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Anastasiadou C, Giannakakis S, Galyfos G, Livieratos L, Kastrisios G, Papapetrou A, Maltezos C. Giant Dorsalis Pedis Pseudoaneurysm Following Cannulation for Arterial Line in a Patient with Systemic Lupus Erythematosus. Vasc Specialist Int 2019; 35:114-117. [PMID: 31297363 PMCID: PMC6609015 DOI: 10.5758/vsi.2019.35.2.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/16/2019] [Accepted: 05/31/2019] [Indexed: 11/20/2022] Open
Abstract
Dorsalis pedis artery (DPA) aneurysms are very rare and fewer than 60 cases have been reported in the literature. Most affected patients present with false aneurysms after orthopedic surgery or trauma. Here we report an unusual case of a giant DPA pseudoaneurysm after cannulation for arterial line placement in a patient newly diagnosed with systemic lupus erythematosus (SLE). A diagnostic delay resulted in necrosis of the overlying skin. Excision of the pseudoaneurysm, ligation of the DPA, and debridement of the foot dorsum were performed, followed by a second flap coverage surgery. Although a DPA false aneurysm is rare after arterial line removal, it can cause the serious complications of skin necrosis, rupture and toe necrosis. Arterial puncture sites should be carefully monitored, especially in patients with SLE or other vasculitis.
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Affiliation(s)
| | | | - George Galyfos
- Vascular Surgery Department, KAT General Hospital, Athens, Greece
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Kang JW, Lee ES, Eun JS, Kim NR, Han SW, Lee SJ, Kang YM, Han MH, Nam EJ. Case of Renal Microaneurysms and Multiple Renal Infarctions in a Patient with Systemic Lupus Erythematosus. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.4.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jong Wan Kang
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Song Lee
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Su Eun
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Na Ri Kim
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Woo Han
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Jin Lee
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Young Mo Kang
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
| | - Man Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eon Jeong Nam
- Division of Rheumatology, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
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Anquetil C, Stavris C, Chanson N, Lambert M, Hachulla E, Launay D, Hatron PY. [Hemorrhagic shock revealing multiple digestive microaneurysms in a patient with systemic lupus erythematosus: Case report and literature review]. Rev Med Interne 2016; 38:56-60. [PMID: 27036226 DOI: 10.1016/j.revmed.2016.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/23/2016] [Accepted: 02/27/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The vascular disorders in systemic lupus erythematosus (SLE) result from various mechanisms and presentations (inflammatory disease or vasculitis, atherosclerosis). CASE REPORT We report on a 34-year-old man with cutaneous, articular, neurological and nephrologic SLE. He presented with catastrophic haemorrhage on microaneurysm rupture of the left hepatic artery. After blood transfusions and immunosuppressive treatments, his condition improves. CONCLUSION Uncommon complication in SLE patients, digestive vasculitis with microaneurysms may occur as in polyarteritis nodosa. In the literature, we identified 10 additional cases of hepatic microaneurysms in SLE patients. The main issue is an earlier diagnosis in order to give appropriate treatment and improve prognosis.
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Affiliation(s)
- C Anquetil
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
| | - C Stavris
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
| | - N Chanson
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
| | - M Lambert
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
| | - E Hachulla
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France; LIRIC, UMR 995, EA2686, 59000 Lille, France
| | - D Launay
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France; LIRIC, UMR 995, EA2686, 59000 Lille, France.
| | - P Y Hatron
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
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Cho YD, Jung KH, Roh JK, Kang HS, Han MH, Lim JW. Characteristics of intracranial aneurysms associated with extracranial carotid artery disease in South Korea. Clin Neurol Neurosurg 2013; 115:1677-81. [PMID: 23545151 DOI: 10.1016/j.clineuro.2013.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 02/23/2013] [Accepted: 03/10/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although it is hypothesized that inflammatory signals and/or hemodynamic stress resulting from carotid disease increase the risk of aneurysm formation and growth, a relationship between intracranial aneurysms and extracranial carotid artery disease (ECAD) has not been explored. Here, we examined the characteristics of intracranial aneurysms associated with ECAD. METHODS A total of 606 consecutive patients with stenosis of 50% or more of the proximal internal carotid artery (pICA) were enrolled. Stenosis was identified by conventional angiography between January 2003 and December 2009. We determined the prevalence of intracranial aneurysms in this population. The characteristics of the aneurysms were analyzed according to the degree and laterality of stenosis. The changes in the aneurysms were tracked for the evaluation of stability. RESULTS In 86 patients (14.2%), 120 aneurysms were detected in association with pICA stenosis. In this group, 97 were associated with unilateral pICA stenosis. The distribution of aneurysms was independent of the laterality of stenosis, but aneurysms were more prevalent in the contralateral side as the stenosis grade increased (P<0.001). All aneurysms with an imaging follow-up (28.9 ± 14.3 months) were stable, and the course was not affected by treatment of the carotid stenosis. In 23 aneurysms associated with bilateral pICA stenosis, there was only one case that increased in size during a 41-month period. CONCLUSION Intracranial aneurysms were most likely associated with ECAD, but were evenly distributed irrespective of the laterality of the stenosis. The distribution was related to the severity of the contralateral pICA stenosis. The low incidence of aneurysm growth or rupture in patients with significant ECAD indicates that these aneurysms do not require immediate intervention more than other conditions.
