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Kwon HJ, Cha JG, Park J. Endovascular treatment of traumatic pseudoaneurysm of the ileal branch of the superior mesenteric artery in a 9-year-old girl: Case report and literature review. Medicine (Baltimore) 2024; 103:e37978. [PMID: 38669393 DOI: 10.1097/md.0000000000037978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Visceral artery aneurysm is a rare and potentially fatal vascular condition that typically affects the superior mesenteric or inferior mesenteric arteries, the splenic, hepatic, and celiac arteries, as well as their branches. Visceral artery aneurysms can usually be treated using endovascular intervention, open surgery, or percutaneous thrombin injection. PATIENT CONCERNS A 9-year-old girl was admitted to our trauma center with abdominal and bilateral leg pain after a car accident involving a head-on collision. DIAGNOSIS Abdominal computed tomography (CT) showed bowel herniation through a muscle defect in the left lateral abdominal wall. There was a small amount of fluid around the liver and spleen, mild thickening of the small bowel wall, and infiltration in the small bowel mesentery, indicating the possibility of small bowel injury. INTERVENTIONS Emergent exploratory laparotomy was performed. After resection of the ischemic parts of the terminal ileum and sigmoid colon, intestinal continuity was reestablished. Primary repair was performed on a traumatic left lateral abdominal wall hernia. She recovered well postoperatively without any complications. A follow-up abdominal CT scan after 2 months showed a pseudoaneurysm of the ileal branch of the superior mesenteric artery. Despite the absence of any gastrointestinal symptoms, the pseudoaneurysm was treated by endovascular intervention using numerous coils because of the significant risk of delayed rupture or massive bleeding. OUTCOMES Follow-up abdominal CT scan after 6 months showed complete occlusion and resorption of the pseudoaneurysm. LESSONS Although it is technically challenging, endovascular coil embolization may be a feasible technique in children with traumatic visceral artery pseudoaneurysms without complications.
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Affiliation(s)
- Hyung Jun Kwon
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jinyoung Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Mavuduru RM, Mohd Ziauddin SA, Bora GS, Gorsi U. Renal artery pseudoaneurysm following robot assisted nephron sparing surgery: two case reports. J Med Case Rep 2024; 18:191. [PMID: 38637904 PMCID: PMC11027276 DOI: 10.1186/s13256-024-04510-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Renal artery pseudoaneurysm following partial nephrectomy is a rare entity, the incidence of this entity is more common following penetrating abdominal injuries, percutaneous renal interventions such as percutaneous nephrostomy(PCN) or Percutaneous nephrolithotomy (PCNL). Although rare, renal artery pseudoaneurysm can be life threatening if not managed timely, they usually present within two weeks postoperatively with usual presenting complains being gross haematuria, flank pain and/or anaemia. CASE PRESENTATION We report case of two female patients 34 and 57 year old respectively of South Asian ethnicity, presenting with renal artery pseudoaneurysm following left sided robot assisted nephron sparing surgery for interpolar masses presenting clinically with total, painless, gross haematuria with clots within fifteen days postoperatively and their successful treatment by digital subtraction angiography and coil embolization. CONCLUSION Renal artery aneurysm is a rare fatal complication of minimally invasive nephron sparing surgery however considering the preoperative and intraoperative risk factors for its development and prompt suspicion at the outset can be life saving with coil embolization of the bleeding arterial aneurysm.
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Affiliation(s)
| | | | | | - Ujjwal Gorsi
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
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Carreira A, Muna S, Grossman AB, Korbonits M. Beware of epistaxis: fatal pseudoaneurysm rupture 30 years after treatment of acromegaly. BMJ Case Rep 2024; 17:e258533. [PMID: 38642934 PMCID: PMC11033645 DOI: 10.1136/bcr-2023-258533] [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] [Indexed: 04/22/2024] Open
Abstract
We present a fatal complication of treatment in a patient with early-onset acromegaly, treated with two transsphenoidal operations, radiotherapy, radiosurgery and pegvisomant. He was diagnosed in his 30s, and controlled from his 40s, with stable residual tumour within the left cavernous sinus. In his 60s, 30 years after surgery/radiotherapy and 14 years after radiosurgery, he developed recurrent episodes of mild epistaxis. A week later, he presented at his local hospital's emergency department with severe epistaxis and altered consciousness. He was diagnosed with a ruptured internal carotid artery (ICA) pseudoaneurysm, but unfortunately died before treatment could be attempted.ICA pseudoaneurysms are rare complications of surgery or radiotherapy and can present with several years of delay, often with epistaxis. This case highlights the importance of life-long monitoring in patients with previous pituitary interventions and early recognition of epistaxis as a herald sign of a potentially catastrophic event, thus leading to timely treatment.
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Affiliation(s)
- Ana Carreira
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Endocrinology, Diabetes and Metabolism, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Solomon Muna
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ashley B Grossman
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Márta Korbonits
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Rodrigues VMA, Silva C, Dias N, de Sousa JT, Morgado LA. Prostatic Fossa Pseudoaneurysm After Robot-Assisted Radical Prostatectomy (RARP): A Case Report. Am J Case Rep 2024; 25:e942746. [PMID: 38566390 PMCID: PMC11003550 DOI: 10.12659/ajcr.942746] [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: 10/01/2023] [Revised: 02/16/2024] [Accepted: 01/31/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND RARP is an established procedure in treatment of localized prostate cancer. Hemorrhagic complications in the postoperative period are rare, but sometimes life-threatening. Adequate monitoring and prompt intervention in these unusual scenarios rely on clinical judgement and blood and imaging studies. Prostatic fossa pseudoaneurysm formation after RARP is very rare and its etiology is not well known; it may be related to small vessel trauma. It becomes apparent with the development of hematuria 1-6 weeks after surgery. CASE REPORT A 58-year-old man underwent RARP with extended lymph node dissection for intermediate-risk prostate cancer, with bilateral preservation of neurovascular bundles and puboprostatic ligaments. He was discharged on day 2 without complications. In the following 4 weeks he came to the Emergency Department 3 times with hematuria and acute urinary retention. Four weeks after surgery, a pelvic CT angiogram showed a 20-mm pseudoaneurysm in the prostatic fossa, which was embolized by percutaneous angiography, with resolution of symptoms. He was discharged soon thereafter. CONCLUSIONS This case study describes a patient with prostatic fossa pseudoaneurysm after RARP. It was diagnosed 1 month after surgery and effectively managed by percutaneous embolization. Despite being a very rare condition, it must be kept in mind, especially when postoperative hematuria develops 1-6 weeks after surgery. Use of a management algorithm including serial blood tests, CT angiogram, and percutaneous angiography can lead to early detection and avoid life-threatening hemorrhage and overall postoperative morbidity.
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Affiliation(s)
- Vasco Manuel Almeida Rodrigues
- Department of Urology, São João University Hospital (CHUSJ), Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carlos Silva
- Department of Urology, São João University Hospital (CHUSJ), Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nuno Dias
- Department of Urology, São João University Hospital (CHUSJ), Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Luís Afonso Morgado
- Department of Urology, São João University Hospital (CHUSJ), Porto, Portugal
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Motohara T, Yamamura K, Ueno S, Takeno H, Nagayama Y, Oda E, Karashima R, Ozaki N, Masuda T, Beppu T. A rare incidence of a hepatic artery pseudoaneurysm following plastic biliary stent insertion. Clin J Gastroenterol 2024; 17:352-355. [PMID: 38363445 DOI: 10.1007/s12328-024-01920-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Abstract
Hepatic artery pseudoaneurysms have been reported to occur in approximately 1% of cases after metal stenting for malignant biliary obstruction. In contrast, only a few cases have been reported as complications after plastic stenting for benign biliary disease. We report a 61-year-old man with cholangitis who presented with a rare complication of hemobilia after implantation of 7 Fr double pigtail plastic biliary stents. No bleeding was observed approximately one month after biliary stent tube removal. Contrast-enhanced CT scan revealed a circularly enhanced lesion (5 mm in diameter) in the arterial phase at the tip of the previously inserted plastic bile duct stent. Color Doppler ultrasonography enhanced the lesion and detected arterial blood flow inside. He was diagnosed with a hepatic artery pseudoaneurysm. However, he had no risk factors such as prolonged catheterization, severe cholangitis, liver abscess, or long-term steroid use. Superselective transarterial embolization using two metal microcoils was successfully completed without damage to the surrounding liver parenchyma. If hemobilia is suspected after insertion of a plastic bile duct stent, immediate monitoring using contrast-enhanced computed tomography or Doppler ultrasonography is recommended.
