Aneurysm Of Sinus Research Articles

Treatment of traumatic lesions of popliteal artery by staged stretching

Objective To investigate the clinical effects of treating traumatic lesions of the popliteal artery by staged stretching. Methods From July 2011 to March 2016, 29 patients with traumatic lesion of the popliteal artery underwent staged stretching after direct end to end anastomosis at Department of Or-thopaedics, The 9th People’s Hospital of Wuxi. They were 19 males and 10 females, with a mean age of 38.3 years (range, from 16 to 61 years). The average length of popliteal artery lesions was 3.7 cm (range, from 2 to 5 cm). After the keen joint was immobilized at flexion by external fixation, direct end to end anastomosis was performed with a proper segmental vascular freedom. From 4 weeks after operation, the popliteal artery was stretched stage by stage to its original length by gradual adjustment of the external fixation till the knee joint was fully extended. The color, skin temperature, pulp tension and capillary reaction of the toes were closely observed after surgery. CT angiography (CTA) was performed 6 months after surgery. The active range of motion was assessed at 12 months after surgery for the knee and ankle joints on the injured limb. Results All the patients were available for an average follow-up of 2 years (range, from 1 to 3 years). Blood supply was good for all the affected limbs. The staged stretching of the popliteal artery resulted in no rupture of any anastomotic stoma or no thrombus. CTA at 6 months after surgery showed fine patency of the popliteal artery and no formation of false aneurysm or arteriovenous fistula. At 12 months after surgery, the knee function was excellent in 15 cases, good in 10 and fair in 4; the ankle function was excellent in 18 cases, good in 8 and fair in 3. Conclusion Staged stretching is a safe, convenient and effective treatment of traumatic lesions of the popliteal artery. Key words: Popliteal artery; Knee injuries; Ankle injuries; Staged stretching

Two Cases of Valsalva Sinus Aneurysm with Rupture into the Right Atrium

Two Cases of Valsalva Sinus Aneurysm with Rupture into the Right Atrium

Лечение аневризмы левого синуса вальсальвы с фистулой в левое предсердие, коарктацией аорты и дефектом межпредсердной перегородки

Лечение аневризмы левого синуса вальсальвы с фистулой в левое предсердие, коарктацией аорты и дефектом межпредсердной перегородки

Чрескожное закрытие прорыва аневризмы синуса вальсальвы у пациентов после открытых кардиохирургических вмешательств

Чрескожное закрытие прорыва аневризмы синуса вальсальвы у пациентов после открытых кардиохирургических вмешательств

Abstract 17265: Comparing Ultrasound Guided and Conventional Method of Venipuncture for Electrophysiological Procedures: A Meta-Analysis

Introduction: There has been steady increase in the number of catheter ablations for the definitive management of atrial fibrillation and it is associated with its own complications with vascular complications being the most common. There are many studies comparing Ultrasound (US) guided versus Conventional Method (CM) of venipuncture for complications as these patients are on therapeutic anticoagulation. We conducted a meta-analysis to look for any difference between the two approaches. Methods: PubMed, Medline, EMBASE and Cochrane databases were analyzed from inception to January 2018 for all studies comparing US vs CM for venipuncture in patients undergoing catheter ablation. Four observational studies and one Randomized Controlled Trial (RCT) with 5158 patients were studied for major and minor vascular complications. Major vascular complications included hematoma/major bleeding (more than or equal to BARC2), AV fistula and pseudo aneurysm. Random effect model was used to estimate the odds ratio of dichotomous outcomes Results: Major and minor vascular complications were significantly less with US guided approach as compared to conventional approach {Odds Ratio (OR): 0.36, 95% CI 0.21-0.61, P=0.0002} and {Odds Ratio (OR): 0.30, 95% CI 0.15-0.64, P=0.002} respectively. Conclusion: Real time ultrasound use for venipuncture access is safer approach with significantly lesser vascular complications in patients with atrial fibrillation on anticoagulation undergoing catheter ablation.

Patients' wishes, pregnancy and vascular access: When one size does not fit all.

