Arteriovenous Aneurysm Research Articles

Arteriovenous aneurysm of the occipital artery

We report an unique case of a giant aneurysm of the occipital artery, with a venous connection to the transverse sinus via an emissary vein. Because of this connection, the term arteriovenous aneurysm is used.

Intramuskuläres Hämangiom der Rachenhinterwand. Diagnose und Differentialdiagnose

We report on the case of a seven-year old boy who developed an enlarged swelling of the oropharynx. Clinical examination revealed a well demarcated cystic tumour. Histopathologically the diagnosis of an intramuscular haemangioma could be made because of the multitude of vascular spaces filled with erythrocytes lying between bundles of smooth muscles. Such a lesion coming from the posterior wall of the oropharynx is not described in literature. In differential diagnosis the angiosarcoma and the arteriovenous aneurysm must have been involved since there were multiple arteries and veins lying close together in couples. Moreover the adenotomia carried out one and a half year earlier prompted us to think about the possibility of a traumatic arteriovenous fistula.

Posterior Fossa Venous Angioma – Can it be Resected?: Review of the Literature through a Case Report

Posterior Fossa Venous Angioma – Can it be Resected?: Review of the Literature through a Case Report

Intraoperative uses of ultrasound in the pediatric neurosurgical patient.

Ultrasound imaging has become a common method for intraoperative evaluation of the central nervous system. Real-time monitoring aids in guidance for aspiration of fluid collections and placement of catheters as well as the localization and evaluation of masses, and confirmation of their complete removal. Color Doppler is useful in the evaluation of blood flow in arteriovenous malformations, aneurysms, and neoplasms. Consultation among the ultrasound staff, neuroradiologists, and neurosurgeons before the operative procedure maximizes the usefulness of ultrasound, thus aiding in the success of surgery.

Cerebrovascular disease in Saudi Arabia.

We studied the pattern and outcome of strokes in 200 Saudi patients. Cerebral infarction constituted 87% of strokes, subarachnoid hemorrhage 4.5%, cerebral hemorrhage 6.5%, and venous infarction 2%. The vessel most commonly involved was part or all of the middle cerebral artery, constituting 52% (90) of the 174 arterial infarcts. Lacunar infarcts were seen in 21% (37) of the patients with arterial infarcts. Among all 200 patients, 8% died and 8% had secondary generalized seizures. Hypertension occurred in 41% of the 174 patients with arterial infarcts and 62% of the 13 with cerebral hemorrhages. The highest incidence of hypertension as a risk factor was among those with lacunar infarcts (81%), ganglionic cerebral hemorrhages (80%), and infarcts of deep branches of the middle cerebral artery (57%). Embolic infarcts due to rheumatic heart disease constituted 11% of all arterial infarcts. We conclude that our pattern of strokes is similar to that of the west rather than that of the Japanese, but with less frequent arteriovenous malformations and aneurysms.

Microsurgical treatment of arteriovenous malformations of the brain in a defined population

During the 10-year period from 1980 to 1989, 90 patients with cerebral arteriovenous malformations were seen at our institution. Two patients with large hematomas were moribund at admission, and no treatment was possible. Of the remaining 88 patients, nine were treated conservatively. Of these, six were too old and debilitated to undergo operations (the arteriovenous malformation was operable in four, inoperable in two), and three refused surgery. Of the 79 patients treated surgically, four died (5%) (three due to late rebleeding) and four are severely disabled (5%). The remaining 71 patients are functionally independent (90%). Microneurosurgery has made possible the excision of 90% of arteriovenous malformations; however, their surgery still remains a challenge for the neurosurgeon. The annual incidence of active arteriovenous malformation surgery was 0.9/100,000/year, and the ratio of arteriovenous malformation surgery to cerebral aneurysm surgery was 1 : 11. A few surgeons specializing in the surgery of arteriovenous malformations and aneurysms should be available in every country.

Orbital Varix Thrombosis

Venous disease of the orbit is a rare occurrence which can become manifest in a variety of ways including an arteriovenous aneurysm or fistula, a cavernous sinus or superior ophthalmic vein thrombosis, and an orbital varix, with and without thrombosis. Three patients had proptosis due to orbital varix thrombosis. The onset, degree of pain, and presence of diplopia were all variable. In two of three patients, computed tomographic (CT) scans showed lesions reminiscent of cavernous hemangiomas. The clinical, radiographic, surgical, and histopathologic features of this entity are described and discussed and a hypothesis is proposed to explain the pathophysiology of orbital varix thrombosis.