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Affiliation(s)
- Toshihiko Motohara
- Department of Gastroenterology, Yamaga City Medical Center, yamaga, Japan
| | - Kensuke Yamamura
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Shigenori Ueno
- Department of Gastroenterology, Yamaga City Medical Center, yamaga, Japan
| | - Hiroshi Takeno
- Department of Gastroenterology, Yamaga City Medical Center, yamaga, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Life Science, Kumamoto University, Kumamoto, Japan
| | - Eri Oda
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | | | - Nobuyuki Ozaki
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Toshiro Masuda
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan.
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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; 184:e603-e612. [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] [MESH Headings] [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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7
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Zhang W, Pang J, Zhou Y. Delayed development of a huge chest wall hematoma post pacemaker implantation: A case report. Pacing Clin Electrophysiol 2024; 47:564-567. [PMID: 37428888 DOI: 10.1111/pace.14785] [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: 03/15/2023] [Revised: 06/11/2023] [Accepted: 06/24/2023] [Indexed: 07/12/2023]
Abstract
An 83-year-old Chinese man presented with a huge left chest wall hematoma and hemorrhagic shock 4 months after permanent pacemaker implantation. Computed Tomography of Angiogram of the left subclavian artery revealed a pseudoaneurysm. He underwent radiologically guided stenting followed by hematoma clearance. It is rare to have delayed formation of pseudoaneurysm at 4 months post pacemaker implantation. Radiologically guided stenting is the preferred treatment, followed by hematoma clearance. It is strongly advised against blind surgery for wound debridement or bleeding detection. Familiarizing with axillary vein anatomy, improving axillary vein cannulation skills, and detecting early complications of artery injury are key strategies in preventing pseudoaneurysm formation post pacemaker implantation.
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Affiliation(s)
- Wenbo Zhang
- Department of Cardiology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Jie Pang
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Ying Zhou
- Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou, China
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Jipa AM, Makary MS. Access Site Femoral Arterial Pseudoaneurysm. J Vasc Interv Radiol 2024; 35:629-630. [PMID: 38521563 DOI: 10.1016/j.jvir.2023.12.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/25/2024] Open
Affiliation(s)
- Andrei M Jipa
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Yang Q, Li B, Sun BJT, Zhong X, Qiu Z, Yang H. The CT-guided percutaneous drainage of pancreatic pseudocyst accompanied by pseudoaneurysm: A case report. Medicine (Baltimore) 2024; 103:e37402. [PMID: 38457581 PMCID: PMC10919489 DOI: 10.1097/md.0000000000037402] [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: 11/07/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
RATIONALE This case report discusses the CT-guided percutaneous drainage of a pancreatic pseudocyst accompanied by a pseudoaneurysm. Pancreatic pseudocysts can erode the peripancreatic artery and produce pseudoaneurysms. This is rare, but it can be life-threatening. PATIENT CONCERNS The case presented involves a 58-year-old female who was diagnosed with pancreatic cancer and underwent surgical treatment. She presented with hematochezia, dizziness, and hypodynamic findings with no obvious cause. Imaging revealed a pancreatic pseudocyst and small arterial aneurysms. To reduce the risk of aneurysm rupture, the patient underwent transcatheter arterial coil embolization. Three days later, CT-guided catheter drainage was performed to reduce the erosion of the arterial wall caused by pancreatic fluid. DIAGNOSES The contrast-enhanced-CT imaging showed a round, slightly high-density lesion in the cyst, suggesting the presence of a pseudoaneurysm. INTERVENTIONS The patient was sent for another transcatheter arterial embolization with coils and n-butyl-2-cyanoacrylate. OUTCOMES After receiving the transcatheter arterial embolization, the patient had no serious bleeding or other complications. LESSONS Early detection and accurate assessment of pseudoaneurysms are essential for appropriate management. This case shows that contrast-enhanced CT is necessary before CT-guided percutaneous drainage of pancreatic pseudocysts. It also shows that, due to the many complications that pancreatic pseudocysts may cause, appropriate treatment of pseudocysts complicated with pseudoaneurysm has important clinical significance.
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Affiliation(s)
- Qimin Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan south Road, Nanchong, Sichuan, People’s Republic of China
| | - Bing Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan south Road, Nanchong, Sichuan, People’s Republic of China
| | - Bai Jin Tao Sun
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan south Road, Nanchong, Sichuan, People’s Republic of China
| | - Xiangkai Zhong
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan south Road, Nanchong, Sichuan, People’s Republic of China
| | - Zhiqiang Qiu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan south Road, Nanchong, Sichuan, People’s Republic of China
| | - Hanfeng Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan south Road, Nanchong, Sichuan, People’s Republic of China
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Shchehlov D, Vyval M, Siddiqui AH, Chapot R, Pastushyn O, Hnelytsia O, Fiehler J, Kalousek V, Kyselyova AA. First Experience of Treatment of Multiple Shrapnel Traumatic Pseudoaneurysms During the War in Ukraine Using Tegus Telemedical System. Clin Neuroradiol 2024; 34:263-267. [PMID: 37382604 PMCID: PMC10881802 DOI: 10.1007/s00062-023-01319-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Dmytro Shchehlov
- Research and Practical Centre for Endovascular Neuroradiology, the NAMS of Ukraine, Platon Mayboroda st., 32, Kyiv, Ukraine
| | - Mykola Vyval
- Research and Practical Centre for Endovascular Neuroradiology, the NAMS of Ukraine, Platon Mayboroda st., 32, Kyiv, Ukraine.
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Science, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, NY, USA
| | - Rene Chapot
- Department of Intracranial Endovascular Therapy, Alfried Krupp Hospital Essen, Essen, Germany
| | - Oleksandr Pastushyn
- Research and Practical Centre for Endovascular Neuroradiology, the NAMS of Ukraine, Platon Mayboroda st., 32, Kyiv, Ukraine
| | - Oleksandr Hnelytsia
- Neurosurgical Department, Zhytomyr Regional Clinical Hospital, Zhytomyr, Ukraine
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Vladimir Kalousek
- Department of Radiology, University Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Anna A Kyselyova
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Jastaniah A, Mychaltchouk L, Genest A, Deckelbaum DL, Fata P, Khwaja K, McKendy K, Razek T, Wong E, Grushka J. Repeat imaging increases detection of delayed pseudoaneurysms in patients with high-grade solid organ injury following abdominal trauma. World J Surg 2024; 48:560-567. [PMID: 38501570 DOI: 10.1002/wjs.12060] [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: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 03/20/2024]
Abstract
BACKGROUND Nonoperative management of abdominal trauma can be complicated by the development of delayed pseudoaneurysms. Early intervention reduces the risk of rupture and decreases mortality. The objective of this study is to determine the utility of repeat computed tomography (CT) imaging in detecting delayed pseudoaneurysms in patients with abdominal solid organ injury. METHODS A retrospective cohort study reviewing Montreal General Hospital registry between 2013 and 2019. Patients with The American Association for the Surgery of Trauma (AAST) grade 3 or higher solid organ injury following abdominal trauma were identified. A chart review was completed, and demographics, mechanism of injury, Injury Severity Score (ISS) score, AAST injury grade, CT imaging reports, and interventions were collected. Descriptive analysis and logistic regression model were completed. RESULTS We identified 195 patients with 214 solid organ injuries. The average age was 38.6 years; 28.2% were female, 90.3% had blunt trauma, and 9.7% had penetrating trauma. The average ISS score was 25.4 (SD 12.8) in patients without pseudoaneurysms and 19.5 (SD 8.6) in those who subsequently developed pseudoaneurysms. The initial management was nonoperative in 57.0% of the patients; 30.4% had initial angioembolization, and 12.6% went to the operating room. Of the cohort, 11.7% had pseudoaneurysms detected on repeat CT imaging within 72 h. Grade 3 represents the majority of the injuries at 68.0%. The majority of these patients underwent angioembolization. CONCLUSIONS In patients with high-grade solid organ injury following abdominal trauma, repeat CT imaging within 72 h enabled the detection of delayed development of pseudoaneurysms in 11.7% of injuries. The majority of the patients were asymptomatic.
