Bilateral Aneurysms Research Articles

Analysis of the Surgical Efficacy and Risk Factors of a One-stage Unilateral Approach for Clipping Bilateral MCA Mirror Aneurysms.

Numerous microsurgical approaches are available for treating middle cerebral artery (MCA) mirror aneurysms. However, a definitive conclusion regarding which approach yields the best outcome has yet to be reached. Thirty-three patients with MCA aneurysms were categorized into 2 groups: one-stage unilateral approach and other surgical approaches. Prognostic differences were compared using the Modified Rankin Scale (mRS). In addition, the length of hospital stay and costs were also compared. Among the patients with a proposed preoperative one-stage unilateral approach, they were divided into success and failure groups, and these factors were collected, including Hunt-Hess grade, contralateral aneurysm orientation and maximum diameter, contralateral A1+M1 length, and contralateral ICA bifurcation angle. These parameters were analyzed using multivariate logistic regressions to identify the risk factors. The prognosis of patients in the one-stage unilateral approach group did not differ significantly from that of other surgical approaches. However, patients in the one-stage unilateral approach group experienced shorter hospital stays and incurred lower hospital expenses. In the multivariate regressions, the length of the contralateral A1+M1 was identified as an independent risk factor. The one-stage unilateral pterional approach for clipping bilateral aneurysms is an effective method of treating MCA mirror aneurysms. However, in cases where patients have an excessive length of A1+M1 on the contralateral side, this approach may result in surgical failure.

Tocilizumab may not be a good option for vascular involvement due to Behçet's syndrome.

Tocilizumab has been increasingly reported as an alternative therapeutic agent in the management of Behçet's syndrome (BS) and it has been mostly tried in BS patients with neurological and eye involvement. As therapeutic responses to each drug may vary across different types of BS involvement, we aimed to report seven patients with large vessel involvement treated with tocilizumab. We enrolled seven BS patients with vascular involvement who were given tocilizumab at the Behçet's Disease Research Centre in Istanbul University-Cerrahpaşa between 2000 and 2022. Demographic information, BS features, types of vascular involvement, previous and concomitant medications, C-reactive protein (CRP) levels, imaging modality results, and outcomes were documented from the patients' medical records. Within a median of 6 months after the initiation of tocilizumab, 5 patients experienced vascular relapses. These relapses included the emergence of new bilateral pulmonary artery aneurysms, a new pulmonary artery thrombus, parenchymal lung involvement, deep vein thrombosis in the lower extremity, and pseudotumor cerebri in one patient each. CRP levels were normal in 4 of the 5 patients at the time of vascular relapse. One of these 5 patients and another patient with aortitis had an exacerbation of mucocutaneous symptoms. In the last patient, venous ulcers did not respond to tocilizumab and were complicated with infection. Tocilizumab could potentially exacerbate vascular manifestations, similar to what is observed with mucocutaneous lesions in BS patients. Furthermore, CRP levels appear to be ineffective in monitoring these patients.

Successful treatments of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome-related macular edema and exudation by intravitreal aflibercept injection in a senile patient: A case report.

The prevalence of idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is <1/1,000,000, and it tends to occur in young women. Panretinal photocoagulation, focal laser photocoagulation, peripheral cryopexy, vitrectomy, and corticosteroid therapy are the traditional treatments. We reported a case of a senile patient with IRVAN syndrome who presented with severe exudation in both eyes and macular edema in the left eye, successfully treated by serial intravitreal aflibercept injections. A 77-year-old Taiwanese woman complained of progressive blurred vision in the left eye and ocular examinations revealed a visual acuity of 20/125 in the left eye. Indirect fundoscopy and fluorescein angiography showed bilateral multiple aneurysms, vasculitis, optic nerve staining, and neovascularizations. In addition, optical coherence tomography demonstrated macular edema with subretinal fluid and exudations in the left eye. Monthly intravitreal injections of antivascular endothelial growth factor with aflibercept 2.0 mg were administered in the left eye. The visual acuity in the left eye improved to 20/50 after 18 months of treatment. Macular edema and subretinal fluid regressed. Furthermore, vessel leakage and optic disc staining also improved. This case is the first to demonstrate successful treatment of IRVAN syndrome-related central macular edema and exudations, in the absence of neovascularization, using a series of intravitreal aflibercept injections as monotherapy.

