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Rais A, Benabderrazik B, El Bouardi N, Akammar A, Haloua M, Alami B, Alaoui MYL, Boubou M, Maaroufi M. Cholecystitis-related cystic artery pseudoaneurysm: Case report. Radiol Case Rep 2024; 19:2156-2159. [PMID: 38515769 PMCID: PMC10950602 DOI: 10.1016/j.radcr.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
The pseudoaneurysms of the cystic artery (CAP) are very uncommon. They usually develop as a result of an acute cholecystitis or after a cholecystectomy. Among the complications, we can find hemorrhaging, biliary blockage, and haemobilia. Limited understanding of the illness makes managing specific cases difficult. We describe a case of a cystic artery pseudoaneurysm complicating an acute cholecystitis that was successfully treated by transcatheter arterial embolization.
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Affiliation(s)
- Asmae Rais
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Btissam Benabderrazik
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Nizar El Bouardi
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Amal Akammar
- Department of radiology mother and child, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Meriem Haloua
- Department of radiology mother and child, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Babdreddine Alami
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | | | - Meryem Boubou
- Department of radiology mother and child, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
| | - Mustapha Maaroufi
- Department of radiology of specialities, CHU Hassan II, university Sidi Mohammed Benabdellah, Fes, Morocco
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2
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Basahai I, Alzeer MA, Almuhanna BS. Successful treatment of gastric bleeding caused by left phrenic artery pseudoaneurysm post-surgery with endovascular embolization: A case report. Radiol Case Rep 2024; 19:2351-2356. [PMID: 38532908 PMCID: PMC10963892 DOI: 10.1016/j.radcr.2024.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/18/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
Pseudoaneurysms are rare but potentially life-threatening complications that may occur after surgical procedures. This report presents the case of a 28-year-old woman who developed a pseudoaneurysm in the Left Inferior Phrenic Artery (LIPA) following a Laparoscopic Sleeve Gastrectomy (LSG). The complication manifested as severe gastrointestinal bleeding. Upper GI Endoscopy and multislice CT scan, repeated twice, failed to localize the bleeding source to treat it. Successful endovascular embolization using a Glue/Lipidol mixture was achieved despite difficulties in localizing the pseudoaneurysm, resulting in immediate symptomatic relief and avoiding surgical intervention. This case shows the importance of prompt identification and management of LIPA pseudoaneurysms following LSG, highlighting the importance of early diagnosis to prevent further hemodynamic deterioration and other adverse outcomes.
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Affiliation(s)
- Izzat Basahai
- Consultant Interventional Radiologist, King Khalid University Hospital, Department of Radiology, King Saud University, Riyadh, Saudi Arabia
| | - Meshari A. Alzeer
- MBBS, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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3
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Bhamidipati T, Adnan SM, Deutsch E, Awad N. Lateral geniculate artery pseudoaneurysm after arthroscopic medial meniscectomy. J Vasc Surg Cases Innov Tech 2024; 10:101397. [PMID: 38304295 PMCID: PMC10831081 DOI: 10.1016/j.jvscit.2023.101397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024] Open
Abstract
Vascular complications after arthroscopy are rare and generally present as transient paresthesia most likely due to nervous injury or vasospasm. Rare cases of genicular artery injuries can occur and generally involve the medial genicular artery due to proximity to the right arthroscopic knee hook. This case, however, represents a rare lateral inferior genicular artery injury resulting in a symptomatic pseudoaneurysm. In addition, during the workup, the best visualization of the pseudoaneurysm was possible using duplex ultrasound. The diagnostic information seen on ultrasound was paramount and superseded the findings from conventional angiography and computed tomography angiography, both of which were nonspecific. In brief, this case not only highlights a rare surgical complication but also emphasizes the importance of duplex ultrasound compared with angiography and computed tomography in the workup of pseudoaneurysms.
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Affiliation(s)
- Theja Bhamidipati
- Division of Vascular and Endovascular Surgery, Jefferson Einstein Health, Philadelphia, PA
| | - Sakib Mohammad Adnan
- Division of Vascular and Endovascular Surgery, Jefferson Einstein Health, Philadelphia, PA
| | - Evan Deutsch
- Division of Vascular and Endovascular Surgery, Jefferson Einstein Health, Philadelphia, PA
| | - Nadia Awad
- Division of Vascular and Endovascular Surgery, Jefferson Einstein Health, Philadelphia, PA
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4
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Fan EY, Abrill Zegarra S, Walker J, Mortimer E, Simons JP. Innominate artery pseudoaneurysm from a Salter-Harris fracture of the sternoclavicular joint. J Vasc Surg Cases Innov Tech 2024; 10:101405. [PMID: 38379617 PMCID: PMC10877183 DOI: 10.1016/j.jvscit.2023.101405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/07/2023] [Indexed: 02/22/2024] Open
Abstract
Fractures and dislocations of the sternoclavicular joint (SCJ) are uncommon, accounting for <5% of all shoulder girdle injuries. They are relatively more common in the pediatric population than in the adult population and can often present concurrently as a posteriorly displaced medial clavicular dislocation with a fracture through the unfused physis. It is especially important to recognize this injury, because its management and potential sequelae are very different from those for fractures of the clavicle shaft. This type of injury frequently requires closed or open operative management because fracture-dislocation of the SCJ can be associated with potentially serious complications such as pneumothorax, brachial plexus injury, vagus nerve injury, tracheal injury, and vascular compromise. Few case reports describe fracture-dislocation of the SCJ resulting in vascular injuries. We describe the case of a 17-year-old boy who sustained a blunt hockey injury resulting in a right physeal fracture-dislocation of the SCJ causing an innominate artery pseudoaneurysm. This was treated with excision of the pseudoaneurysm, bovine pericardial patch angioplasty repair of the innominate artery, and open reduction and internal fixation of the medial clavicular physeal fracture.
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Affiliation(s)
- Emily Y. Fan
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | | | - Jennifer Walker
- Division of Cardiac Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Errol Mortimer
- Department of Orthopedic Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Jessica P. Simons
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
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Cunningham-Hill M, Jones B, Pillai L, Zimmerman P. Treatment of a contained rupture of a splenic artery pseudoaneurysm with direct thrombin injection. J Vasc Surg Cases Innov Tech 2024; 10:101398. [PMID: 38304297 PMCID: PMC10830532 DOI: 10.1016/j.jvscit.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/17/2023] [Indexed: 02/03/2024] Open
Abstract
Splenic artery pseudoaneurysm is a rare and potentially fatal condition. In the present report, we describe the case of a 50-year-old woman with chronic pancreatitis who presented with worsening abdominal pain. Computed tomography demonstrated a 3.5-cm splenic artery pseudoaneurysm of the mid-splenic artery. The patient underwent attempted endovascular repair of the pseudoaneurysm that was unsuccessful. Open conversion revealed an inaccessible splenic artery due to chronic pancreatitis that resulted in dense retroperitoneal fibrosis, and repair was achieved via direct thrombin injection under ultrasound guidance of the pseudoaneurysm and splenectomy. The patient recovered well, and computed tomography at 3 days postoperatively revealed complete thrombosis of the pseudoaneurysm.
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Affiliation(s)
- Matthew Cunningham-Hill
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Brendan Jones
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Lakshmikumar Pillai
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Pamela Zimmerman
- Heart and Vascular Institute, West Virginia University School of Medicine, Morgantown, WV, USA
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Yano R, Hirooka M, Nakamura Y, Imai Y, Koizumi Y, Watanabe T, Yoshida O, Tokumoto Y, Abe M, Hiasa Y. A case of hepatocellular carcinoma with pseudoaneurysm formation upon lenvatinib administration. Clin J Gastroenterol 2024; 17:319-326. [PMID: 38281290 DOI: 10.1007/s12328-023-01914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024]
Abstract
A 79-year-old man received treatment for multiple intrahepatic hepatocellular carcinoma with atezolizumab + bevacizumab. However, he developed lower back pain attributed to spinal metastases upon tumor enlargement; thus, he was admitted to our hospital for a change from atezolizumab + bevacizumab to lenvatinib and radiation therapy for the spinal metastases. On the 11th day after starting lenvatinib treatment, a pulsatile aneurysm appeared in the tumor, detected using abdominal ultrasonography Micro B-flow imaging, which visualized blood flow at a high frame rate; this was diagnosed as a pseudoaneurysm. The patient refused treatment for the pseudoaneurysm; therefore, he was carefully followed up. Fortunately, the pseudoaneurysm disappeared on the 17th day. One month later, the tumor had become completely necrotic. Lenvatinib demonstrated effectiveness in inhibiting angiogenesis in the tumor, as evidenced by a decrease in tumor blood flow. This case report suggests that pseudoaneurysm formation within the tumor occurs early after the administration of lenvatinib; thus, clinicians must be aware of the potential risk of pseudoaneurysm rupture.
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Affiliation(s)
- Ryo Yano
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan.
| | - Yoshiko Nakamura
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan
| | - Yusuke Imai
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan
| | - Takao Watanabe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan
| | - Yoshio Tokumoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitukawa 454, Toon, Ehime, 791-0295, Japan
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Zhang RS, Ro R, Bamira D, Vainrib A, Zhang L, Nayar AC, Saric M, Bernard S. Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction. Curr Cardiol Rep 2024:10.1007/s11886-024-02042-5. [PMID: 38526749 DOI: 10.1007/s11886-024-02042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.