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Affiliation(s)
- Atif Jastaniah
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lydia Mychaltchouk
- McGill Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Alexandre Genest
- McGill Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Dan L Deckelbaum
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Paola Fata
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Kosar Khwaja
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Katherine McKendy
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tarek Razek
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Evan Wong
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeremy Grushka
- Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
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Mohamadnejad M, Ali Asgari A, Al-Haddad M. Hemosuccus Pancreaticus Caused by Splenic Artery Pseudoaneurysm: Two Cases Diagnosed and Treated With EUS. Clin Gastroenterol Hepatol 2024; 22:A43-A44. [PMID: 37730153 DOI: 10.1016/j.cgh.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Mehdi Mohamadnejad
- Liver and Pancreaticobiliary Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ali Asgari
- Liver and Pancreaticobiliary Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
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Charan BD, Thanneru S, Sebastian LJD, Jain S. Reconstructive endovascular treatment of petrous ICA pseudoaneurysm in skull base osteomyelitis: a hidden catastrophe. BMJ Case Rep 2024; 17:e258539. [PMID: 38417939 PMCID: PMC10900339 DOI: 10.1136/bcr-2023-258539] [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] [Indexed: 03/01/2024] Open
Abstract
Skull base osteomyelitis can be more life-threatening in immunocompromised patients and patients with diabetes. Here, we present a case of a petrous internal carotid artery pseudoaneurysm resulting from skull base osteomyelitis in a diabetic male in his 50s. This case report highlights the need to be conscious of the various complications associated with skull base osteomyelitis, be proficient in detecting them and treat them as early as possible for better outcomes. After adequate control of the disease process with medical treatment, immediate management of the aneurysm with balloon angioplasty and stenting was done. Acknowledging the trivial nasal and ear bleed, radiological evaluation is necessary to rule out rare complications like pseudoaneurysms in a diagnosed case of skull base osteomyelitis. In the discussion, we have cited the various treatment methods and similar cases of pseudoaneurysm caused by osteomyelitis. Currently, the patient continues to live a disease and disability-free life.
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Higashino N, Sonomura T, Ikoma A, Tamai K, Fukuda K, Kawai N, Minamiguchi H. Balloon-Assisted Arterial Embolization of Pseudoaneurysms Using NBCA-Lipiodol-Iopamidol Mixture in Two Clinical Cases. Cardiovasc Intervent Radiol 2024; 47:268-270. [PMID: 37875616 DOI: 10.1007/s00270-023-03571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Nobuyuki Higashino
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan.
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Kurumi Tamai
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Nobuyuki Kawai
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
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15
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Tam SC, Ting ACW, Cheng SWK. Common carotid artery pseudoaneurysm secondary to erosion by an oesophageal stent: a case report. Hong Kong Med J 2024; 30:66-68. [PMID: 38186231 DOI: 10.12809/hkmj2210435] [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] [Indexed: 01/09/2024] Open
Affiliation(s)
- S C Tam
- Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - A C W Ting
- Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - S W K Cheng
- Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
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Radding S, Harfouche MN, Dhillon NK, Ko A, Hawley KL, Kundi R, Maddox JS, Radowsky JS, DuBose JJ, Feliciano DV, Kozar RA, Scalea TM. A pseudo-dilemma: Are we over-diagnosing and over-treating traumatic splenic intraparenchymal pseudoaneurysms? J Trauma Acute Care Surg 2024; 96:313-318. [PMID: 37599423 DOI: 10.1097/ta.0000000000004117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Splenic embolization for traumatic vascular abnormalities in stable patients is a common practice. We hypothesize that modern contrast-enhanced computed tomography (CT) over diagnoses posttraumatic splenic vascular lesions, such as intraparenchymal pseudoaneurysms (PSA) that may not require embolization. METHODS We reviewed the experience at our high-volume center with endovascular management of blunt splenic injuries from January 2016 to December 2021. Multidisciplinary review was used to compared initial CT findings with subsequent angiography, analyzing management and outcomes of identified vascular lesions. RESULTS Of 853 splenic injuries managed overall during the study period, 255 (29.9%) underwent angiography of the spleen at any point during hospitalization. Vascular lesions were identified on 58% of initial CTs; extravasation (12.2%) and PSA (51.0%). Angiography was performed a mean of 22 hours after admission, with 38% done within 6 hours. Embolization was performed for 90.5% (231) of patients. Among the 130 patients with PSA on initial CT, 36 (27.7%) had no visible lesion on subsequent angiogram. From the 125 individuals who did not have a PSA identified on their initial CT, 67 (54%) had a PSA seen on subsequent angiography. On postembolization CT at 48 hours to 72 hours, persistently perfused splenic PSAs were seen in 41.0% (48/117) of those with and 22.2% (2/9) without embolization. Only one of 24 (4.1%) patients with PSA on angiography observed without embolization required delayed splenectomy, whereas 6.9% (16/231) in the embolized group had splenectomy at a mean of 5.5 ± 4 days after admission. CONCLUSION There is a high rate of discordance between CT and angiographic identification of splenic PSAs. Even when identified at angiogram and embolized, close to half will remain perfused on follow-up imaging. These findings question the use of routine angioembolization for all splenic PSAs. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Sydney Radding
- From the Department of Surgery (S.R.), Virginia Commonwealth University, Richmond, VA; R Adams Cowley Shock Trauma Center (M.N.H., N.K.D., K.L.H., R.K., J.S.M., J.S.R., D.V.F., R.A.K., T.M.S.), University of Maryland Medical System, Baltimore, Maryland; Department of Surgery (A.K.), Stanford University, Stanford, California; and Department of Surgery (J.J.DB.), University of Texas at Austin, Austin, Texas
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Burzotta F, Bianchini F, Di Giusto F, Bianchini E, Aurigemma C, Romagnoli E, Marano R, Trani C. Long-Term Outcome of Percutaneously Managed Coronary Pseudoaneurysm Caused by Stent Fracture. JACC Cardiovasc Interv 2024; 17:315-316. [PMID: 37943199 DOI: 10.1016/j.jcin.2023.09.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | - Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Marano
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Kajy M, Kerndt CC, Weber PC, Leacche M, Rendon RYL. Conservative Management of LVAD-Associated Ventricular Pseudoaneurysm. Methodist Debakey Cardiovasc J 2024; 20:1-4. [PMID: 38250571 PMCID: PMC10798165 DOI: 10.14797/mdcvj.1301] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Left ventricular assist devices (LVAD) are surgically implanted mechanical support devices utilized with increasing frequency as a bridge to myocardial recovery, destination therapy, and heart transplantation. While the use of such devices in patients with advanced heart failure has shown significant survival benefits and improved quality of life, they bear their own risks and complications.1 Bleeding, infection, pump thrombosis, and stroke are just some of the serious complications associated with LVADs.2 LVAD-associated pseudoaneurysms are rare, with prior reports of occurrence at the left ventricular apex and at the anastomosis site of the outflow graft to the ascending aorta.3,4 Typically, this device-related complication requires surgical repair and, if at all feasible, heart transplantation. However, in cases of difficult anatomy, unfavorable position, and significant comorbidities, surgery may be contraindicated due to high surgical risk. This case portrays a patient suffering from a left ventricular pseudoaneurysm after HeartMate-III implantation that was not amenable to surgical repair due to heightened surgical risk. We document the first pseudoaneurysm associated with the HeartMate-III in available literature and describe a novel management strategy of documented nonoperative course of LVAD-associated pseudoaneurysm, with the patient surviving 56+ months with medical optimization and management.
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Affiliation(s)
- Marvin Kajy
- Corewell Health/Michigan State University, Grand Rapids, Michigan, US
| | - Connor C Kerndt
- Corewell Health/Michigan State University, Grand Rapids, Michigan, US
| | - Paul C Weber
- Corewell Health/Michigan State University, Grand Rapids, Michigan, US
| | - Marzia Leacche
- Corewell Health/Michigan State University, Grand Rapids, Michigan, US
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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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20
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Li XQ, Wu YJ, Wang JZ, Li A, Zheng YL, Yang XJ. Bronchial embolisation for infected pulmonary artery pseudoaneurysms causing haemoptysis. Clin Radiol 2024; 79:e189-e195. [PMID: 37949801 DOI: 10.1016/j.crad.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
AIM To report the authors' experience of bronchial artery embolisation (BAE) in a series of patients to control haemoptysis associated with infected pulmonary artery pseudoaneurysms (PAPs). MATERIALS AND METHODS All patients who underwent BAE based on computed tomography angiography (CTA) findings indicative of haemoptysis between February 2019 and September 2022 at Xiangyang Central Hospital were identified. Charts of patients with haemoptysis and infectious PAPs were reviewed retrospectively. Data were collected data on age, sex, underlying pathology, source pulmonary artery of the PAP, association with cavitary lesions or consolidation, systemic angiography findings, technical and clinical success, and follow-up. RESULTS Seventeen PAPs were treated in 16 patients, with a mean age of 60.3 years (range: 37-82 years). The most common underlying cause was tuberculosis (15/16, 93.8%). Imaging by CTA did not identify the source pulmonary artery for 15 (88.2%) PAPs; all were associated with cavitary lesions or consolidation. All PAPs were visualised on systemic angiography. The technical and clinical success rates were both 87.5%. Two patients who experienced a recurrence of haemoptysis during follow-up underwent repeat CTA, which confirmed the elimination of the previous PAP. CONCLUSION BAE may be a valuable technique to control haemoptysis associated with infectious PAPs that are visualised on systemic angiography. A possible contributing factor is PAPs arising from very small pulmonary arteries.
