145.e14. [PMID: 29778611 DOI: 10.1016/j.avsg.2018.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Only 3 cases of aorto-cisterna chyli fistula have been described in the literature but none with a resulting pseudoaneurysm (PSA). METHODS A 68-year-old man presented following a motor vehicle collision. Imaging revealed a retroperitoneal hematoma with enhancement of the cisterna chyli, representing an aortic to cisterna chyli fistula. Three days later, computed tomography angiography showed resolution of the fistula, but revealed a PSA. The patient underwent arteriography that confirmed the PSA, and then a computed tomography-guided thrombin injection was performed. Follow-up imaging showed resolution of the PSA. RESULTS Only 3 cases of aorto-cisterna chyli fistula have been described. We hypothesize that this fistula was caused from his L2 vertebral body fracture, which avulsed the lumbar artery and injured the cisterna chyli. The cisterna chyli provided an outflow tract for the aortic injury. We believe this type of fistula follows a benign clinical course. Aorto-cisterna chyli fistula is rare, and reports point to spontaneous resolution. Our case is unique in that the patient progressed from a fistula to a PSA. Options for treatment of this PSA include covered stent graft, open repair, coil embolization, or thrombin injection. CONCLUSIONS This case report describes an extremely rare diagnosis and the natural history of this aorto-cisterna chyli fistula. Furthermore, the resulting aortic PSA was successfully treated with computed tomography-guided thrombin injection, which in the appropriate setting, should be considered an acceptable option.
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Affiliation(s)
- Brian M Freeman
- Department of Surgery, Greenville Health System, Greenville, SC
| | | | | | - Allyson L Hale
- Department of Surgery, Greenville Health System, Greenville, SC
| | - Sagar S Gandhi
- Department of Surgery, Greenville Health System, Greenville, SC
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Galanakis V. Pseudoaneurysm of the gastroduodenal artery: an unusual cause for hyperamylasaemia. BMJ Case Rep 2018; 2018:bcr-2017-223882. [PMID: 29643139 DOI: 10.1136/bcr-2017-223882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 79-year-old man was admitted electively for investigation of weight loss. While he was an inpatient, he developed severe epigastric pain and an initial blood test revealed an acutely raised amylase (>2000) and deranged liver function tests. A contrast CT angiography showed a large haematoma adjacent to the duodenum, spreading in the retroperitoneal space, arising from a 2 cm bleeding pseudoaneurysm in the region of the gastroduodenal artery. Due to his underlying comorbidities, he was deemed unfit for surgical repair and he had coil embolisation with successful haemostasis. The gastroduodenal artery aneurysms are rare and constitute 1.5% of all visceral artery aneurysms. They can be an incidental finding or they can present with haemorrhagic shock, abdominal pain and rarely with obstructive jaundice or hyperamylasaemia. The diagnosis is usually made with an angiography. Variable treatment options are available depending on the patient's fitness and haemodynamic stability.
