Aneurysmal Dilatation Research Articles

Risk Factor Analysis in Vascular Access Complications for Hemodialysis Patients.

Background: Chronic kidney disease (CKD) and renal failure remain critical global health challenges, with vascular access complications posing significant obstacles in hemodialysis management. Methods: This study investigates the early and late complications associated with vascular access procedures in a cohort of 1334 patients from Timiș County Emergency Clinical Hospital. Patients were categorized into early complications, occurring within 30 days postoperatively, and late complications, developing beyond this period. Demographic data, comorbidities, and lifestyle factors, including age, gender, body mass index (BMI), smoking status, hypertension, diabetes, and cardiovascular disease (CVD), were recorded and analyzed. Early complications included thrombosis, hemorrhage, edema, and non-maturation, while late complications involved thrombosis, aneurysmal dilation, venous hypertension, and infections. Results: Hemorrhage (32.3%) and thrombosis (30.8%) were the most prevalent early complications, influenced significantly by diabetes and hypertension. Non-maturation showed a strong association with diabetes and cardiovascular disease (odds ratio: 1.70). For late complications, thrombosis was most frequent, with hypertensive patients exhibiting increased risk (relative risk: 1.18). BMI was a significant factor in both early and late complications. Risk analysis using odds ratios and relative risks revealed distinct patterns of complication risks based on comorbidities and smoking status. Logistic regression modeling for thrombosis demonstrated moderate predictive accuracy (AUC: 0.64). Conclusions: These findings suggest that clinical interventions, such as stricter perioperative glycemic and blood pressure control, and personalized surgical strategies for patients with high BMI or comorbidities, could significantly reduce the incidence of vascular access complications and improve outcomes in this high-risk population.

Syphilitic aortitis: from the past to the present (view of a dermatovenerologist)

In order to improve the diagnosis and treatment of syphilitic aortitis, an analysis of known data on the clinical manifestations, course and diagnosis of this pathology was conducted, illustrating our own observations with the subsequent implementation of recommendations in clinical practice. The problem of syphilitic aortitis - the most frequent manifestation of late syphilis - was considered. Current data on clinical manifestations, possibilities and problems of diagnosing this pathology were presented. Modern methods of serological research used in the diagnosis of syphilitic aortitis were analyzed in detail; the course, complications and prognosis of this pathology were separately considered. All these aspects were illustrated by our own observations of clinical cases of syphilitic aortitis, which are of interest due to their rarity in clinical practice and demonstrate the importance of correct diagnosis and appropriate treatment. Serological tests for syphilis, ultrasound examination of the heart, extracardiac vessels and internal organs; X-ray examinations were used when examining patients. It was concluded that lesions of the cardiovascular system are currently among the most common forms of visceral syphilis. Syphilitic aortitis with symptoms of cardiovascular damage, which are caused by aortic valve insufficiency, narrowing of the ascending coronary arteries, aneurysmal dilatation of the ascending part and aortic arch, occurs in the late stages of syphilitic infection. Even in patients with syphilis who have been treated in the past with penicillin drugs, cardiovascular damage may occur, namely aortitis with aortic valve insufficiency. The most informative methods for detecting late cardiovascular damage are: enzyme-linked immunosorbent assay, passive hemagglutination reaction, immunoblotting and computed tomography of the heart and echocardiography. Special attention is paid to the fact that the uniqueness of the above observations lies in the fact that complicated forms of aortitis began to occur more often and also in treated syphilis patients who had previously been treated with water-soluble penicillin. Aortitis also occurs against the background of seroconversion (positivity) of non-treponemal tests, which were previously negative after treatment.

Endovascular therapy for aneurysmal dilatation and arteriovenous fistula of the superior mesenteric artery.

We present a clinical case illustrating the feasibility of endovascular treatment of superior mesenteric aneurysm associated with an arteriovenous fistula. The patient presented with abdominal pain and diarrhea on admission. Computed tomography angiography revealed an aneurysmal dilatation of the superior mesenteric artery and vein with an arteriovenous fistula. Endovascular therapy successfully managed the condition by reconstructing the artery, closing the fistula, and occluding the aneurysm. No aneurysm rupture or endoleak occurred, and the patient's symptoms on admission resolved. Endovascular treatment is a viable alternative for patients with superior mesenteric aneurysms and arteriovenous fistulas, but larger studies and further follow-up are needed to evaluate the safety and long-term efficacy of endovascular treatment.