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Affiliation(s)
- X-Q Li
- Department of Interventional Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - Y-J Wu
- Department of Interventional Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - J-Z Wang
- Department of Interventional Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - A Li
- Department of Interventional Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - Y-L Zheng
- Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China
| | - X-J Yang
- Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, China.
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张 陈, 陈 旭, 吴 圣, 冯 莉, 王 琰, 陈 妤, 段 敏, 王 科, 宋 琳. [Internal carotid artery pseudoaneurysm caused by parapharyngeal abscess: A case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:1135-1138. [PMID: 38101801 PMCID: PMC10724003] [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] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Indexed: 12/17/2023]
Abstract
Pseudoaneurysms of the neck are seldom, and those caused by neck infections especially parapharyngeal abscess are even rarer. However, it is life-threatening and may bring sudden death due to the obstruction of airway and the pseudoaneurysms rupture. We analyzed the clinical features, diagnosis and treatment of the disease through a case summary and literature review in order to guide clinical diagnosis and treatment of pseudoaneurysms. The patient, whom we presented was an 87-year-old male and admitted in emergency of our hospital with the chief complaint of neck swelling for 7 days and shortness of breath for 2 days. Cervical ultrasound examination showed that there was an liquid dark area next to the left common carotid artery which was approximately 8.0 cm × 5.0 cm, consideration of formation of left carotid artery pseudoaneurysm, and the liquid dark area which was visible on the right considered of pseudoaneurysm or infection. Angiography of neck showed a clustered high-density shadow around the bifurcation of the left carotid artery, with an overall range of approximately 65 mm × 52 mm × 72 mm, the pseudoaneurysms for sure, while on the right side of the lesion, mixed low density shadows with air could be seen, the parapharyngeal abscess for sure.Then he was diagnosed as the pseudoaneurysm of left internal carotid artery which was caused by parapharyngeal abscess. After tracheal intubation and anti-infection treatment, the patient died due to hemorrhagic shock of the ruptured of the pseudoaneurysm. Morever we performed literature search on PubMed, Wanfang database and CNKI with keywords of "neck pseudoaneurysm, neck infection, parapharyngeal abscess" and enrolled 10 cases. Then we summarized the clinical characteristics and treatment. We analyzed and summarized the 10 case reports, in which the number of male was 7. Among them, there were 4 pediatric, and 6 adults were enrolled overall. Most of the symptoms were neck swelling, and the diseased blood vessel was mainly the right internal carotid artery which accounted for half overall. All the patients underwent surgical intervention, and recovered well. So we draw the conclusion that the clinical incidence of cervical pseudoaneurysms is low and can be caused by a variety of factors, especially caused by infectious factors. When a patient has a progressive pulsating mass in the neck, the preliminary diagnosis should be made by ultrasound as soon as possible, and the aortic enhancement CT should be used to further confirm.For a patient with cervical pseudo-aneurysms caused by parapharyngeal infections, he should take operation timely combined with antibiotic treatment in time.
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Affiliation(s)
- 陈光 张
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 旭岩 陈
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 圣 吴
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 莉莉 冯
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 琰 王
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 妤 陈
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 敏 段
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 科 王
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 琳琳 宋
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
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Shimada A, Yamamoto T, Dohi S, Yokoyama Y, Endo D, Tabata M. Acute endocarditis complicated by left ventricular pseudoaneurysm with acute bloody pericardial effusion: A case report. Medicine (Baltimore) 2023; 102:e36233. [PMID: 38065878 PMCID: PMC10713172 DOI: 10.1097/md.0000000000036233] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
RATIONALE Delay in seeking medical attention for high fever and inadequate diagnosis can lead to rapid progression of inflammation and spread to surrounding tissues and organs. Staphylococcus aureus is a common cause of systemic infections, and infectious endocarditis can swiftly become severe; therefore, careful management is required. PATIENT CONCERNS A 54-year-old woman was admitted to our hospital with high fever and progressive loss of consciousness. Meningitis was suspected, and antibiotic treatment was initiated. Blood culture revealed methicillin-sensitive Staphylococcus aureus. Subsequently, the patient developed hypotension, bradycardia, and cardiac arrest and underwent emergency cardiopulmonary resuscitation. DIAGNOSES Transesophageal echocardiography performed during the procedure revealed significant vegetation at the posterior leaflet of the mitral valve, an abscess at the valve annulus, and a pseudoaneurysm of the left ventricular posterior wall. INTERVENTIONS The patient underwent emergency small incision pericardiotomy drainage, and her blood pressure and heart rate stabilized. After pericardial drainage, acute renal failure, fulminant hepatitis, and disruption of coagulation function were observed, and she was treated with plasma exchange therapy and intravenous immunoglobulin. Resection of the huge vegetation, debridement, patch closure of the ventricular perforation, and mitral valve replacement were performed. OUTCOMES Surgical findings showed massive vegetation in the posterior leaflet of the mitral valve, an annular abscess in the posterior leaflet of the mitral valve connected to the left ventricular posterior wall, and a pseudoaneurysm. Postoperatively, her pseudoaneurysm resolved and her cardiac function stabilized, while circulatory failure due to bacteremia progressed, and she gradually developed acidosis and unstable blood pressure. Plasma exchange and continuous hemodiafiltration were continued; however, she died of progressive multiorgan failure. LESSON Staphylococcus aureus bacteremia can cause fatal complications. Even when symptoms of meningitis are suspected, it is essential to examine the patient for endocarditis. Delayed diagnosis can lead to fatal endocarditis-related complications.
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Affiliation(s)
- Akie Shimada
- Department of Cardiovascular Surgery, Nerima Hospital, Juntendo University, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Nerima Hospital, Juntendo University, Tokyo, Japan
| | - Shizuyuki Dohi
- Department of Cardiovascular Surgery, Nerima Hospital, Juntendo University, Tokyo, Japan
| | - Yasutaka Yokoyama
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Daisuke Endo
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
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Buchholz J, Ronald J, Smith TP. Lumbar Artery Pseudoaneurysm following Inferior Vena Cava Filter Placement. J Vasc Interv Radiol 2023; 34:2265-2266. [PMID: 37634847 DOI: 10.1016/j.jvir.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Joseph Buchholz
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - James Ronald
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Tony P Smith
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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Beigh A, Mazumder MA. Successful treatment of a brachial artery pseudoaneurysm in a brachiobasilic arteriovenous fistula using ultrasound-guided manual compression. J Ultrasound 2023; 26:955-957. [PMID: 36260216 PMCID: PMC10632190 DOI: 10.1007/s40477-022-00701-3] [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: 02/21/2022] [Accepted: 06/16/2022] [Indexed: 10/24/2022] Open
Abstract
Pseudoaneurysm is a well-recognized complication seen in arteriovenous fistula (AVF) which usually involves the venous segments. Ultrasound-guided manual compression (UGMC) is a non-invasive and effective treatment for the management of pseudoaneurysms involving the venous segment. Pseudoaneurysm of the arterial segment of AVF is rare complication which usually needs surgical intervention. We report the first successful treatment case of a brachial artery pseudoaneurysm in a brachiobasilic arteriovenous fistula using ultrasound-guided manual compression. The patient presented with a 30 × 30 mm pulsatile swelling below the cubital fossa after second session of hemodialysis using an AVF created 8 weeks earlier. Ultrasound doppler demonstrated a brachial artery pseudoaneurysm in the non-transposed brachiobasilic fistula. Complete occlusion of the cavity with thrombus formation was accomplished after 55 min of compression and the psuedoaneurysm did not recur. UGMC can be an alternative treatment option for select cases of arterial segment pseudoaneurysm in AVF.