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Affiliation(s)
- Robert S Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Richard Ro
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Daniel Bamira
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Alan Vainrib
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Lily Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ambika C Nayar
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Muhamed Saric
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Samuel Bernard
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
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Oka N, Kuriyama A, Ishisaka Y. Coil embolization of a giant pseudoaneurysm associated with a disrupted axillary artery: a case report. CVIR Endovasc 2024; 7:28. [PMID: 38466506 DOI: 10.1186/s42155-023-00408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/21/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Stent-graft placement is generally used to treat pseudoaneurysm (PSA) of the axillary artery (AA) trunk to maintain the patency of peripheral vessels. Coil embolization of a PSA associated with a disrupted AA trunk has rarely been reported. CASE PRESENTATION A 54-year-old woman presented with swelling of her right shoulder. She had had a right proximal humeral fracture 12 years earlier. Contrast-enhanced computed tomography (CECT) and subsequent angiograms revealed a giant PSA at the disrupted, distal right AA. There were collateral flows to the brachial artery from the proximal to the right AA. To preserve collateral flows to the brachial artery, selective embolization of the inflow artery that derived from the distal AA was performed with hydrogel-coated coils. The post-embolization arteriogram showed no flow into the PSA, but collateral flows to the brachial artery we preserved. The post-embolization course was uneventful. The patient regained warmth in her right arm and hand on post-embolization day 4. Repeat CECT on post-embolization day 9 confirmed blood-flow to her right radial artery. CONCLUSIONS While a stent-graft should be used if the AA trunk can be preserved, coil embolization should be considered for PSA if the AA trunk is disrupted but collaterals are preserved.
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Affiliation(s)
- Naoki Oka
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki, Okayama, 710-8602, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki, Okayama, 710-8602, Japan.
| | - Yukio Ishisaka
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Okayama, Japan
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Ghorbani M, Keykhosravi E, Vatanparast M, Elyassirad D, Golchin N, Mirsardoo H, Hasanpour M. Traumatic middle meningeal artery aneurysm: a case report. Neurochirurgie 2024; 70:101545. [PMID: 38417248 DOI: 10.1016/j.neuchi.2024.101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Traumatic intracranial aneurysms are rare, making up about 1% of all intracranial aneurysms. They can happen due to direct injury or blunt force, with the middle cerebral artery being the most frequent site. The middle meningeal artery (MMA) is the main artery that supplies the cranial dura mater, and, because of its location, is susceptible to damage after trauma. This article reported an unusual case of giant post-traumatic MMA pseudoaneurysm. CASE A 45 year-old man was referred to our department with a history of craniectomy. He complained of non-specific headache, but neurological examination was normal. A follow-up brain CT scan identified a right temporal fossa hyperdense mass. Digital subtraction angiography diagnosed a traumatic MMA aneurysm. The patient was treated with preoperative aneurysm embolization and surgical resection. DISCUSSION Traumatic MMA aneurysm is a rare presentation after head trauma. It can manifest as epidural hematoma, subdural hematoma or intraparenchymal hematoma, and sometimes resembles the present case, which was discovered incidentally. CONCLUSION Pseudoaneurysm is a rare complication of MMA trauma, with late presentation. It should be considered in patients with history of traumatic brain injury and temporal fossa extra-axial mass lesion with vascular characteristics.
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Affiliation(s)
- Mohammad Ghorbani
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Ehsan Keykhosravi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Mahsa Vatanparast
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Daniel Elyassirad
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Navid Golchin
- Iran University of Medical Sciences, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Hojjat Mirsardoo
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Mohammad Hasanpour
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran.
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Wershing K, Colon J, Alegria J, Paolillo J, Wallihan D, Schwartz M. Left Ventricular Pseudoaneurysm in an Adult With a Repaired Partial Atrioventricular Canal Defect. CASE (Phila) 2024; 8:174-179. [PMID: 38524982 PMCID: PMC10954580 DOI: 10.1016/j.case.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•LV pseudoaneurysm formation is rare after congenital heart disease repair. •Conservative management of LV pseudoaneurysm was successful in this unique case. •CCT and 3D printing are valuable in the characterization of LV pseudoaneurysm.
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Affiliation(s)
- Kathryn Wershing
- Department of Pediatrics, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
| | - Joseb Colon
- Congenital Cardiac 3D Printing Program, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
| | - Jorge Alegria
- Adult Congenital Heart Disease Program, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
| | - Joseph Paolillo
- Adult Congenital Heart Disease Program, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
- Division of Pediatric Cardiology, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
| | - Daniel Wallihan
- Division of Radiology, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
| | - Matthew Schwartz
- Adult Congenital Heart Disease Program, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
- Division of Pediatric Cardiology, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
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Lu GD, Yang W, Jia ZY, Liu S. Endovascular reconstruction of high cervical and long-segment carotid artery dissections with Leo plus stent. Neuroradiology 2024; 66:409-416. [PMID: 38191867 DOI: 10.1007/s00234-023-03274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/24/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Endovascular reconstruction has emerged as a viable alternative for carotid artery dissections (CADs) that are unresponsive to antithrombotic therapy. However, high cervical and long-segment CADs pose challenges during endovascular treatment due to their distal location and tortuous anatomy. We presented our experiences using endovascular reconstruction with the Leo plus stent for this type of CAD. METHODS We conducted a retrospective review of patients with high cervical and long-segment CADs treated using the Leo plus stent. We analyzed patient demographics, clinical presentations, procedural features, complications, and follow-up outcomes. RESULTS A total of 17 patients (mean age, 48.1 years) with 17 CADs were identified. Seven of these dissections were accompanied by pseudoaneurysm. The mean length of the dissection was 5.7 cm, and the mean degree of stenosis was 92.3%. A single Leo plus stent was deployed in 15 patients, while another Wallstent carotid stent was used in 2 cases. All stents were successfully positioned in their intended sites. The average degree of residual stenosis was 22.2%. There were no perioperative complications. With a median follow-up duration of 29 months, no ischemic stroke events occurred. All but one Leo plus stent remained patent during follow-up, and all 7 pseudoaneurysms had disappeared at the last radiological assessment. CONCLUSION Our experience in treating high cervical and long-segment CADs with the Leo plus stent demonstrates that this approach is practical, safe, and effective, as evidenced by long-term observations. The Leo Plus stent appears to be a suitable option for managing this type of CAD.
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Affiliation(s)
- Guang-Dong Lu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Wei Yang
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Zhen-Yu Jia
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China.
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12
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Ali AE, Haggag A, Almehmi A. Catheter-based therapy for traumatic pseudoaneurysm of the anterior tibial artery. Radiol Case Rep 2024; 19:1060-1063. [PMID: 38259710 PMCID: PMC10801127 DOI: 10.1016/j.radcr.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Tibial artery pseudoaneurysms often result from penetrating or blunt trauma to the lower extremities, or after orthopedic and endovascular interventions. Clinically, these lesions manifest as an expanding pulsatile mass of the affected area accompanied with pain and erythema. Despite the rare occurrence, traumatic tibial pseudoaneurysms can be associated with significant morbidity including local discomfort, rupture, and lower limb ischemia. Duplex ultrasound is considered the gold standard for diagnosis. Treatment options include surgical repair, ultrasound-guided compression or thrombin injection, and endovascular repair. In this report, we describe a 42-year-old male who presented to our center with pulsatile swelling over the mid-lateral aspect of the left leg. The diagnosis of a large anterior tibial artery pseudoaneurysm was made on clinical basis and was confirmed with computed tomography angiography. The lesion was treated endovascularly with a covered stent graft. In conclusion, this case highlights the role of endovascular therapy as a surgery-sparing and minimally invasive approach in managing traumatic peripheral arterial pseudoaneurysms with excellent clinical outcomes.
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Affiliation(s)
- Ahmed E. Ali
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Akram Haggag
- Department of Medicine, Crestwood Medical Center, Huntsville, AL, USA
| | - Ammar Almehmi
- Department of Radiology and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Khela M, Kasir R, Lokken RP, Clark AJ, Theologis AA. Bilateral dual iliac screw pelvic fixation for adult spinal deformity: a case report of a superior gluteal artery pseudoaneurysm secondary to aberrant iliac screw trajectory. Spine Deform 2024; 12:501-505. [PMID: 37882967 PMCID: PMC10867056 DOI: 10.1007/s43390-023-00774-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE To present a case of a pseudoaneurysm of a branch of the left superior gluteal artery (SGA) secondary to lateral wall perforation from an iliac screw and its subsequent evaluation and management. METHODS Case report. RESULTS A 67-year-old female with a history of degenerative flatback and scoliosis and pathological fractures of T12 and L1 secondary to osteodisciitis underwent a single0stage L5-S1 ALIF and T9-pelvis posterior instrumented fusion with bilateral dual iliac screw fixation, revision T11-S1 decompression, and T12 and L1 irrigation and debridement and partial corpectomies. During the operation, non-pulsatile bleeding was encountered after creating an initial trajectory for the more proximal of the two left iliac screws. While the initial post-operative course was benign, the patient was readmitted for hypotension and anemia. Computed tomography of the abdomen/pelvis demonstrated a pseudoaneurysm (2.3 cm × 2.1 cm × 2.3 cm) of a branch of the left SGA. Diagnostic angiogram confirmed a pseudoaneurysm off of one of the branches of the left SGA. Endovascular embolization using multiple coils resulted in a complete cessation of blood flow in the pseudoaneurysm. At 2 years follow-up, no symptoms suggestive of recurrence of the pseudoaneurysm were reported. CONCLUSIONS A pseudoaneurysm of a branch of the left superior gluteal artery as a result of lateral wall perforation from an aberrantly placed iliac screw during an adult spinal deformity operation involving dual screw pelvic fixation is reported. Prompt recognition, multidisciplinary collaboration, and appropriate intervention were key in achieving a successful outcome and preventing further morbidity.
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Affiliation(s)
- Monty Khela
- School of Medicine, Creighton University, Omaha, NE, USA
| | - Rafid Kasir
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA
| | - R Peter Lokken
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Aaron J Clark
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA.
