Bilateral Aneurysms Research Articles

Abstract 203: Long-term Outcome Of Kawasaki Disease With Giant Coronary Aneurysms Which Waste Cardiac Follow-up; A Case Report

We report 2 cases of Kawasaki disease (KD) which required surgical interventions long after initial diagnosis. Case 1: Twenty-one years-old male. He was diagnosed as KD at the age of 1. Despite he received intravenous gamma-globulin therapy, bilateral giant coronary aneurysms were formed. In addition, multiple aneurysms include abdominal, iliac and axillary arteries were formed simultaneously. Coronary angiography (CAG) was thought to be dangerous because of iliac artery aneurysm formation. He received medical follow-up with aspirin administration only. He referred to our department at the age of 13. Ischemic changes were confirmed on both treadmill exercise test and cardiac scintigraphy. CAG showed 75% right coronary artery (RCA) stenosis and 99% left main trunk stenosis. Coronary artery bypass grafting (CABG) was performed and his postoperative course has been uneventful. Case 2: Thirty-seven years-old male. He was diagnosed as KD at the age of 1. Left giant coronary aneurysms were formed and subsequently aneurysm was occluded. Aspirin was administrated, but he interrupted medication and follow-up for himself. He referred to our institution due to cardiopulmonary arrest during exercise. After successful resuscitation, CAG revealed total occlusion of RCA and 99% left coronary artery stenosis. Emergent CABG was performed and no postoperative sequel has occurred. Both cases didn’t receive sufficient assessment during the follow-up period. As a result, fatal cardiac event was occurred in case 2. Coronary aneurysm tends to change into combine aneurysmal and stenotic lesion. Long time follow up is necessary even if patients have no symptom. In addition, to decrease lost follow up patients, we should explain the risk of sudden cardiac death repeatedly and emphasis necessity of long term follow-up and medication.

Effectiveness of Exclusion of a Persistent Sciatic Artery Aneurysm with an Amplatzer™ Plug

Persistent sciatic artery is a rare developmental anomaly. In its complete form, it provides the major arterial supply to the lower leg since the femoral system is hypoplastic. These unique arteries are prone to aneurysm formation and most commonly present with complications related to aneurysm formation, which can lead to limb loss. We encountered a 68-year-old man presenting with bilateral lower-extremity ischemia who was found to have bilateral persistent sciatic artery aneurysms. One aneurysm had already thrombosed, but the other was still patent. We treated this patient with a hybrid open and endovascular repair on the patent side. The aneurysm was excluded with an Amplatzer™ plug (St. Jude Medical, Inc., St. Paul, MN) followed by a femoropopliteal bypass with saphenous vein in situ to revascularize the lower leg. To our knowledge, this is only the second report of a persistent sciatic artery aneurysm successfully treated with Amplatzer plug occlusion.

Treatment of Symptomatic Bilateral Cavernous Carotid Aneurysms: Long-term Results of 6 Cases

Bilateral cavernous carotid aneurysms (CCAs) are very rare. A treatment strategy for symptomatic bilateral CCAs has not been established because of their complex pathogenesis. Here we report our treatment strategy and long-term results for 6 cases of symptomatic bilateral CCAs. From January 2007 to December 2013, we treated 6 patients (2 men and 4 women; mean age at first treatment, 56.0 years) with symptomatic bilateral CCAs. All patients began to experience unilateral symptoms. Five of the 6 underwent high-flow bypass (HFB) with parent artery occlusion (PAO), and 1 received PAO only. Mean follow-up period after the first treatment was 61.3 months. All symptoms improved after the treatment. Five contralateral CCAs became enlarged during the follow-up period. Of these, 4 became symptomatic. One patient received superficial temporal-middle cerebral artery bypass with PAO, 2 received HFB with PAO, and 1 refused treatment. Final modified Rankin Scale scores were 0 in 4 patients, 1 in 1 patient, and 2 in 1 patient. There was no mortality in this series. HFB with PAO is feasible as the first treatment for symptomatic bilateral CCAs. This treatment strategy steadies and simplifies future treatment of contralateral CCAs should they become symptomatic.

Contralateral Approach to Internal Carotid Artery Ophthalmic Segment Aneurysms: Angiographic Analysis and Surgical Results for 30 Patients.