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Affiliation(s)
- Aadil Beigh
- Khyber Medical Institute, Khayam Chowk, Srinagar, Jammu and Kashmir, India
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Kazumori H, Onoe M, Ooya S, Ohno Y, Kawashima K. Covered self-expandable metal stent for hemostasis of ruptured pseudoaneurysm caused by partial stent-in-stent method. Endoscopy 2023; 55:E1268-E1269. [PMID: 38128590 PMCID: PMC10736111 DOI: 10.1055/a-2219-2756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Hideaki Kazumori
- Department of Gastroenterology, Matsue Seikyo General Hospital, Matsue, Japan
| | - Masaki Onoe
- Department of Internal Medicine II, Shimane University, Izumo, Japan
| | - Satoshi Ooya
- Department of Internal Medicine II, Shimane University, Izumo, Japan
| | - Yasuhiko Ohno
- Department of Gastroenterology, Matsue Seikyo General Hospital, Matsue, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University, Izumo, Japan
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26
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Huang CJ, Zhong W, Zhong M, Liu ZD, Fan WX, Li YQ, Wang XF, Zhong ZX. [A case report of percutaneous closure of left ventricular pseudoaneurysm]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:1196-1198. [PMID: 37963757 DOI: 10.3760/cma.j.cn112148-20230907-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- C J Huang
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - W Zhong
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - M Zhong
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - Z D Liu
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - W X Fan
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - Y Q Li
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - X F Wang
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
| | - Z X Zhong
- Department of Cardiology, Guangdong Meizhou People's Hospital, Meizhou 514031, China
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Kim SW, Nam IC, Kim DR, Kim JJ, Park SE. Subclavian Artery Pseudoaneurysm Following Bedside Temporary Hemodialysis Catheter Insertion: A Case Report. Medicina (Kaunas) 2023; 59:2038. [PMID: 38004087 PMCID: PMC10672835 DOI: 10.3390/medicina59112038] [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] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
A pseudoaneurysm of the subclavian artery following central venous catheter placement is a rare but potentially fatal complication that often requires surgical intervention. However, surgical repair of the subclavian artery remains challenging. Herein, we report the case of a male patient undergoing hemodialysis who developed a pseudoaneurysm of the subclavian artery after a bedside central vein catheter placement. Hemostasis was successfully achieved by selecting the pseudoaneurysm using a microcatheter. At the 10-month follow-up, the pseudoaneurysm was completely excluded, and the patient was in a stable condition. The patient underwent native arteriovenous fistula creation and hemodialysis. Endovascular treatment could be an effective nonsurgical treatment for subclavian artery pseudoaneurysms and has been attempted as a first-line treatment option.
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Affiliation(s)
- Sang-Woo Kim
- Department of Radiology, School of Medicine, Jeju National University, Jeju National University Hospital, 15, Aran 13-gil, Jeju 63241, Republic of Korea; (S.-W.K.); (D.-R.K.); (J.-J.K.)
| | - In-Chul Nam
- Department of Radiology, School of Medicine, Jeju National University, Jeju National University Hospital, 15, Aran 13-gil, Jeju 63241, Republic of Korea; (S.-W.K.); (D.-R.K.); (J.-J.K.)
| | - Doo-Ri Kim
- Department of Radiology, School of Medicine, Jeju National University, Jeju National University Hospital, 15, Aran 13-gil, Jeju 63241, Republic of Korea; (S.-W.K.); (D.-R.K.); (J.-J.K.)
| | - Jeong-Jae Kim
- Department of Radiology, School of Medicine, Jeju National University, Jeju National University Hospital, 15, Aran 13-gil, Jeju 63241, Republic of Korea; (S.-W.K.); (D.-R.K.); (J.-J.K.)
| | - Sung-Eun Park
- Department of Radiology, School of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Changwon 51472, Republic of Korea;
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Ponna PK, Fischell TA, Agrawal Y. Radial artery pseudoaneurysm rupture after cardiac catheterization. J Invasive Cardiol 2023; 35. [PMID: 37992332 DOI: 10.25270/jic/23.00065] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
A 73-year-old man with history significant for paroxysmal atrial fibrillation on apixaban underwent percutaneous coronary intervention (PCI) of the left anterior descending artery via transradial access. The patient was discharged on clopidogrel, atorvastatin, carvedilol, isosorbide mononitrate, losartan, and apixaban.
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Affiliation(s)
| | - Tim A Fischell
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
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29
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Yamamoto H, Nanto M, Kishida K, Goto Y, Hashimoto N. Iatrogenic Vertebral Arteriovenous Fistula Involving Brachiocephalic Vein Due to Central Venous Catheterization: A Case Report. J Endovasc Ther 2023; 30:779-783. [PMID: 35735198 DOI: 10.1177/15266028221105181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a case of vertebral arteriovenous fistula (VAVF) caused by iatrogenic trauma of central venous catheterization (CVC) involving brachiocephalic vein (BCV). CASE REPORT A 79-year-old female was referred for assessment of a vertebral artery (VA) aneurysm at the V1 segment. The patient had no signs other than a vascular murmur on the right neck and was diagnosed 20 years after undergoing CVC. Right vertebral angiography revealed a high-flow shunt from the V1 segment of the right VA and draining into the right BCV. The fistula had a single communication between a pseudoaneurysm and large varix. We diagnosed the patient with CVCinduced VAVF (CIVAVF) involving BCV and obliterated the shunt by selective transarterial and transvenous embolization of the pseudoaneurysm under flow control using a balloon catheter with no complications. CONCLUSION This case highlights the point that CIVAVF involving BCV is rare but possible. In addition, there is a possibility that CIVAVF involving BCV does not demonstrate the findings of arterial steal or retrograde venous drainage and is undiagnosed for a long term due to lack of neurological manifestation and other subjective symptoms. We also showed that endovascular treatment can be feasible and useful for CIVAVF involving BCV.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masataka Nanto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kengo Kishida
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yudai Goto
- Department of Neurosurgery, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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30
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Ghasemi-Rad M, Shastri R, Amaresh A, Wynne D, Whigham C. Trans-Arterial Balloon-Assisted Embolization of Traumatic Giant Hepatic Pseudoaneurysm With Thrombin. Vasc Endovascular Surg 2023; 57:764-767. [PMID: 36964763 DOI: 10.1177/15385744231165595] [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] [Indexed: 03/26/2023]
Abstract
Giant hepatic pseudoaneurysms are rare after injury. We report a case of a 20-year-old male, post gunshot injury to his right upper quadrant of the abdomen with delayed blood loss. CTA of the abdomen demonstrated a 6.5 cm right hepatic artery pseudoaneurysm. This was successfully embolized with balloon assisted trans-arterial thrombin injection.
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Affiliation(s)
- Mohammad Ghasemi-Rad
- Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ravi Shastri
- Department of Neuro-interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Amar Amaresh
- Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - David Wynne
- Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Cliff Whigham
- Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
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31
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Reijnen MMPJ, van Werkum MH, Frans F, van Schaik PM. The Use of Autologous Subcutaneous Fat Tissue to Embolize an Infected Iliac Artery Pseudoaneurysm. Vasc Endovascular Surg 2023; 57:816-819. [PMID: 37518891 DOI: 10.1177/15385744231192880] [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] [Indexed: 08/01/2023]
Abstract
We describe a patient with a fistula between small bowel and a polyester patch of the common iliac artery. After emergency treatment with an endograft, the patch was replaced by a venous patch. Within 3-week a symptomatic pseudoaneurysm developed. It was decided to embolize the pseudoaneurysm using autologous subcutaneous fat, followed by a femoro-femoral crossover bypass using an allograft. Using this technique, the pseudoaneurysm was successfully excluded. This case shows that subcutaneous fat tissue can be used as an autologous embolic material, also in larger vessel pathology and in cases of ongoing infection, where regular embolization material cannot be used.
