Artery Aneurysm Research Articles

Brachial artery aneurysm as a late complication of arteriovenous fistula.

Brachial artery aneurysm (BAA) is a rare late complication of arteriovenous fistula (AVF). It brings the risk of peripheral embolism and hand ischemia and is defined by brachial artery diameter above 10 mm or by regional dilatation by >50%. BAA is described in the literature in closed radiocephalic arteriovenous fistulas after kidney transplantation. The aim of the study was to analyze the prevalence of BAA and of their more dangerous forms. A observational one center study performed on patients after kidney transplantation with AVF or arteriovenous graft (AVG). We invited all patients followed up for kidney transplantation in our center. Arterial diameter greater than 10 mm was considered as a brachial artery aneurysm to simplify the detection and evaluation of aneurysms. About 162 patients with AVF after kidney transplantation were examined between 4/2018 and 4/2020. Brachial artery aneurysm was detected in 34 patients (21%) with AVF or AVG, of them 7 had confirmed wall thrombi. AVF flow volume of more than 1500 ml/min increased the risk of BAA development by 4.54x. Eight aneurysms were treated surgically. After this surgery, the primary patency was 87.5% in 12 months. Brachial artery aneurysm was relatively frequent in our study compare to the literature. Aneurysm or dilatation of the brachial artery is more frequent in functional AVFs. Surgical correction is necessary in cases of complicated aneurysms to prevent distal embolization.

Abstract 10512: Sialic Acid-rich Fc Having A Strong Anti-inflammatory Effect In Kawasaki Disease Model

Introduction: Kawasaki disease (KD), which is the most common multisystem vasculitis with unknown causes in childhood, causes coronary artery (CA) aneurysms. High-dose intravenous immunoglobulin (IVIG) is the most standard treatment. However, the problem with current high-dose IVIG therapy is that it is inefficient for both patients and cost because it contains ineffective parts and requires a high total dose. It has recently been reported that sialic acid in the fragment crystallizable (Fc) region has an anti-inflammatory effect. Hypothesis: In the KD model, a small amount of sialic acid-rich (SR-)Fc has an anti-inflammatory effect equivalent to that of high-dose IVIG. Methods: A Candida albicans cell wall extract (CAWE)-induced KD-like vasculitis model was established in DBA/2 mice. IgG, antigen-binding fragment (Fab), and Fc with 2g/kg/0.5ml, and IgG, SR-IgG, and SR-Fc with 0.2g/kg/0.5ml, and placebo 0.5ml were administered intraperitoneally 3 times every other day (n=5, respectively). Four weeks after treatment, we compared the incidence of CA inflammation between each group. Histological analysis was performed by using a quantified scoring system: grade 1; <20 cells /HPF, grade 2; <100cells/HPF, grade 3; >100cels/HPF, grade 4; distraction of elastic lamina, grade 5; neointimal proliferation. Results: All five mice in placebo group had the infiltration grade 3 or higher (100%), whereas none of the mice in IgG group had the infiltration (0%). In Fab group, three out of four had the infiltration (75%, one mouse died), whereas in Fc group, only one out of five had the infiltration (20%). In one-tenth dose IgG group, two out of four had the infiltration (50%, one mouse died), whereas in one-tenth dose SR-IgG and SR-Fc group, 20% or less of them had the infiltration (one out of five, zero out of five, respectively). Treatment with one-tenth dose SR-IgG and SR-Fc significantly suppressed CAWE-induced vasculitis ( p <0.05 and 0.01, respectively). Conclusions: It was shown that the immunoglobulin effect was mainly in the Fc region and one-tenth dose SR-Fc had an anti-inflammatory effect equivalent to that of high-dose IgG in a Candida -induced KD mouse model. One-tenth doses SR-Fc may be an alternative treatment to high-dose IVIG in KD patients.