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Liang Y, Zhao Y, Liu H, Wang Z. The position of the aorta relative to the spine in patients with Pott's thoracolumbar angular kyphosis. J Orthop Sci 2018; 23:289-293. [PMID: 29198597 DOI: 10.1016/j.jos.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/26/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
STUDY DESIGN Analyze the position of the aorta in patients with Pott's thoracolumbar angular kyphosis by computed tomography. OBJECTIVE To investigate the anatomic position of the aorta relative to spine in patients with Pott's thoracolumbar angular kyphosis. SUMMARY OF BACKGROUND DATA The complication of aorta injury is rare in the procedure of spinal osteotomy for the correction of Pott's thoracolumbar angular kyphotic deformity. However, there would be a disastrous consequence once it happened. Therefore, knowing about the position of aorta relative to the spine is of great importance. From the authors' knowledge, there are no reports about the research on the position of the aorta relative to the spine in patients with Pott's thoracolumbar angular kyphosis. METHODS Thirty patients with Pott's thoracolumbar angular kyphosis and thirty patients without spine deformity were recruited and divided into two groups. The CT images of both groups from T10 to L1 were obtained to evaluate the left pedicle-aorta angle and distance. In the patients with Pott's thoracolumbar angular kyphosis, the affected vertebral bodies were fused, so we measured the left pedicle-aorta angle and distance of the fused vertebral bodies. For the normal group, we measured the left pedicle-aorta angle and distance from T10 to L1 and got the average data, then compared with the Pott's group with independent sample t test. The Pearson correlation analysis was used to evaluate the association between the change of the aortic position and Konstam's angle and LL. RESULTS The left pedicle-aorta angles (-8.95 + 2.89°) in Pott's group are smaller and the distances (6.36 + 0.77 cm) are larger than those in normal group (P < 0.05). In patients with Pott's thoracolumbar angular kyphosis, with increased Konstam's angle, the left pedicle-aorta angles becomes smaller (r = -0.495, P < 0.05) and the left pedicle-aorta distances becomes larger (r = 0.486, P < 0.05). However, there is no remarkable correlation between lumbar lordosis and the left pedicle-aorta angles or distances. CONCLUSION In patients with Pott's thoracolumbar angular kyphosis, the aorta of the fused vertebrate shifts anteromedially to the vertebral body, and the aorta is relatively farther away from the vertebral body compared with the normal subjects. Therefore, the surgeon should be aware of the change of the position of the aorta to avoid the disastrous complication vessel injury.
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Affiliation(s)
- Yan Liang
- Peking University People's Hospital, Beijing, 100044, China.
| | - Yongfei Zhao
- The General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, 100853, China.
| | - Haiying Liu
- Peking University People's Hospital, Beijing, 100044, China.
| | - Zheng Wang
- The General Hospital of Chinese People's Liberation Army (301 Hospital), Beijing, 100853, China.
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Delayed Traumatic Aortic Pseudoaneurysm Formation Causing Vertebral Body Erosion and Back Pain: Case Report and Literature Review. World Neurosurg 2018; 110:232-239. [DOI: 10.1016/j.wneu.2017.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/21/2022]
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Massara M, Prunella R, Gerardi P, Lillo A, De Caridi G, Serra R, Notarstefano S, Impedovo G. Infrarenal Abdominal Aortic Pseudoaneurysm: Is It a Real Emergency? Ann Vasc Dis 2017. [PMID: 29515707 PMCID: PMC5835426 DOI: 10.3400/avd.cr.17-00048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abdominal aortic pseudoaneurysm is a rare but life-threatening condition that occurs due to penetrating or blunt trauma. Clinical manifestations are variable, and the time interval from the initial trauma to diagnosis is variable. A prompt diagnosis and an aggressive management approach are required to avoid catastrophic complications. Possible treatment options are open surgical repair, endovascular repair, pseudoanerysmal sac thrombosis induction through direct thrombin injection, and coil embolization. Here, we present the case of a 75-year-old man affected by an infrarenal abdominal aortic pseudoaneurysm presenting with abdominal and lumbar pain for 3 days, who was successfully treated with an endograft.
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Affiliation(s)
- Mafalda Massara
- Vascular Surgery Unit, SS, Annunziata Hospital, Taranto, Italy
| | | | | | - Antonio Lillo
- Vascular Surgery Unit, SS, Annunziata Hospital, Taranto, Italy
| | | | - Raffaele Serra
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Changal KH, Lim F, Sunkara T, Hamdani SU. Unusual presentation of silently growing abdominal aortic aneurysm causing biliary obstruction. BMJ Case Rep 2017; 2017:bcr-2017-220539. [PMID: 28947424 DOI: 10.1136/bcr-2017-220539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Biliary obstruction is a rare presentation of abdominal aortic aneurysm (AAA). The most common symptoms of AAA are abdominal or back pain and limb ischaemia from thromboembolism. We report a case of a 67-year-old male who was diagnosed with obstructive jaundice secondary to an AAA. CT angiogram revealed compression of the common bile duct by the large AAA, causing diffuse intrahepatic and extrahepatic ductal dilatation. Surgical repair of the aortic aneurysm was successful, and patient's symptoms improved.