Contralateral aneurysm clipping can be applied to bilateral intracranial aneurysms of the anterior circulation and to selected aneurysms on the medial wall of the internal carotid artery (ICA). To identify anatomic and radiological parameters that would favor a contralateral microsurgical approach to ICA-ophthalmic segment (ICA-opht) aneurysms. For the period January 1957 to December 2012, we retrospectively analyzed 268 patients with ICA-opht aneurysms treated in our institution. Of these patients, 30 underwent a contralateral approach; 15 patients (50%) had multiple intracranial aneurysms, and 15 patients had a single aneurysm on the contralateral side of the craniotomy. Thirty saccular aneurysms located on the contralateral ICA were treated. Six aneurysms (20%) were present in patients with a subarachnoid hemorrhage due to associated aneurysms, whereas 24 aneurysms (80%) had no history of bleeding. Contralateral aneurysms were smaller than 14 mm and showed no wall irregularities, calcifications, or secondary pouches. Projections of the aneurysms were superomedial (n = 23, 77%), medial (n = 4, 13%), and superior (n = 3, 10%). The median prechiasmatic distance was 5.7 mm (range, 3.4-8.7 mm), the median interoptic distance was 10.5 mm (range, 7.6-15.9 mm), and the median distance between both ICAs was 14.7 mm (range, 10.4-21.4 mm). The contralateral approach for ICA-opht aneurysms remains a treatment option for intracranial aneurysms. Its feasibility depends on specific anatomic parameters related to the aneurysm itself and to the prechiasmatic distance, interoptic distance, and relationship of the ICA with the anterior clinoid process.

Romantic Name for a Deadly Condition: Kissing Aneurysms of the Pericallosal Artery – A Case Report

Background: Kissing aneurysms are two independent but adjacent aneurysms protruding from two contralateral arterial locations. This report describes a successfully treated case of kissing aneurysms at the Department of Neurosurgery, Medical University of Gdansk. Case: A 45-year-old asymptomatic woman was diagnosed with unruptured bilateral aneurysms located in the pericallosal-callosomarginal division. Her medical history included a previous intracranial aneurysm and arterial hypertension. The patient underwent a successful treatment by surgical clipping and was discharged in good condition; neither disability nor neurologic deficit was noticed upon discharge. Surgical wound healing was complicated by an infection and resulted in a reoperation for the patient. Conclusion: The etiology of kissing aneurysms is still unknown and the best treatment method stills remains unclear. Thus, every case has to be carefully and individually assessed by an interdisciplinaryteam. As a result, patient transfer to an experienced neurosurgical center could be beneficial.

Bilateral pulmonary artery aneurysm in Behcet's disease

, et al., Bilateral pulmo .1016/j.injr.2015.02.005 Investigatory reports were haemoglobin 11.5 g/dl, Erythrocyte Sediment Ratio (ESR) 87 mm/h, C reactive protein (CRP) 20.79 mg/L and serum creatinine 0.41 mg/dl. A diagnosis of Behcet's disease (BD) was made and he was treated with prednisolone (10mg/day) and azathioprine (50mg/day). There was initial clinical improvement but subsequently he developed recurrent haemoptysiswhile hewas still on azathioprine and prednisolone. CT Pulmonary angiographywas done. Axial and coronal oblique MIP (Maximum Intensity Projections) images showed aneurysmal dilatation of the descending

Role of superior hypophyseal artery in visual function impairment after paraclinoid carotid artery aneurysm surgery.

Although a number of studies have assessed the surgical treatment of paraclinoid-segment carotid artery aneurysms and resulting visual complications, less attention has been given to the results with respect to the superior hypophyseal artery (SHA). The authors evaluated the relationship between the aneurysm, the SHA itself, and postoperative visual function in patients with ruptured and unruptured SHA aneurysms. From January 1991 through December 2013, 181 patients with 190 paraclinoid carotid artery aneurysms received treatment at Shinshu University Hospital and its affiliated hospitals. The authors retrospectively analyzed charts, operative records, operative videos, and neuroimaging findings for these patients with or without postoperative visual complications. The authors identified 72 SHA aneurysms in 70 patients (mean age 58 years). Of 69 patients (1 patient died) evaluated, postoperative visual complications occurred in 9 (13.0%). Although the aneurysm size and SHA sacrifice did not lead to postoperative visual impairment, simultaneous treatment of bilateral aneurysms was a risk factor for postoperative visual complications. Unilateral SHA impairment may be safe (i.e., it may not induce ischemia of the optic pathway) for many, but not all, patients with SHA aneurysm.