Rapidly Enlarged Bilateral Isolated Internal Iliac Artery Aneurysms Associated With Systemic Lupus Erythematosus

Rapidly Enlarged Bilateral Isolated Internal Iliac Artery Aneurysms Associated With Systemic Lupus Erythematosus

Silent Aortic Valve Perforation in a Patient with S. Salivarius Infective Endocarditis

Streptococcus salivarius is a commensal bacterium of the oral and gut flora and is rarely implicated in infective endocarditis (IE). Herein, we present a case of a 69-year-old male who presented with fatigue, weight loss, and no fever, ultimately diagnosed with IE complicated by severe aortic regurgitation. Initial investigations revealed leukocytosis, anemia, hyperkalemia, and elevated troponins. Imaging studies revealed bilateral common iliac artery aneurysms and atrophic kidneys with renal cysts. Transthoracic and transesophageal echocardiograms revealed mobile aortic vegetation, severe aortic regurgitation, and valve perforation. Blood cultures identified Streptococcus salivarius/vestibularis. The patient underwent aortic valve replacement, resulting in clinical improvement and negative blood cultures. The discussion highlights the rarity of S. salivarius causing IE and emphasizes the challenges in management, including the need for timely surgical intervention and multidisciplinary care in complicated IE cases. This case underscores the importance of considering atypical pathogens in IE and the complexities involved in its diagnosis and management. Further research is warranted to elucidate such cases' clinical implications and optimal management strategies.

Endovascular Aneurysm Repair (EVAR) in Rupture of the Infrarenal Abdominal Aortic Aneurysm (AAA) with Severe Neck Angulation in Conscience of National Health Coverage in Tertiary Referral Hospital in Indonesian: Case Report

AbstractAn aortic aneurysm is a condition with focal dilation of 50% or more over the normal aortic diameter. The most frequent form of aortic aneurysms is infrarenal. Endovascular aortic aneurysm repair is a valid treatment for treating patients with abdominal aortic aneurysm. Abdominal aortic aneurysms (AAAs) are electively repaired to prevent rupture. We present a case of an elderly man with an impending rupture of intraluminal infrarenal AAA with bilateral common iliac arteries aneurysms. Overall, the patient had completed the procedure and made a good postoperative recovery with fully coverage of Indonesian national health insurance.

Endovascular repair of bilateral common iliac artery aneurysms using intraoperative positioning system

Intraoperative positioning system (IOPS; Centerline Biomedical, Inc) is a novel technology that allows for real-time intravascular navigation of endovascular devices using an electromagnetic field. In this report, we describe the use of IOPS for effective treatment of bilateral common iliac artery aneurysms with endovascular aortoiliac repair using iliac branch endoprostheses. Our experience suggests that this technology has the potential to reduce radiation and contrast use in endovascular procedures, although its application is currently limited. To the best of our knowledge, this is the first reported case of bilateral internal iliac cannulations for iliac branch endoprosthesis placement using IOPS.

Bilateral giant coronary aneurysms with cardiogenic shock

Bilateral giant coronary aneurysms with cardiogenic shock

Complex retrograde transarterial access and embolization of a giant internal iliac artery aneurysm after occlusion failure of Micro vascular plug (MVP) embolization and preceding EVAR in the distal ectatic Aorta and bilateral iliac artery aneurysms

The therapy of pelvic aneurysms is minimally invasive through interventional radiology using various devices and embolic agents: &#x0D; 1. By using a covered stent/prosthesis to maintain antegrade flow when a landing zone, i.e., a&#x0D; vascular segment angiographically present into which the stent can be placed to bridge the neck of the aneurysm, thereby interrupting aneurysm perfusion. &#x0D; 2. Through complete embolization of the aneurysm using embolic agents/coils. &#x0D; 3. As performed in our case, by covering the aneurysm (Img 14 A-C) with a covered stent /prosthesis, following prior embolization of the branching vessels using macroembolic agents. In cases where there is insufficient occlusion of the aneurysm with residual perfusion, secondary em- bolization becomes considerably more complex due to the occlusion of the anatomically antegrade access and the altered hemodynamics around the aneurysm causing retrograde collateralization. Through detailed analysis of CT angiography, even in static CT, retrograde circulation could be iden- tified, allowing for a minimally invasive secondary approach to the aneurysm without the need for general anesthesia and/or surgery. By completely eliminating the aneurysm, the risk of rupture in the elderly patient was minimally invasively eliminated. The treatment of this patient exemplifies the possibilities that embolization with a wide array of embolic agents and catheters offers in a hemo- dynamically very complex situation.

