Bilateral Aneurysms Research Articles

Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft.

Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the "bell-bottom" technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the "snorkel and sandwich" technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bell-bottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the "snorkel and sandwich" technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications.

Total Endovascular Repair by Sandwich Technique Thoracoabdominal Aortic Dissecting Aneurysm with Aneurysm Related Disseminated Intravascular Coagulation (DIC)

Purpose: To present a rare case of thoracoabdominal aortic dissecting aneurysm combined with aneurysm related disseminated intravascular coagulation (DIC) and the novel treatment of total endovascular aneurysm repair (EVAR) with Sandwich technique. Case Report: A 78-year-old man was admitted with thoracoabdominal aortic dissecting aneurysm (TAADA) combined with bilateral iliac artery aneurysm (BIAA) accompanied by aneurysm related DIC. With adequate transfusion of blood components and a continuous subcutaneous injection of low molecular weight heparin, surgical repair of the multiple aortic lesions was carried out successfully. He received a total endovascular repair by sandwich technique to reconstruct all visceral branches. Postoperative laboratory evaluation demonstrated resolution of the coagulopathy. The optimal quality of life were achieved without any coagulopathy, paraplegia, pelvic organs ischemia or claudication and with an ideal blood pressure control during the 2-years’ following-up. Conclusion: Total endovascular aneurysm repair by sandwich technique appears to be a feasible, safe, and effective treatment for the management of thoracoabdominal aortic dissecting aneurysm. Confidential conclusion needs more cases to be done.

Complete aortic sac shrinkage following endovascular repair of ruptured abdominal aortic aneurysm (REVAR)

A 59 year old gentleman with a background history of hypertension and hyperlipedaemia, presented to the emergency department with abdominal and chest pain. He was confused and haemodynamically unstable. His blood pressure at presentation was 70/40 His pulse was 125, on examination his abdomen was tender centrally and in the left flank. A fast scan revealed asizeable abdominal aortic aneurysm. Patient underwent a CT scan angiogram on route to the operating theatre. The CT scan confirmed a rupturedabdominal aortic aneurysm (AAA). It was 5.8cm at maximum diameter. There was a large retroperitoneal haematoma on the left side. The patient had bilateral common iliacsaccular artery aneurysms, measuring 3.5 cm on the right and 2.5 cm on the left (Figures 1). The anatomy of the aneurysm was suitable for endovascular repair of the ruptured abdominal aortic aneurysm (REVAR).

Surgical treatment of «Mirror» aneurysms of the internal carotid artery

A relatively high occurrence of "mirror" aneurysms of the anterior cerebral circulation in neurosurgical practice necessitates generalization of experience of using different surgical approaches. The choice of treatment is usually associated with the number of surgical stages. Forty nine patients (19 males and 30 females) with mirror aneurysms of the anterior circulation underwent one- and two-step surgery at the Novosibirsk Federal Center of Neurosurgery in 2013-2015. The total number of bilateral aneurysms was 51 couples (102 aneurysms). The patients' age ranged from 19 to 66 years (mean age, 47.1±11.6 years). Most of the patients (47) underwent elective surgery; 2 patients were operated on in acute subarachnoid hemorrhage. Sixty nine microsurgical operations and 19 endovasal interventions were performed during the main step. Microsurgery alone was used in 34 cases; endovascular surgery alone was performed in 6 cases; a combination of the techniques was used in 9 cases. Ten patients underwent one-step surgery, and 39 patients underwent two-step surgery. The radicalness of surgery amounted to 94.1% for the microsurgical technique and 83.3% for the endovasal technique. The excellent and good functional outcome (modified Rankin scale, 0-2) was achieved in 46 (93.9%) patients, and the poor outcome (mRs, 3-5) was observed in 3 (6.1%) patients. Generalization of the results indicates that one-stage surgery is more preferable in the treatment of mirror cerebral aneurysms. However, the two-stage approach remains important and, in the case of certain anatomical peculiarities, is the only possible treatment. A combination of microsurgical and endovascular techniques improves clinical outcomes in treatment of mirror aneurysms of the anterior part of the cerebral arterial circle.

Pure tentorial subdural hematoma from rupture of aneurysm along the transmastoid branches of the occipital artery.