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14
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Ali AA, Hussein AM, Albay E, Siyad AAA, Hassan MO, Ahmed SA. A blunt traumatic giant pseudoaneurysm of the brachiocephalic artery: A case report from Somalia. Int J Surg Case Rep 2024; 116:109329. [PMID: 38325112 PMCID: PMC10859269 DOI: 10.1016/j.ijscr.2024.109329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Pseudoaneurysm of the brachiocephalic artery is a rare condition that can occur as a result of various causes, including trauma, iatrogenic injury, and infection. The clinical presentation of brachiocephalic artery pseudoaneurysms can vary depending on the size and location of the pseudoaneurysm. The treatment options for innominate artery pseudoaneurysms include both surgical and endovascular approaches. Our goal of the study is to increase awareness and early detection of blunt injuries in the chest, clavicle, or sternoclavicular joint that may cause a vascular injury. CASE PRESENTATION We present here A 24-year-old male came to present with an acute onset of dyspnea, stridor (an abnormal, high-pitched respiratory sound produced by irregular airflow in a narrowed airway), a worsening cough, and chest pain that had been worsening over several months. His medical history was significant for blunt chest trauma secondary to a bicycle fall 3 months earlier. DISCUSSION A traumatic giant pseudoaneurysm of the innominate artery is a rare but potentially life-threatening condition. Treatment options for brachiocephalic artery pseudoaneurysm include both endovascular and surgical approaches. This case report contributes to the current literature when any patient has a blunt injury in the chest, clavicle, or sternoclavicular joint and is highly suspect of a vascular injury. To increase awareness, we first need to exclude if there is any vascular injury, which helps to detect it early and intervene. CONCLUSION Brachiocephalic artery traumatic large pseudoaneurysm is an uncommon but potentially fatal disorder that can arise from a number of different sources. Achieving favorable results requires prompt diagnosis and proper care, which may include open surgical repair and endovascular procedures. To better comprehend the condition and optimize its management approaches, more investigation and case studies are required.
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Affiliation(s)
- Abdijalil Abdullahi Ali
- Department of cardiovascular surgery at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia.
| | - Abdinafic Mohamud Hussein
- Department of cardiovascular surgery at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Erkan Albay
- Department of cardiovascular surgery at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ali Abdulkadir Ali Siyad
- Department of cardiovascular surgery at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Omar Hassan
- Department of Cardiology at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Said Abdirahman Ahmed
- Department of Cardiology at Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
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15
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Viswam D, B K, Venugopal A, Parmar G. Endovascular treatment of sporadic renal angiomyolipoma presenting with Wunderlich syndrome. Radiol Case Rep 2024; 19:1051-1054. [PMID: 38226046 PMCID: PMC10788370 DOI: 10.1016/j.radcr.2023.11.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Angiomyolipomas are benign renal hamartomas with - fat, smooth muscle, and abnormal blood vessel (tortuous, dysmorphic) components. The risk of hemorrhage is related to size of the tumor, presence of aneurysm, associations with tuberous sclerosis. In this case report we review the case of a 42-year-old woman presenting with acute flank pain and decreased hemoglobin, who was diagnosed with AML with right renal artery pseudo aneurysm on CT. Subsequent coil embolization of feeding vessels and using PVA particles was successfully done. Selective embolization remains a minimally invasive, attractive option, and a nephron sparing approach.
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Affiliation(s)
- Devta Viswam
- Department of Radiodiagnosis, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Keerthiraj B
- Department of Radiodiagnosis, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Anand Venugopal
- Department of Radiodiagnosis, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Geetanjali Parmar
- Department of Radiodiagnosis, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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16
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Ok T, Seo KD, Lee IH. Fatal Femoral Pseudoaneurysm Rupture after Endovascular Intervention: A Case Report and Literature Review. Neurointervention 2024; 19:52-56. [PMID: 38303611 PMCID: PMC10910178 DOI: 10.5469/neuroint.2024.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
A rupture of a femoral pseudoaneurysm is an extremely rare complication of endovascular procedures, but its outcome can be life-threatening. In this report, we present a case of a femoral pseudoaneursym rupture in a patient in their early 90s following intra-arterial mechanical thrombectomy for acute ischemic stroke. Despite receiving medical and surgical interventions, the patient subsequently developed multiple organ failure, ultimately resulting in death. This case emphasizes the critical role of appropriate selection of vascular closure technique and careful post-procedural monitoring, particularly in high-risk patients.
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Affiliation(s)
- Taedong Ok
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwon-Duk Seo
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Il Hyung Lee
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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17
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Damadian BE, Machnicki SC. I saw the sign: He felt a pang and we saw the Yin-Yang (sign). Clin Imaging 2024; 107:110087. [PMID: 38241966 DOI: 10.1016/j.clinimag.2024.110087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
The yin-yang sign, also known as the Pepsi sign, is used to describe the classic appearance of bidirectional blood flow within an aneurysm or pseudoaneurysm sac on color Doppler ultrasound. The corresponding spectral Doppler finding is a "to-and-fro" waveform, caused by inflow to the aneurysm/pseudoaneurysm sac during systole and outflow during diastole. It is important to recognize this sign in order to quickly identify the presence of an aneurysm or pseudoaneurysm and prevent complications such as expansion and rupture.
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Affiliation(s)
- Brianna E Damadian
- Northwell Health/Lenox Hill Hospital, Department of Radiology, 100 East 77th Street, New York, NY 10075, United States of America.
| | - Stephen C Machnicki
- Northwell Health/Lenox Hill Hospital, Department of Radiology, 100 East 77th Street, New York, NY 10075, United States of America
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18
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Hashio A, Hamano E, Ozaki S, Hatyakeyama K, Ikeda Y, Niwa A, Yamada N, Ikedo T, Yamada K, Imamura H, Mori H, Iihara K, Kataoka H. Pathological changes in the lenticulostriate artery indicate the mechanisms leading to intracranial hemorrhage in Moyamoya disease: a case report. Acta Neurochir (Wien) 2024; 166:116. [PMID: 38421418 DOI: 10.1007/s00701-024-05992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/03/2024] [Indexed: 03/02/2024]
Abstract
This case report details the pathological findings of a vessel wall identified as the bleeding point for intracranial hemorrhage associated with Moyamoya disease. A 29-year-old woman experienced intracranial hemorrhage unrelated to hyperperfusion following superficial temporal artery-middle cerebral artery bypass surgery. A pseudoaneurysm on the lenticulostriate artery (LSA) was identified as the causative vessel and subsequently excised. Examination of the excised pseudoaneurysm revealed a fragment of the LSA, with a disrupted internal elastic lamina and media degeneration. These pathological findings in a perforating artery, akin to the circle of Willis, provide insights into the underlying mechanisms of hemorrhage in Moyamoya disease.
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Affiliation(s)
- Atsushi Hashio
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Saya Ozaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kinta Hatyakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akihiro Niwa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Naoto Yamada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Taichi Ikedo
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hisae Mori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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19
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Bruno A, Vendetti F, Papalexis N, Russo M, Papadopoulos D, Mosconi C. Percutaneous balloon-assisted ultrasound-guided direct thrombin embolization of superficial femoral artery pseudoaneurysm: a case series and literature review. CVIR Endovasc 2024; 7:19. [PMID: 38363514 PMCID: PMC10873257 DOI: 10.1186/s42155-024-00428-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/18/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Superficial femoral artery (SFA) pseudoaneurysms, a rare but potentially life-threatening complication, that can arise after vascular interventions or trauma. This case series explores the efficacy and safety of a minimally invasive treatment modality, percutaneous ultrasound-guided thrombin injection (PUGTI) combined with balloon occlusion, in three patients with SFA pseudoaneurysms. CASE PRESENTATION Three patients (age: 71-82 years; 3 female) with SFA pseudoaneurysms underwent PUGTI with balloon occlusion. The procedure involved direct thrombin injection under ultrasound guidance while occluding the parent artery using a balloon catheter. Follow-up was conducted at 1 week and 1 month post-procedure to assess technical success, complications, and recurrence. CONCLUSION PUGTI combined with balloon occlusion appears to be a safe and effective treatment for SFA pseudoaneurysms, particularly for larger pseudoaneurysms. The procedure is associated with a high technical success rate. Balloon occlusion may offer a safer alternative to direct thrombin injection without occlusion, as it potentially minimizes the risk of complications such as distal thromboembolism.
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Affiliation(s)
- Antonio Bruno
- Alma Mater Studiorum, Università Di Bologna, Bologna, Italy
| | | | | | - Mattia Russo
- Alma Mater Studiorum, Università Di Bologna, Bologna, Italy.
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20
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Iuliani K, Lawler A, Schrope D, Locke E. Echocardiographic and pathologic identification of an aorto-left atrial fistula secondary to infective endocarditis in a canine patient. J Vet Cardiol 2024; 52:61-67. [PMID: 38430823 DOI: 10.1016/j.jvc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 03/05/2024]
Abstract
A dog was presented for lameness, fever, and extreme lethargy. On physical exam, a new heart murmur, arrhythmia, and joint effusion were detected. These findings were not detected two months prior. A diagnostic work-up confirmed septic suppurative inflammation in multiple joints. Echocardiogram revealed aortic valvular endocarditis along with a communication, as a consequence of a fistula, that extended from just below the aortic sinotubular junction to the left atrial lumen. Due to a poor prognosis, humane euthanasia was elected. Necropsy and histopathology confirmed infective endocarditis of the aortic valve and an aorto-left atrial fistulous tract extending from the left coronary sinus of the aortic valve to the lumen of left atrium.