Treatment of splenic artery aneurysms of patients with cirrhosis in the Waiting list

Objective. The aim of our work was to evaluate the immediate and remote results of ligation of splenic artery aneurysm in orthotopic liver transplantation in patients with decompensated liver cirrhosis.Material and methods. From June 2018 to May 2024, 232 liver transplants from a posthumous donor were performed at the Surgical Clinic of the Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin. In 4 patients (1.7%), the presence of aneurysmal dilatation of the splenic artery was revealed at the preoperative stage. During orthotopic liver transplantation, patients underwent ligation of the splenic artery proximal and distal to the aneurysms.Results. Mean time for the isolation and ligation of the splenic artery aneurysm was 18.4±3.3 minutes. In no case was there any damage or bleeding from either the branches or the aneurysm of the splenic artery; and there was no damage to the spleen. No adverse events related to the splenic artery aneurysm ligation were recorded in either early or late postoperative periods. In all cases, the control examination did not reveal any ischemic changes in the splenic parenchyma.Conclusion. Ligation of the splenic artery aneurysm during orthotopic liver transplantation is a safe, effective and necessary surgical intervention that can improve long-term results by reducing the risk of death from aneurysm rupture in the postoperative period.

Surpass Streamline Flow Diverter for the Treatment of Craniocervical Unruptured Dissecting Aneurysms: A multi-institutional retrospective study.

Currently, there is no established treatment consensus for craniocervical unruptured dissecting aneurysms (UDAs). This study aimed to assess the safety and efficacy of the Surpass Streamline Flow Diverter (SSFD) for treating craniocervical UDAs. A retrospective review of three centers' databases was conducted to identify patients with craniocervical UDAs treated with SSFDs from January 2021 to December 2023. Data, including patient and aneurysm characteristics, procedure details, imaging findings, and follow-up data, were analyzed. The study included 35 patients with 35 craniocervical UDAs. The mean maximal length of the UDAs was 13.0 ± 6.0 mm, with 57% ranging from 10 to 25 mm. At a mean follow-up of 8.7 ± 2.5 months, the complete occlusion rate was 71% (25/35), with no recurrences detected. Perioperative complications occurred in 3 patients (9%), comprising ischemic stroke in 2 patients (6%) and hemorrhagic stroke in 1 patient (3%). All patients had a good clinical outcome at the 6-month follow-up (mRS < 3). Multivariate logistic regression analysis revealed that aneurysmal dilation with stenosis (OR=0.034, 95% CI: 0.001 - 0.845; p=0.04) was a significant predictive factor for incomplete occlusion of treated aneurysms. Our findings suggest that SSFD is a safe and effective tool for craniocervical UDAs, demonstrating a high occlusion rate, acceptable complication rate, and good clinical outcome.

Anterior communicating artery aneurysm microsurgery resulted in a proximal pseudoaneurysm

Intracranial pseudoaneurysms (IPAs), characterized by compromised vessel wall layers, represent &lt;1% of all intracranial aneurysms. They often materialize along the vessel wall and are vulnerable to rupture, resulting in a mortality rate of up to 50%. Treatment is complex due to the fragility of pseudoaneurysms, the absence of a suitable surgical neck, and frequently associated intracranial atherosclerosis and calcification. This study reports a rare instance of an IPA following a microsurgical clipping of an intracranial aneurysm. A 48-year-old male with severe headache, vomiting, and brief unconsciousness was diagnosed with a ruptured anterior communicating artery aneurysm. After successful microsurgical clipping, a follow-up computed tomography angiogram revealed a new aneurysmal dilation on the anterior aspect of the pre-bifurcation segment of the right internal carotid artery (ICA). A subsequent craniotomy was performed to address the ICA pseudoaneurysm. Owing to the calcification surrounding the pseudoaneurysm, it was safeguarded with crushed muscle and cellulose fabric. Follow-ups showed no pseudoaneurysm enlargement, and the patient recovered with no neurological deficits. Iatrogenic IPAs post-aneurysmal clipping are exceptionally rare yet dangerous entities necessitating rapid intervention to minimize morbidity and mortality. Tailoring treatment modalities based on patient-specific characteristics, lesion attributes, and surgical expertise is fundamental. A cautious follow-up regimen is also suggested to monitor the pseudoaneurysm’s dimensions effectively.