Background:Pure subdural hematoma (without subarachnoid, intraventricular, or intraparenchymal hemorrhage) due to a ruptured intracranial aneurysm is rare. Most reported cases involve an aneurysm along the internal carotid artery, posterior communicating artery, or middle cerebral artery. No reports have described an aneurysm along the transmastoid branches of the occipital artery.Case Description:A 70-year-old female presented with sudden-onset, excruciating headaches, associated with dizziness, nausea, and emesis. There was no history of trauma. Computed tomography (CT) head demonstrated a pure tentorial subdural hematoma. Vascular imaging revealed bilateral aneurysms along the transmastoid branches of the intracranial portion of both the occipital arteries. Consequently, these branches were embolized, with no residual filling of the aneurysms. After the procedure, the patient remained neurologically well. The patient was monitored appropriately for vasospasm, and was discharged home 10 days after presentation.Conclusion:Rupture of aneurysms along intracranial branches of the occipital artery can lead to pure subdural hematoma along the tentorium.

両側後脛骨動脈瘤を契機に診断された血管型Ehlers-Danlos 症候群の1 例

両側後脛骨動脈瘤を契機に診断された血管型Ehlers-Danlos 症候群の1 例

Bunches of grapes in renal polyarteritis nodosa

A 26-year-old woman presented to a local community hospital with fever and abdominal pain. Clinical examination showed mild abdominal and bilateral lumbar tenderness. Blood analysis showed C-reactive protein of 401 mg/l, leukocyte count of 15,340/mm3, and serum creatinine of 71 μmol/l. Chest radiograph and abdominal ultrasound were normal. She was diagnosed with pyelonephritis despite negative urinalysis and was discharged. Soon after, her condition worsened with 5 kg weight loss, myalgia, and arthralgia. Two months later, she was readmitted with severe left flank pain. Contrast-enhanced abdominal computed tomography (CT) showed a large subcapsular hematoma surrounding the left kidney (Figure 1). Multiple bilateral intrarenal aneurysms of variable diameter (1–14 mm) were detected during the arterial phase (Figure 1) with the appearance of bunch of grapes. Multiple bilateral wedge-shaped low-attenuation involving cortex and medulla suggesting kidney infarcts were also detected (Supplementary Figure 1 online). Urinalyses showed microscopic hematuria and proteinuria of 0.9 g/24 h. Comprehensive autoimmune including Anti-neutrophil cytoplasmic antibodies (ANCA) research and viral screenings were negatives.

Management strategy for bilateral complex vertebral artery aneurysms.

Bilateral complex vertebral artery aneurysms (BCoVAAns) have no established strategy of management. We retrospectively reviewed five consecutive patients with unruptured BCoVAAns between January 2006 and December 2012. Considering surgical risks of lower cranial nerve (LCN) injuries and eventual growth of an opposite side lesion after unilateral vertebral artery (VA) occlusion, we proposed a strategy of combined open and interventional treatment using revascularization. We applied the following several specific techniques: (1) proximal clipping and occipital artery-posterior inferior cerebellar artery (OA-PICA) and/or superficial temporary artery (STA)-superior cerebellar artery (SCA) bypasses; (2) Distal blood pressure, motor evoked potentials (MEPs), and somatosensory evoked potentials (SEPs) monitoring after parent artery temporary occlusion for safe permanent occlusion of the proximal portions of VA and PICA; (3) V3 to V4 bypass using radial artery (RA) graft with proximal clipping or trapping, two of them combined with OA-PICA bypass; (4) VA fenestration as an opportunity to preserve the flow of the parent artery. Two patients were treated bilaterally and 3 unilaterally, with modified Rankin scale assessed at 39 months postoperatively in average 0 in 2, 1 in 2, and 2 in 1, respectively, and the untreated opposite side lesions without regrowth or bleeding. Two patients with patent V3-RA-V4 bypass complained of dysphagia due to LCN palsies. One of them however suffered a cerebellar infarction due to occlusion of the OA-PICA bypass. When BCoVAAns require surgical treatment, revascularization or preservation of the VA should be considered at the first operation. By doing so, the opposite aneurysm can be effectively occluded by coil embolization, even with VA sacrifice if required.