Concentric ballooned catheterization to the fractional non-newtonian hybrid nano blood flow through a stenosed aneurysmal artery with heat transfer

The current work analyzes the effects of concentric ballooned catheterization and heat transfer on the hybrid nano blood flow through diseased arterial segment having both stenosis and aneurysm along its boundary. A fractional second-grade fluid model is considered which describes the non-Newtonian characteristics of the blood. Governing equations are linearized under mild stenosis and mild aneurysm assumptions. Precise articulations for various important flow characteristics such as heat transfer, hemodynamic velocity, wall shear stress, and resistance impedance are attained. Graphical portrayals for the impact of the significant parameters on the flow attributes have been devised. The streamlines of blood flow have been examined as well. The present finding is useful for drug conveyance system and biomedicines.

Direct Carotid-Cavernous Fistula with early drainage into inferior petrous sinus

Carotid-cavernous fistulas (CCF) are classified in direct (Barrow A) and indirect. The direct comunication between the cavernous segment of the internal carotid artery and the cavernous sinus defines direct CCF. In the present case, is described a 51-year-old female patient, diagnosed with subarachnoid hemorrhage through head tomography. The patient underwent an agiographic study, wen was identified a large dissecant aneurysm in the right internal carotid artery and a direct CCF with early drainage into the ophthalmic vein and inferior petrous sinus, manifesting paralysis of the third cranial nerve.

Differential Diagnosis between Marfan Syndrome and Loeys-Dietz Syndrome Type 4: A Novel Chromosomal Deletion Covering TGFB2.

Marfan syndrome (MFS) and Loeys–Dietz syndrome type 4 (LDS4) are two hereditary connective tissue disorders. MFS displays ectopia lentis as a distinguishing, characterising feature, and thoracic aortic ectasia, aneurysm, dissection, and systemic features as manifestations overlapping with LDS4. LDS4 is characterised by the presence of hypertelorism, cleft palate and/or bifid uvula, with possible ectasia or aneurysms in other arteries. The variable age of onset of clinical manifestations makes clinical diagnosis more difficult. In this study, we report the case of a patient with Marfan syndrome diagnosed at our centre at the age of 33 on the basis of typical clinical manifestations of this syndrome. At the age of 38, the appearance of ectasia of the left common iliac artery and tortuosity of the iliac arteries suggested the presence of LDS4. Next Generation Sequencing (NGS) analysis, followed by Array-CGH, allowed the detection of a novel chromosomal deletion including the entire TGFB2 gene, confirming not only the clinical suspicion of LDS4, but also the clinical phenotype associated with the haploinsufficiency mechanism, which is, in turn, associated with the deletion of the entire gene. The same mutation was detected in the two young sons. This emblematic case confirms that we must be very careful in the differential diagnosis of these two pathologies, especially before the age of 40, and that, in young subjects suspected to be affected by MFS in particular, we must verify the diagnosis, extending genetic analysis, when necessary, to the search for chromosomal alterations. Recently, ectopia lentis has been reported in a patient with LDS4, confirming the tight overlap between the two syndromes. An accurate revision of the clinical parameters both characterising and overlapping the two pathologies is highly desirable.

Biomarkers of inflammation and fibrosis in young adults with history of Kawasaki disease.

BackgroundMyocardial histology from autopsies of young adults with giant coronary artery aneurysms following Kawasaki disease (KD) shows bridging fibrosis beyond the territories supplied by the aneurysmal arteries. The etiology of this fibrosis is unknown, but persistent, low-level myocardial inflammation and microcirculatory ischemia are both possible contributing factors. To investigate the possibility of subclinical myocardial inflammation or fibrosis, we measured validated biomarkers in young adults with a remote history of KD.MethodsWe measured plasma calprotectin, galectin-3 (Gal-3), growth differentiation factor-15 (GDF-15), soluble ST2 (sST2), and serum procollagen type 1C-terminal propeptide (P1CP) in 91 otherwise healthy young adults with a remote history of KD and in 88 age-similar, healthy controls. KD subjects were stratified by coronary artery aneurysm (CAA) status and history of remote myocardial infarction (MI).ResultsAfter correction for multiple testing, calprotectin, Gal-3, and GDF-15 levels were significantly higher in subjects with persistent CAA (n = 26) compared with KD subjects with remodeled CAA (n = 20, p = 0.005, 0.001, 0.0036, respectively). In a multivariable regression model with CA status as the main predictor and adjusting for sex, MI history, and interval from KD onset, CA status was a significant predictor (Persistent CAA vs KD Normal CA) of calprotectin, Gal-3, GDF-15 and sST2 levels (p = 0.004, <0.001, 0.007, and 0.049, respectively).ConclusionsThese results suggest that ongoing inflammation and fibrosis may be occurring in individuals with persistent CAA. Longitudinal follow-up is needed to clarify the clinical significance of these elevated biomarker levels in this patient population that requires life-long monitoring.