Controversies in Chronic Aortic Dissection

AbstractChronic type B aortic dissection (cTBAD) often requires intervention due to complications like aortic aneurysmal dilatation and rupture, traditionally managed via open surgery. With the continued rise of endovascular therapies, thoracic endovascular aortic repair (TEVAR) is increasingly used, although its role in cTBAD is debated due to challenges such as a thick dissection septum, poor landing zones, and persistent false lumen flow. However, mounting evidence demonstrates TEVAR is a viable option for cTBAD, particularly for patients with high risks treated with open surgery. Advances in endovascular techniques, such as false lumen obliteration techniques and landing zone optimization strategies, have enhanced its technical success rate and clinical outcomes. However, continued research is needed to validate these methods and confirm their long-term benefits. In this review article, we not only update the emerging endovascular armamentarium but also discuss the technical considerations in catheter-based treatment approaches and respective outcomes.

Clinical characteristics of coronary artery involvement in children with Behcet's syndrome.

To review the clinical features, treatment, and prognosis of coronary involvement in Behcet's syndrome in children. Retrospectively analyzed medical records of BS patients admitted to our institution from 2012 to 2024. Six children with BS with coronary involvement were admitted, including 2 males and 4 females. The mean age was 5.7years and the mean course was 17.2months. All of them had coronary dilatation, including 1 case with aneurysmal dilatation, 2 cases with bilateral coronary dilatation, 4 cases with unilateral dilatation, and 4 cases with valvular disease. No symptom for coronary artery dilation and all of coronary dilatation were detected by echocardiography. Manifestations of extracardiac vascular involvement included arteriovenous wall thickness and thrombosis. Five cases had only arterial involvement and one case had both artery and vein involvement. Pulmonary artery was involved in 1 case. All of them were treated with glucocorticoid and immunosuppressant, 1 child was treated with TNF-α, and 1 received aortic valvuloplasty due to a large number of aortic regurgitations. The patient with coronary aneurysm died suddenly after giving up treatment, and the other 4 cases were all improved to varying degrees. Vascular involvement is an important factor affecting the prognosis of Behcet's syndrome. Patients with coronary involvement are occultic and difficult to diagnose. Both arteries and veins can be involved, and some patients have severe symptoms. Clinicians should attach great importance to early vascular screening, especially coronary artery. Early combined medication may help improve the prognosis. Key Points • Vascular involvement is an important factor affecting the prognosis of Behcet's syndrome. • Coronary involvement in BS is rare in children, which is predominantly coronary dilatation. • The onset of BS with coronary involvement is insidious and easy to be missed, so early coronary artery screening in children with BS should be emphasized. • Early combined medication may help improve the prognosis of BS with coronary involvement.

An Umbrella Literature Review on Aortopathy and Fluoroquinolone Use

Background: Aortic dissection and aortic rupture are critical vascular events often predisposed by aneurysmal dilation of the aorta. The use of fluoroquinolone has been associated with aortic dissection and aortic rupture, necessitating a careful clinical review before use. Despite black box warnings, fluoroquinolones continue to be one of the commonly prescribed antibiotics. Critical care providers, specifically those who work in close association with high-volume aortic centers, can play an active role in antibiotic stewardship in the use of fluoroquinolones in patients with a known or predisposition to aortopathy. Aim: This paper provides a brief review of the potential effects of fluoroquinolones on the development of aortic aneurysm, dissection, and or rupture and the cautions to be exercised when using fluoroquinolones, especially in people who are predisposed to developing aortopathies. Methods: A rapid umbrella review was conducted on the effects of fluoroquinolones on aortopathy and the potential for acute aortic events associated with their use. The PICO (Population, Intervention, Comparator, Outcome) strategy coined the research question. It is as follows: In patients with known aortopathy or a known risk of aortopathy, what are the risks of an acute aortic event from taking fluoroquinolones compared to other antibiotics? A meta-analysis was done with selected studies utilizing a random effects model (utilizing Statsdirect software), which showed a pooled effect that favored the association of fluoroquinolones with aortopathy. Findings: Meta-analysis results showed a pooled effect that favored the association of fluoroquinolones with aortopathy. Discussion: Fluoroquinolone use potentiates the risk of developing aortic aneurysm and aortic dissection. Despite published evidence and warnings from manufacturers and regulatory bodies, fluoroquinolone use continues to be a covert contributor to the development of aortopathy. Conclusion: The literature reports multiple instances of fluoroquinolone-induced aortopathy. As such, fluoroquinolones should be reserved for use in situations where their benefits clearly outweigh the risks.