Bilateral İliyak Arter Anevrizmalı Olguya Cerrahi Yaklaşım

Bilateral İliyak Arter Anevrizmalı Olguya Cerrahi Yaklaşım

Blue Toe Sendromu ile Prezente Olan Bilateral Popliteal Arter Anevrizması

Blue Toe Sendromu ile Prezente Olan Bilateral Popliteal Arter Anevrizması

Right ventricular thrombus with pulmonary artery aneurysm in a young male: A rare presentation of Behçet's disease.

We describe an adolescent patient presenting with hemoptysis. Detailed clinical work up of the patient showed right ventricular thrombus and bilateral pulmonary artery aneurysms along with the prescribed criteria for the diagnosis of Behcet's disease. Younger age of the patient was another distinctive feature of this case. Six months of therapy with cyclophosphamide and prednisolone resulted in near complete clinicoradiological response.

Bilateral Aneurysm of the Internal Jugular Vein Associated with Menkes Disease: Diagnosis, Risk Factors and Management

Menkes disease is a rare genetic disease due to an abnormality in copper metabolism. Clinical picture mainly includes neurological and cutaneous symptoms, and may present vascular complications. We report two cases of bilateral aneurysms of the internal jugular vein associated with Menkes disease, which were discovered by the appearance of cervical swellings a few months after birth. Diagnosis was set by Doppler ultrasonography and no specific treatment was decided for both cases. A review of literature then presents the diagnosis method, risk factors and management of aneurysms of the internal jugular vein in Menkes disease.

Duplex Ultrasound Findings of Popliteal Artery Aneurysms With Acute Limb Ischemia

Popliteal artery aneurysms are rare, but they have the potential to be limb threatening as a result of thrombosis and distal embolization. Duplex sonography may be used to effectively detect popliteal artery aneurysms and determine patency of the runoff arteries. Findings may include dilatation of the popliteal artery during gray-scale imaging with intraluminal heterogeneous echoes indicating the presence of mural thrombus. Abnormal or absent Doppler signals in the more distal arteries with intraluminal heterogeneous echoes may indicate the presence of thrombus, likely from embolization. This case presents the duplex sonography findings of bilateral popliteal artery aneurysms in conjunction with lower extremity acute arterial thrombosis and an abdominal aortic aneurysm.

腹部大動脈瘤に対しステントグラフト内挿術施行後，遠隔期に両側総腸骨動脈瘤を合併した1 例

腹部大動脈瘤に対しステントグラフト内挿術施行後，遠隔期に両側総腸骨動脈瘤を合併した1 例

Generalized aneurysmal disease in association with autosomal dominant polycystic disease.

A 78-year-old man with end-stage kidney disease secondary to autosomal dominant polycystic disease (ADPKD) on haemodialysis, presented to our institution following a myocardial infarction. He was known to have cystic involvement of his liver and spleen, significant mitral regurgitation secondary to mitral valve prolapse, and a distant history of abdominal aortic aneurysm repair. There was no family history of ADPKD or history of cerebral aneurysms. Coronary angiogram revealed widespread large coronary artery aneurysms affecting both branches of the left and right coronary artery, as well as significant atherosclerotic disease (Figure 1). During work up for coronary artery bypass surgery and mitral valve replacement, multiple other sites of aneurysmal disease were identified, including a 5 cm thoracic aortic aneurysm and bilateral femoral artery aneurysms (Figure 2). Fig. 1. Aneurysmal involvement of the mid to distal left anterior descending coronary artery (black arrow). Fig. 2. Bilateral femoral artery aneurysms (white arrows) together with large polycystic kidneys. Note incidental finding of calcified cyst in left polycystic kidney (black arrow). Whilst waiting for cardiac surgery the patient developed septic shock secondary to an infected renal cyst, requiring prolonged intensive care admission and extended rehabilitation. Given his age and frailty a decision was made to manage his widespread aneurysmal disease conservatively with regular radiographic surveillance. Previous case series have suggested a high incidence of coronary artery aneurysms in association with ADPKD. Hadimeri et al. [1] observed coronary aneurysms in 4 out of 30 (13%) ADPKD patients. This is markedly higher than the incidence observed in the general population, of ∼1.5% of patients studied by coronary angiography or autopsy [2]. There is less evidence regarding the link between ADPKD and aortic, thoracic and femoral aneurysms. While Bailey et al. [3] studied the association between aortic aneurysms and ADPKD, the study was unable to conclusively link the two conditions. Evidence linking thoracic or femoral aneurysms with ADPKD appears predominantly limited to case studies [4]. Given that the gene responsible for ADPKD has been linked with abnormalities of vascular smooth muscle, myofibroblasts, extracellular matrix and collagen defects [5], it seems reasonable for there to be widespread vascular abnormalities in this patient population, although it seems to be seldom described. In summary, we present a rare case of a patient with ADPKD and associated coronary artery aneurysms as well as aorto/iliac aneurysms.