Abstract 17623: A Case of Biopsy-proven Immunoglobulin G4-Related Disease Associated With Multiple Giant Coronary Artery Aneurysms, Peripheral Arterial Aneurysms, End Stage Renal Disease, and Heart Failure

A 54-year-old man with remote large cell non-Hodgkin’s lymphoma in remission following R-CHOP and severe atopic dermatitis was transferred from another hospital with a non-ST elevation myocardial infarction. Over the preceding year, the patient had suffered recurrent admissions for acutely decompensated heart failure with a newly depressed left ventricular ejection fraction (LVEF) of 20% by echocardiography and rapidly progressive end-stage renal disease of unclear etiology requiring the initiation of hemodialysis. Prior workup had demonstrated an infrarenal abdominal aortic aneurysm and bilateral common iliac artery aneurysms with subsequent computed tomography (CT) additionally demonstrating a superior mesenteric artery aneurysm. The patient was taken for immediate coronary arteriography, which demonstrated giant aneurysms in the left main and right coronary arteries, as well as multivessel severe stenoses. CT coronary angiogram demonstrated significant circumferential wall thickening throughout the coronary vasculature. Given concern for IgG4-related disease (IgG4-RD), a renal biopsy was pursued that confirmed the diagnosis. 18F-fluorodeoxyglucose positron emission tomography-CT identified only mild aortic inflammation. The patient was treated with high-dose steroids and rituximab. The serological inflammatory markers improved, and he underwent coronary artery bypass grafting. Pericardial, aortic adventitial, left internal mammary artery, and saphenous vein biopsies showed cardiovascular involvement of IgG4-RD. The patient has been maintained on rituximab with normalization of his LVEF and no recurrence of chest pain over the past eighteen months. IgG4-RD is a fibroinflammatory systemic disease newly described in 2003 and only recently found to involve the cardiovascular system with several reports of peripheral aneurysmal disease. To our knowledge, the current case represents the first report of a patient successfully treated for biopsy-proven IgG4-RD associated with coronary artery disease and left ventricular systolic dysfunction. IgG4-RD may represent a novel mechanism underlying some forms of peripheral and coronary arterial disease and may offer new insights into vascular biology.

A ruptured superficial femoral artery aneurysm: A case report

True atherosclerotic aneurysms of superficial femoral artery (SFA) are rare and often associated with other peripheral or aortic aneurysms. We are reporting the case of a 78-year-old man who has been admitted with a ruptured superficial femoral artery aneurysm associated with bilateral popliteal artery aneurysm. The patient underwent successful aneurysm resection and bypass grafting.

Alternative Solution for Bilateral Common Iliac Aneurysm in a Patient With Left External Iliac Artery Occlusion

8 Joynt KE, Blumenthal DM, Orav E, Resnic FS, Jha AK. Association of public reporting for percutaneous coronary intervention with utilization and outcomes among medicare beneficiaries with acute myocardial infarction. JAMA 2012;308:1460e8. 9 Chaturvedi S, Bruno A, Feasby T, Holloway R, Benavente O, Cohen SN, et al. Carotid endarterectomydan evidence-based review: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 2005;65:794e801. 10 Kresowik TF, Bratzler DW, Kresowik RA, Hendel ME, Grund SL, Brown KR, et al. Multistate improvement in process and outCan Patients Select the Best Hospital