The impact of initial vascular morphology on outcomes in patients with intracranial vertebral artery dissection presenting with isolated headache.

The prognosis of isolated headache intracranial vertebral artery dissection (iVAD) without subarachnoid hemorrhage (SAH) or stroke is unknown. The authors of this study aimed to evaluate isolated headache iVAD prognosis. This is a single-center retrospective study of consecutive patients who presented with headache as their main complaint and underwent MRI between November 2016 and August 2022; those with acute isolated headache iVAD who were followed up for vascular morphological stability were eligible for study inclusion. The patients were divided into three groups based on the vascular morphology at initial diagnosis: aneurysm dilatation without stenosis (group 1), aneurysm dilatation with stenosis (group 2), and no aneurysm dilatation (group 3). Prognosis, time to radiological stability, and final vascular morphology were compared among the groups. One hundred five patients with isolated headache iVAD were included in the study. During a median follow-up of 478 (IQR 143-1094) days, none of the patients developed SAH or stroke, but 3/41 (7%) patients in group 1 underwent endovascular intervention for aneurysm enlargement. Patients in group 1 required significantly more long-term follow-up for morphological stability (p = 0.013), primarily due to aneurysm enlargement (p < 0.001), and were more likely to require surgical intervention (p = 0.043) than those in the other two groups. Residual aneurysm risk was significantly associated with initial vascular morphology in group 1 (OR 7.28, 95% CI 2.30-23.1, p < 0.001). Most patients with isolated headache iVAD had a favorable prognosis. However, patients with aneurysm dilatation without stenosis required the most careful follow-up, as this group had the highest aneurysm enlargement risk from early disease onset through the chronic phase. In such cases, patients may require surgical intervention to prevent critical conditions.

SOX17 - Associated Pulmonary Hypertension in Children: A Distinct Developmental and Clinical Syndrome

ObjectiveTo characterize clinical, hemodynamic, imaging, and pathologic findings in children with pulmonary arterial hypertension (PAH) and variants in SOX17, a novel risk gene linked to heritable and congenital heart disease-associated PAH. Study designWe assembled a multi-institutional cohort of children with PAH and SOX17 variants enrolled in the Pediatric Pulmonary Hypertension Network (PPHNet) and other registries. Subjects were identified through exome and PAH gene panel sequencing. Data were collected from registries and retrospective chart review. ResultsWe identified 13 children (8 female, 5 male) aged 1.6 to 16 years at diagnosis with SOX17 variants and PAH. Seven patients had atrial septal defects (ASD) and two had patent ductus arteriosus. At diagnostic cardiac catheterization, patients had severely elevated mean pulmonary artery pressure (mean 78, range 47-124 mmHg) and markedly elevated indexed pulmonary vascular resistance (mean 25.9, range 4.9-55 WU*m2). No patients responded to acute vasodilator testing. Catheter and CT angiography imaging demonstrated atypical pulmonary artery anatomy including severely dilated main pulmonary arteries, lack of tapering in third and fourth order pulmonary arteries, tortuous ‘corkscrewing’ pulmonary arteries, and abnormal capillary ‘blush.’ Several children had pulmonary artery stenoses and two had systemic arterial abnormalities. Histologic examination of explanted lungs from three patients disclosed plexiform arteriopathy and extensive aneurysmal dilation of alveolar septal capillaries. ConclusionsSOX17-associated PAH is a distinctive genetic syndrome characterized by early onset severe PAH, extensive pulmonary vascular abnormalities, and high prevalence of congenital heart disease with intracardiac and interarterial shunts, suggesting a role for SOX17 in pulmonary vascular development.