Reconstruction of brachial artery in posttraumatic false aneurysm

In the article were reflected important issues of ethiopathogenesis, diagnostics and treatment of false aneurysm of brachial artery. Literature view and personnel experience of authors are shown that main causes of developing false aneurysm of brachial artery are non-revealing vessels injuries due to diagnostic-treating mistakes. Despite of using modern methods of mini-invasive treatment of aneurysm treatment till now the open surgery is continued to be a gold standard. In the clinical case are shown all features of diagnostics and successful treatment of false aneurysm of brachial artery with good middle-remote results.

Management of Giant Pulmonary Artery Aneurysm with Quadricuspid Valve Stenosis

AbstractThe pulmonary artery aneurysm (PAA) is a rare disease with no well-defined guidelines about the diagnostic criteria and its management. In fact, the indications for surgical treatment and the type of surgical approach are not clear. However, in case of giant PAAs with hypertension and pulmonary valve abnormalities, surgery should be considered as an effective and safe approach to prevent dissections or ruptures. In this report, we describe a successful case of surgical repair, using a Bioconduit with a pericardial patch to recreate the pulmonary artery bifurcation in a 72-year-old male with aneurysm of the pulmonary artery (max diameter: 72 mm), associated with quadricuspid pulmonary valve stenosis and pulmonary hypertension. The procedure was uncomplicated and the follow-up computed tomography scan at 4 months showed correct positioning of the graft with no sign of contrast leakage.

The Use of Levosimendan in the Treatment of Neurogenic Stress Cardiomyopathy in a Patient with Nontraumatic Subarachnoid Hemorrhage (Case Report)

We present a case of cardiogenic shock due to neurogenic stress cardiomyopathy (NSC) in a patient with nontraumatic subarachnoid hemorrhage caused by a ruptured aneurysm of the right pericallosal artery. Due to the catecholamine-resistant shock, levosimendan was administered under advanced hemodynamic control, including transpulmonary thermodilution and echocardiography. This resulted in an improved cardiac contractility and reduced demand for catecholamines. Full stabilization of hemodynamic parameters was achieved by day 5. In the discussion section we reviewed available published case reports of using levosimendan in stress cardiomyopathy treatment.

Giant aneurysms of the distal posterior inferior cerebellar artery – systematic review

Background Posterior inferior cerebellar artery (PICA) aneurysms are uncommon and are typically found at the origin or proximal segments of the vessel. Giant aneurysms are uncommon and present unique treatment challenges. Giant distal PICA aneurysms are exceedingly rare and have traditionally been managed via open surgical approaches. Methods A total of 207 studies were assessed, identifying 26 cases of giant distal PICA aneurysms from 26 separate publications. One additional case is described followed by a review of presentation, anatomical characteristics, treatment and outcome. Results Presentation was due to local mass effect in 19 (70%), hydrocephalus in 4 (15%) and acute haemorrhage in 5 (19%). All reported cases were partially (86%) or completely (14%) thrombosed. The telovelotonsillar segment was involved in 18/24 (75%) cases. Two cases (7%) were associated with an arteriovenous malformation. Twenty-two (81%) were managed surgically and 5 (19%) managed endovascularly. Outcome was good in 22 (85%) and poor in one (4%). Conclusions Giant distal PICA aneurysms can be managed effectively through a variety of open surgical and endovascular techniques.