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Affiliation(s)
- Khalid Hamid Changal
- Department of Internal Medicine, Mercy St. Vincent's Medical Center, Toledo, Ohio, USA
| | - Francis Lim
- Department of Internal Medicine, Mercy St. Vincent's Medical Center, Toledo, Ohio, USA
| | - Tejasvi Sunkara
- Department of Internal Medicine, Mercy St. Vincent's Medical Center, Toledo, Ohio, USA
| | - Syed Uzair Hamdani
- Department of Gastroenterology, Mercy St. Vincent's Medical Center, Toledo, Ohio, USA
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Tin K, Sobani ZA, Horovitz J, Rahmani R. Aortic and splanchnic artery aneurysms: Unusual causes of biliary obstruction - A retrospective cohort from literature. Int J Surg 2017; 39:163-168. [PMID: 28153785 DOI: 10.1016/j.ijsu.2017.01.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/09/2017] [Accepted: 01/27/2017] [Indexed: 01/07/2023]
Abstract
Mechanical obstruction of the biliary tree and resultant stasis are the cornerstone of a spectrum of diseases ranging from biliary colic to fulminant cholangitis. Infrequently acquired abnormalities of the abdominal vasculature can lead to biliary obstruction. In 2010, we reported a case of acute cholangitis resulting from compression of extra hepatic bile duct by an abdominal aortic aneurysm (AAA). We subsequently conducted a follow up scoping review of literature to identify other cases of acquired abdominal arterial abnormalities resulting in biliary obstruction looking at their management and outcomes. The articles were independently reviewed by two of the authors and pertinent data was extracted. The data was divided on an anatomic basis into two groups: one with primary aortic pathology and one with splanchnic vessel pathology. We identified 39 cases of biliary obstruction secondary to acquired aortic or splanchnic vessel abnormalities; 16 were caused by AAAs and 23 by splanchnic vessels. The cases were managed via conservative, endoscopic, endovascular or open surgical options based on the available technology and expertise. Although uncommon, recognition of aortic and splanchnic arterial abnormalities as a potential cause of biliary obstruction is important as management entails not only cautious decompression of the biliary tree but also addressing the underlying vascular pathology. We recommend that extrinsic biliary compression by an aneurysm or pseudoaneurysm be considered among the differential diagnosis in patients presenting with biliary obstruction and a known lesion of the abdominal vasculature.
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Affiliation(s)
- Kevin Tin
- Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Zain A Sobani
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Joel Horovitz
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rabin Rahmani
- Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA; Albert Einstein College of Medicine, NY, USA.
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Abed H, Ball WR, Stone T, Houghton A. Very late rupture of a post-traumatic abdominal aortic pseudoaneurysm. BMJ Case Rep 2017; 2017:bcr-2016-218356. [PMID: 28130287 DOI: 10.1136/bcr-2016-218356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Post-traumatic abdominal aortic pseudoaneurysms remain a rare yet severe complication of aortic injuries and may present many years later. Clinical presentations vary, from the traditional aneurysmal symptoms of abdominal and/or back pain with or without a pulsatile mass, to a fatal rupture. We present the case of a man aged 42 years, with a history of blunt abdominal trauma 14 years ago, presenting with symptoms of non-specific lower abdominal pain and a recent history of straining due to constipation. Clinical examination revealed umbilical bruising, in keeping with Cullen's sign, and extensive postsacral bruising. This case highlights some of the atypical manifestations of aneurysmal rupture and the importance of early recognition and management.
