Case Of Aortic Aneurysm Research Articles

Aortic Aneurysm–Surgical Treatment in Apollo Hospitals, Dhaka

Objective: In developing country, treatment of aortic aneurysm is costly. Surgical treatment is rather cheaper than stent implantation. Long term outcome is favourable with surgical treatment. Methods: This is a retrograde study, was done in Apollo Hospitals Dhaka from 21st December, 2006 to 12th July 2014. 32 patients were operated. Age range was from 22 to 81 years (mean 55.33), male 28, female 4. Infrarenal aortic aneurysm cases were 20, thoraco abdominal aneurysm cases were 4, dissectingaortic aneurysm cases were 2 (CABG+Bracheocephalic artery reimplantation with 8 mm graft), Descending thoracic aortic aneurysm rupture cases were 2, Descending thoracic aortic aneurysm cases were 2, Descending thoracic aortic aneurysm + Bentall procedures were2. Emergency (37.5%) operations were 12 cases :- 6 cases were infrarenal leaking aneurysm, 2 cases were leaking abdominal aortic aneurysm, 2 cases were dissecting aortic aneurysm, 2 cases were Descending thoracic aortic aneurysm rupture. Results: Overall mortality rate was 15.62% (5 cases). Among emergency cases there were 6.25% (2 cases) death rate, per operative one – Descending thoracic aorta rupture in a 75 years old gentleman. Another lady of 35 years died 3 months later where emergency surgery was done for dissecting aortic aneurysm. In routine cases mortality rate was 9.37% (3 cases) – 1 month later a case of thoraco abdominal aneurysm dieddue to diabetic complication, 1 month later 22 years old gentleman (Descending thoracic aortic aneurysm with Bentall procedure) diedas a complication of tracheostomy (tracheo-innominate artery fistula) - sudden severe bleeding; another death in 46 years old gentleman where graft leakage occurred4 years after abdominal aortic aneurysm repair. Rest of the patients arein continuous follow up with us and are doing well.

Whole exome sequencing for the identification of a new mutation in TGFB2 involved in a familial case of non-syndromic aortic disease

BackgroundNon-syndromic aortic disease (NSAD) is a frequently asymptomatic but potentially lethal disease characterised by familial cases of thoracic aortic aneurysms and dissections. This monogenic but genetically heterogeneous condition is primarily inherited as an autosomal dominant disorder with low penetrance and variable expression. Mutations in ACTA2, TGFBR1, TGFBR2, MYH11, SMAD3, MYLK, and FBN1 genes have been described but still, there are many unresolved familial cases. MethodsThe whole exome of two distantly related and affected members of a Spanish family with multiple cases of NSAD was analysed through 5500 SOLiD™ System for the identification of shared and putative pathogenic variants. ResultsA new mutation termed c.C1042T:p.R348C (NM_001135599.2) was identified in TGFB2, a gene located in an evolutionary highly conserved region (Chr1: 218,519,577-218,617,961) that has been recently connected to this disease. The analysis of other family members using capillary sequencing confirmed cosegregation of the mutation with the disease and its incomplete penetrance. ConclusionsThe repeated implication of TGFB2 in the development of thoracic aortic aneurysms and dissections suggests that this gene should be considered during genetic diagnosis of this disease. An accurate diagnosis of affected individuals and additional family members at risk allows for a personalised and more efficient gene-based follow-up and treatment. Finally, the reiterative presence of common musculoskeletal and craniofacial additional features in patients with TGFB2 mutations suggests the existence of a new yet undefined connective tissue syndrome responsible for not only aortic dilation, but also for the other extracardiac alterations present in the affected patients.

Aortic valve aneurysm responsible for acute congestive heart failure and histological findings: A case report

We experienced a case of acute congestive heart failure in a 73-year-old man who had been followed up due to mild-to-moderate aortic stenosis and moderate-to-severe aortic regurgitation. A huge aortic valve aneurysm was found to extend from his right coronary cusp to a left ventricular outflow tract, resulting in moderate subaortic obstruction and severe aortic regurgitation. Surgical repair was performed and a perforated aneurysm of right aortic cusp was identified. Histological examinations suggested that healed infective endocarditis was responsible for the formation of an aneurysm in the aortic valve.<Learning objective: Aortic valve aneurysm is an uncommon complication of infective endocarditis. The infective process of a cardiac valve is thought to augment valvular tissue injury, resulting in aneurysmal formation and perforation of the valvular aneurysm. We report an uncommon case of aortic valve aneurysm that was histologically suggested to be caused by subclinical infective endocarditis. The subaortic obstruction and aortic regurgitation were successfully treated using a surgical procedure.>

A Case of an Infrarenal Mycotic Abdominal Aortic Aneurysm Caused by Bartonella henselae

Introduction: Bartonella spp. is a highly unusual cause of mycotic aneurysms. We describe the first case of an infected aortic aneurysm secondary to Bartonella henselae endocarditis in an immunocompromised patient. Report: A 72-year-old woman presented with severe left lower quadrant pain. Computed tomography angiography showed an infrarenal mycotic aneurysm, and transoesophageal echocardiogram revealed aortic valve vegetation. Serology confirmed the presence of B. henselae endocarditis. Given the patient's comorbidities, the aneurysm was successfully treated by endovascular repair and antibiotic therapy. Discussion: Endovascular stent-grafting is an alternative treatment option for mycotic aneurysms in high-risk patients who are unsuitable for open repair. A Case of an Infrarenal Mycotic Abdominal Aortic Aneurysm Caused by Bartonella henselaeEJVES ExtraVol. 27Issue 5PreviewBartonella spp. is a highly unusual cause of mycotic aneurysms. We describe the first case of an infected aortic aneurysm secondary to Bartonella henselae endocarditis in an immunocompromised patient. Full-Text PDF Open Access

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...