Ruptured arterial aneurysm in Wegener\u2019s granulomatosis: a case report

BackgroundAneurysm formation is a possible, but rare, complication of granulomatosis with polyangiitis, known as Wegener’s granulomatosis. Urgent diagnosis and therapy is very important because a ruptured aneurysm could be life threatening.Case presentationWe, therefore, present the case of a 63-year-old Greek man who was diagnosed with granulomatosis with polyangiitis and retroperitoneal hematoma due to ruptured aneurysm in renal artery and upper pancreaticoduodenal artery. His clinical course was complicated by acute renal failure and acute respiratory failure due to alveolar hemorrhage. Emergency coil embolization was performed. Postembolization recovery was uneventful; no bleeding occurred. The patient underwent mechanical ventilation and continuous veno-venous hemofiltration and received combined immunosuppression and supportive therapy, but eventually died 30 days after admission to hospital from severe septic shock and multiple organ failure.ConclusionEndovascular treatment is the therapy of choice, especially for patients with ruptured aneurysms that are hemodynamically stable. Early diagnosis is very important, as urgent embolization and early initiation of immunosuppression therapy are the treatment of choice.

Large anterior tibial artery pseudoaneurysm as a rare complication to vascular surgery

A pseudoaneurysm is a rare complication to vascular reconstruction and may be limb threatening if not treated. A patient previously treated for an aneurysm of the left popliteal artery presented to our outpatient clinic with swelling and reduced active movement. Computed Tomography Angiography revealed an 8.1 cm large pseudoaneurysm of the anterior tibial artery (ATA). The pseudoaneurysm was successfully treated with an interposition vascular graft to the patent ATA. Open surgical repair was the only option with resection of the pseudoaneurysm and insertion of an interposition vascular graft with and end-to-side anastomosis. The giant ATA pseudoaneurysm was successfully treated with insertion of a new end-to-side graft anastomosis with interposition to the old patent vascular graft.

PULMONARY ARTERY ANEURYSM- IDIOPATHIC

SUMMARY&#x0D; A 28-years old female presented with complaints of palpitations and mild retrosternal chest pain. CXR showed a prominent Pulmonary artery. A TTE study revealed a huge main pulmonary artery whereas the branches were of normal size. CT angio revealed aneurysmal main Pulmonary artery and normal sized branches. No concomitant etiology was noted, hence labelled as “idiopathic pulmonary artery aneurysm”.&#x0D; CASE DESCRIPTION&#x0D; A 28-year-old female presented with retrosternal chest pain and palpitations for the last six months. Multiple systolic clicks and murmur III/VI heard in the pulmonary area. ECG was unremarkable. Chest X-Ray showed no cardiomegaly and a prominent pulmonary artery. Transthoracic echocardiography showed aneurysmally dilated main pulmonary artery (size: 5.7cm). Pulmonary valve was thickened with mild regurgitation. CT angiogram demonstrated dilated main pulmonary artery (axial dimension: 5.8cm) with normal-sized branches (Figure1). Immunological workup was negative. She was advised surgical intervention which she agreed to pursue soon at a tertiary care hospital near her hometown.&#x0D; LEARNING POINTS&#x0D; &#x0D; Pulmonary artery aneurysm has an incidence of 1 in 14,000, (based on 109,571 autopsies).1&#x0D; The maximum normal diameter of MPA is 29mm in males and 27 mm in females. For interlobar branches the maximum size it 17 mm.2 If the size exceeds 4 cm it is “aneurysmal” which may be true of false.&#x0D; PAA could be congenital due to Eisenmenger’ syndrome, Pulmonary valve stenosis and absent pulmonary valve syndrome. Connective tissue disorders (Marfan’s syndrome, alpha-1 antitrypsin deficiency and Ehlers-Danlos syndrome) and autoimmune disorders (Behcet’s disease and Hughes-Stovin syndrome).3&#x0D; Acquired causes include PAH, auto-immune disease (vasculitis), trauma infections, malignancy and idiopathic.&#x0D; For intervention no consensus of opinion is available. However expert opinion recommends it when the patient becomes symptomatic or pulmonary artery diameter exceeds 5 cm to 6 cm.&#x0D; &#x0D; QUESTIONS WITH ANSWERS&#x0D; &#x0D; Question 1: Is there any difference in the measurement of PA size by echocardiography and CT?&#x0D; Question 2: What is the usual site of dissection in PAA?&#x0D; Question 3: In Pulmonary arterial tree what is the most frequent site of aneurysm?&#x0D; Question 4: Some cases of pulmonary artery aneurysms can be managed medically- Y/N?&#x0D; Question 5: The technique of choice for diagnosing PA aneurysm is pulmonary angiography or CT angiogram?&#x0D; &#x0D; Answers&#x0D; &#x0D; Question 1: Yes&#x0D; Question 2: Main PA&#x0D; Question 3: Right lobar artery&#x0D; Question 4: Yes&#x0D; Question 5: CT angiogram&#x0D; &#x0D; References&#x0D; &#x0D; Deterling RA Jr and Clagett OT. Aneurysm of the pulmonary artery; review of the literature and report of a case. Am Heart J. 1947;34:471-99.&#x0D; Truong QA, Massaro JM, Rogers IS, Mahabadi AA, Kriegel MF, Fox CS. Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography: The Framingham Heart Study. Circ Cardiovasc Imaging 2012;5:147-54.&#x0D; Agarwal S, Chowdhury UK, Saxena A, Ray R, Sharma S, Airan B. Isolated idiopathic pulmonary artery aneurysm. Asian Cardiovasc Thorac Ann. 2002;10(2):167-9.&#x0D;