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Affiliation(s)
- Haneen Abed
- Keele University School of Medicine, Staffordshire, UK
| | - William Robert Ball
- Department of General Surgery, Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK
| | - Timothy Stone
- Department of Radiology, Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK
| | - Andrew Houghton
- Department of Vascular Surgery, Royal Shrewsbury Hospital, Shrewsbury, UK
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14
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Beebe HG. Endografting in Aortic Trauma: Let's Keep it in Perspective. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hugh G. Beebe
- University of Michigan Medical School, Ann Arbor, Michigan, and the Jobst Vascular Center, Toledo, Ohio, USA
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15
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Salsamendi J, Pereira K, Rey J, Narayanan G. Endovascular Coil Embolization in the Treatment of a Rare Case of Post-Traumatic Abdominal Aortic Pseudoaneurysms: Brief Report and Review of Literature. Ann Vasc Surg 2016; 30:310.e1-8. [DOI: 10.1016/j.avsg.2015.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/11/2015] [Accepted: 07/19/2015] [Indexed: 11/25/2022]
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16
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Posttraumatic infrarenal abdominal aortic pseudoaneurysm treated with bifurcated endovascular graft stent. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:146-9. [PMID: 26161108 PMCID: PMC4495132 DOI: 10.5114/pwki.2015.52289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 05/26/2014] [Accepted: 06/09/2014] [Indexed: 12/03/2022] Open
Abstract
Posttraumatic infrarenal aortic pseudoaneurysms are rare and potentially lethal lesions. We report the case of a 32-year-old man presenting with infrarenal aortic pseudoaneurysm eight months after being stabbed in the back and right flank. His pseudoaneurysm was close to the iliac bifurcation, so we decided to deploy a bifurcated endovascular graft stent, the TriVascular Ovation endovascular stent. Imaging one month after the procedure revealed no endoleak and slight shrinkage of the pseudoaneurysm.
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Endovascular Repair of an Asymptomatic Aortic Pseudoaneurysm after Penetrating Injury. Ann Vasc Surg 2014; 28:1933.e15-8. [DOI: 10.1016/j.avsg.2014.06.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/30/2014] [Accepted: 06/19/2014] [Indexed: 11/21/2022]
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18
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Li X, Zhao JC, Huang B, Feng Y. Management of giant posttraumatic abdominal aortic pseudoaneurysm and aortic occlusion using a unique hybrid procedure combining transcatheter device closure and open surgical repair. Ann Vasc Surg 2014; 28:1322.e7-11. [PMID: 24509368 DOI: 10.1016/j.avsg.2013.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/16/2013] [Accepted: 12/08/2013] [Indexed: 02/05/2023]
Abstract
Posttraumatic abdominal aortic pseudoaneurysm (AAP) is a rare but life-threating disease. Here, we described a case of posttraumatic AAP with acute abdominal aortic occlusion and its successful treatment using a unique hybrid procedure. An 18-year-old male was referred, with a giant AAP among visceral arteries, which occluded the aorta and left renal artery. An infrequently used ventricular septal device was delivered via femoral access and successfully plugged the tear. Then the isolated pseudoaneurysm was resected through open surgery without major bleeding. At 6 months after operation, the patient was alive without evidence of complications. This hybrid procedure combining transcatheter device closure and open surgery was a successful attempt in the subemergency treatment of posttraumatic AAP.
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Affiliation(s)
- Xiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Ji-Chun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China.
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Barman P, Farber A. Traumatic pseudoaneurysm of the visceral aortic segment managed using both open surgery and endovascular therapy. Ann Vasc Surg 2011; 25:840.e13-7. [PMID: 21620675 DOI: 10.1016/j.avsg.2011.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Revised: 01/26/2011] [Accepted: 02/09/2011] [Indexed: 11/30/2022]
Abstract
Pseudoaneurysm (PSA) formation is not a rare entity in the thoracic aorta, but is much rarer in the visceral aortic segment. This vascular lesion is most commonly because of penetrating trauma. We present the case of a patient with PSA of the visceral aortic segment that was treated by both surgical and endovascular methods and review the previously published data on the presentation, diagnosis, and management of visceral aortic PSAs.
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Affiliation(s)
- Pranab Barman
- Section of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, MA 02118, USA.