Surgical treatment of intracranial aneurysms via the pterional keyhole approach

Modify the pterional approach for intracranial aneurysms clipping with minimally invasive concept to reduce the risk of iatrogenic surgical trauma. A 4.0 cm skin incision was made along the temporal hairline and centered on the pterion, temporal muscle was incised along the sylvian fissure.A bone flap with 2.0 to 2.5 cm in diameter was milled after a bone hole was drilled just on the sphenoid ridge, which was drilled off as needed then.Aneurysms were exposed after dissection of sylvian fissure and cistern, as well as cerebrospinal fluid releasing.A total of 123 cases with 140 intracranial aneurysms were treated surgically via the pterional keyhole approach, including 6 large aneurysms, 4 giant aneurysms, and 17 cases with multiple aneurysms (34 aneurysms). Of 3 cases with bilateral aneurysms, 2 were treated via bilateral approach as well as 1 via unilateral approach. Contralateral approach was used in 1 case with ophthalmic artery aneurysm, which pointed medial. Concomitant intracranial tumors were removed simultaneously in 2 cases, and one of them was diagnosed with middle cerebral artery aneurysm and tuberculum sellae meningioma, the other one with posterior communicating artery aneurysm and middle cranial fossa menigioma. Of the 140 aneurysms, 139 aneurysms were clipped and 1 was trapped.Postoperative image showed 4 cases had residual of aneurysm neck. 3 cases had incomplete dysfunction of oculomotor nerve and 1 had mild hemiplegia after surgery and recovered eventually. 4 cases presented with aggravated disturbance of consciousness, of whom 3 cases were caused by ischemia and 1 by brain edema.Unusual ipsilateral hemiplegia occurred in 1 case in Hunt&Hess grade IV, which caused by contralateral vasospasm. Postoperative courses in other cases were uneventful. As a minimally invasive and effective approach, the pterional keyhole approach is applicable to intracranial aneurysms clipping for patients without any necessary for decompressive craniectomy. Surgical related complications and operative duration can be reduced significantly.

Bilateral Saphenous Vein Graft Aneurysms

SESSION TITLE: Procedures Case Report Posters SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: More than 50 years have passed since CABG was first successfully performed in humans. Despite many improvements in surgical technique, complications of CABG continue to occur. Here, we present a rare case of bilateral saphenous vein graft aneurysm as a late complication of CABG. CASE PRESENTATION: 77 yo man with CAD status post CABG 12 years ago, presented for evaluation of chest pain and dyspnea. On examination, his vitals were stable and his exam was unremarkable. Basic labs, including cardiac enzymes, were unrevealing. A chest x-ray demonstrated fullness in the right hilum worrisome for a mass (1). CT of the chest with contrast confirmed two large anterior mediastinal masses as well as mediastinal lymphadenopathy. Percutaneous CT guided biopsy showed only blood and was complicated by a hemothorax. Further work up with bronchoscopy and biopsy was non diagnostic. Coronary CT angiography revealed aneurysms of two coronary bypass vein grafts (2). The right graft was patent to the RCA, but the left was occluded. Patient was offered surgical treatment, but he declined, opting for conservative management. He is doing well 1 year after initial diagnosis. DISCUSSION: Saphenous Vein Graft Aneurysm (SVGA) is a rare complication of CABG. The overall incidence is likely less than 0.5% of grafts. Proposed etiologies include exposure to arterial pressures, atherosclerotic changes, infection, and technical factors during harvest and transplant. Typical presentation is with chest pain, dyspnea, and MI, but a large number of patients are asymptomatic. Multiple studies have documented aneurysmal enlargement, however the rate of growth is variable. Large aneurysms have higher rates of mechanical complications, but increasing size has not been demonstrated to increase the risk of rupture or death. Treatment data is limited, with some case series advocating conservative management 1, and others suggesting surgical treatment 2. Recently, increasing percutaneous options are becoming available. CONCLUSIONS: Anterior mediastinal mass with a history of CABG should raise suspicion for SVGA. More data is needed to determine optimal treatment. Reference #1: Dieter, R. S., et al. (2003). “Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: Treatment algorithm based upon a large series.” Cardiovasc Surg 11(6): 507-513. Reference #2: Sareyyupoglu, B., et al. (2009). “Surgical treatment of saphenous vein graft aneurysms after coronary artery revascularization.” Ann Thorac Surg 88(6): 1801-1805. DISCLOSURE: The following authors have nothing to disclose: Michael Tatusov No Product/Research Disclosure Information

Acute rupture of a feeding artery aneurysm after embolization of a brain arteriovenous malformation