Quantitative magnetic resonance angiography to assess post embolization hemodynamics following pipeline embolization.

Delayed intraparenchymal hemorrhage is a known complication of the Pipeline Embolization device (PED); however, its etiology is unclear and some have suggested it is a flow related phenomenon. Quantitative magnetic resonance angiography (QMRA) serves as a powerful tool to collect and analyze hemodynamic data. We report a detailed characterization of short-term hemodynamics after PED placement. Patients who underwent PED placement for a distal internal carotid artery (ICA) aneurysm between 2017 to 2019 with post embolization QMRA were reviewed. Aneurysm characteristics, flow volume rate (ml/min), mean, systolic, and diastolic flow velocities (cm/s), vessel diameter (mm), pulsatility index, Lindegaard ratio, and wall shear stress (WSS) were collected. A total of 67 patients were included. Post-procedure patients were found to have a significantly lower ICA flow on the side with flow diversion when compared to the side without flow diversion (218 vs. 236.3; P < 0.05). Average ICA flow after flow diversion for aneurysms >2 cm was significantly lower when compared to the untreated side (187.7 vs. 240.4; P < 0.05). There was no difference in MCA or ACA flow or velocity. WSS was significantly lower in the treated ICA (8.2 vs. 9.0; P < 0.05). Lindegaard ratio was not different in the treated vs. contralateral untreated sides. PED placement for distal ICA aneurysms results in lower flow, mean velocity, and WSS when compared to the contralateral untreated ICA. This is not demonstrated distal to the Pipeline device in the ACA or MCA territories. Ultimately these findings suggest hemodynamic changes are not a cause of PED complications.

Giant coronary artery aneurysms involving more than one coronary artery: case report