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20
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Queiroz AB, Silva ESD, Aun R, Benitti DA, Bertoldi V, Puech-Leão P. Abdominal aortic pseudoaneurysm diagnosed 42 years after abdominal gunshot wound. Clinics (Sao Paulo) 2011; 66:1113-4. [PMID: 21808886 PMCID: PMC3129951 DOI: 10.1590/s1807-59322011000600034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- André Brito Queiroz
- Department of Surgery, Vascular and Endovascular Division, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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21
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Kakkos SK, Shepard AD. Delayed presentation of aortic injury by pedicle screws: Report of two cases and review of the literature. J Vasc Surg 2008; 47:1074-82. [DOI: 10.1016/j.jvs.2007.11.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Revised: 11/01/2007] [Accepted: 11/01/2007] [Indexed: 10/22/2022]
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22
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Medina CR, Indes J, Smith C. Endovascular treatment of an abdominal aortic pseudoaneurysm as a late complication of inferior vena cava filter placement. J Vasc Surg 2006; 43:1278-82. [PMID: 16765254 DOI: 10.1016/j.jvs.2006.02.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 02/05/2006] [Indexed: 11/29/2022]
Abstract
Pseudoaneurysms of abdominal aorta after inferior vena cava (IVC) filter placement are uncommon, with associated morbidity and mortality. We report a case in which an abdominal aortic pseudoaneurysm resulted from erosion of a Bird's Nest (Cook, Bloomington, IN) IVC filter into the wall of the abdominal aorta. A 64-year-old woman with an IVC filter placed 10 years prior presented to the emergency department complaining of abdominal pain. A computed tomography scan of the abdomen and pelvis showed a 1.4-cm x 2.0-cm infrarenal aortic pseudoaneurysm adjacent to the IVC filter site. A Zenith endograft (Cook) was used via an open femoral artery exposure to successfully treat the pseudoaneurysm.
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Affiliation(s)
- Carlos R Medina
- Department of Surgery, Temple University Hospital, Philadelphia, PA 19140, USA.
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23
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Bikk A, Rosenthal D, Kohlman M, Lai KM, Wellons ED. Traumatic superior mesenteric arteriovenous fistula and aortic pseudoaneurysm 20 years after repair. Vascular 2006; 13:350-4. [PMID: 16390653 DOI: 10.1258/rsmvasc.13.6.350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A case of traumatic superior mesenteric arteriovenous fistula (SMAVF) and aortic pseudoaneurysm successfully treated by a unique combination of operative and endovascular techniques with a 20-year follow-up is reviewed. After 20 years, the patient presented with an aortoenteric fistula, which was managed with a cryopreserved aortic interposition graft. In this report, we review the evolution of the treatment for traumatic SMAVF and aortic pseudoaneurysm and the current management of aortoenteric fistula.
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Affiliation(s)
- Andras Bikk
- Department of Vascular Surgery, Atlanta Medical Center, Atlanta, GA, USA
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24
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Tucker S, Rowe VL, Rao R, Hood DB, Harrell D, Weaver FA. Treatment Options for Traumatic Pseudoaneurysms of the Paravisceral Abdominal Aorta. Ann Vasc Surg 2005; 19:613-8. [PMID: 16010502 DOI: 10.1007/s10016-005-4652-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Penetrating gunshot wounds (GSWs) to the abdominal aorta are frequently lethal. Alternative management options for treatment of traumatic pseudoaneurysms of the abdominal aorta are illustrated by three patient case histories. Patient A sustained two GSWs to the abdomen (midepigastrium, right subcostal region). He was hypotensive in the field. Emergent laparotomy was undertaken with suture ligature of a celiac injury and distal pancreatectomy/splenectomy for a pancreatic injury. Postoperative abdominal CT for an intraabdominal infection with leukocytosis revealed a 4 cm traumatic pseudoaneurysm of the abdominal aorta that extended from the suprarenal aorta to