Rasmussen's Aneurysm: A Rare Cause of Massive Hemoptysis in Pulmonary Tuberculosis

Rasmussen's aneurysm is a rare cause of hemoptysis in patients with tuberculosis. It is an under-recognised vascular complication of active pulmonary tuberculosis, with a mortality rate of over 50%. It is secondary to an aneurysmal dilatation of the pulmonary artery adjacent to tuberculous cavity. Thoracic CT angiography is the gold standard for making a positive diagnosis and precising the hemorrhagic site, with a mapping of the pulmonary artery damage. Rupture of the artery can cause massive hemoptysis, which can sometimes be devastating. It is important to remember that hemoptysis persists despite successful bronchial artery embolisation in all patients with tuberculosis.

Predicting outcomes of unruptured intracranial artery dissection with clear symptoms onset using clinical and radiological features

We investigated the clinical and radiologic predictors of unruptured symptomatic intracranial artery dissection (IAD) outcomes. Unruptured symptomatic IAD patients who underwent vessel wall magnetic resonance imaging (VW-MRI) and time-of-flight magnetic resonance angiography (TOF-MRA) within 1 month after symptom onset, followed for over 12 months were included. Baseline features predicting the clinical outcome of recurrent symptoms and radiologic outcomes of aneurysmal dilatation and occlusion were analyzed using logistic regression analysis. The Kaplan–Meier method calculated the median time to morphological stability. Patients with aneurysmal dilatation were categorized into progressive and non-progressive enlargement subgroups. Seventy-three IADs from 65 patients were included. All patients showed benign clinical course (mRS 0–1). No baseline features were predictive of recurrent symptoms. Aneurysmal dilatation was associated with increased outer diameter in baseline VW-MRI (OR, 23.15; 95% CI, 3.78–141.75, P < 0.001) and TOF-MRA (OR, 10.81; 95% CI, 2.16–53.99, P = 0.004). Occlusion was inversely associated with preserved patency in baseline VW-MRI (OR, 0.1; 95% CI, 0.01–0.74, P = 0.024) and TOF-MRA (OR, 0.14; 95% CI, 0.02–0.98; P = 0.048). The median time to morphological stability was 3.9 months (95% CI, 3.16–5.5). While baseline features did not significantly differ between aneurysmal dilatation subgroups, follow-up imaging revealed significant differences in remodeling index, normalized wall index, relative signal intensity of intramural hematoma, and presence of onion-skin appearance and intramural hematoma (all P < 0.05). Our findings suggest that while unruptured IAD presents a benign clinical outcome, follow-up imaging may be necessary to monitor the progressive enlargement of aneurysmal dilatation.

Diffuse large B-cell lymphoma of the ileum: A case report highlighting diagnostic imaging and surgical intervention

Abstract: Gastrointestinal (GI) lymphoma, a form of extranodal variant of non-Hodgkin lymphoma (NHL), poses diagnostic challenges due to its nonspecific symptoms. Constituting 30%–40% of extranodal NHL cases, GI lymphomas frequently involve the stomach, small bowel, and ileocecal region. Diffuse large B-cell lymphoma (DLBCL) is noted as the predominant form of extranodal NHL. This report describes the diagnostic imaging and surgical intervention in an unusual occurrence of ileal DLBCL in a man aged 60. Initial ultrasound and subsequent comprehensive evaluation using contrast-enhanced computed tomography showed extensive ileal wall thickening, aneurysmal dilatation in the affected segment, a few enlarged pelvic lymph nodes, and heterogeneously enhancing deposits in the mesentery. The surgical intervention included right hemicolectomy and ileocolic anastomosis, revealing a 10-cm ileal mass and the mesenteric deposit. Histopathological analysis identified high-grade B-cell NHL, suggestive of DLBCL-germinal center subtype.

Successful treatment of large hemoptysis and pseudoaneurysm of the pulmonary artery associated to oesophagomediastinal fistula with amphotericin B cholesterol sulfate complex: A case report.