Co-prevalence of arterial aneurysm location - a correlation analysis based on a retrospective cross-sectional observational study.

Background: The aim of this retrospective single-centre cross-sectional observational study was to investigate co-prevalence of arterial aneurysm location systematically. Patients and methods: Patients with the diagnosis of any arterial aneurysm from January 2006 to January 2016 were investigated in a single centre. Patients with hereditary disorders of connective tissue, systemic inflammatory disease, or arterial pathologies other than true aneurysms were excluded. Aneurysm locations were assessed for every patient included. For patients with at least two co-existing aneurysms, co-prevalence of aneurysm location was investigated by calculating correlation coefficients and applying Fisher's exact test. This study report is prepared according to the STROBE statement. Results: Of 3107 identified patients with arterial aneurysms, 918 were excluded. Of the remaining 2189 patients, 951 patients with at least two aneurysms were included in the study. Bilateral aneurysm combinations of paired iliac, femoral and popliteal arteries showed the highest correlation (ϕ=0.35 to 0.67), followed by bilateral combinations of subclavian (ϕ=0.36) and internal carotid (ϕ=0.38) arteries. Abdominal aortic aneurysms in combination with visceral artery aneurysms (ϕ=-0.24 to -0.12), popliteal arteries (ϕ=-0.22) and the ascending aorta (ϕ=-0.19) showed the lowest correlation, followed by the descending aorta in combination with the common iliac arteries (ϕ=-0.12 to -0.13). Conclusions: In our study sample, aneurysm co-prevalence was highly non-random. This should be considered in the context of aneurysm screening programs.

Bilateral Eggshell-like Internal Iliac Artery Aneurysms.

Bilateral Eggshell-like Internal Iliac Artery Aneurysms.

Evaluation of associations between outflow morphology and rupture risk of abdominal aortic aneurysms

PurposeThis study aimed to evaluate the association between the outflow morphology and abdominal aortic aneurysm (AAA) rupture risk, to find risk factors for future prediction models. Materials and methodsWe retrospectively analyzed 46 patients with ruptured AAAs and 46 patients with stable AAAs using a 1:1 match for sex, age, and maximum aneurysm diameter. The chi-square test, paired t-test, and Wilcoxon signed-rank test were used to compare variables. Logistic regression was performed to evaluate variables potentially associated with AAA rupture. Receiver operating characteristic curve analysis and the area under the curve (AUC) were used to assess the regression models. ResultsRuptured AAAs had a shorter proximal aortic neck (median (interquartile range, IQR): 24.0 (9.4–34.2) mm vs. 33.3 (20.0–52.8) mm, p = 0.004), higher tortuosity (median(IQR): 1.35 (1.23–1.49) vs. 1.29 (1.23–1.39), p = 0.036), and smaller minimum luminal area of the right common iliac artery (CIA) (median (IQR): 86.7 (69.9–126.4) mm2 vs. 118.9 (86.3–164.1)mm2, p = 0.001) and left CIA (median(IQR): 92.2 (67.3,125.1) mm2 vs. 110.7 (80.12, 161.1) mm2, p = 0.010) than stable AAA did. Multiple regression analysis demonstrated significant associations of the minimum luminal area of the bilateral CIAs (odds ratio [OR] = 0.996, 95 % confidence interval [CI] 0.991–0.999, p = 0.037), neck length (OR = 0.969, 95 % CI 0.941–0.993, p = 0.017), and aneurysm tortuosity (OR = 1.031, 95 % CI 1.003–1.063, p = 0.038) with ruptured AAAs. The AUC of this regression model was 0.762 (95 % CI 0.664–0.860, p < 0.001). ConclusionsThe smaller minimum luminal area of the CIA is associated with an increased risk of rupture. This study highlights the potential of utilizing outflow parameters as novel and additional tools in risk assessment. It also provides a compelling rationale to further intensify research in this area.