the level of the renal arteries. Six weeks later, he underwent an open repair. Patient B sustained multiple GSWs to his right arm and right upper quadrant. He was hemodynamically stable. He underwent abdominal exploration for a grade 3 liver laceration. Postoperative abdominal CT revealed a supraceliac abdominal aortic pseudoaneurysm. An aortogram demonstrated a 1.5 cm defect in the aortic wall above the celiac trunk communicating with the inferior vena cava (IVC). He underwent endovascular repair with covered aortic stent graft. Patient C sustained multiple thoracoabdominal GSWs. He was hemodynamically stable. Emergent laparotomy revealed multiple left colonic perforations, two duodenal lacerations, and an unsalvageable left kidney laceration. Postoperatively, he developed a duodenal-cutaneous fistula with multiple intraabdominal abscesses. Serial CT scans revealed an enlarging infrarenal aortic pseudoaneurysm. He underwent angiographic coil embolization and intraarterial injection of thrombin into the pseudoaneurysm sac. The average time from injury to surgical treatment was 46 days (range 29-67). Postoperatively, none of the patients developed paraplegia. Advances in endovascular techniques have provided options to deal with traumatic pseudoaneurysms of the abdominal aorta. In a hemodynamically stable patient with a traumatic pseudoaneurysm, careful selection of a specific intervention can be tailored to the clinical scenario electively.
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Affiliation(s)
- Sonny Tucker
- Department of Surgery, Keck University of Southern California School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033, USA
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Singh TM, Hung R, Lebowitz E, Wallbom A, Shaver D, Soria J, Zarins CK. Endovascular Repair of Traumatic Aortic Pseudoaneurysm With Associated Celiacomesenteric Trunk. J Endovasc Ther 2005; 12:138-41. [PMID: 15683266 DOI: 10.1583/04-1390.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report stent-graft repair of a traumatic aortic pseudoaneurysm in proximity to a celiacomesenteric trunk. CASE REPORT An 18-year-old woman suffered a large gunshot wound to the right flank. At laparotomy, only a large, nonexpanding right retroperitoneal hematoma was found, which was thought to represent significant penetrating trauma to the kidney mass. The patient was monitored in the intensive care unit. One week later, computed tomography revealed a partially infarcted right kidney and a 2.3-cm supraceliac aortic pseudoaneurysm, with adjacent bullet fragments. An angiogram confirmed the pseudoaneurysm and showed it to be 7 mm from the celiacomesenteric trunk. Endovascular repair was undertaken with a 16 x 55-mm AneuRx stent-graft, which was successfully placed across the aortic pseudoaneurysm without covering the celiacomesenteric trunk. Imaging at 12 months revealed no endoleak and full pseudoaneurysm exclusion. CONCLUSIONS This operative approach is appropriate for the individual patient who has suitable anatomy and a clinical course that requires immediate repair of an aortic injury to prevent further complications and delays in ancillary treatments.
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Affiliation(s)
- Tej M Singh
- Division of Vascular and Endovascular Surgery, Sant Clara Valley Medicl Center, San Jose, CA 95128, USA.
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26
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Raghavendran K, Singh G, Arnoldo B, Flynn WJ. Delayed Development of Infrarenal Abdominal Aortic Pseudoaneurysm After Blunt Trauma: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2004; 57:1111-4. [PMID: 15580042 DOI: 10.1097/01.ta.0000053399.86908.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
MESH Headings
- Accidents, Traffic
- Adult
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/etiology
- Aortic Aneurysm, Abdominal/surgery
- Glasgow Coma Scale
- Humans
- Male
- Time Factors
- Tomography, X-Ray Computed
- Wounds, Nonpenetrating/complications
- Wounds, Nonpenetrating/diagnostic imaging
- Wounds, Nonpenetrating/surgery
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Affiliation(s)
- Krishnan Raghavendran
- Department of Surgery, Division of Trauma and Critical Care, State University of New York at Buffalo, Buffalo, New York 14215, USA.