BackgroundCoronary artery aneurysms are rare findings in patients undergoing coronary angiography. The presence of multiple coronary artery aneurysms located in more than one coronary artery is even more uncommon. The pathophysiology of such aneurysms is unknown, but the majority are often due to atherosclerosis, congenital heart disease, or vasculitis.Case presentationWe present a rare case of a 78-year-old female patient who presented with unstable angina and non-ST segment elevation myocardial infarction. On coronary angiography, she was found to have three separate 1 cm saccular aneurysms involving the proximal left anterior descending coronary artery. The right coronary artery could not be visualized. Computed chest tomography revealed a 6.6 × 6.3 cm saccular aneurysm of the right coronary artery, and a 4.4 cm fusiform aneurysm of the ascending aorta. The patient gave no history of percutaneous coronary intervention or cardiac surgical procedures. She had a previous history of endovascular stenting of an abdominal aortic aneurysm. The sizable right coronary artery aneurysm showed extrinsic compression of both the right atrium and ventricle with right ventricular hypokinesis. Serological studies for vasculitis were all negative. Pathology of the aneurysm wall revealed calcific atherosclerosis without evidence of vasculitis. The patient underwent subtotal resection of the right coronary aneurysm with ligation of the proximal and distal ends of the right coronary artery and double bypass surgery to the left anterior descending and right posterior descending coronary arteries.ConclusionThe presence of multiple, large coronary artery aneurysms is very rare. Treatment can be challenging and should be individualized. Surgical treatment is recommended for giant coronary artery aneurysms to prevent potential complications.

Endovascular treatment of complex bifurcation aneurysms using the pConus device: clinical cases

The objective is to present the clinical experience of using the pConus stent-like device in the treatment of complex bifurcation aneurysms.Clinical cases. A 64-year-old patient was admitted with complaints of periodic headache without loss of consciousness and an increase in focal symptoms. Saccular aneurysms of the anterior communicating artery and the left superior cerebellar artery were found without signs of subarachnoid hemorrhage. For occlusion of the aneurysm of the left superior cerebellar artery (dimensions 7.4 х 5.3 mm, neck width 5.0 mm, facing left and up, body/neck ratio 1.48, the branch of the artery branched off from the neck), a pConus device (crown diameter 8 mm) was used with micro-coils.A 61-year-old patient was admitted with complaints of headache in the occipital region, accompanied by repeated vomiting and an increase in blood pressure to 200/110 mm Hg. Subarachnoid hemorrhage and a saccular aneurysm of the basilar artery bifurcation (facing up, anteriorly and somewhat to the left, measuring 4.9 x 3.4 mm, neck width 3.1 mm, dome/neck ratio 1.1) were revealed. A pConus device was used for micro-coils occlusion (4-25-6 mm).In the postoperative period, both patients did not experience an increase in focal neurological symptoms. Control angiography after 6 months confirmed stable occlusion, all major vessels were passable.Conclusion. In the described cases, there were no technical problems during the installation and implantation of the device. The use of the pConus device in the treatment of complex bifurcation aneurysms technically simplifies surgical intervention, since it does not require catheterization of the efferent vessels of the aneurysm.

Stenting of ruptured gastroduodenal artery pseudoaneurysm

Gastroduodenal artery (GDA) aneurysm is a rare surgical entity that causes various symptoms. In the case of rupture, it usually presents an ominous prognosis and mortality rate of up to 40%. Although open surgical procedure is a mainstay, endovascular intervention is emerging a promising treatment in recent years, due to its advantages and safety. We present a case of upper gastrointestinal bleeding caused by ruptured GDA pseudoaneurysmin a 71-year-old woman, with medical episodes of acute pancreatitis, a pancreatic body tumor removal surgery was performed, and now the tumor is relapsing and metastasizing. The treatment approach is blocking off the pseudoaneurysm by a covered stent. The procedure was successful and the patient is asymptomatic. Two months later, the pseudoaneurysm reduces its size and completely excluded from the preservation of the blood flow in the artery.Follow-up to 26 month, patient is well, no symptoms or recurrence. Endovascular interventional treatment in the case of GDA aneurysms is considered a promising alternative not only to open surgery but also to an effective emerging technique even in the acute setting.