Internal iliac debranching in combination with abdominal aortic stent graft to treat bilateral common iliac aneurysms

Introduction&#x0D; Common iliac artery aneurysms are often diagnosed during routine screening for infrarenal abdominal aortic aneurysms. Preserving the internal iliac artery helps avoid colonic ischemia and buttocks claudication. Hybrid surgery combining internal iliac artery transposition and endovascular treatment is a method with good early and long-term results.&#x0D; Methods&#x0D; We report of a case of bilateral common iliac artery aneurysm treated by hybrid surgery and endovascular intervention at Dong Nai General Hospital&#x0D; Results&#x0D; A 69 year-old male, diagnosed with bilateral common iliac artery aneurysm and left internal iliac artery occlusion. Surgical transposition was performed to repimplant the right internal iliac artery into the right external iliac artery, folowed by endovascular treatment, the right branch of the graft was placed at the external iliac artery, the left branch of the graft was placed at the common iliac artery. Postoperative condition was stable, no early complications recorded&#x0D; Conclusion&#x0D; Hybrid surgery to treat iliac aortic aneurysms and common iliac artery aneurysms has quite good mid- and long-term results. The initial successful implementation of this technique at Dong Nai General Hospital contributes to team development, reduces the load on central hospitals and brings practical benefits to patients.

A Case of Behcet's Disease with Bilateral Pulmonary Artery Aneurysm

A Case of Behcet's Disease with Bilateral Pulmonary Artery Aneurysm

Left Main Coronary Artery and Bilateral Mammary Artery Aneurysms in a Patient With Extensive Aortopathy.

Left Main Coronary Artery and Bilateral Mammary Artery Aneurysms in a Patient With Extensive Aortopathy.

Bilateral Renal Artery Aneurysm: Clinical Case Report

Introduction: Renal artery aneurysms are rare vascular anomalies and even more exceptional is they are located in both renal arteries in this case. The literature reports an approximate occurrence of 0.01 to 0.09 in the general population. Its appearance predominates in the female gender and the most common location is in the right renal artery. The peak age of occurrence is between 40 and 60 years. Its physiopathology is generally caused by inflammatory processes and muscular fibrodysplasias; however, when they are intraparenchymal, they are associated with congenital collagenopathies or polytraumatisms. Clinical case: 74-year-old male patient with a personal history of Parkinson's disease, adrenocortical adenoma and diverticulosis. During the study of his basic pathology, a simple and contrast angiography of the abdomen was performed, after the verification of his renal function, which was within normal ranges (urea 44.4 mg/dl, creatinine 1.04 mg/dl). The presence of images suggestive of aneurysms in the left renal arteries was reported as an incidental finding, therefore he was referred to the Department of Angiology and Vascular Surgery. The clinical case was discussed by the medical staff of the Department of Angiology and Vascular Surgery, concluding that the rare bilateral renal artery aneurysm pathology does not meet criteria for open or endovascular surgery, therefore it is indicated to continue regular monitoring to determine possible growth and intervention in case of risk of rupture. Conclusions: With the development of imaging techniques, the incidental finding of renal artery aneurysm is going to be more and more frequent. The presence of symptoms is also fundamental in making decisions regarding the need for surgery. In asymptomatic patients, non-aggressive treatment is recommended; however, the clinical evaluation of each patient should be individualized.

Abstract 101: Ophthalmic Artery Aneurysm Embolization Resulting in Resolution of Headaches and Visual Symptoms