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Affiliation(s)
- M M P J Reijnen
- Department of Surgery, Rijnstate, Arnhem, The Netherlands
- Multi-Modality Medical Imaging group, TechMed Center, University of Twente, Enschede, The Netherlands
| | - M H van Werkum
- Department of Radiology, Rijnstate, Arnhem, The Netherlands
| | - F Frans
- Department of Surgery, Rijnstate, Arnhem, The Netherlands
| | - P M van Schaik
- Department of Surgery, Rijnstate, Arnhem, The Netherlands
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32
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Laimer G, Deeg J, Gruber H, Skalla-Oberherber E, Scharll Y, Loizides A. Occlusion of upper limb artery pseudoaneurysms with US-guided fibrin glue injection: a valid minimally invasive treatment option? Two case reports. Med Ultrason 2023; 25:355-358. [PMID: 36191245 DOI: 10.11152/mu-3754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Arterial pseudoaneurysms (PSAs) typically occur after (iatrogenic) damage (i.e., puncture) to the arterial wall and are the most frequent complication following percutaneous interventions.In this article we report on successful treatments of two iatrogenic PSAs in two patients (87-year-old male; 69-yearold-female) with a brachial (10 x 7 mm; 10 mm-length "neck") and radial (17 x 7 mm; 3 mm-length "neck") artery PSA by US-guided fibrin glue injection (UGFI). Both PSAs were effectively occluded without any complications. To our knowledge this is the first report on successful treatments of upper limb artery PSAs using UGFI, which may represent a valid first-line, minimally invasive treatment option for brachial artery PSA.
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Affiliation(s)
- Gregor Laimer
- Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Johannes Deeg
- Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Hannes Gruber
- Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | | | - Yannick Scharll
- Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Alexander Loizides
- Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
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Xie D, Jiang L, Zhang J, Li X, Guo Y. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa: a rare case after percutaneous transluminal coronary angioplasty. BMC Cardiovasc Disord 2023; 23:477. [PMID: 37752428 PMCID: PMC10521427 DOI: 10.1186/s12872-023-03512-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an uncommon but potentially life-threatening condition. The most common pathogenic factors of P-MAIVF are infective endocarditis and surgical valve operation. Here, we report a rare case of P-MAIVF which occurred one year after percutaneous transluminal coronary angioplasty (PTCA). CASE PRESENTATION A 31-year-old man developed a P-MAIVF one year after PTCA. Transthoracic echocardiography (TTE) revealed a pseudoaneurysm between the aortic root and the left atrium. Three-dimensional transesophageal echocardiography (3D-TEE) clearly demonstrated the orifice of the pseudoaneurysm. This case was initially diagnosed by ultrasound, and the prognosis was good after surgical repair. CONCLUSIONS We report a rare case of P-MAIVF that occurred one year after PTCA.
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Affiliation(s)
- Debo Xie
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Lulu Jiang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Jun Zhang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Xin Li
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Yanli Guo
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
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Lombardi M, Bianchini F, Romagnoli E, Paraggio L, Aurigemma C, Burzotta F, Trani C. Postcatheterization Forearm Artery Pseudoaneurysm Resolution in the Context of Subsequent PCI. JACC Cardiovasc Interv 2023; 16:2178-2180. [PMID: 37409993 DOI: 10.1016/j.jcin.2023.05.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Marco Lombardi
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lazzaro Paraggio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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35
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Mak RK, Fung HS, Chan KS. Embolization of a Massage Gun-Induced Pseudoaneurysm in the Supraclavicular Fossa. J Vasc Interv Radiol 2023; 34:1637. [PMID: 37620058 DOI: 10.1016/j.jvir.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 08/26/2023] Open
Affiliation(s)
- Renata Kiri Mak
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Kowloon, Hong Kong.
| | - Hon Shing Fung
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Kwong Shun Chan
- Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong
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36
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Zuchowski AJ, Martin JG. Rapid Development of a Large Pulmonary Pseudoaneurysm in a Segment of Necrotic Lung. J Vasc Interv Radiol 2023; 34:1636. [PMID: 37620057 DOI: 10.1016/j.jvir.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 08/26/2023] Open
Affiliation(s)
- Adam J Zuchowski
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | - Jonathan G Martin
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina
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37
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Chen T, Li Y, Qiao S, Fu H. Occult deterioration of an aortic annular abscess: how do we diagnose a pseudoaneurysm periaortic valve? A case report. BMC Cardiovasc Disord 2023; 23:405. [PMID: 37592223 PMCID: PMC10433627 DOI: 10.1186/s12872-023-03434-1] [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: 12/21/2022] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Infectious endocarditis (IE) is a disease caused by the colonization of toxic microorganisms on the endocardium of heart valves [1]. Although much progress has been made in the diagnosis and treatment of IE, its complications, such as annular abscesses [2], still have a high mortality rate. In this case, we describe a patient with infective endocarditis complicated by occult deteriorated aortic annular abscess. CASE PRESENTATION A 44-year-old man was admitted due to weakness of his right limbs and unclear speech for 10 h. He had recurrent fevers for 1 month before admission. Transthoracic echocardiography showed a mix-echoic vegetation attached to the bicuspid aortic valve, moderate aortic regurgitation and a possible aortic annular abscess. Blood cultures were negative and empiric antibiotic therapy was begun. The patient did not have fever again and seem to be clinically improved. However, follow-up transesophageal echocardiography revealed a large periaortic abscess led to aortic sinus pseudoaneurysm. The patient underwent mechanical prosthetic valve replacement and annulus reconstruction successfully. Perivalvular abscess may be insidious deterioration in patients who seem to be clinically improved, which requires us to pay more attention. DISCUSSION Occult deterioration of an aortic annular abscess is rare and more attention should be paid. Re-evaluation of echocardiography is required even if the patient's symptoms improve.
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Affiliation(s)
- Tienan Chen
- Department of Cardiovascular Surgery, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Yinling Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Shuai Qiao
- Department of Cardiovascular Surgery, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Huaying Fu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.
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Li FQ, Su DJ, Zhang WJ, Chen ZK, Li GX, Li SX, Peng YX, Dang L, Wang WH. Endovascular treatment for massive haemoptysis due to pulmonary pseudoaneurysm: report of 23 cases. J Cardiothorac Surg 2023; 18:244. [PMID: 37580779 PMCID: PMC10426096 DOI: 10.1186/s13019-023-02346-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/09/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of endovascular treatment for massive haemoptysis caused by pulmonary pseudoaneurysm (PAP). METHODS The clinical data, imaging data, and endovascular treatment protocol of 23 patients with massive haemoptysis caused by continuous PAP were retrospectively analysed. The success, complications, postoperative recurrence rate, and influence of the treatment on pulmonary artery pressure were also evaluated. RESULTS Nineteen patients with a bronchial artery-pulmonary artery (BA-PA) and/or nonbronchial systemic artery-pulmonary artery (NBSA-PA) fistula underwent bronchial artery embolization (BAE) and/or nonbronchial systemic artery embolization (NBSAE) + pulmonary artery embolization (PAE). The pulmonary artery (PA) pressures before and after embolization were 52.11 ± 2.12 (35-69 cmH2O) and 33.58 ± 1.63 (22-44 cmH2O), respectively (P = 0.001). Four patients did not have a BA-PA and/or NBSA-PA fistula. Embolization was performed in two patients with a distal PAP of the pulmonalis lobar arteria. Bare stent-assisted microcoils embolization was performed in the other two patients with a PAP of the main pulmonary lobar arteries. The PA pressures of the four patients before and after treatment were 24.50 ± 1.32 (22-28 cmH2O) and 24.75 ± 1.70 (22-29 cmH2O), respectively (P = 0.850). The technique had a 100% success rate with no serious complications and a postoperative recurrence rate of 30%. CONCLUSION Endovascular treatment is safe and effective for massive haemoptysis caused by PAP. BAE and/or NBSAE can effectively reduce pulmonary hypertension in patients with a BA-PA and/or NBSA-PA fistula.
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Affiliation(s)
- Fen-Qiang Li
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China.
| | - Dong-Jun Su
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Wan-Jia Zhang
- Department of Vascular and Tumour Intervention, Liangzhou Hospital, Wuwei City, Gansu Province, China
| | - Zhong-Ke Chen
- Department of Interventional Radiology, Affiliated Hospital of Gansu Medical College, PingLiang, Gansu Province, China
| | - Geng-Xiang Li
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Shuang-Xi Li
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Yu-Xing Peng
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Lei Dang
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China
| | - Wen-Hui Wang
- Department of Interventional Radiology, The Frist Hospital of Lanzhou University, Lanzhou, China.