Staged endovascular embolization of large arteriovenous malformations (AVMs) is frequently performed to gradually reduce flow and prevent abrupt hemodynamic changes. While feeding artery aneurysms have been associated with increased risk of hemorrhage in the setting of AVMs, decisions regarding if and when to treat these aneurysms vary. Acute, fatal rupture of a feeding artery aneurysm following embolization of a large, unruptured AVM has been infrequently reported in the literature. A 69-year-old female presented with headache and mild left hemiparesis referable to a 5 cm right fronto-parieto-temporal AVM with surrounding vasogenic edema. The AVM was associated with numerous bilateral feeding artery aneurysms (the largest was a 2 cm right middle cerebral artery (MCA) bifurcation aneurysm). There was also a large, partially thrombosed venous varix. Staged embolization of the AVM was performed. Several hours after the third stage of her embolization, she became obtunded, with a fixed and dilated right pupil. Head computed tomography (CT) showed a large intraparenchymal hemorrhage with midline shift in the right sylvian fissure, remote from the AVM nidus. She was taken to surgery for a decompressive craniectomy and hematoma evacuation. The MCA aneurysm was confirmed to be the source of hemorrhage and it was clipped. Despite aggressive medical and surgical treatments, the patient died. An increase in AVM feeding artery pressure following endovascular embolization may contribute to the rupture of a feeding artery aneurysm. For this reason, treatment of large arterial aneurysms on feeding pedicles should be considered prior to embolization of the AVM nidus.

Use of Physician-Modified Endografts to Repair Unilateral or Bilateral Aortoiliac Aneurysms

This article presents an endovascular approach to repair a unilateral or bilateral aortoiliac aneurysm with a bifurcated iliac limb that can maintain perfusion to the internal iliac artery (IIA) bilaterally through a brachial access. A standard infrarenal aortic aneurysm repair is performed followed by iliac aneurysm exclusion. To obtain exclusion in the common iliac artery aneurysm, a bifurcated Endurant iliac limb is modified to compartmentalize iliac flow 2-3cm above the internal iliac ostia. Then, a balloon-expandable covered stent graft is used to achieve sealing in the IIA and external iliac artery (EIA). The IIA is stented from the arm and the EIA is stented from the groin. There was no in-hospital or 30-day mortality. The procedural design was followed in each of the patients who received treatment. Technical success was 100%, short-term clinical success was 92%, and midterm clinical success was 83%. Average dosage of contrast medium was 116 mL (range, 55-193 mL), and average fluoroscopy time was 42.1 min (range, 20.8-91.6 min). Average length of hospital stay was 2.6 days (range, 1-9 days). There was 1 recorded endoleak. No reports of gluteal claudication, sexual dysfunction, or bowel or spinal claudication have been found. The technique described here does not require an up-and-over approach, allowing simplified bilateral repair. Although this is a promising technique, long-term durability needs to be evaluated in a controlled prospective study.

Bilateral dissecting aneurysms of the internal carotid arteries misdiagnosed as skull base tumors: A case report.

A 45-year-old female presented with a five-year history of intermittent headaches and a two-month history of left hypoglossal nerve palsy. Computed tomography and magnetic resonance imaging of the head revealed space-occupying lesions in the base of the skull with accompanying bone erosion, which were suggestive of skull base chordomas. However, an endoscopic endonasal transsphenoidal biopsy was also performed and pathological analysis of the lesion suggested a thrombosis. Cranial magnetic resonance angiography revealed old dissecting aneurysms of the bilateral internal carotid arteries (ICAs), which led to a definitive diagnosis. The patient was successfully treated with anticoagulants and antiplatelet agents. The present case study suggests that, for patients with space-occupying lesions of the skull base and symptoms of cranial nerve palsy, the possibility of an ICA dissection should be prioritized during the differential diagnosis.

Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case

Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a...

Abstract 215: Fatal Arrhythmia In The Adult Patient Of Kawasaki Disease

We herein report the two adult patients hardly predictable sudden cardiac arrest caused by presumed Kawasaki disease (KD). Case 1: A 29- year-old man who had a history of KD at 10 months of his age complicated with bilateral giant coronary aneurysms, and was received a surgery of coronary artery bypass grafting (CABG) when he was 17 years old. He was transferred to emergency center because of sudden cardiac arrest during live concert and revived by automated external defibrillator (AED). Case 2: A 26-year-old man with a history of KD at 1year old of his age, complicated with bilateral giant coronary aneurysms, and was received a catheter intervention of rotational atherectomy (ROTA) to left anterior descending (LAD) artery at 16 years old of his age. He suddenly fell with ventricular fibrillation (VF) on playing futsal, and was hospitalized after revival by AED. Both of them had past history of myocardial infarction (MI) in their youths, however, did not have left ventricular dysfunction, symptomatic arrhythmia, and evidence of acute MI at admission. Therefore, it was difficult to strongly predict possibility of fatal arrhythmia in these cases. Finally, they received the second CABG’s for each after stabilizing and returned to their daily lives. It had been rarely reported a fatal arrhythmia in asymptomatic KD patients with normal left ventricular function with revival with recent spread of life support with public access of defibrillator. Our experiences may suggest one style with a paradigm shift in management of patients with coronary artery complications at the remote period of KD.