Pregnancy in dialysis patients is a rare but important event that challenges our knowledge and demands re-thinking many aspects of our practice, including vascular access. This editorial briefly discusses some open questions on vascular access in this situation that challenge the motto 'fistula first' and underline the need for personalised approaches. Information on vascular access in pregnant women is scant. Different approaches may be considered between women on dialysis already on a well-functioning tunnelled catheter and newly placed catheters: while a tunnelled catheter in a woman already stabilised on outpatient dialysis, who has shown being able to take correct care of it and who has freely chosen this option, is a reasonable choice, central venous catheters placed during pregnancy, especially in the hospital setting, may have a high risk of complications. Conversely, pregnancy may increase the risk of development of fistula aneurysms, but the frequency of this complication is still unknown. The problem of whether or not shifting pregnant patients on peritoneal dialysis to daily haemodialysis sessions is still open, as well as the role of patients' preference for avoidance of an invasive procedure, or refuse of pain. In the wait for answers, reflecting on the problems encountered by pregnant women on dialysis should make us reflect on how to improve vascular access management for all our patients.

A case of reptured aortic sinus aneurysm into left ventricle diagnosed by cardiac magnetic resonance

A case of reptured aortic sinus aneurysm into left ventricle diagnosed by cardiac magnetic resonance

Surgical interventions for autogenous arteriovenous fistula aneurysms in hemodialysis patients

Objectives. The aim of this study was to emphasize the importance of surgical intervention perfotmed before development of arteriovenous fistula (AVF) aneurysm complications. Methods. The patients were categorized into two groups: Patients undergoing elective surgery for autogenous AVF aneurysm were defined as elective group (Group 1), whereas those who underwent emergency surgery due to ruptured aneurysmal fistulas were defined as emergency group (Group 2). All elective cases were evaluated by doppler ultrasonography before surgery. All patients had temporary hemodialysis catheters. In the patients with salvaged fistulas, the fistulas was rested for 1 week. A new fistula was created in patients with not salvaged fistula. Results. A total of 31 patients (54.8% male, mean age: 41.2 ± 14.7 years) were in Group 1 and 7 patients (57.1% male, mean age: 53 ± 9.4 years) were in Group 2. Significant difference was observed between two groups in terms of fistula preservation. Salvaged fistulas were significantly higher in the Group 1 than Group 2 (p = 0.003). In Kaplan-Meier curves, cumulative primary AVF patency rates at 1, 3 and 6 months were 96.3%, 81.5%, and 77.8% in Group 1 and 66.7%, 66.7%, and 66.7% in Group 2, respectively (log-rank; p = 0.536). Conclusions. Consultation of these cases with a cardiovascular surgeon before they reach the rupture stage is an important condition for both the patency of the fistula and the vital risk of the patient.

Application of Combined Special Staining in the Observation of Vascular Pathology

Objective To evaluate the value of combined special staining technique in observing pathological changes in blood vessels. Methods Totally 999 vascular specimen were harvested from patients with complete medical records,clear diagnosis,and age≥18 years in the Pathology Department of Beijing Anzhen Hospital from January 2014 to September 2017.All specimen were stained with HE,Verhoef-Van Gieson,AB/PAS,and Masson. Then,the result of HE staining was compared with that of the combined special staining (Verhoef-Van Gieson,AB/PAS,and Masson).Results HE staining only showed a small amount of elastic fiber fracture. In contrast,the combined special staining clearly showed the pathological changes including fractures,decreased elastic fibers,and aggregation of extracellular mucous matrix. Diseases in these 999 patients included aneurysm of sinus of valsalva (SVA) (n=3),aortic root aneurysm (ARA) (n=177),thoracic aortic aneurysm (TAA) (n=78),abdominal aortic aneurysm (AAA) (n=17),total thoracoabdominal aortic aneurysm (tTAAA) (n=32),and aortic dissection (AD) (n=692). The median scores of combined special staining of SVA (Z=3.857,P=0.040),ARA (Z=14.307,P=0.000),TAA (Z=26.939,P=0.000),AAA (Z=22.412,P=0.000),tTAAA (Z=15.926,P=0.000),and AD (Z=39.213,P=0.000) were significantly higher than that of HE staining. Conclusion The combined Verhoeff-Van Gieson,AB/PAS,and Masson special staining is an effective technique for observing pathological changes of elastic fibers and mucus in blood vessels.