Introduction Cerebral aneurysms are a rare cause of headaches and visual symptoms. Most common locations include anterior communicating artery, internal carotid arteries (ICAs), middle cerebral arteries, and tip of the basilar artery. While most unruptured aneurysms are asymptomatic, when symptoms do occur, they are most often headaches, cranial nerve palsies, or bilateral temporal hemianopsia due to compression of surrounding nerves or the optic chiasm. Rarely, thrombus formation within an aneurysm can lead to symptoms via distal embolization and infarction. The literature is limited regarding repeated aneurysmal microembolism formation or transient alterations in blood flow dynamics leading to episodic symptoms. Methods We report the case of a 55 year‐old woman with Ehlers‐Danlos syndrome and syringomyelia who presented to the hospital with one week of intermittent left eye visual disturbances, characterized by either complete transient monocular vision loss or blurriness lasting for 30 seconds at a time and occurring multiple times per day. These symptoms were also associated with pressure‐like headaches that originated around the left eye and radiated to the left side of her head. Results Neurological and ophthalmological examinations were notable for normal cranial nerve function, including intact visual acuity, visual fields, color vision and extraocular movements in each eye. On a dilated fundoscopic exam, there were no retinal or optic disc abnormalities. The rest of the neurological exam was normal. Head and neck CTA and subsequent digital subtraction angiography (DSA) showed multiple bilateral ICA aneurysms, as well as a 4 millimeter left ophthalmic artery aneurysm. Brain and orbits MRI with contrast showed no acute abnormalities, including no evidence of infarction or intracranial hemorrhage. She was started on clopidogrel due to concern for recurrent retinal transient ischemic attacks as well as escalating doses of nortriptyline for empiric treatment of possible ocular migraines. In follow‐up three months later, she continued to have the same visual and headaches symptoms. She underwent a successful elective flow diversion embolization of the ophthalmic artery aneurysm with subsequent resolution of her symptoms Conclusion Here we describe a case of a patient who presented with episodic monocular vision changes and headaches ipsilateral to an ophthalmic artery aneurysm, who experienced complete resolution of these symptoms following flow diversion embolization of the aneurysm. Although the precise pathophysiological relationship between the aneurysm and her visual symptoms is unclear, potential mechanisms include aneurysmal microthrombus formation with retinal embolization and dissolution, hemodynamic retinal blood flow changes related to the aneurysm, or recurrent ocular migraines triggered by the ophthalmic artery aneurysm.

Incorporation of internal iliac arteries as target vessels during physician-modified fenestrated branched endovascular repair of pararenal abdominal aortic aneurysm with concomitant bilateral short common iliac artery aneurysms

This report describes an alternative endovascular approach to iliac branch devices for treatment of an abdominal aortic aneurysm with concomitant bilateral short common iliac aneurysms. The short distance between the renal arteries and internal iliac artery origins made the addition of distal iliac branch devices to the proximal fenestrated stent graft challenging. We elected to perform physician-modified fenestrated branched endovascular repair, using four fenestrations for the visceral and renal arteries and an additional two directional branches for the bilateral internal iliac arteries. The patient recovered uneventfully, and the 24-month follow-up imaging shows successful aneurysm exclusion with patent internal iliac artery branches.

Clipping of Bilateral Ophthalmic Artery Aneurysms Through a Single Craniotomy.

Bilateral ophthalmic aneurysms are rare and involve two aneurysms in the ophthalmic arteries, one on each, leading to potential symptoms such as vision loss and headaches. The treatment options for aneurysms, ranging from surgery and endovascular embolization to observation, depend on various factors, including aneurysm size and the patient's health.Microsurgery, while presenting complexities due to the intricate anatomy of the anterior clinoid region, offers potential advantages such as enhanced decompression rates and reduced aneurysm recurrence. The presented surgical video illustrates the treatment of bilateral ophthalmic artery aneurysms via a single craniotomy. This method reduces surgical duration and trauma, facilitating quicker patient recovery. However, this method bears potential risks, especially to both optic nerves. As underscored in the video, the utmost anatomical understanding in the anterior clinoid area is pivotal for successful outcomes and reduced complications.

Recurrent events of acute coronary syndrome in young adult patients after Kawasaki disease.

I encountered three adult patients with major coronary artery occlusion after Kawasaki disease in childhood, who had developed again acute coronary syndrome of adults in the peripheral branches, such as the 4thsegments, the atrioventricular node artery, and the posterior descending artery, of the right coronary artery. I reviewed their clinical course and coronary angiograms. Their age at onset of acute coronary syndrome ranged from 29 to 33 years. The male patient with a previous anteroseptal myocardial infarction in children had a symptomatic occlusion of the branch of the 4thposterior descending artery at 32 years of age. Acute coronary syndrome occurred in the area of 4thatrioventricular node artery in two female patients. The collateral arteries from the circumflex artery to the 4th atrioventricular node arteries were not clearly injected. It was suspected that they had developed bilateral giant aneurysms after acute Kawasaki disease. Two patients had an acute myocardial infarction due to thrombotic occlusion in a giant aneurysm of the right coronary artery or the left anterior descending artery, and one patient had an asymptomatic coronary occlusion of the right coronary artery and left anterior descending artery in children. Occlusion of peripheral coronary arteries in adulthood can occur in patients with multi-vessel disease caused by Kawasaki disease. Recurrent events of acute coronary syndrome can occur in adults, although its prevalence may be low. Carefulfollow-up in adults is also needed in this population.