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Yu MWL, Li AM, Lai MH, Chan KCC. Rare but life-threatening cause of massive haemoptysis in an adolscent with tuberculosis: Rasmussen's aneurysm. BMJ Case Rep 2023; 16:e255480. [PMID: 37580099 PMCID: PMC10432668 DOI: 10.1136/bcr-2023-255480] [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] [Indexed: 08/16/2023] Open
Abstract
Rasmussen's aneurysm is a rare yet fatal cause of massive haemoptysis in pulmonary tuberculosis. Early identification and timely intervention are of utmost importance to reduce the associated mortality. A girl in early adolescence presented with persistent fever and massive haemoptysis who required intubation and was subsequently confirmed to have tuberculosis. CT pulmonary angiogram showed the presence of pseudoaneurysms in the left upper and lower lobes. The haemoptysis resolved following the embolisation of the culprit's vessel. Residual lung destruction was evident on CT after a 12-month course of antituberculosis therapy. Rasmussen's aneurysm is a significant vascular complication of cavitary tuberculosis and needs to be considered in patients presenting with massive haemoptysis.
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Affiliation(s)
| | - Albert M Li
- Faculty of Medicine, Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ming Hei Lai
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Kate Ching Ching Chan
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Takamatsu C, Ibrahim R, Corban MT, Klewer SE, Seckeler MD. Transcatheter Treatment of Right Ventricular Outflow Tract Compression by a Pseudoaneurysm in Tetralogy of Fallot. JACC Cardiovasc Interv 2023; 16:1931-1934. [PMID: 37409996 DOI: 10.1016/j.jcin.2023.05.036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Chelsea Takamatsu
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona, USA
| | - Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona, USA
| | - Michel T Corban
- Sarver Heart Center, University of Arizona Tucson, Tucson, Arizona, USA
| | - Scott E Klewer
- Department of Pediatrics (Cardiology), University of Arizona Tucson, Tucson, Arizona, USA
| | - Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona Tucson, Tucson, Arizona, USA; Steele Children's Research Center, University of Arizona Tucson, Tucson, Arizona, USA.
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Bechay K, Katz MD, Quinn B. Endovascular embolization with EVOH for the treatment of a Rasmussen aneurysm. J Radiol Case Rep 2023; 17:8-14. [PMID: 37654897 PMCID: PMC10435256 DOI: 10.3941/jrcr.v17i8.4687] [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] [Indexed: 09/02/2023] Open
Abstract
First-line treatment of pulmonary artery aneurysms/pseudoaneurysms (PAA/PAPA) is percutaneous or endovascular embolization. The present case of a Rasmussen aneurysm, a PAPA caused by Tuberculosis (TB), was successfully treated with ethylene-vinyl alcohol (EVOH), a radiopaque liquid embolic agent with favorable characteristics. A 35-year-old man presented as a new patient with hemoptysis, and CT imaging revealed multiple cavitary lesions and a 2.1 cm aneurysm in the upper right lobe. Endovascular treatment was delivered and a complete lack of filling of the lesion was noted on post-treatment angiography. The patient's history includes risk factors and past TB infection. Despite the suspicious imaging, diagnostic tests were negative for active TB in this patient. He was then found to have MRSA bacteremia and a mediastinal lymph node positive for M. avium. The etiology of this aneurysm is suspicious for the superinfection of a chronic tuberculous cavity with M. avium, MRSA, or both.
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Affiliation(s)
- Kirollos Bechay
- David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Michael David Katz
- Department of Interventional Radiology, Keck Hospital of USC, Los Angeles, CA
| | - Brian Quinn
- Department of Interventional Radiology, Olive View-UCLA Medical Center, Los Angeles, CA
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Taneja V, Shah D, Dessai R, Sondhi M, Nautiyal M, Garg A. Recurrent idiopathic pancreatitis complicating as emphysematous pancreatitis and gastroduodenal artery pseudoaneurysm: A rare case report. Ann Afr Med 2023; 22:385-387. [PMID: 37417030 PMCID: PMC10445719 DOI: 10.4103/aam.aam_245_21] [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: 11/29/2021] [Accepted: 12/17/2022] [Indexed: 07/08/2023] Open
Abstract
Emphysematous pancreatitis (EP) is a rare and potentially fatal condition of the pancreas. It is associated with gas-forming bacteria and is characterized by the presence of gas in or around the pancreas. It is identified by a computed tomography scan of the abdomen. Although predisposing factors are not precisely known, diabetes mellitus, which predisposes to gas gangrene, is seen to be commonly associated with patients of EP. EP being potentially fatal requires immediate management. Surgery is generally indicated in EP. However, EP can also managed conservatively. In our case, the patient developed recurrent pancreatitis, the cause being idiopathic, and the second episode of acute pancreatitis was complicated by EP and gastroduodenal artery pseudoaneurysm.
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Affiliation(s)
- Vinus Taneja
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Darshit Shah
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Rishikesh Dessai
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Manuj Sondhi
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Manishi Nautiyal
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Ambuj Garg
- Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
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43
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Munaf M, Gadhinglajkar S, Nayanar VKN, Dash PK, Puthuvasserry S, Sagar S. Radial artery pseudoaneurysm following pediatric arterial cannulation. Ann Card Anaesth 2023; 26:359-360. [PMID: 37470545 PMCID: PMC10451147 DOI: 10.4103/aca.aca_171_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/28/2022] [Accepted: 12/25/2022] [Indexed: 07/21/2023] Open
Affiliation(s)
- Mamatha Munaf
- Department of Cardiothoracic and Vascular Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Shrinivas Gadhinglajkar
- Department of Cardiothoracic and Vascular Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - V Krishna N. Nayanar
- Department of Cardiothoracic and Vascular Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Prasanta K. Dash
- Department of Cardiothoracic and Vascular Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Suneel Puthuvasserry
- Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sunil Sagar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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44
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Kim JY, Laroia A, Bello RM. Iatrogenic thoracic aortic pseudoaneurysm as a rare complication of intra-aortic balloon pump: Radiologic findings of multiple imaging modalities. J Cardiovasc Comput Tomogr 2023; 17:e13-e15. [PMID: 37225562 DOI: 10.1016/j.jcct.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Ji Yang Kim
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Lowa City, IA, 52242, USA.
| | - Archana Laroia
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Lowa City, IA, 52242, USA
| | - Rodrigo Moreira Bello
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Lowa City, IA, 52242, USA
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45
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Diego P, Fabián M, Constanza M, Mirna L, Martin P. Dialysis access graft occlusion with contrast and ultrasound guided thrombin injection for intractable arm edema and pseudoaneurysm. J Vasc Access 2023; 24:798-801. [PMID: 34590510 DOI: 10.1177/11297298211047330] [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] [Indexed: 11/17/2022] Open
Abstract
We present the case of a patient with a brachio-basilic graft forearm loop with intractable edema and thrombosed central veins. She showed up with an important edema after some effort and a previously thrombosed pseudoaneurysm with significant growth. She refused angioplasty treatment for central veins, the graft had not been used for dialysis during the last year, so that arteriovenous graft (AVG) ligation was considered. Due to local conditions thrombin percutaneous embolization was performed to avoid possible complications of a conventional surgery approach. AVG occlusion was done in 10 min by fluoroscopy and ultrasound guidance. In 24 h the patient was significantly better and after 1 week she had no edema at all. There were no complications and no recanalization was observed after 3 months. Percutaneous thrombin embolization is a safe and effective technique for AVG occlusion in case of intractable arm edema with central vein thrombosis, and most likely to be considered in other situations where arteriovenous graft or fistula ligature is needed.
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Affiliation(s)
- Pinto Diego
- Department of Vascular Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Montalvo Fabián
- Department of Vascular Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Melendez Constanza
- Department of Nephrology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Lapadula Mirna
- Department of Nephrology, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Perez Martin
- Department of Nephrology, Hospital Privado de Comunidad, Mar del Plata, Argentina
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Rajendran J, Panwar R, Singh AN, Dash NR, Pal S, Srivastava DN, Sahni P, Madhusudhan KS. Management and outcomes of pseudoaneurysms presenting with late hemorrhage following pancreatic surgery: A six-year experience from a tertiary care center. Indian J Gastroenterol 2023; 42:361-369. [PMID: 37166698 DOI: 10.1007/s12664-023-01357-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/04/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND/PURPOSE Late hemorrhage following pancreatic surgery is associated with significant morbidity and mortality. Pseudoaneurysm (PSA) is an important source of late hemorrhage, which is effectively and safely managed by embolization. We aim to retrospectively review the outcomes of embolization for pseudoaneurysms causing late post-pancreatectomy hemorrhage over a period of six-years at our tertiary care center. METHODS Between 2014 and 2020, 616 pancreatic surgeries were performed and 25 patients had late hemorrhage (occurring > 24 hours post-operatively). The clinical parameters related to late hemorrhage, associated complications, embolization details, treatment success and their short-and long-term outcomes were analyzed. RESULTS Sixteen of 25 patients had PSA on digital subtraction angiography. Embolization was performed in these patients with technical and clinical success rates of 94.1% and 100%, respectively. Compared to patients without PSA, patients with PSA had significant hemoglobin drop (2.5 g/dL vs. 1.5 g/dL, p = 0.01), higher incidence of sentinel bleed (50% vs. 11.1%, p = 0.05) and lower requirement for surgery for bleeding (0% vs. 44.4%, p = 0.02). Clincally relevant postoperative pancreatic fistula and bile leak were seen in 72% and 52% of patients, respectively. Eight of these embolized patients died due to sepsis. The long-term outcome was good, once the patients were discharged. CONCLUSION Late hemorrhage after pancreatic surgery was associated with high mortality due to complications such as pancreatic fistula and bile leak. Sentinel bleeding was an important clinical indicator of PSA. Angiographic embolization is safe and effective without any adverse short or long-term outcomes.