Oesophagomediastinal fistula is uncommon. Oesophageal fistulas, may manifest as recurrent pneumonias. While pulmonary infections can lead to pulmonary artery pseudoaneurysms (PAPs), particularly in fungal infections. PAPs pose a rupture risk, potentially causing life-threatening hemoptysis. We report a unique case of a 45-year-old male who presented with sudden cough, dyspnea, and hemoptysis. Bronchoscopy triggered massive hemoptysis, necessitating emergency embolization. Persistent hemoptysis prompted further imaging, revealing an aneurysmal dilation located next to the spine and infectious lesions, suggesting an oesophagomediastinal fistula. After initiating therapy with Amphotericin B Cholesterol Sulfate Complex and fistula closure, the patient's hemoptysis resolved, with imaging resolution of the PAP. Long-term Voriconazole therapy ensured continued improvement. This case highlights the rarity and severity of such fistulas may be associated with fungal infections and PAPs, emphasizing the importance of prompt recognition, aggressive treatment for favourable outcomes.

Numerical investigation on the impact of different coronary aneurysms morphologies on thrombus formation and hemodynamics: a comparative study.

Coronary artery aneurysms (CAAs) are morphologically classified as saccular and fusiform. There is still a great deal of clinical controversy as to which types of CAA are more likely to cause thrombosis. Therefore, the main objective of this study was to evaluate the trend of thrombus growth in CAAs with different morphologies and to assess the risk of possible long-term complications based on hemodynamic parameters. Utilizing computed tomography angiography (CTA) data from eight healthy coronary arteries, two distinct morphologies of coronary artery aneurysms (CAAs) were reconstructed. Distribution of four wall shear stress (WSS)-based indicators and three helicity indicators was analyzed in this study. Meanwhile, a thrombus growth model was introduced to analyze the thrombus formation in CAAs with different morphologies. The research results showed the distribution of most WSS indicators between saccular and fusiform CAAs was not statistically significant. However, due to the presence of a more pronounced helical flow pattern, irregular helical flow structure and longer time of flow stagnation in saccular CAAs during the cardiac cycle, the mean and maximum relative residence time (RRT) were significantly higher in saccular CAAs than in fusiform CAAs (P < 0.05). This may increase the risk of saccular coronary arteries leading to aneurysmal dilatation or even rupture. Although the two CAAs had similar rates of thrombosis, fusiform CAAs may more early cause obstruction of the main coronary flow channel where the aneurysm is located due to thrombosis growth. Thus, the risk of thrombosis in fusiform coronary aneurysms may warrant greater clinical concern.

Tetralogy of Fallot With Absent Pulmonary Valve Syndrome: The Experience of a Tertiary Care Center in a Developing Country.

Tetralogy of Fallot with an absent pulmonary valve is a very rare variant of tetralogy. It is characterized by absent valve tissue, severe pulmonary regurgitation, and secondary aneurysmal dilatation of the pulmonary arteries. In this study, we aim to investigate the clinical presentations, management strategies, and outcomes of patients with tetralogy of Fallot and absent pulmonary valve. We retrospectively reviewed the charts of all patients who presented to the American University of Beirut Medical Center between January 2010 and December 2020 and who were diagnosed with this anomaly. A total of 300 cases of tetralogy of Fallot were identified, of which 18 patients had absent pulmonary valves. They were followed up for an average of 8.2 years. Prenatal diagnoses were made in four patients, while 13 patients were identified in the neonatal period, with an average age of 4.5 days. Genetic testing confirmed DiGeorge syndrome in one patient. Five patients underwent surgical intervention in the neonatal period, while the remaining patients were operated on during their early childhood. While overall there were no surgical mortalities nor any need for reinterventions, a variety of morbidities were encountered. This study provides an overview of this rare anomaly and its management in a developing country.

Morphological rationale for surgical treatment of patients with true splenic artery aneurysm

Aim. To study the morphological features of the wall structure of the splenic artery aneurysm in order to identify the safest and most effective method of surgical treatment.Materials and methods. From 2020 to 2023, 43 patients underwent surgery for true splenic artery aneurysm. Interventions involved laparoscopic clipping of aneurysm branches, laparoscopic resection of aneurysm, laparoscopic splenectomy, and resection of giant splenic artery aneurysm. A clinical and morphological study of 16 slides of splenic artery aneurysm was performed. The aneurysm wall and the adjacent wall of the splenic artery without macroscopic signs of lumen dilatation for 1 cm from the aneurysmal dilatation were examined.Results. Microscopic study revealed fragments of loose, edematous wall of large elastic arteries with atherosclerosis, atheromatosis and calcification. Atherosclerotic plaques were observed in the intima; calcium deposits were detected in 81.25% of slides, and defects in elastic fibers – in all slides. The elastic membrane was thinned or had a discontinuous structure. Morphological changes in the wall of the splenic artery persisted up to 1.0 ± 0.2 cm proximal and distal to the aneurysm.Conclusion. Taking into account the revealed features of the morphological structure of the aneurysm, the formation of an end-to-end vascular anastomosis of the splenic artery, clipping or suturing of the aneurysm neck pose a significant risk of aneurysm recurrence. Laparoscopic clipping of splenic artery aneurysm branches at a distance of &gt;1.5 cm from the edges of the aneurysm becomes the operation of choice for patients in this category.