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Affiliation(s)
- K Iuliani
- Oradell Animal Hospital, 580 Winters Ave, Paramus, NJ, 07652, USA.
| | - A Lawler
- Oradell Animal Hospital, 580 Winters Ave, Paramus, NJ, 07652, USA
| | - D Schrope
- Oradell Animal Hospital, 580 Winters Ave, Paramus, NJ, 07652, USA
| | - E Locke
- Antech Diagnostics, 7555 Danbro Crescent, Mississauga, ON, L5N 6P9, Canada
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21
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Rac G, Ellis JL, Janakiraman S, Plumb A, Elliott N, Lanzotti NJ, Lee JH, Gali K, Quek ML, Patel HD, Gupta GN. Risk of pseudoaneurysm and bleeding complications after partial nephrectomy: comparison of tumor enucleation to standard margin technique. J Robot Surg 2024; 18:65. [PMID: 38329585 DOI: 10.1007/s11701-023-01808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/23/2023] [Indexed: 02/09/2024]
Abstract
Partial nephrectomy (PN) is the gold standard for the resection of amenable small renal masses. Some surgeons have adopted tumor enucleation (TE) over the standard margin PN (SPN) technique based on preservation of healthy renal parenchyma by following the tumor pseudocapsule. However, TE may also confer additional advantages due to avoidance of sharp incision including reduction in perioperative and bleeding complications. Therefore, we evaluated the rate of pseudoaneurysms and other complications following TE vs. SPN. A retrospective cohort study of patients undergoing PN (TE and SPN) between 2008 and 2020 was conducted. Baseline characteristics were compared between the TE and SPN cohorts with univariable and multivariable logistic regression models. A total of 534 patients were included, 195 (36.5%) receiving TE and 339 (63.5%) SPN. There were no differences in baseline patient demographics. There was no difference in RENAL nephrometry scores between the two groups (p = 0.47). TE had lower rates of postoperative complications (11.3 vs. 21.5%, p = 0.002). TE had less bleeding complications (2.1 vs. 8.0%, p = 0.002) with no pseudoaneurysm events following TE compared to 12 following SPN (0.0 vs. 3.5%, p = 0.008). Need for interventional radiology largely reflected pseudoaneurysm differences (0 (0.0%) TE vs. 13 (3.8%) SPN, p = 0.006. Readmission occurred less often after TE vs. SPN (4.1 vs. 8.3%, p = 0.07). Patients receiving TE experienced no clinically significant pseudoaneurysm formation and were less likely to have any bleeding complication or major complication postoperatively. TE may be preferred when minimizing morbidity aligns with patient selection and preferences.
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Affiliation(s)
- Goran Rac
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Jeffrey L Ellis
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Sarang Janakiraman
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Arden Plumb
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA.
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA.
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
| | - Nicholas Elliott
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | | | - Jae Han Lee
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Keshava Gali
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
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22
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Payman AA, Pecoraro NC, Tsiang JT, Souter J, Hand R, Bechara CF, Serrone JC. Stenting for Traumatic Pseudoaneurysms of the Cervical Internal Carotid Artery: Case Report and Systematic Review. World Neurosurg 2024:S1878-8750(24)00199-2. [PMID: 38336211 DOI: 10.1016/j.wneu.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The optimal stenting approach for traumatic pseudoaneurysms (PSA) of the extracranial internal carotid artery (ICA) remains underinvestigated. We present a case of a traumatic pseudoaneurysm of the extracranial ICA managed with stenting and review of prior published similar cases. METHODS The systematic review followed PRISMA-S guidelines and included studies that investigated traumatic pseudoaneurysms of the extracranial ICA managed by stent placement. Statistical analysis assessed the association between the type of injury and stent type, dual antiplatelet therapy (DAPT) duration, and clinical presentation, and the association between stent type and DAPT duration. RESULTS Our search yielded 82 publications with 135 patients with extracranial ICA PSA treated with stenting. The odds of neck hematoma presentation was 12.2 times greater for patients with penetrating rather than blunt injuries (P = 0.000002). Covered stents had 2.02 times higher odds of use for penetrating rather than blunt injuries compared to bare metal stents. (P = 0.0029). Shorter duration DAPT was seen with bare metal stents having 1.25 higher odds of DAPT duration less than one month compared to covered (P = 0.001). CONCLUSIONS In traumatic extracranial ICA pseudoaneurysms, covered stents are used more commonly for penetrating injuries compared to blunt injuries. Penetrating injuries are more strongly associated with the presentation of a hematoma compared to blunt injuries. Stent type may influence the recommended DAPT duration. Surgeons should consider these findings when selecting stent type and DAPT duration with patients presenting with traumatic extracranial ICA pseudoaneurysm.
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Affiliation(s)
- Andre A Payman
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
| | - Nathan C Pecoraro
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John T Tsiang
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John Souter
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert Hand
- Loyola University Medical Center, Maywood, Illinois, USA
| | - Carlos F Bechara
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Joseph C Serrone
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Department of Neurological Surgery, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA
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23
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Mohamed AR, Alharbi A, Sajdeya O, Moustafa A, Younes S, Grande R. Left ventricular narrow-neck pseudoaneurysm following a redo mitral valve replacement. Cardiovasc Revasc Med 2024; 59:17-20. [PMID: 37391324 DOI: 10.1016/j.carrev.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/31/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Affiliation(s)
| | | | - Omar Sajdeya
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | | | - Stephanie Younes
- Division of Cardiovascular Medicine, Promedica-Toledo Hospital, Toledo, OH, USA
| | - Robert Grande
- Division of Cardiovascular Medicine, Promedica-Toledo Hospital, Toledo, OH, USA
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24
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D'Onofrio A, Piazza M, Andreatta G, Cao I, Lombardi V, Pittarello D, Grego F, Antonello M, Gerosa G. Endovascular aortic arch repair under monitored anaesthesia care: maximizing microinvasiveness. Eur J Cardiothorac Surg 2024; 65:ezae032. [PMID: 38317061 DOI: 10.1093/ejcts/ezae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
Patients with aortic arch pathologies after surgery for type-A acute aortic dissection represent a challenging population since open surgery is associated with a non-negligible rate of mortality and complications. Microinvasive endovascular aortic arch repair Arch-Thoracic EndoVascular Aortic Repair (Ar-TEVAR) has shown promising results in high-risk patients. Ar-TEVAR is usually performed under general anaesthesia. We report the case of an 83-year-old man with a history of ascending aorta replacement for type-A acute aortic dissection who was referred for an anastomotic pseudoaneurysm. Ar-TEVAR using an off-the-shelf single-branch aortic arch stent graft was chosen. In order to further minimize procedural invasiveness, monitored anaesthesia care (local anaesthesia with sedation and analgesia) was performed since it provides less stress on the cardiovascular and respiratory systems and overall leads to a faster recovery especially in elderly patients.
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Affiliation(s)
| | - Michele Piazza
- Division of Vascular Surgery, University of Padova, Padova, Italy
| | - Giulio Andreatta
- Division of Cardiac Anesthesia and Intensive Care, University of Padova, Padova, Italy
| | - Irene Cao
- Division of Cardiac Surgery, University of Padua, Padova, Italy
| | | | - Demetrio Pittarello
- Division of Cardiac Anesthesia and Intensive Care, University of Padova, Padova, Italy
| | - Franco Grego
- Division of Vascular Surgery, University of Padova, Padova, Italy
| | | | - Gino Gerosa
- Division of Cardiac Surgery, University of Padua, Padova, Italy
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Seno DH, Siregar MAR, Afriansyah A, Arisutawan IPK, Leonardo K. A rare case report of renal vein embolization after failed selective angioembolization to treat delayed complication of percutaneous nephrolithotomy. Int J Surg Case Rep 2024; 115:109257. [PMID: 38266367 PMCID: PMC10832494 DOI: 10.1016/j.ijscr.2024.109257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) has been considered the standard procedure for renal caliculi for its safety, shorter operative time, and cost-effectivity. Despite being minimally invasive, rare complications may still occur. This case presented a rare case of renal venous pseudoaneurysm after PCNL. PRESENTATION OF CASE A 34-year-old male was diagnosed with left lower calyx renal stone sized 14x13x8 mm with 388-571 Hounsfield Unit (HU). He underwent left mini PCNL with standard protocol. However, on two-weeks follow-up, gross haematuria was presented on emergency department admission. Patient underwent two times cystoscopy and blood clot evacuation. Postoperative contrast-enhanced CT showed saccular lesion sized 6.7 mm × 4.8 mm in the interlobar vein of left kidneys' lower pole. Patient was then consulted to Cardiothoracic-Vascular division, and undergone selective angiography and left renal artery embolization-coiling (VortX Diamond-18). Complaints and haemoglobin decline persists; thus, another attempt of embolization was performed with a different approach. Follow-up arteriography and venography showed complete obliteration of the aneurysm sac, followed by cessation of symptoms. This study is reported in line with SCARE criteria. DISCUSSION This is a rare case where a second embolization attempt (specifically via vein) was needed to overcome PCNL postoperative complication. Reviewing vascular complications risk factors after PCNL is crucial. This case report suggests complication management could be handled appropriately through procedures of selective angiography and embolization. CONCLUSION Coil embolization targeting the vein is a potentially effective and safe for selective cases of renal vein pseudoaneurysm. This case shows the importance of multidisciplinary approach and collaboration for better patient management.