Interventionskardiologie im Kindesalter

Interventional heart catheterizations are catheterizations for a therapeutic purpose. The widest spread example is the balloon atrioseptostomy (BAS) according to Rashkind, which is performed in patients with transposition of the great arteries preceding interatrial corrective surgery, in patients with right-sided valve atresias and interatrial obstruction and in patients with complex mitral atresia. In 248 BAS, performed within 20 years we observed 26 (= 10.5%) minor and 3 (= 1.2%) lethal complications. When the BAS is ineffective or the atrial septum very muscular, the Park-blade-septostomy may be performed, provided corrective surgery is out of question. intravasal foreign bodies, e.g. catheter fragments can be extracted without harm and risk by the Dotter retriever. This prevents grave complications. Arteriovenous aneurysms, coronary fistulas or aortopulmonary collaterals can be embolized by steel coils, detachable balloons or Ivalon particles. With increasing frequency patent ducts, seldom also atrial or ventricular septal defects are closed by means of the Rashkind occluder. Balloonvalvuloplasty (BVP) of pulmonary or aortic stenosis became generally accepted. In cooperative studies of the German Society of Pediatric Cardiology in 305 BVP's of pulmonary stenosis 4% complications with one late death have been observed. In aortic stenosis of children early mortality was 1.6%, complication rate 20%, in the critical aortis stenosis of infants early mortality was 19%, complication rate 50%. So BVP of pulmonary and non-critical aortic stenosis may be considered as the treatment of choice, while BVP of critical aortic stenosis and other stenosis of valves or vessels has to be further evaluated.

Trigeminal Neuralgia associated with Posterior Fossa Arteriovenous Malformation and Aneurysm fed by the Same Artery

A 45-year-old male was admitted for evaluation of left facial pain of 11-years' duration. Fifteen years prior to admission, he had had an episode of subarachnoid hemorrhage. Neurological examination revealed no definite abnormalities except for trigeminal neuralgia involving the left second division of the nerve. Computed tomography scan showed an irregular enhanced lesion involving the lateral aspect of the left cerebellar hemisphere. Vertebral angiograms revealed an arteriovenous malformation (AVM) fed by both the dilated left anterior inferior cerebellar (AICA) and superior cerebellar arteries (SCA) and draining into the superior petrosal and transverse sinuses via three enlarged draining veins. A saccular aneurysm was incidentally visualized at the proximal portion of the dilated AICA. The AVM was successfully extirpated through the left retromastoid craniectomy. The trigeminal nerve was directly compressed both rostrally and caudally at its entry zone by two dilated feeding arteries of the SCA and the AICA. The aneurysm was simultaneously obliterated. The postoperative course was uneventful, and the excruciating facial pain completely subsided. Postoperative angiograms confirmed disappearance of both the AVM and the aneurysm. Posterior fossa AVMs causing trigeminal neuralgia in the literature are reviewed, and the association of the AVM and the aneurysm in the posterior fossa is also discussed.

Spontaneous Rupture of the Kidney: Case Report and Review of the Literature

Spontaneous Rupture of the Kidney: Case Report and Review of the Literature

Labetalol to Control Blood Pressure After Cerebrovascular Surgery

Fifteen patients who had undergone neurovascular surgery for arteriovenous malformations or cerebrovascular aneurysms and had intracranial pressure (ICP) monitors were studied. The patients had been treated initially with sodium nitroprusside to maintain their arterial BP in a prescribed range, but, because of excessive nitroprusside dose requirements, they were considered either to have refractory BP or to be at risk for thiocyanate toxicity. Intravenous labetalol therapy was started either by frequent bolus pulse therapy every 1 to 2 h or by continuous infusion therapy. The degree of desired arterial BP control and the effects on ICP and cerebral perfusion pressure (CPP) were assessed and compared with the results during nitroprusside therapy. The degree of arterial BP control with labetalol was assessed to be good; 11 patients were weaned off nitroprusside and the remaining four patients had a substantial reduction in their nitroprusside requirements, needing an average of only 1.5 micrograms/kg.min of nitroprusside to control their BP compared with average requirements of 10 micrograms/kg.min of nitroprusside before labetalol therapy. Labetalol therapy improved CPP in six patients and ICP in five patients, with no significant change in cerebral pressure in the remainder. Overall, the CPP in the 15 patients improved from 63 +/- 15 (SD) mm Hg with nitroprusside to 65 +/- 10 mm Hg with labetalol therapy and the ICP decreased from 11.3 +/- 6.1 mm Hg with nitroprusside to 8.6 +/- 3.1 mm Hg with labetalol therapy (p less than .05 by Wilcoxon matched pairs).(ABSTRACT TRUNCATED AT 250 WORDS)