Association exceptionnelle d’un anévrysme poplité bilatéral et d’un anévrysme de l’aorte abdominale au cours d’un syndrome de Marfan

Marfan syndrome is an autosomal dominant disorder with rheumatoid, ophthalmological, neurological, cutaneous and cardiovascular manifestations. Aneurysmal lesions affecting both the abdominal aorta and the peripheral arteries are not often described in the literature. We report a case associating a bilateral popliteal aneurysm and an aneurysm of the infra-renal abdominal aorta.

Experimental Three-Dimensional Biomodel of Complex Aortic Aneurysms by Rapid Prototyping Technology

Abstract The rapid prototyping technology allows the fabrication of three-dimensional (3D) biomodels from two-dimensional images. This process has been used in many areas, including the medical field; however, it seems to represent a new technology regarding vascular models. Although surgical techniques for treatment of aortic aneurysms (AA) have been developed recently, because of its anatomical limitations, complex AAs still remain a challenge. This study aimed to describe the manufacture of 3D biomodels of AA from computed tomography angiography images. Four cases of AA were selected: one abdominal, one thoracic, and the last contained bilateral aneurysms in the common iliac arteries. The images were edited with specific software, which built the 3D images and made them capable of being printed by a PolyJet technology machine. All biomodels represented the aneurysms in life-size dimensions and correctly reproduced their morphology. The average time of manufacture was 18 hours and the biomodels cost, on...

Unusual Neuro-Ophthalmologic Disturbances due to Internal Carotid Aneurysm

The majority of internal carotid aneurysm neuro-ophthalmologic disturbances are eyeball pain, complex ophthalmoplegia, pulsatile proptosis with conjunctival congestion and venous stasis retinopathy. Acute or chronic visual loss and visual field defect, clinical neuro-ophthalmological findings, resembling parasellar tumors or retrobulbar optic neuritis, are less usual in patients with aneurysms. Two cases of cerebral aneurysms with unusual neuro-ophthalmologic disturbances are presented. Case 1: Report of a 51-year-old female with left eye vision loss and inferonasal quadratanopia - a diagnosis of retrobulbar neuritis prior our neuro-ophthalmologic consultation was made. Computed tomography angiography showed right carotid artery aneurysm. Surgical treatment post cerebral angiography was suggested. Case 2: Report of a 56-year-old male with acromegaly and chiasmal neuro-ophthalmologic syndromes was described: left monocular vision loss, proptosis with third nerve palsy, dilated pupil and binasal hemianopia. MR angiography showed bilateral internal carotid artery aneurysm. No surgical treatment was performed, but endocrinological treatment was necessary. Two cases of internal carotid aneurysms were presented with unusual neuro- ophthalmologic disturbances, mimicking an optic neuritis and parasellar tumor. In conclusion the accurate differential diagnosis requires the correct neuroimaging - MRI and digital angiography, and the cooperation between the neuro-ophthalmologist, the interventional neuro-radiologist and the neurosurgeron.

Early outcomes of iliac branch grafts in the endovascular repair of abdominal aortic aneurysms with concomitant bilateral common iliac artery aneurysms at a Japanese institution.