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Affiliation(s)
- Doddy Hami Seno
- Department of Surgery, Division of Urology, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Moammar Andar Roemare Siregar
- Department of Surgery, Division of Urology, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Andika Afriansyah
- Department of Surgery, Division of Urology, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - I Putu Kokohana Arisutawan
- Department of Surgery, Division of Cardiothoracic and Vascular, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kevin Leonardo
- Department of Urology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Li Q, Jiang Z, Yuan M, Xu C, Zeng L. A foreign body that has been left for 20 years causes a pseudoaneurysm of the middle cerebral artery: a case report. J Med Case Rep 2024; 18:39. [PMID: 38297354 PMCID: PMC10832239 DOI: 10.1186/s13256-023-04334-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND We report a patient with extensive subarachnoid hemorrhage caused by the rupture of a middle cerebral artery pseudoaneurysm from a foreign body that had been left for two decades. CASE PRESENTATION A 74-year-old male patient from Han nationality was admitted to the emergency department of our hospital with impaired consciousness for 1 hour. Cranial computed tomography examination indicated a massive subarachnoid hemorrhage with intraventricular blood accumulation, and a high-density short strip dense shadow was seen in the M1 segment of the right middle cerebral artery, considering the possibility of a foreign body. Subsequently, a cerebral angiography was suggested; the foreign body was seen through the right middle cerebral artery, and the aneurysm was seen in the lower wall, so a pseudoaneurysm was considered. The emergent surgical intervention involved the clipping of the pseudoaneurysm and intracranial extraction of the foreign body. Unfortunately,the patient ultimately expired due to severe pulmonary infection. CONCLUSION Intracranial pseudoaneurysm caused by foreign body has been rarely reported previously, and microsurgical treatment of an intracranial pseudoaneurysm caused by a foreign body is a good choice.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zhengfang Jiang
- Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
- Department of Neurosurgery, Sichuan Mianyang 404 Hospital, Mianyang, 621000, China.
| | - Miao Yuan
- Department of Neurosurgery, Sichuan Mianyang 404 Hospital, Mianyang, 621000, China
| | - Chenglang Xu
- Department of Neurosurgery, Sichuan Mianyang 404 Hospital, Mianyang, 621000, China
| | - Lingyong Zeng
- Department of Neurosurgery, Sichuan Mianyang 404 Hospital, Mianyang, 621000, China
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Abramov I, Labib MA, Altshuler D, Houlihan LM, Gonzalez-Romo NI, Luther E, Ivan ME, Lawton MT, Morcos JJ, Preul MC. Step-by-Step Dissection of the Extreme Lateral Transodontoid Approach to the Anterior Craniovertebral Junction: Surgical Anatomy and Technical Nuances. World Neurosurg 2024; 182:e5-e15. [PMID: 37925146 DOI: 10.1016/j.wneu.2023.10.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Multicompartmental lesions of the anterior craniovertebral junction require aggressive management. However, the lesions can be difficult to reach, and the surgical procedure is difficult to understand. The aim of this study was to create a procedural, stepwise microsurgical educational resource for junior trainees to learn the surgical anatomy of the extreme lateral transodontoid approach (ELTOA). METHODS Ten formalin-fixed, latex-injected cadaveric heads were dissected under an operative microscope. Dissections were performed under the supervision of a skull base fellowship-trained neurosurgeon who has advanced skull base experience. Key steps of the procedure were documented with a professional camera and a high-definition video system. A relevant clinical case example was reviewed to highlight the principles of the selected approach and its application. The clinical case example also describes a rare complication: a pseudoaneurysm of the vertebral artery. RESULTS Key steps of the ELTOA include patient positioning, skin incision, superficial and deep muscle dissection, vertebral artery dissection and transposition, craniotomy, clivus drilling, odontoidectomy, and final extradural and intradural exposure. CONCLUSIONS The ELTOA is a challenging approach, but it allows for significant access to the anterior craniovertebral junction, which increases the likelihood of gross total lesion resection. Given the complexity of the approach, substantial training in the dissection laboratory is required to develop the necessary anatomic knowledge and to minimize approach-related morbidity.
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Affiliation(s)
- Irakliy Abramov
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - David Altshuler
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lena Mary Houlihan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nicolas I Gonzalez-Romo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Evan Luther
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jacques J Morcos
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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John S, Khan M, Kesav P, Raj D, Hussain SI. Primary Angiitis of Central Nervous System related intracranial aneurysm with spontaneous occlusion after immunomodulatory treatment. J Cerebrovasc Endovasc Neurosurg 2024:jcen.2024.E2023.04.010. [PMID: 38287464 DOI: 10.7461/jcen.2024.e2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024] Open
Abstract
Primary Angiitis of the Central Nervous System (PACNS) is an uncommon disease with kaleidoscopic clinical manifestations. Ischemic strokes are commoner than their hemorrhagic counterpart. Intracranial pseudoaneurysms are rarely reported in PACNS cohorts. We hereby describe the case of a 39-year-old female, who presented for evaluation of acute onset of left middle cerebral artery (MCA) ischemic stroke, with cerebral angiogram showing multifocal stenosis and irregularities in intracranial blood vessels with an aneurysm arising from the lenticulostriate branch of the left MCA M1 segment. A diagnosis of probable PACNS was made and patient initiated on immunomodulatory treatment with corticosteroids. 12 weeks follow up neuroimaging studies revealed resolution of the previously described intracranial aneurysm, thereby postulating the possibility of a pseudoaneurysm related to the underlying angiitis.
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Affiliation(s)
- Seby John
- Department of Neurology and Neurointerventional Surgery, Neurological Institute (NI), Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi, UAE
| | - Muhammad Khan
- Department of Biomedical Engineering, Khalifa University, Abu Dhabi, UAE
| | - Praveen Kesav
- Department of Neurology, Neurological Institute (NI), Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi, UAE
| | - Divya Raj
- Department of Neurology, Neurological Institute (NI), Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi, UAE
| | - Syed Irteza Hussain
- Department of Neurology and Neurointerventional Surgery, Neurological Institute (NI), Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi, UAE
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Kejiou H, Rizziki A, Ouhmich M, Benzirare A, Mahi OE. [Case report : Rare case of a spontaneous pseudoaneurysm of the superficial femoral artery revealing Behçet's disease in a young patient]. Ann Cardiol Angeiol (Paris) 2024; 73:101707. [PMID: 38262254 DOI: 10.1016/j.ancard.2023.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/02/2023] [Accepted: 10/26/2023] [Indexed: 01/25/2024]
Abstract
Behçet's disease is a chronic inflammatory vascular disorder that can affect arteries and veins of various sizes. Arterial involvement, which plays a significant prognostic role, requires a treatment approach involving corticosteroids, immunosuppressants, and potentially surgical or endovascular procedures. This article presents the case of a young man diagnosed with Behçet's disease, manifested by a spontaneous pseudoaneurysm in the superficial femoral artery. The patient underwent surgical intervention to remove the pseudoaneurysm and restore circulation using a venous graft. This case underscores the importance of considering Behçet's disease in vascular manifestations.
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Affiliation(s)
- Houssam Kejiou
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc.
| | - Abdellah Rizziki
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc
| | - Mohamed Ouhmich
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc
| | - Adnane Benzirare
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc
| | - Omar El Mahi
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc
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Nicolino TI, Costantini J, Astore I, Yacuzzi CH, Astoul Bonorino J, Costa Paz M, Carbó L. Incidence of vascular injury associated with knee arthroplasty: series of cases. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-023-03814-5. [PMID: 38252291 DOI: 10.1007/s00590-023-03814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The incidence of vascular injury associated with knee arthroplasty is scarce, but, when they occur, the consequences are serious. OBJECTIVES Describe the incidence of vascular lesions in our center and evaluate time to diagnosis, resolution and follow-up. MATERIALS AND METHODS Retrospective cohort during the 2010-2019 period of primary arthroplasties and knee revision. The incidence of vascular lesions and their demographic characteristics were analyzed. Type of lesion, diagnostic method and treatment were recorded. It was evaluated in distant follow-up of pain and functionality. RESULTS 7.940 primary total knee arthroplasty and revision surgeries were recorded, and a report of 7 emergency cases for vascular lesions was also recorded, with an incidence of 0.088%. 3 vascular lesions were caused by direct laceration of the popliteal artery, 1 case of thrombosis of the popliteal artery and 3 cases of pseudoaneurysmal lesion of the superior genicular artery. Three vascular lesions that occurred in primary arthroplasty were immediately repaired by a vascular surgeon. Pseudoaneurysm lesions and thrombosis were resolved by angiographic procedure. DISCUSSION Vascular complications around the knee are rare. Time to diagnosis and treatment is essential. Digital angiography is a diagnostic and therapeutic tool. There are various repair techniques, whether it's embolization, cauterization, stenting or endoprosthesis; therefore, digital angiography is a safe method with a low complication rate. CONCLUSION The incidence of vascular lesions in knee arthroplasty in our center is very low. The cases were diagnosed and resolved early, without registering subsequent complications with good functional results in distant follow-up.
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Affiliation(s)
- T I Nicolino
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of San Justo, Buenos Aires, Argentina
| | - J Costantini
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - I Astore
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Carlos H Yacuzzi
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - J Astoul Bonorino
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of San Justo, Buenos Aires, Argentina
| | - M Costa Paz
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - L Carbó
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Harutyunyan L, Jalal S. Popliteal pseudoaneurysm from suspected mechanical stress injury secondary to stent fracture and perforation: A case report. SAGE Open Med Case Rep 2024; 12:2050313X231223865. [PMID: 38205140 PMCID: PMC10777754 DOI: 10.1177/2050313x231223865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
Popliteal artery aneurysms may be divided into true and false aneurysms (pseudoaneurysms). We present a case of a right popliteal pseudoaneurysm. A 67-year-old male presented to the hospital with significant pain in the right calf. A peripheral angiogram revealed extensive stent thrombosis in the right lower extremity. A thrombectomy and balloon angioplasty were done to reestablish blood flow. 2 weeks later the patient presented after a driving trip, with a peripheral angiogram revealing a popliteal pseudoaneurysm. Vascular intervention was performed, replacing the right popliteal artery with a 6 mm polytetrafluoroethylene graft. There is a high degree of suspicion for mechanical stress injury from prolonged knee flexion. The etiology of the pseudoaneurysm was most likely from mechanical stress, despite its historical association with true aneurysms. Although differentiating between true and false aneurysms is important in determining etiology, these are not all-inclusive and overlap of causation may occur.