Alexis Carrel and the early days of tissue transplantation

Alexis Carrel (1873-1944) , the French-born sur geon and scientist is now rightl y given his place as the pioneer of surgical methods of organ transplantation: he has not lacked recent biographers.l- Th e extent to which he anticipated modern organ transplantation technique and his remarkable insight into transplantation biology has made his work seem visionary, and an isolated individual effort. His writings on broader issues have added to this reputation. Closer examination of Carrel and his work in the context of his times shows a different and more complicated story. Marie Joseph August Carrel (Fig.I-1) was born on 28 June 1873 near Lyon in France. His father died when he was 5 years old and Carrel then took his father's name-Alexis. After a conventional schooling, at which he did not excel, he graduated in medicine at Lyon in 1893, and then commenced surgical training there. During the early part of this training Carrel published conventional papers on arterio-venous aneurysm and on the new operation of gastro-enterostomy. In 1900 he obtained an MD degree with a thesis on thyroid cancer, an interest of Professor Jaboulay, the Head of Department. Jaboulay had also an interest in vascular surgery and had already published a paper, with Briau, describing the successful suturing of the divided donkey carotid artery, using everting interrupted silk sutures. There had been other earlier successful papers on such methods of vascular surg ery , notably Eck's junction of the portal vein and vena cava, and a number of reports had described experimental suturing of lateral injuries of arteries. II These methods had increasingly used fine round-bodied needles and fine silk using continuous or interrupted suturing passing through all the coats of the vessel. The most det ailed of these reports is that of Dorfler in 1899, which can perhaps be taken as the origin of the modern method.'? However, without anticoagulation, even these sound methods had a high failure rate, and it was to be expected that alternative methods were experimented with. From 1900there was a short period of enthusiasm for Payr's alternative method using magnesium rings as a stent over which the vessels were drawn and tied . The first experimental kidney transplant, carried out by Ullmann in Vienna in 1902, used Payr's tubes.'?

The ultrastructure of experimental aneurysms in rabbits

The fine structure of tissue from 6 berry aneurysms, 7 saccular aneurysms and 2 fusiform aneurysms produced by microvascular surgery in rabbits was examined. The rabbits were maintained on a stock diet and sacrificed from 3 mth to 3 yr 10 mth postoperatively. The aneurysmal walls exhibited thickening of the intimal type with progressive destruction of normal architecture and degenerative and necrotic changes in the smooth muscle cells. Thickening, lamination, redundancy, reticulation and separation of basement membranes about muscle cells and an abundance of matrix vesicles and cell debris were prominent features. In several aneurysms, extracellular lipid, cholesterol clefts and lipophages were observed and fibrin was found in 4 aneurysmal walls. These vascular lesions evinced remarkable similarity to the degenerative changes in experimental arteriovenous aneurysms, human cerebral aneurysms and spontaneous atherosclerosis.

Digital Subtraction Angiography

Digital subtraction angiography (DSA) is an alternative method for imaging the cerebral vasculature. Intravenous DSA is used primarily for evaluating the common carotid bifurcation. The superior image quality of arterial DSA makes it more suitable for studying intracranial arteriovenous malformations, aneurysms, and tumor circulation.

CT in the diagnosis of cerebral vascular malformations.