Vasodilator-Stimulated Phosphoprotein to Monitor Clopidogrel Posology in a 7-Year-Old Child Stented for a Post-Traumatic Intracranial Internal Carotid Artery Aneurysm

AbstractMany pediatric medical protocols or drug posology like biantiplatelet therapy are extrapolated from adult care. This association could be indicated in specific pediatric situations such as ischemic stroke, some cardiac conditions, or to control post stent thrombosis/stenosis. If acetylsalicylic acid is commonly used, few data are available about optimal management of clopidogrel in children. We describe the case of a 7-year-old girl admitted to pediatric intensive care unit who undergoes a transitory hemiparesis after a bicycle accident. Brain magnetic resonance imaging reveals a subarachnoid hemorrhage and a wide right Sylvian arachnoid cyst. Hemorrhage predominated at the level of the optochiasmatic cistern, close to the right internal carotid artery. At the same level, angiography revealed a small aneurysm of the internal carotid artery supposed to be a postfalse traumatic aneurysm. The deployment treated this aneurysm of a flow diverter. The treatment was performed under continuous systemic heparin therapy associated with intravenous acetylsalicylic acid, and Clopidogrel was administered immediately after the procedure. An oral bi antiplatelet treatment was initiated the day 2 with acetylsalicylic acid and clopidogrel (1 mg/kg/day). To monitor clopidogrel posology, a vasodilator-stimulated phosphoprotein [VASP]) was performed. The final VASP assay result was 20% for a clopidogrel posology at 0.5 mg/kg/day. Blood pressure and neurological examination were normal during all the hospitalization. VASP assay can be used in children to define the optimal posology of clopidogrel. Further studies are required to determine an optimal initial posology.

SUPPURATION OF IATROGENIC FEMORAL ARTERY ANEURYSM

The article describes the application of methods and methods of reconstructive surgery of iatrogenic false aneurysms of the left femoral artery. Experience shows the optimality of the choice and method of surgical treatment of iatrogenic aneurysms of the femoral artery by restoring prosthetic arteries. The article presents a clinical case of surgical treatment of iatrogenic aneurysm of the left femoral artery resulting from a puncture of the left femoral artery. The elimination of the aneurysm was accompanied by plastic surgery of the defect (5–6 cm) of the left femoral artery by applying prosthetics to the vessels. The rationale for the choice of surgical intervention is given.

English

BACKGROUND The sellar and juxtasellar region is a complex area where varied pathologies can occur. Differentiation among various pathologies may not always be easy, since many of these lesions mimic pituitary adenomas on clinical presentation, endocrinologic and radiologic examinations. The study intends to describe the imaging characteristics of the spectrum of pathological conditions affecting these regions using magnetic resonance imaging (MRI). METHODS The main source of data for the study were patients from hospitals attached to Bangalore Medical College and Research Institute, Bengaluru viz. Victoria Hospital, Bowring and Lady Curzon Hospital and Vani Vilas Hospital. Patients with suspected sellar and juxtasellar pathology on clinical examination referred to the Department of Radiodiagnosis from November 2017 to May 2019 underwent MRI study using Siemens 1.5-T Magnetom Avanto MR system. Magnetic resonance imaging was done in all patients according to the pituitary protocol. RESULTS Among the 50 patients, there were 16 males and 34 females. Most of the patients were in the third to fifth decade of life. The various abnormalities on MRI included neoplastic (68 %), malformative (8 %), vascular (6 %), granulomatous, infectious and inflammatory (18 %) lesions. Pituitary adenomas (46 %) were the most common lesions in sellar and juxtasellar regions, followed by tuberculosis (10 %), craniopharyngioma (8 %), Rathke's cleft cyst (6 %), meningioma (6 %), internal carotid artery (ICA) aneurysm (4 %), epidermoid (2 %) and miscellaneous lesions. CONCLUSIONS MR imaging characteristics were sufficiently distinct to allow various sellar and juxtasellar pathologies to be differentiated from each other. The spectrum of MRI findings were related to neoplastic, malformative, infectious, inflammatory, granulomatous and vascular causes. Our study observed that MRI with appropriate imaging protocols is the essential imaging modality in evaluation of sellar and juxtasellar lesions. KEYWORDS Pituitary, Sellar, Juxtasellar, Magnetic Resonance Imaging