Assessing abdominal aortic aneurysm growth using radiomic features of perivascular adipose tissue after endovascular repair

ObjectivesThe study aimed to investigate the relationship between the radiomic features of perivascular adipose tissue (PVAT) and abdominal aortic aneurysm (AAA) growth after endovascular aneurysm repair (EVAR).MethodsPatients with sub-renal AAA who underwent regular follow-up after EVAR between March 2014 and March 2024 were retrospectively collected. Two radiologists segmented aneurysms and PVAT. Patients were categorised into growing and non-growing groups based on volumetric changes observed in two follow-up computed tomography examinations. One hundred seven radiomic features were automatically extracted from the PVAT region. Univariable and multivariable logistic regression was performed to analyse radiomic features and clinical characteristics. Furthermore, the performance of the integrated clinico-radiological model was compared with models using only radiomic features or clinical characteristics separately.ResultsA total of 79 patients (68 ± 9 years, 89% men) were enroled in this study, 19 of whom had a growing aneurysm. Compared to the non-growing group, PVAT of growing AAA showed a higher surface area to volume ratio (non-growing vs growing, 0.63 vs 0.70, p = 0.04), and a trend of low dependence and high dispersion manifested by texture features (p < 0.05). The area under the curve of the integrated clinico-radiological model was 0.78 (95% confidence intervals 0.65–0.91), with a specificity of 87%. The integrated model outperformed models using only radiomic or clinical features separately (0.78 vs 0.69 vs 0.69).ConclusionsHigher surface area to volume ratio and more heterogeneous texture presentation of PVAT were associated with aneurysm dilation after EVAR. Radiomic features of PVAT have the potential to predict AAA progression.Clinical relevance statementRadiomic features of PVAT are associated with AAA progression and can be an independent risk factor for aneurysm dilatation to assist clinicians in postoperative patient surveillance and management.Key PointsAfter EVAR for AAA, patients require monitoring for progression.PVAT surrounding growing AAA after EVAR exhibits a more heterogeneous texture.Integrating PVAT-related features and clinical features results in better predictive performance.Graphical

Ruptured coronary sinus aneurysm in pregnancy combined with cardiogenic shock and elevated V1 and aVR ST segments: Case report.

Sinus of Valsalva aneurysm (SOVA), a rare cardiac malformation, is usually congenital and rarely acquired and most commonly occurring in the right coronary sinus. The clinical presentation of patients with SOVA varies. It is usually asymptomatic when it has not ruptured, and when it compresses neighboring structures or ruptures, it can lead to heart failure or shock, at which point urgent surgical intervention is usually required. Rupture of the sinus of Valsalva aneurysm (RSOVA) during pregnancy is really hard to come by, especially if the clinical presentations resemble that of an acute myocardial infarction. This report describes a pregnant woman with severe chest pain and hypotension with aVR and V1 ST-segment elevation due to RSOVA. Effects of RSOVA on the fetus, disease survival, and prognosis. RSOVA. Open SOVA repair. The patient's blood pressure returned to normal range and clinical symptoms disappeared after the surgery. After 3 months of follow-up, the patient was hemodynamically stable without chest discomfort, and an echocardiogram showed a normal aortic sinus. Progressive aneurysm dilatation or rupture has a poor prognosis. A thorough history and physical examination are fundamental, with echocardiography being the initial diagnostic tool of choice, and other ancillary tests (e.g., computed tomography) being used to complement and confirm the diagnosis. Surgery remains the current treatment of choice for patients with RSOVA, while the continuation of pregnancy in pregnant patients with RSOVA remains a case-by-case measure.