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Affiliation(s)
- Jayapal Rajendran
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Rajesh Panwar
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Anand Narayan Singh
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
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47
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Borges AP, Antunes C, Donato P. Prevalence of celiac artery compression by median arcuate ligament in patients with splanchnic artery aneurysms/pseudoaneurysms submitted to endovascular embolization. Abdom Radiol (NY) 2023; 48:1415-1428. [PMID: 36801957 PMCID: PMC10115732 DOI: 10.1007/s00261-023-03844-x] [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: 12/05/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE To study the association between median arcuate ligament compression (MALC) of celiac artery (CA) and splanchnic artery aneurysms/pseudoaneurysms (SAAPs) submitted to endovascular embolization. METHODS Single center retrospective study of embolized SAAPs between 2010 and 2021, to evaluate the prevalence of MALC, and compare demographic data and clinical outcomes between patients with and without MALC. As a secondary objective, patient characteristics and outcomes were compared between patients with different causes of CA stenosis. RESULTS MALC was found in 12.3% of 57 patients. SAAPs were more prevalent in the pancreaticoduodenal arcades (PDAs) in patients with MALC, compared to those without MALC (57.1% vs. 10%, P = .009). Patients with MALC had a greater proportion of aneurysms (71.4% vs. 24%, P = .020), as opposed to pseudoaneurysms. Rupture was the main indication for embolization in both groups (71.4% and 54% of patients with and without MALC, respectively). Embolization was successful in most cases (85.7% and 90%), with 5 immediate (28.6% and 6%) and 14 non-immediate (28.6% and 24%) post-procedure complications. Thirty and 90-day mortality rate were 0% in patients with MALC, and 14% and 24% in patients without MALC. Atherosclerosis was the only other cause of CA stenosis, in 3 cases. CONCLUSIONS In patients with SAAPs submitted to endovascular embolization, the prevalence of CA compression by MAL is not uncommon. The most frequent location for aneurysms in patients with MALC is in the PDAs. Endovascular management of SAAPs is very effective in patients with MALC, with low complications, even in ruptured aneurysms.
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Affiliation(s)
- Ana Paula Borges
- Medical Imaging Department, Coimbra University Hospitals, Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Academic and Clinical Centre of Coimbra, Coimbra, Portugal.
| | - Célia Antunes
- Medical Imaging Department, Coimbra University Hospitals, Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging Department, Coimbra University Hospitals, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, Coimbra, Portugal
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48
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Villacis-Nunez DS, West Z, Khan AY, Rodriguez F, Shane AL, Rytting H, Shashidharan S, Clifton MS, Woods G, Clabby M, Prahalad S. Successful Medical-Surgical Management of Intracardiac Thrombosis and Pulmonary Pseudoaneurysms in an Adolescent With Hughes-Stovin Syndrome. J Investig Med High Impact Case Rep 2023; 11:23247096231166672. [PMID: 37032536 PMCID: PMC10101212 DOI: 10.1177/23247096231166672] [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: 12/07/2022] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023] Open
Abstract
We present an adolescent male with a single intracardiac mass and pulmonary emboli, complicated by peripheral venous thrombosis and subsequent development of pulmonary pseudoaneurysms, leading to diagnosis of Hughes-Stovin syndrome. Remission was achieved with cyclophosphamide, corticosteroids, and pseudoaneurysm resection and maintained with infliximab and methotrexate.
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Affiliation(s)
- D. Sofia Villacis-Nunez
- Division of Pediatric Rheumatology,
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
| | - Zachary West
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Hospital
Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Adil Y. Khan
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Hospital
Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Fred Rodriguez
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Sibley Heart Center, Atlanta, GA,
USA
| | - Andi L. Shane
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Division of Pediatric Infectious
Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta,
GA, USA
| | - Heather Rytting
- Department of Pathology, Children’s
Healthcare of Atlanta, Atlanta, GA, USA
| | - Subhadra Shashidharan
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Congenital Cardiac
Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew S. Clifton
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Surgery, Emory University
School of Medicine, Atlanta, GA, USA
| | - Gary Woods
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Pediatrics, Emory
University School of Medicine, Atlanta, GA, USA
| | - Martha Clabby
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Sibley Heart Center, Atlanta, GA,
USA
| | - Sampath Prahalad
- Division of Pediatric Rheumatology,
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,
USA
- Children’s Healthcare of Atlanta,
Atlanta, GA, USA
- Department of Human Genetics, Emory
University School of Medicine, Atlanta, GA, USA
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49
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Guevara-Noriega KA, Walter R, Guevara-Noriega U. Remote endovascular treatment of femoral pseudoaneurysms in hostile groins: technical note. Arch Cardiol Mex 2023; 93:249-251. [PMID: 37037224 PMCID: PMC10161821 DOI: 10.24875/acm.21000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 04/14/2022] [Indexed: 04/12/2023] Open
Affiliation(s)
- Kerbi A. Guevara-Noriega
- Department of Vascular Surgery, Consorci Sanitari Parc Tauli, Sabadell, Spain
- General Surgery Residency Program, Jackson Memorial Hospital, Miami, United States of America
| | - Ramsey Walter
- General Surgery Residency Program, Jackson Memorial Hospital, Miami, United States of America
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50
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Mehra R, Dhillan R, Manral S. Endovascular salvage of tubercular aortitis presenting as descending thoracic aortic pseudoaneurysm in association with vertebral tuberculosis. BMJ Case Rep 2022; 15:e251838. [PMID: 36323447 PMCID: PMC9639030 DOI: 10.1136/bcr-2022-251838] [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] [Indexed: 06/16/2023] Open
Abstract
A gentleman in his late 30s presented with a history of evening rise of temperature and generalised malaise of 1-week duration. He had associated upper back pain with tingling and numbness of both lower limbs. An unexplained episode of hypotension with hemoptysis propelled a computed tomography (CT) examination of chest which was suggestive of a pseudoaneurysm of the posterior wall of descending thoracic aorta in the vicinity of the Pott's spine with a prevertebral and paravertebral abscess, for which he was referred to vascular surgeons.Tubercular involvement of vasculature is a rare disease, aortic involvement even rarer. Less than 50 cases of vertebral tuberculosis with tubercular thoracic aortic aneurysm have been reported in the medical literature, but the disease carries a colossal mortality and morbidity.After a multidisciplinary teamwork, thoracic endovascular aortic repair was done for exclusion of the aneurysmal segment, with simultaneous antitubercular and broad-spectrum antibiotic chemotherapy. The patient recuperated well.
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MESH Headings
- Male
- Humans
- Aneurysm, False/complications
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/therapy
- Aortitis/complications
- Aortitis/diagnostic imaging
- Aortitis/surgery
- Aortic Aneurysm, Thoracic/complications
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/surgery
- Tuberculosis, Cardiovascular/complications
- Tuberculosis, Cardiovascular/diagnostic imaging
- Tuberculosis/complications
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/surgery
- Endovascular Procedures
- Blood Vessel Prosthesis Implantation
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Affiliation(s)
- Rohit Mehra
- Department of Vascular and Endovascular Surgery, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Rishi Dhillan
- Department of Vascular and Endovascular Surgery, Army Hospital (Research and Referral), New Delhi, New Delhi, India
| | - Sushma Manral
- Department of Radiodiagnosis, Holy Family Hospital, New Delhi, India
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