In 72 patients with spontaneous intracranial haemorrhage and vascular malformation, 27 of 49 arterial aneurysms were diagnosed by CT (the smallest one of 4mm diameter being stalked), as were all (18) of the arteriovenous aneurysms (angiomas), but of the venous malformations (5) only 2 (aneurysms of the vein of Galen) were so diagnosed. In the 25 patients with spontaneous subarachnoid haemorrhage, in whom vascular malformation had not been diagnosed through angiography or CT, CT showed the position and extent of the parenchymatous lesion or the existence of blood in the subarachnoid space or ventricules. Finally, in 15 patients with subjective or neuropsychiatric disturbances, 9 arterial and 6 arteriovenous aneurysms were diagnosed by CT and were verified by angiography, which would probably not have been performed if CT had not been performed. Thus it is clear that vascular malformations are often diagnosed by CT. In many cases information is revealed which would not be suspected with angiography, while in other cases angiography is more selective and accurate.

Intracranial arteriovenous malformations and aneurysms in childhood and adolescence.

Clinical data of 19 arteriovenous malformations (AVM) and 15 aneurysms (AN) are presented. Combined clinical, neurophysiological and neuroradiological follow-up studies have been carried out on the surviving patients (14 AVM and 10 AN). Two patients with multiple AN had coarctation of the aorta. Three AVM of the Vein of Galen showed typical symptoms within the 1st year of life, all other lesions became evident later than 5 years of age. In the acute phase of the disease clinical history and neurological deficits of AVM and AN tend to be very similar. Subarachnoid hemorrhage with or without intracranial hematoma is the most frequent initial symptom. A CT scan is valuable as a first orientating investigation but morphology and operability of the vascular lesion is only demonstrated by angiography. The prognosis of AVM and AN is promising as soon as the first critical period has been survived. AVM patients show significantly less severe residual neurological and psychiatric defects than AN cases. EEG-follow-up studies and CT scans are helpful for controlling residual functional and morphological cerebral damage in survivors.

Therapeutic Embolization of the Kidney with Detachable Silicone Balloons

AbstractDetachable silicone balloons were used for therapeutic renal artery embolization in 14 patients. Hematuria was controlled by occlusion of the arteriovenous fistulas in 6 patients and aneurysms in 3. The method was used for preoperative occlusion of the renal artery in 4 patients with renal cell carcinoma and for renal ablation in an attempt to cure hypertension in 1 additional patient.Detachable silicone balloons offer a safe and precise method for the occlusion of traumatic arteriovenous fistulas and aneurysms of the renal artery branches. Although balloon embolization also can be applied to the preoperative occlusion of renal neoplasms the conventional embolization techniques using absorbable gelatin sponge and coils are equally effective with less expense. No complications were observed in our 14 patients.

Arteriovenous aneurysm of the mandible: Report of a case

An arteriovenous aneurysm of the mandible in a 10-year-old boy presented as a pulsating epulis associated with slight intraoral bleeding. A few hours after the child was admitted to the hospital, there was a massive spontaneous hemorrhage which was successfully arrested by ligation of the external carotid artery. Rapid regression and recalcification of the lesion have followed this preliminary procedure which, unexpectedly, has proved in this case to be the best form of definitive treatment. A review of the literature concerning the treatment of this rare lesion is given.

Segmental renal autotransplantation in a patient with a single kidney affected by arteriovenous malformation and aneurysm

A 24 year old man with severe renovascular hypertension was diagnosed as having an arteriovenous malformation of the left kidney with an aneurysm of the renal artery 12 years after right nephrectomy. Surgical reconstruction proved unsuccessful, but subsequent autotransplantation of the lower segment of the kidney 18 hours later saved the patient. He made an excellent recovery and is now normotensive and able to lead a normal life.

Ultrasonic imaging and tissue characterization of liver metastases: 1000 cases, 3 years follow-up

The deleterious influence of arteriovenous fistulas upon the heart was first demonstrated by Reid1 in a series of interesting survival experiments on animals. Following the production of large arteriovenous communications in dogs, cardiac hypertrophy and dilatation and the evidence of myocardial insufficiency developed. This investigation was prompted by Reid's clinical experience with patients with arteriovenous aneurysms. In two such cases cardiac hypertrophy and dilatation had been noted by Osler and Halsted, but no causal relationship was considered.The present knowledge of the pathological physiology associated with such fistulas is in large measure due to Reid2, Holman3, Lewis and Drury,4 but certain of the phenomena associated with this interesting condition are still incompletely understood.The results of the study of this case added a new observation to the published data regarding arteriovenous aneurysms. In general, our findings are in accord with the excellent clinical and experimental work of Holman, but differ in several respects from the investigations of Lewis and Drury.