Portal vein aneurysm associated with arterioportal fistula after hepatic anterior segmentectomy: Thought-provoking complication after hepatectomy

BackgroundFew cases of postoperative arterioportal fistula (APF) have been documented. APF after hepatectomy is a very rare surgery-related complication.Case presentationA 62-year-old man was diagnosed with hepatocellular carcinoma in segments 5 and 8, respectively. Anterior segmentectomy was performed as a curative surgery. Each branch of the hepatic artery, portal vein, and biliary duct for the anterior segment was ligated together as the Glissonean bundle. The patient was discharged on postoperative day 14. Three months later, dynamic magnetic resonance imaging showed an arterioportal fistula and portal vein aneurysm. Surprisingly, the patient did not have subtle symptoms. Although a perfect angiographic evaluation could not be ensured, we performed angiography with subsequent interventional radiology to avoid sudden rupture. Arteriography was immediately performed to create a portogram via the APF from the stump of the anterior hepatic artery, and portography clearly revealed hepatofugal portal vein flow. Portography also showed that the stump of the anterior portal vein had developed a 40-mm-diameter portal vein aneurysm. Selective embolization of the anterior hepatic artery was accomplished in the whole length of the stump of the anterior hepatic artery, and abnormal blood flow through the APF was drastically reduced. The portal vein aneurysm disappeared, and portal flow was normalized. Dynamic computed tomography after embolization clearly demonstrated perfect interruption of the APF. The patient maintained good health thereafter.ConclusionsPost-hepatectomy APFs are very rare, and some appear to be cryptogenic. Our thought-provoking case may help to provide a possible explanation of the causes of post-hepatectomy APF.

OP-391 - Catheter Ablation for Wolff Parkinson White Syndrome with Coronary Sinus Aneurysm

A 48 year old man was admitted to our hospital because of palpitations and deterioration in exercise capacity. Transthoracic echocardiography was performed and showed normal function. Electrocardiogram (ECG) showed pre-excitation, which was manifested by a shortened PR interval (< 120 ms), a widened QRS (> 100 ms), and a negative delta wave (abnormal initial QRS vector) in D2, D3 and aVF and left axis deviation (Panel A). With the present ECG findings, accessory pathway were considered to be the septal wall of the right atrium and radiofrequency ablation was decided. A decapolar catheter was positioned in the coronary sinus (CS) and a 7 French ablation catheter with a 4 mm tip electrode (The RF Marinr™ MC catheter, USA) was introduced via the right femoral vein and placed septal wall of the right atrium. Applications of RF energy (50W at 700°C) delivered in the septal wall of the right atrium failed to eliminate the accessory pathway (Panel B). The ECG was evaluated again and the accessory pathway was thought to be of epicardial origin because of that CS venography was performed and it demonstrated coronary sinus aneurysm (Panel C). The ablation catheter was repositioned on aneurysm and recorded an early atrial signal representing activity (Panel D). Ablation in this area achieved successful abolition of ventriculoatrial conduction via an accessory pathway (Panel E). After the procedure, ECG showed that the delta wave had disappeared and provided normal sinus rhythm (Panel F).

Treatment of arteriovenous fistula aneurysms in hemodialysis patients and introduction of Tan-Gor skin flap technique

Treatment of arteriovenous fistula aneurysms in hemodialysis patients and introduction of Tan-Gor skin flap technique

Endovascular Treatment of Pulsatile Tinnitus by Sigmoid Sinus Aneurysm: Technical Note and Review of the Literature

Pulse-synchronous tinnitus is rare, and it almost always points toward a vascular pathology. We encountered a 56-year-old patient presenting with a 3-month history of right-side tinnitus who was found to have a sigmoid sinus aneurysm after initial imaging. The patient was managed successfully with dual endovascular access and stent placement across the aneurysm, with a subsequent complete symptomatic relief. Description of the endovascular management of sigmoid sinus aneurysm is not infrequent in the literature. This report provides a brief review of the available literature specifically addressing the management strategies.