Endovascular aneurysm repair (EVAR) is used to treat abdominal aortic aneurysms (AAAs) with bilateral common iliac artery aneurysms (CIAAs), and an interruption of the bilateral internal iliac arteries (IIAs) is often needed, which may cause postoperative ischemic complications. An iliac branch device (IBD) has thus been introduced as an endovascular technique to preserve the IIA flow. This study aimed to evaluate the technical feasibility and short-term results of using an IBD when treating AAA with bilateral CIAAs in a Japanese institution, where IBD use has still not been approved by the government. EVAR was performed using an IBD in six patients at high risk for open repair of an AAA with bilateral CIAAs. Advanta V12 stent grafts were successfully placed in the IIA, bridging between the IIA and the IBD side branch from the contralateral iliac artery. Subsequently, EVAR was performed as usual. The technical success rate was 100%. At the most recent follow-up (mean follow-up period, 14.2months), all IBDs were patent. No patients complained of buttock claudication or ischemic colitis. The implantation of an IBD during EVAR is technically feasible in Japanese AAA patients with bilateral CIAAs, and may be a viable method to avoid pelvic ischemic complications, such as intractable buttock claudication.

Parallel Endografts in the Treatment of Distal Aortic and Common Iliac Aneurysms

Endovascular treatment of distal abdominal aortic aneurysms (D-AAA) and bilateral common iliac artery aneurysms (BCIAA) may present technical challenges for standard EVAR. Parallel iliac leg endografts (ILEs) of standard aortic devices and covered stents have been successfully employed to treat patients with D-AAA and BCIAA. The perioperative and long-term results of this straightforward endovascular technique are presented. Beginning in 2009, patients deemed unfit for open surgery underwent parallel endografts D-AAA and BCIAA exclusion. Avoiding the use of a main body, ILEs are simultaneously delivered from both femoral arteries, landing parallel into the aortic neck (parallel grafts: PG). Distal landing zones including external iliac arteries (EIAs) are reached using appropriate ILEs. A third parallel covered stent graft (Viabahn, Gore) is delivered from a left brachial approach to maintain prograde blood flow to one internal iliac artery (IIA) when needed. Eighteen patients were successfully treated using parallel endografts, nine for BCIAA and nine for D-AAA. All D-AAA presented an irregular saccular shape, including three penetrating aortic ulcers and two pseudoaneurysms of previous aortic grafts. Prograde flow to one IIA was successfully maintained using a Viabahn graft in five patients with BCIAA. Mean aneurysm size was 50 mm in D-AAA and 43 mm in BCIAA. One patient required a perioperative ILE extension to treat a type Ib endoleak. One patient suffered a minor stroke 24 hours after the procedure. Two type II endoleaks were observed postoperatively. Five patients died of non-aneurysm related causes during follow-up. No new endoleaks, graft displacements or occlusions were observed during follow-up (median: 26 months, range 12-42 months). Successful exclusion of D-AAA and BCIAA was achieved in high-risk patients using parallel endografts, allowing antegrade blood flow to one IIA when needed. Commercially available endografts were used in a simple and effective approach, with excellent follow-up results.

Clipping of bilateral aneurysms of middle cerebral arteries through unilateral pterional approach

Objective To Investigate the feasibility of clipping of bilateral aneurysms of middle cerebral arteries (MCA) through unilateral pterional approach.Methods The clinical data of 14 cases of bilateral MCA aneurysms were collected.The head CTA or DSA examination after operation and during the follow-up period (6-12 months) were reviewed.Finally the GOS scores were evaluated.Results 13 cases of patients were treated by unilateral pterional approach for the treatment of bilateral aneurysms of MCA.In 1 case,the ipsilateral aneurysm was excluded and the contralateral aneurysm was clipped.The size of all the aneurysms was less than 5mm.The contra-arteries of M1 were more than 14mm in 3 cases.The aneurysms pointed to insular lobe in 2 cases and 7 cases had the parent artery atherosclerosis.All the aneurysms were clipped.The postoperative GOS was 5 in all the patients.The postoperative head CTA or DSA examination showed that there was no aneurysm recurrence.Conclusions It was feasible for clipping of bilateral aneurysms of MCA through unilateral pterional approach.But the brain edema,contra-lateral aneurysm size,arterial aneurysm point,parent artery atherosclerosis and the length of the opposite M1 should be considered. Key words: Cerebral aneurysms; Unilateral approach; Middle cerebral artery; Bilateral; Microsurgery