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Affiliation(s)
- Luiza Harutyunyan
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Shwan Jalal
- Department of Interventional Cardiology, Memorial Hospital, Gulfport, MS, USA
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Mosbahi S, Siepe M, Desai ND, Pregaldini F, Nucera M, Berezowski M, Kelly JJ, Jiang F, Zhao Y, Szeto WY, Schoenhoff FS, Bavaria JE. The non to moderately dilated root in acute type A aortic dissection: outcomes of the PENN-BERN registry in young, non-syndromic patients. Eur J Cardiothorac Surg 2024; 65:ezae024. [PMID: 38244577 DOI: 10.1093/ejcts/ezae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/27/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES There is an ongoing debate regarding whether patients benefit more from root replacement compared to a reconstruction of the sinuses of Valsalva in acute type A aortic dissection (aTAAD). In those with known or suspected connective tissue disorders, root replacement is considered appropriate. However, there are currently no diameter-based guidelines regarding the best approach in patients with minimally to moderately dilated root and no connective tissue disorders. METHODS From January 2005 to December 2022, a two-centre registry of aTAAD was created. Patients were included based on their age (≤60 years), the absence of root entry and dilatation >50 mm and the absence of syndromic hereditable aortic disease. Patients were divided into 2 groups based on the proximal procedure, root reconstruction and root replacement. Propensity score pair matching was performed based on preoperative characteristics. RESULTS Cumulative incidence of reintervention at 10 years was slightly higher after root reconstruction 13% vs 3.9% in the matched group (P = 0.040). Survival at 10 years was not affected by the procedure independently of the matching 72.1% vs 71.4% (P = 0.2). Uni- and multivariate Cox regressions showed that a root diameter of >40 mm was associated with a hazard ratio of 7.7 (95% confidence interval 2.6-23) and 5.4 (7-17), respectively, for reoperation for aneurysm and pseudoaneurysm. CONCLUSIONS Rate of reoperation due to proximal pseudoaneurysm and aneurysm could be significantly reduced with a lower threshold of 40 mm to replace the aortic root in aTAAD than in elective cases.
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Affiliation(s)
- Selim Mosbahi
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Matthias Siepe
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Fabio Pregaldini
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Maria Nucera
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Mikolaj Berezowski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - John J Kelly
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Fei Jiang
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Yu Zhao
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Florian S Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Gou B, Tu B, Xin FY, Zhang JC, Wang J, Liu J. Iatrogenic Pseudoaneurysm with Acute Arterial Thrombosis in Multiple Branches of the Lower Limbs Treated by Ultrasound-guided Thrombin Injection: A Case Report. Curr Med Imaging 2024; 20:1-5. [PMID: 38389376 DOI: 10.2174/0115734056280421231129104558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 02/24/2024]
Abstract
INTRODUCTION With the development of vascular intervention, pseudoaneurysm complications are increasing. Ultrasound-guided thrombin injection (UGTI) is currently the treatment of choice for pseudoaneurysm, but the pharmacological properties of thrombin may trigger acute thrombosis within the vessel lumen. Despite a very low incidence, this type of primary arterial thrombosis is a serious complication of UGTI, and cases involving multiple branches of the lower limb arteries are particularly rare. CASE PRESENTATION Here, we report a case of a 65-year-old male who underwent UGTI for the treatment of an iatrogenic pseudoaneurysm of the femoral artery complicated by acute thrombosis of multiple arteries in the lower limbs, and the patient ultimately underwent a successful thrombectomy. CONCLUSION We reviewed the case and analyzed the possible etiologic causes, providing a reference for future clinical work.
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Affiliation(s)
- Bo Gou
- Department of Ultrasound, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Bin Tu
- Department of Ultrasound, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Feng-Yue Xin
- Department of Ultrasound, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Ji-Cheng Zhang
- Department of Ultrasound, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jie Wang
- Department of Ultrasound, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jian Liu
- Department of Ultrasound, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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Melman YF, Ogilvie M. An unusual cause of pocket hematoma: Injury to a superior thoracic artery branch. HeartRhythm Case Rep 2024; 10:38-40. [PMID: 38264104 PMCID: PMC10801067 DOI: 10.1016/j.hrcr.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
| | - Mark Ogilvie
- Department of Interventional Radiology, McKay-Dee Hospital, Ogden, Utah
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Mohamed Irshad MR, Raja J, Mahajan S. RVOT pseudoaneurysm post biventricular repair for tetralogy of Fallot with single pulmonary artery. Indian J Thorac Cardiovasc Surg 2024; 40:83-85. [PMID: 38125321 PMCID: PMC10728407 DOI: 10.1007/s12055-023-01558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 12/23/2023] Open
Abstract
Pseudoaneurysm of the right ventricular outflow tract (RVOT), post repair for tetralogy of Fallot (TOF), is a rare occurrence with few cases reported in literature. TOF with single pulmonary artery is in itself a rare occurrence. RVOT pseudoaneurysm in a case of TOF with single pulmonary artery has not been reported to the best of our knowledge. RVOT pseudoaneurysm is a catastrophic complication which has very few symptoms and has to be picked up early to avoid dire consequences. We have reported such a rare occurrence to highlight the importance of looking out for such complications in rare presentations where anatomy is altered. Supplementary information The online version contains supplementary material available at 10.1007/s12055-023-01558-9.
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Affiliation(s)
- M. R. Mohamed Irshad
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institution of Medical Education and Research, PGIMER, Chandigarh, 160012 India
| | - Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institution of Medical Education and Research, PGIMER, Chandigarh, 160012 India
| | - Sachin Mahajan
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institution of Medical Education and Research, PGIMER, Chandigarh, 160012 India
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Lu T, Shen R, Xv M, Ye Q, Shen J. Successful endoscopic combined with endovascular haemostasis of a ruptured pseudoaneurysm of the duodenal bulb: A case report. J Int Med Res 2024; 52:3000605231222413. [PMID: 38179804 PMCID: PMC10771055 DOI: 10.1177/03000605231222413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Pseudoaneurysms are uncommon but their rupture and bleeding can lead to serious complications and be fatal. We present here a case of a man in his late 70s who was transferred to our hospital with persistent gastrointestinal bleeding. One month prior to his admission, he had undergone surgery for a fracture to his left knee. Endoscopic examination found pulsating blood vessels on a duodenal ulcer, which suddenly ruptured and caused significant bleeding. Immediate endoscopic haemostasis was administered and the bleeding decreased. Considering the high rate of rebleeding that may occur with a pseudoaneurysm, the patient underwent interventional radiology that culminated in a diagnosis of a pseudoaneurysm originating from gastroduodenal artery (GDA); successful embolization was achieved. Tests showed that the patient had Helicobacter pylori infection. We hypothesised that the H. pylori infection had led to the occurrence of the duodenal bulb ulcer, and the patient's left knee fracture and surgery a month previously had contributed to this predisposition for a pseudoaneurysm.
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Affiliation(s)
- Ting Lu
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Ruiwei Shen
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Minhong Xv
- Department of Endoscopy Center, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Qunqun Ye
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Jianwei Shen
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
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Sokol Z, Oselkin M. Spinal subarachnoid hemorrhage as a consequence of dissection with pseudoaneurysm in a cervical radiculomedullary branch of the anterior spinal artery. Radiol Case Rep 2024; 19:403-407. [PMID: 38033669 PMCID: PMC10681874 DOI: 10.1016/j.radcr.2023.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Spinal subarachnoid hemorrhage is a rare condition, and it generally arises as a consequence of arteriovenous malformation, although more rarely can be caused by aneurysm, dissection, or pseudoaneurysm. In the following, we present a case of a 58-year-old male who while undergoing treatment for nephrolithiasis, developed persistent hypertension, refractory to his home medications, along with headache, neck pain, and unilateral ptosis and upper extremity ataxia. Initial CT scan demonstrated acute subarachnoid hemorrhage in the posterior fossa extending to the C7 level, Angiography ultimately revealed a focal irregularity compatible with dissection and 1mm pseudoaneurysm within the left anterior spinal artery radiculomedullary feeder at the C5-6 level. The patient was managed conservatively with 81mg ASA and repeat angiography revealed resolution of the lesion, in concordance with management of dissection and pseudoaneurysm of the carotid and vertebral arteries. Subarachnoid hemorrhage as a consequence of dissection and pseudoaneurysm of a cervical radiculomedullary feeder has been previously unreported in the literature.
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Affiliation(s)
- Zachary Sokol
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St. Bethlehem, PA 18015 USA
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad St, Philadelphia, PA 19140 USA
| | - Martin Oselkin
- Department of Neurosurgery, St Luke's University Health Network, 801 Ostrum St. Bethlehem, PA 18015 USA
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Rossi M, Krokidis M, Kashef E, Peynircioglu B, Tipaldi MA. CIRSE Standards of Practice for the Endovascular Treatment of Visceral and Renal Artery Aneurysms and Pseudoaneurysms. Cardiovasc Intervent Radiol 2024; 47:26-35. [PMID: 38030849 PMCID: PMC10770226 DOI: 10.1007/s00270-023-03620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms is an effective, minimally invasive treatment that has been successfully used since the early 1990s, with refined and expanded techniques and tools currently offering excellent outcomes. Due to increased detection of such lesions in recent years, many of which are asymptomatic, revision of the indications for intervention and the correct endovascular treatment approaches has become essential. PURPOSE This document will presume that the indication for treatment is clear and approved by the multidisciplinary team and will define the standards required for the performance of each intervention, as well as their relative advantages and limitations. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of the endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in endovascular treatments. The writing group reviewed the existing literature on visceral and renal artery aneurysms and pseudoaneurysms, performing an evidence search using PubMed to identify publications in English and relating to human subjects from 1990 to 2022. The final recommendations were formulated through consensus. RESULTS Endovascular treatment has an established role in the successful management of visceral and renal artery aneurysms and pseudoaneurysms, and this Standards of Practice document provides up-to-date recommendations for its safe performance.