Characteristic Echocardiographic Manifestations of Behçet's Disease

The objective of this study was to determine the characteristic echocardiographic manifestations of Behçet's disease. Ninety-seven Behçet's patients admitted to our hospital from January 2002 to December 2016 were retrospectively analyzed. There were 63 patients (64.9%) with cardiac involvement; these included 47 men (74.6%) and 16 women (25.4%). Of these 63 patients, most (74.6%) exhibited valvular lesions, especially aortic regurgitation. The primary characteristic manifestations of valves were cusp prolapse with aneurysmal changes, vegetation-like lesions and echo-free spaces within the annulus. Second (30.0%) were aortic lesions, including aortic dilation or aneurysm formation, aortic pseudoaneurysm and coronary sinus aneurysm. Other manifestations, such as cardiac thrombosis, coronary arterial pseudoaneurysm, pulmonary aneurysm and pericardial effusion, were rare. Cardiac involvement is not uncommon in Behçet's patients, especially in males, and it is characterized by valvular disease, especially aortic regurgitation. The diagnosis of Behçet's disease should be considered when evaluating patients with these characteristic echocardiographic manifestations.

Эндоваскулярная окклюзия прорыва аневризмы левого синуса Вальсальвы через 45 лет после пластики аневризмы правого синуса

Эндоваскулярная окклюзия прорыва аневризмы левого синуса Вальсальвы через 45 лет после пластики аневризмы правого синуса

Clinical profile of refractory intradialytic hypertension due to a giant AV fistula

An arteriovenous fistula (AVF) aneurysm extending from the cubital region to the clavicle over the left arm which presented with interdialysis hypertension and high-output cardiac failure showing a reduction of blood pressure and improvement of ejection fraction after the construction of a new AVF in the other arm.

Coronary Sinus Aneurysm: Incidental discovery during coronary artery bypass grafting

Coronary Sinus Aneurysm: Incidental discovery during coronary artery bypass grafting

Transesophageal Echocardiogram as a Diagnostic Tool for Cardioembolic Cerebrovascular Event Secondary to Thrombus into Valsalva Sinus Aneurysm

Se presenta el caso de una paciente femenina de 54 anos de edad remitida para la realizacion de un ecocardiograma transesofagico por sospecharse evento cerebrovascular cardioembolico secundario a fibrilacion auricular, en el estudio se documento una masa de aspecto quistico en aspecto posterior de la raiz aortica, trabeculada, con flujo dinamico y la presencia de trombos en su interior ademas esclerosis valvular aortica con insuficiencia leve sin estenosis, valvula mitral engrosada con aspecto reumatico con insuficiencia leve, hipertrofia concentrica severa del ventriculo izquierdo con hipoquinesia leve generalizada FEVI 48% y derrame pericardico circunferencial de aprox. 80 ml sin repercusion hemodinamica, no trombos en auriculilla izquierda, se considero aneurisma de seno de Valvalva, la paciente fue llevada a correccion quirurgica en donde se confirma hallazgo de seno de Valsalva con flujo a traves de un orificio de la comisura hacia seno de Valsalva derecho sin comunicacion con la auricula derecha, 12 dias posterior a la cirugia la paciente es egresada sin complicaciones cardiovasculares para continuar con rehabilitacion por secuelas del evento cerebro vascular. El aneurisma de senos de Valsalva es un hallazgo raro encontrandose entre el 0.14- 0.35% de pacientes sometidos a cirugia cardiaca con una prevalencia en la poblacion de 0.09%. La presentacion clinica puede ser desde asintomatica a causar disnea, dolor toracico, simular infarto del miocardio o incluso endocarditis. La correccion quirurgica cuando se presenta el aneurisma sin otras comorbilidades es baja con sobrevida de 94% en 10 anos.

A case of successful surgical treatment of infected false aneurysms of the coronary artery after previous stenting

This article presents a case of surgical treatment of a false aneurysm and coronary-left atrial fistula developed after balloon angioplasty and stenting of the circumflex artery. The percutaneous coronary intervention has also led to the development of infective endocarditis of the mitral valve. So far, no descriptions of such complications have been met both in domestic and world literature. This unique clinical case could be useful for novice endovascular surgeons, while experienced cardiovascular surgeons might make use of it when choosing the tactics of surgical treatment.Received 18 September 2017. Revised 13 December 2017. Accepted 15 December 2017.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsI.I. Skopin, P.V. Kakhktsyan were involved in choosing tactics of the surgical treatment. I.I. Skopin revised the article. P.V. Kakhktsyan performed the surgery, searched the literature. G.G. Aleksanyan is the physician, collected data for the article.

Surgical interventions for arteriovenous fistula aneurysms: Our single-center experience

Surgical interventions for arteriovenous fistula aneurysms: Our single-center experience