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Affiliation(s)
- Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Liu C, Tang QB, Zeng H, Yu XH, Xu LB, Li Y. Clinical and pathological analysis of hepatic artery aneurysm in a patient with systemic lupus erythematosus: report of a case. Surg Today 2011; 41:1571-4. [PMID: 21969165 DOI: 10.1007/s00595-010-4470-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 11/18/2010] [Indexed: 11/26/2022]
Abstract
A hepatic artery aneurysm is an unusual but life-threatening hepatobiliary complication occurring in patients with systemic lupus erythematosus (SLE), and early diagnosis and treatment of this complication are essential. A 31-year-old man with SLE presented with recurring epigastric pain and jaundice for 2 months; he was diagnosed with choledocholithiasis and underwent surgery. Hemobilia was found intraoperatively, and two hepatic artery aneurysms were identified in the left lateral lobe during postoperative arteriography. Major hemobilia occurred 6 days after the operation, and the patient was immediately treated with selective embolization of the hepatic artery. However, the major hemobilia recurred 2 days later, and he was treated with a left lateral lobectomy and ligation of the proximal hepatic artery. The patient recovered uneventfully and is in good condition. A histological analysis revealed small- and medium-sized arteritis as well as hepatic artery aneurysm. Systemic lupus erythematosus complicated by a hepatic artery aneurysm should be considered in the differential diagnosis of patients showing symptoms of abdominal pain, jaundice, or gastrointestinal bleeding.
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Affiliation(s)
- Chao Liu
- Department of Hepato-Pancreato-Biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong Province, PR China
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Pollono EN, Madoff DC, Spence SC, Suarez-Almazor ME. Multiple hepatic artery aneurysms in a patient with systemic lupus erythematosus. Lupus 2009; 19:93-5. [PMID: 19884215 DOI: 10.1177/0961203309345721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Systemic vasculitis is a known complication of patients with systemic lupus erythematosus (SLE). Inflammation of the vessels can result in the development of arterial aneurysms with a potential risk of rupture or bleeding. CASE HISTORY We present the case of a 56-year-old woman with SLE who developed three episodes of gastrointestinal (GI) bleeding without evidence of lesions in the GI tract. Multiple aneurysms of the hepatic artery were identified and treated with endovascular embolization, with no further GI bleeding. After embolization, the patient developed multiple bilomas that required percutaneous drainage, and subsequent abscesses which eventually resolved without further complications. CONCLUSION Hepatic aneurysms, possibly secondary to vasculitis, may cause GI bleeding, and should be suspected in patients with SLE and GI bleeding with no apparent cause identifiable through standard endoscopy of the upper and lower GI tract.
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Affiliation(s)
- E N Pollono
- Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, Section of Rheumatology, the University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Tsai YG, Lai JH, Kuo SY, Chen HC, Wan HL, Chang DM. Ruptured renal microaneurysms complicated with a retroperitoneal abscess for a patient with systemic lupus erythematosus. Lupus 2003; 12:317-20. [PMID: 12729057 DOI: 10.1191/0961203303lu325cr] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Renal artery aneurysm is extremely rare among patients with systemic lupus erythematosus.(SLE). Herein, we report on a 22-year-old male lupus patient who presented with acute abdominal pain, anemia and subsequent hypertension. Abdominal computed tomography revealed a peri-renal hematoma over the right kidney. A renal angiography revealed bilateral renal microaneurysms. The patient subsequently developed a right-side retroperitoneal abscess 4 weeks after hematoma formation and received an emergent laparotomy with drainage. Subsequent culture ofthe abscess-derived fluid revealed the presence of Proteus mirabilis and Escherichia coli. Following appropriate antipyretic and immunosuppressive drugs therapy, the patient recovered successfully. To the best of our knowledge, this is the first report of SLE associated with a retro-peritoneal abscess probably secondary to a ruptured renal microaneurysm.
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Affiliation(s)
- Y G Tsai
- Division of Rheumatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Repbulic of China
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Kong KO, Koh ET, Lee HY, Wee KP, Feng PH. Abdominal crisis in a young man with systemic lupus erythematosus. Lupus 2002; 11:186-9. [PMID: 11999884 DOI: 10.1191/0961203302lu154cr] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medium-sized artery aneurysms are rare in patients with systemic lupus erythematosus (SLE). We report on a 21-year-old Chinese man with SLE and secondary antiphospholipid syndrome (APS) who presented with acute abdominal pain due to a ruptured right hepatic artery aneurysm. He was also found to have aneurysms of the left hepatic artery and splenic artery on autopsy. There have been only eight cases of hepatic artery aneurysm and one case of splenic artery aneurysm associated with SLE in the English literature. Abdominal aneurysm must be suspected in SLE patients presenting with acute abdominal pain, haemoperitoneum or occult bleeding.
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Affiliation(s)
- K O Kong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
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