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Affiliation(s)
- Michele Rossi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome-Sant'Andrea University Hospital, Rome, Italy.
| | - Miltiadis Krokidis
- National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Elika Kashef
- Imperial College Healthcare NHS Trust, London, UK
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marcello Andrea Tipaldi
- Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome-Sant'Andrea University Hospital, Rome, Italy
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Dhillon NK, Harfouche MN, Hawley KL, DuBose JJ, Kozar RA, Scalea TM. Embolization of Pseudoaneurysms is Associated With Improved Outcomes in Blunt Splenic Trauma. J Surg Res 2024; 293:656-662. [PMID: 37839096 DOI: 10.1016/j.jss.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/27/2023] [Accepted: 08/27/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The necessity of angioembolization for all splenic pseudoaneurysms (PSAs) is unknown after blunt trauma. We compared the outcomes of patients with PSAs managed with splenic artery embolization (EMBO) versus no embolization (NO-EMBO). METHODS We retrospectively reviewed all patients with blunt splenic trauma and PSA on initial computed tomography scan admitted to an academic, urban, Level I trauma center from 2016 to 2021. Patients who had emergent splenectomy or died before discharge were excluded. Demographics, injury and computed tomography characteristics, and details regarding angiography, if pursued, were collected. The primary outcome was failure of nonoperative management (FNOM), as defined by need for delayed splenectomy for the EMBO group versus delayed splenectomy or embolization for the NO-EMBO group. RESULTS One hundred and fifty-six patients were in the final study population, of which 96 (61.5%) were in the EMBO group and 60 (38.5%) were in the NO-EMBO group. Patient demographics and mechanism of injury were similar between the two cohorts. The two cohorts had similar imaging findings, however, EMBO patients had more compartments with hemoperitoneum (2 versus 1, P < 0.01). Patients who underwent embolization had a lower FNOM rate (3.1% versus 13.3%, P = 0.02). CONCLUSIONS Splenic artery embolization in the setting of PSA is associated with lower rates of FNOM versus nonembolization. It is unclear if addressing the PSA itself with embolization drives the decreased FNOM rate.
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Affiliation(s)
- Navpreet K Dhillon
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
| | - Melike N Harfouche
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
| | - Kristy L Hawley
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
| | - Joseph J DuBose
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, Texas
| | - Rosemary A Kozar
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
| | - Thomas M Scalea
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland.
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Hasanpour M, Golchin N, Mirsardoo H, Alagha A, Elyassirad D, Keykhosravi E. Pseudoaneurysm formation after placement of a FRED flow diverter stent in a patient with iatrogenic ICA injury during transsphenoidal surgery: A case report. Neurochirurgie 2024; 70:101520. [PMID: 38056410 DOI: 10.1016/j.neuchi.2023.101520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Mohammad Hasanpour
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Navid Golchin
- Iran University of Medical Sciences, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Hojjat Mirsardoo
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Ahmad Alagha
- Department of Neurosurgery, Salamat-Farda Hospital, Tehran, Iran
| | - Daniel Elyassirad
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Keykhosravi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Khatri S, Parikh R, Smith M, Friedman J. Endovascular management of colic artery pseudoaneurysm: A case report of successful intervention in a 59-year-old male with abdominal hematoma. Radiol Case Rep 2024; 19:449-454. [PMID: 38046917 PMCID: PMC10692486 DOI: 10.1016/j.radcr.2023.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Visceral artery pseudoaneurysms, including inferior mesenteric artery pseudoaneurysms, are rare, occurring at an estimated incidence of 0.01%-0.2%. The literature reports only around 60 cases of inferior mesenteric pseudoaneurysm to date. The management of this condition lacks a consensus; nevertheless, coil embolization remains the preferred approach for stable patients. Here, we present a unique clinical scenario involving a 59-year-old male who underwent exploratory laparotomy for a retroperitoneal hematoma. Subsequently, he was diagnosed with an inferior mesenteric pseudoaneurysm, specifically affecting the left colic artery, and successfully managed using coil embolization.
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Affiliation(s)
| | | | - Matthew Smith
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
| | - Joseph Friedman
- Department of Radiology, Jamaica Hospital Medical Center, Queens, NY 11418, USA
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Riestra Guiance I, Meade C, McCambridge A, Bendel E, Kern R. Pulmonary artery pseudoaneurysm arising from primary lung neoplasm: A proposed mechanism. Respir Med Case Rep 2023; 47:101965. [PMID: 38283187 PMCID: PMC10821629 DOI: 10.1016/j.rmcr.2023.101965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/09/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024] Open
Abstract
Pulmonary artery pseudoaneurysms (PAPs) are rare and life-threatening occurrences. We present a 57-year-old male patient with squamous cell lung cancer, who presented with hemoptysis. Bronchoscopy did not reveal ongoing bleeding. Imaging showed a left lower lobe tumor, a cavitary lesion communicating with the bronchus, and a pulmonary artery pseudoaneurysm. Successful embolization of the originating segmental branch of the pulmonary artery was performed. The pathogenesis of PAPs associated with primary lung malignancies remains poorly understood. We propose a four-step mechanism involving primary tumor expansion, central cavitary necrosis, direct arterial invasion, inflammatory response, vessel wall damage, pseudoaneurysm formation, and subsequent filling of the former cavitary lesion. This case emphasizes the importance of considering PAPs in primary lung malignancies, particularly in male patients with squamous cell pathology. Understanding the proposed pathogenic mechanism could lead to early detection, prompt intervention, and improved outcomes.
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Affiliation(s)
| | - Charles Meade
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amanda McCambridge
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Emily Bendel
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ryan Kern
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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von Buchwald CL, Mohammed M, Shpilsky D, Frisoli T, Lee J, Pedro Engel Gonzalez PA, Wang D, O'Neill B, O'Neill WW, Villablanca PA. Contemporary experience of percutaneous management of complex aortic and ventricular pseudoaneurysms associated to perivalvular leak. A case series and review of literature. Cardiovasc Revasc Med 2023:S1553-8389(23)00937-5. [PMID: 38212236 DOI: 10.1016/j.carrev.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Percutaneous closure of aortic and ventricular pseudoaneurysms (PSA) has only been reported on a case report and series basis. In previous case reports, percutaneous closure has been performed successfully in patients of prohibitive surgical risk. This case series aims to show feasibility of percutaneous closure of aortic and ventricular pseudoaneurysm secondary to perivalvular leak (PVL) in a small patient population and the utility of multimodality imaging as an integral tool in procedural planning. This is the largest complex case series to date describing the feasibility and success rate of complex PSA closure, with a follow-up period of up to 4 years. MATERIAL AND METHODS We performed institutional review and systemic literature review to identify all paravalvular leak cases with associated pseudoaneurysm formation for which a closure procedure was performed. Ten patients were identified. Pooled analysis for cases from institutional review (n = 10) and systemic literature review (n = 39) was performed. The success rate was 100 %. At 30-days, the mortality was 0 %. CONCLUSION In paravalvular leak patients with subsequent pseudoaneurysm formation, exhaustive imaging evaluation is required for closure. However, it can be achievable with favorable rates of success.
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Affiliation(s)
| | - Mustafa Mohammed
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Daniel Shpilsky
- Center for Structural Heart Disease, Henry Ford Hospital, Cardiology Division, Detroit, MI, USA
| | - Tiberio Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, Cardiology Division, Detroit, MI, USA
| | - James Lee
- Center for Structural Heart Disease, Henry Ford Hospital, Cardiology Division, Detroit, MI, USA
| | | | - DeeDee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Cardiology Division, Detroit, MI, USA
| | - Brian O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Cardiology Division, Detroit, MI, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Cardiology Division, Detroit, MI, USA
| | - Pedro A Villablanca
- Center for Structural Heart Disease, Henry Ford Hospital, Cardiology Division, Detroit, MI, USA
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Havan N. Influence of anatomical factors on the efficacy of treating femoral pseudoaneurysms with ultrasound-guided compression technique: A prospective cohort study. Ir J Med Sci 2023:10.1007/s11845-023-03581-6. [PMID: 38052750 DOI: 10.1007/s11845-023-03581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Femoral pseudoaneursysm treatment is still controversial. AIMS The aim of this study was to evaluate the anatomic features related to femoral pseudoaneurysm (FPA) closure failure for ultrasound-guided compression (USGC). METHODS This was a single-center, prospective, cohort study. FPA patients admitted to the radiology department for USGC were included in the study. Age, sex, duration of FPA, thrombosis, ratio of thrombosis to FPA diameter, feeding artery, tortiosity, connection properties, length and width of the neck, volume, and fistula-to-common femoral artery (CFA) speed ratio were reported during color Doppler ultrasonography (CDUS) scanning. RESULTS The study was completed with 192 patients. FPA compression therapy was successful in 155 patients and failed in 37 patients. FPA without a narrow connection (p < 0.001), FPA without existing thrombosis (p < 0.001), a lower thrombosis ratio (p < 0.001), a longer duration of FPA (p = 0.035), a shorter neck length, a wider neck width (p < 0.001), and a higher fistula-to-CFA speed rate (p < 0.001) were related to FPA closure failure with USGC. ROC analysis of the fistula-to-CFA speed ratio showed that a ratio of 1.01 had 47% sensitivity and 63% specificity for USGC treatment failure (AUC, 0.72; p < 0.05). CONCLUSIONS Failure of FPA closure with USGC is closely related to anatomic features of FPA. Evaluating the anatomical features of FPA before deciding the treatment method can be beneficial for patients and clinicians.