Abstract 213: Caracteristics of Kawasaki Disease in Chile: Temuco′s experience

Kawasaki Disease (KD) is a vasculitis mainly affecting children under two years old and harms arterial vessels (especially coronary) causing dilatation, aneurysms and eventual myocardial complications. Though etiology is unknown, a relationship with an infectious agent is suspected. Diagnosis is doing by clinical criteria and laboratory support. KD cases reported in Latin America go along abscence of management protocols and it is not considered notifiable disease. In order to contribute to a greater understanding of this disease, a retrospective - descriptive analysis of 75 patients diagnosed with KD at the time of discharge was carried out from January 2005 to August 2014 at Hospital Dr.Hernán Henríquez Aravena, Temuco, Chile. Information was tabulated in Microsof Office Excel 2007 and a statical analysis were performed using STATA 11.0 program. Average age 2 years 7 months (range 2 months to 17 years). Sex Male/Female 49%/51%. Prior consultations 85% (64/75). Initial diagnosis KD 51% (38/75). Fever 100% (75/75), 64%(48/75) about 39 ° C. Eye involvement 68% (51/75). Oropharyngeal erythema 87% (55/75). Strawberry tongue 40% (30/75). BCG erythema 19% (14/75). Rash 83% (62/75). Erythema/oedema of hands and foots 73% (55/75). Cervical adenopathy 41% (31/75). Irritability 55% (41/75). Leukocytosis 36% (27/75). Plaquetosis 69%(52/75) and periungual descamation 39% (29/75). Echocardiogram abnormal at startup 28% (21/75), (6/75)8% prior application of IVGG and 5%(4/75)remained with coronary involvement. A single dose of 2g/kg of Intravenous Gamma Globuline (IVGG) was administrated to 97%(73/75). Aspirin 50 mg/kg initial and 5 mg/kg during the following. A second dose of IVGG was required in 13% (10/75). Two patients were treated with anticoagulant for giant aneurysms and in one case, bilateral brachial aneurysms. Tipycal KD in 73% (55/75) and 27%(20/75) incomplete. Further clinical suspicion is needed, because a high percentage of patients had coronary involvement at diagnosis. Those who received early IVGG coronary involvement were lower. Prominent among coronary involvement factors are extreme age, atypical or incomplete forms and high RCP. Needed be considered KD as a notifiable disease, considering the economic and social implications.

Abstract 176: Persistent Peripheral Arteritis Long After Kawasaki Disease - Another Documentation Of Ongoing Vascular Inflammation -

A 22-year-old male patient, who was suffered from Kawasaki disease (KD) at 1 year and 1 month of age and left with bilateral axillary arterial aneurysms (AAA) and regressed coronary aneurysm, visited us because of left hand edema and itchiness. He has been taking aspirin for thromboprophylaxis of AAA and well without any vascular event for these 20 years and does not have any sign of inflammatory disease. Digital subtraction angiography of bilateral arms revealed complete occlusion of left AAA with multiple collateral arteries supplying blood flow to the distal arm and persistent giant right AAA with 12 mm in diameter with only mild stenosis proximal to this AAA. To determine if the active inflammatory process is going on the axillary artery wall, the patient underwent positron emission tomography (PET) using fluorodeoxyglucose (FDG) with co-registration of multi-detector x-ray computed tomography, PET indeed showed significant FDG uptake inside and part of the outer wall of the left AAA and only minimum FDG uptake at the right AAA. For left arm ischemia, he underwent resection of the left AAA and successful axilla-brachial artery bypass surgery using a reversed autologous saphenous vein graft that relieved his symptoms. Histological examination of the resected wall of AAA showed significant intimal thickening and the immunohistochemistry study labeling CD68, as the marker of macrophages, showed relatively dense staining of the intimal thickening of left AAA wall compatible with FDG uptake. This is the first documentation of persistent inflammation of peripheral arterial wall long after KD using FDG-PET that must have resulted in peripheral arterial remodeling.