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27
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Smith AD, Mohammed F, Watson GMT, Howlett DC. Common bile duct compression by an abdominal aortic aneurysm: an unusual cause of biliary tract dilatation. Eur J Gastroenterol Hepatol 2002; 14:767-9. [PMID: 12169986 DOI: 10.1097/00042737-200207000-00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Extra-hepatic bile duct compression is encountered commonly among patients with pancreatic disease, primary sclerosing cholangitis, and cholangiocarcinoma. However, in an elderly lady with predominantly cholestatic liver test abnormalities, magnetic resonance cholangiopancreatography (MRCP) demonstrated a large abdominal aortic aneurysm that was causing extra-hepatic bile duct compression and concomitant proximal bile duct dilatation. This unusual and uncommon finding was almost certainly the explanation for her liver test dysfunction. This report draws attention to the increasing role for MRCP as an accurate, but non-invasive means of appraisal of the pancreatico-biliary tree. In addition, an unusual and uncommon cause of extra-hepatic bile duct compression is discussed.
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Affiliation(s)
- Alastair D Smith
- Department of Medicine, Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK.
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28
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Brasch AV, Raissi SS, Hackner EL, Khan SS, Nagai T, Siegel RJ. Transesophageal echocardiographic identification of an abdominal aortic pseudoaneurysm complemented by a transpulmonary echo contrast agent. Am J Cardiol 1999; 84:240-1, A9. [PMID: 10426351 DOI: 10.1016/s0002-9149(99)00245-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pseudoaneurysm of the abdominal aorta, a rare complication after traumatic injuries, represents a diagnostic challenge for which sophisticated imaging modalities are often used for its early identification. We describe a case in which transesophageal echocardiographic examination complemented by a transpulmonary echo contrast agent was useful not only in demonstrating the pseudoaneurysm, but in helping to localize the intravascular communication between the aorta and the pseudoaneurysm.
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Affiliation(s)
- A V Brasch
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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29
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Lim CH, Lim J, Tan YS. Traumatic Pseudoaneurysm of the Abdominal Aorta. Asian Cardiovasc Thorac Ann 1999. [DOI: 10.1177/021849239900700215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Delayed pseudoaneurysm of the abdominal aorta is an exceedingly rare but potentially fatal complication following blunt abdominal trauma. A 25-year-old male presented 3 months after a road traffic accident with central abdominal pain. A 4-cm pseudoaneurysm of the infrarenal aorta was detected by computed tomography. Successful surgical repair was performed with an interposition graft and reimplantation of the inferior mesenteric artery.
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Affiliation(s)
| | - Jeremy Lim
- Ministry of Health Republic of Singapore
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30
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Bechara-Zamudio L, Olivé G, Barone H, Cociolo JJ, Peirano M, Daza J, Benito M, Hourquebie H. Traumatic abdominal aortic pseudoaneurysm treated with balloon-expandable bifurcated endoprosthesis. J Vasc Surg 1998; 28:345-8. [PMID: 9719331 DOI: 10.1016/s0741-5214(98)70171-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 22-year-old man came to our institution with upper gastrointestinal bleeding and massive intra-abdominal hemorrhage. His history included an abdominal gunshot, with aortic and multiple intestinal perforations, 9 months before. At the time of the original injury, he was treated elsewhere by primary closure of the aortic laceration and multiple intestinal resections. An aortic pseudoaneurysm was revealed by means of an angiogram of the descending aorta. Conventional surgical procedures were deemed not feasible because of previous abdominal operations, so a balloon-expandable bifurcated endoprosthesis was constructed and inserted into the terminal aorta through the femoral approach, with resolution of the abdominal aortic pseudoaneurysm.
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Affiliation(s)
- L Bechara-Zamudio
- Department of Cardiovascular Surgery, Hospital Militar Central, Universidad de Buenos Aires, Argentina
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31
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Beebe HG. Endografting in aortic trauma: let's keep it in perspective. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1997; 4:352-3. [PMID: 9418197 DOI: 10.1583/1074-6218(1997)004<0352:eiatls>2.0.co;2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- H G Beebe
- University of Michigan Medical School, Ann Arbor, USA
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