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Affiliation(s)
- Nuri Havan
- Department of Radiology, Atasehir Florance Nightingale Hospital, Küçükbakkalköy, Işıklar Cd. No: 35/A, 34750, Ataşehir/Istanbul, Turkey.
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Cikach F, Sale S, Roselli EE, Pettersson G, Elgharably H. Re-operation for a detached left coronary button from an aortic root conduit causing a large retro-sternal pseudoaneurysm. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 38058148 DOI: 10.1510/mmcts.2023.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Our goal was to replace the previous composite graft with a bioprosthesis. The approach involved axillary artery and femoral vein cannulation and cardiopulmonary bypass with moderate hypothermia for re-entry of the chest and deep hypothermia with circulatory arrest to get control of and to clamp the aorta when entering the pseudoaneurysm. The myocardial protection strategy was general cooling and retrograde cardioplegia through direct coronary sinus cannulation and antegrade cardioplegia in the coronary ostia when possible. After the pseudoaneurysm was entered, the graft was divided in the middle, and the distal end was dissected out under circulatory arrest sufficiently to allow clamping and to resume systemic circulation. The graft was not dissected out beyond the previous anastomosis. Under another period of circulatory arrest, the distal graft was removed to the mid-arch, and a new graft was attached with a hemiarch anastomosis. Then the root was dissected out, and both coronary ostia were mobilized. The mechanical aortic valve and previous graft material were explanted. A new bioprosthetic valved conduit was used to replace the aortic root, and the coronary buttons were re-implanted directly in the new graft.
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Affiliation(s)
- Frank Cikach
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Shiva Sale
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Haytham Elgharably
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
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Nakata K, Moriyama S, Takaki J, Takeo M, Doi H, Matsumura T, Fukui T. Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report. Surg Case Rep 2023; 9:210. [PMID: 38044395 PMCID: PMC10694109 DOI: 10.1186/s40792-023-01789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Mitral-aortic intervalvular fibrosa (MAIVF) is a fibrous region connecting the anterior mitral leaflet (AML) and aortic valve. Pseudoaneurysm of the MAIVF is a rare condition that has been reported as a sequela of infective endocarditis (IE) and surgical trauma. Here, we report a case of a ruptured pseudoaneurysm of the MAIVF, along with some literature reviews. CASE PRESENTATION A 65-year-old man diagnosed with moderate aortic regurgitation five years previously had a fever of unknown origin. He suddenly developed headache and apraxia and was transported to our hospital. He was diagnosed with intracranial hemorrhage and admitted. One week after admission, echocardiography revealed aorto-mitral discontinuity and protrusion with severe regurgitant flow from left ventricular outflow tract to the left atrium. The AML was suspected to have ruptured. However, intraoperatively, the AML structure was preserved. A ruptured pseudoaneurysm of the MAIVF was also observed. Therefore, we successfully performed pseudoaneurysm repair using a bovine pericardial patch, aortic valve replacement, and mitral annuloplasty. CONCLUSIONS P-MAIVF is a rare but potentially life-threatening complication of IE, for which timely diagnosis and prompt appropriate therapeutic intervention are required. In the present case, although neither obvious active IE nor history of previous IE could be identified, healed IE was considered based on the clinical course. The patient had intracranial hemorrhage (ICH) with well-controlled heart failure and underwent elective surgical repair more than one month after the onset of ICH, while the clinical course after the surgical procedure was uneventful.
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Affiliation(s)
- Kosuke Nakata
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro, Kumamoto, 866-8533, Japan.
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan.
| | - Shuji Moriyama
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Jun Takaki
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Masahiro Takeo
- Department of Cardiology, Kumamoto Rosai Hospital, Yatsushiro, Kumamoto, Japan
| | - Hideki Doi
- Department of Cardiology, Kumamoto Rosai Hospital, Yatsushiro, Kumamoto, Japan
| | - Toshiyuki Matsumura
- Department of Cardiology, Kumamoto Rosai Hospital, Yatsushiro, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
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McKinley T, Burnham K, Aranda M, Simon T. Surely you can't B. cereus: Bacillus cereus infection resulting in spontaneous pseudoaneurysm of a nonaccessed arteriovenous graft. J Vasc Surg Cases Innov Tech 2023; 9:101333. [PMID: 38023325 PMCID: PMC10654019 DOI: 10.1016/j.jvscit.2023.101333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/09/2023] [Indexed: 12/01/2023] Open
Abstract
Vascular graft infections are a well-described complication of loop arteriovenous grafts (AVGs) placed for hemodialysis access and are reported to occur in 0.5% to 6.0% of AVGs. The most common microorganisms implicated in these infections are the Staphylococcus species. We present a case of a chronically nonaccessed graft rupture caused by an indolent B. cereus colonization, which is usually a foodborne contaminant. The finding of this organism as the causal agent in an AVG infection warrants further research into the potential emergence of the Bacillus species as a contributing factor in the morbidity and mortality resulting from AVG infection.
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Affiliation(s)
- Thomas McKinley
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA
| | - Kristin Burnham
- School of Medicine, Uniformed Services University, Bethesda, MD
| | - Marcos Aranda
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA
| | - Todd Simon
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA
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Tilahun ZB, Teklesilassie H, Addisie A, Leykun D, Kebede T. Iatrogenic pseudoaneurysm of the superior thyroid artery after thyroidectomy. Int J Surg Case Rep 2023; 113:109005. [PMID: 37976720 PMCID: PMC10685046 DOI: 10.1016/j.ijscr.2023.109005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION A pseudoaneurysm arising from the superior thyroid artery is extremely rare. To the best of our knowledge, STA Pseudoaneurysm after thyroidectomy has not been reported. CASE PRESENTATION A 21-year-old female presented with anterior neck swelling of two years duration. Physical exam revealed a thyroid mass that measures 10 cm ∗ 8 cm. Neck US showed MNG (TIRADS 3) and FNAC suggested colloid goiter. Near Total Thyroidectomy was performed. On the 10th postoperative day, she noticed a painless, progressive left-sided neck swelling which is increasing in size with no active bleeding and no compressive symptoms. There is a 6x4cm tense pulsatile left-sided neck swelling adjacent to the thyroid cartilage and anterior to sternocleidomastoid muscle with a healed neck collar incision. CBC and coagulation profile were normal. Head and Neck CTA show aneurysmal dilatation of STA 3.8 cm × 3.2 cm with thrombosis of the posterior part of the lesion. CLINICAL DISCUSSION STA Pseudoaneurysms are quite rare events but could lead to catastrophic complications. Clinical manifestations can include pulsating painful mass in the neck, dysphagia, dyspnea, bleeding from the oral cavity, and cerebrovascular symptoms. It should be investigated with Color Doppler ultrasound, MRI and CTA. CONCLUSION In our case, the pseudoaneurysm occurred after thyroidectomy which has not been reported previously. The diagnosis was made by a computed tomography scan and the patient was treated by open STA ligation as endovascular service isn't available in our setup. Clinicians should therefore include pseudoaneurysm of STA or adjacent arteries in their differential diagnosis and intervene early to avoid devastating complications.
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Affiliation(s)
| | - Henok Teklesilassie
- Addis Ababa University, College of Health Sciences, School of Medicine, Ethiopia
| | | | - Dagim Leykun
- Addis Ababa University, College of Health Sciences, School of Medicine, Ethiopia
| | - Tesfaye Kebede
- Addis Ababa University, College of Health Sciences, School of Medicine, Ethiopia
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Lima GB, Breite M, Pochettino A, Bonnichsen C, DeMartino RR, Mendes BC. Endovascular repair of an ascending aortic pseudoaneurysm. J Vasc Surg Cases Innov Tech 2023; 9:101279. [PMID: 37767350 PMCID: PMC10520440 DOI: 10.1016/j.jvscit.2023.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/10/2023] [Indexed: 09/29/2023] Open
Affiliation(s)
- Guilherme B. Lima
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Matthew Breite
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Alberto Pochettino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Crystal Bonnichsen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Bernardo C. Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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50
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Satam K, Sorondo S, Paisley M, Chandra V. Hybrid repair of an innominate artery pseudoaneurysm after blunt traumatic injury in a bovine arch. J Vasc Surg Cases Innov Tech 2023; 9:101225. [PMID: 38106347 PMCID: PMC10725054 DOI: 10.1016/j.jvscit.2023.101225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/08/2023] [Indexed: 12/19/2023] Open
Abstract
Innominate artery injury is an uncommon consequence of blunt trauma to the neck due to its protected position behind the thorax. A 38-year-old male presented as a trauma with a right-sided pseudoaneurysm emanating from the distal innominate artery after falling from a three-story building. On imaging, he also had a bovine arch. He underwent hybrid repair with covered stent placement from the common carotid into the innominate artery, carotid-subclavian bypass, and plugging of the subclavian artery. The patient recovered with no cerebral insult, neurological deficits, or rupture. Post-traumatic innominate artery pseudoaneurysms can successfully be repaired via a hybrid surgical approach.
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Affiliation(s)
| | - Sabina Sorondo
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA
| | | | - Venita Chandra
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA
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