Yersinia enterocolitica: a rare cause of infected aortic aneurysm successfully treated with antibiotics and endovascular repair

Introduction: Yersinia enterocolitica is a Gram‐negative coccobacillus belonging to the family Enterobacteriaceae. We present a rare case of abdominal aortic aneurysm infected with Y. enterocolitica that was successfully managed using intravenous antibiotics and endovascular aneurysm repair. Case presentation: A 74‐year‐old male was admitted with a 1‐week history of feeling generally unwell with worsening abdominal pain radiating through to his back. Inflammatory markers were raised and blood cultures grew Y. enterocolitica biotype 2. A computed topography scan revealed a 50 mm infected abdominal aortic aneurysm. The patient was successfully treated with intravenous antibiotics and endovascular aneurysm repair. Conclusion: Whilst endovascular aneurysm repair has been increasingly used to treat aortic aneurysms infected with a variety of pathogens, this is, to our knowledge, the first reported case of an aortic aneurysm infected with Y. enterocolitica being treated by such a technique. Further research is required to establish the long‐term outcomes of patients undergoing endovascular repair of infected aneurysms.

Invited Commentary

Do genes really control our biologic destiny? In the case of aortic pathology, this is true for several disease types. Recent studies have linked the syndromes of Marfan with mutations in the gene fibrillin 1 (FBN1), Loeys-Dietz with mutations in the transforming growth factor β receptor 1 and 2 genes (TGFβR1/2), and Ehlers-Danlos type IV with mutations in the collagen type III alpha 1 gene (COL3A1). Other nonsyndromic cases of familial thoracic aortic aneurysms have been found in association with mutations in the genes for SMAD family member 3 (SMAD3), myosin heavy chain 11 (MYH11), actin alpha 2 smooth muscle aorta (ACTA2), myosin light chain kinase (MYLK), matrix metallopeptidase 9 (MMP9), and Notch1 (NOTCH1).

Aortoiliac aneurysm with congenital right pelvic kidney

The association of congenital pelvic kidney with abdominal aortoiliac aneurysm is an extremely rare clinical finding. Previous reports have described various methods of aneurysm repair with successful preservation of the function of pelvic kidney. However, to our knowledge, reconstruction of more than two renal arteries has not been established. We report a case of abdominal aortic aneurysm complicated by congenital right pelvic kidney in a 72-year-old man. Computed tomography (CT) revealed an abdominal aortic aneurysm with a maximum diameter of 54mm and a right common iliac aneurysm of 45mm. In addition, he had a congenital right pelvic kidney and CT angiography identified three right pelvic renal arteries. The upper artery originated from the bifurcation of the terminal aorta and the lower two originated from the right common iliac artery. Three-dimensional CT was helpful for the accurate planning of the operation. Open surgical repair of the aortoiliac aneurysm with a Dacron bifurcated graft replacement was decided and reimplantation of all three right pelvic kidney arteries to the right limb of the graft was also performed. For renal preservation, the right pelvic kidney arteries were perfused with cold Ringer's lactate using a rapid infusion pump and coronary perfusion cannula. The patient's postoperative course was uneventful, and worsening of renal function was not observed. The perfusion of renal arteries with cold Ringer's solution was thought to be a simple and appropriate procedure for renal protection.

Hybrid procedure to treat aortic arch aneurysm combined with aortic arch coarctation and left internal carotid artery aneurysm (Case Report)

Aortic arch aneurysm is a rare condition but carries a high risk of rupture. We report one case of aortic arch aneurysm combined with aortic arch coarctation and left internal carotid artery aneurysm, which is extremely rare. Left internal carotid artery aneurysm resection and revascularization, carotid and carotid graft bypass combined with endovascular stent graft and embolization with coils were successfully performed. There were no any complaints and complications at 8 months follow-up. The follow-up CTA demonstrated thrombus formation in the aneurysm lumen, no endoleak and the aortic arch and bypass graft were all patent. We feel that hybrid procedure may be a valuable therapeutic alternative when treating this type of lesion. However, long-term clinical efficacy and safety have yet to be confirmed.

術前化学療法中に中心静脈ポート感染から感染性大動脈瘤を生じた胃癌の1例

症例は72歳，男性．高度進行胃癌に対して，右上腕に末梢穿刺型中心静脈カテーテル（Peripherally inserted central catheter:以下PICC）を用いた中心静脈（Central venous:以下CV）ポート留置下に術前化学療法を行った．1コース終了後に右上腕の腫脹と疼痛を伴う発熱を認め，CVポート感染に伴う菌血症と血栓性静脈炎と診断．CVポート抜去，抗生剤投与，抗凝固療法を行った．炎症所見が遷延するため第18病日に行った胸腹部造影CTで感染性胸部大動脈炎を認め，治療継続にも関わらず同部位が瘤化し増大，切迫破裂に陥った．第45病日にようやく感染が沈静化し，第67病日のCTでは瘤の増大が停止した．第100病日に大動脈ステントグラフト内挿術を施行し，第130病日には胃癌の根治手術を行った．化学療法目的のCVポートによる重症感染性合併症症例を経験したので報告する．

Zone II Coverage in the Context of an Anomalous Left Vertebral Artery

Anomalous left vertebral arteries are uncommon occurring in roughly 4% of the population. Typically of no clinical consequence, they become very important in the context of endovascular repair of an arch aneurysm with Zone II coverage, requiring a deliberate strategy tailored to the anatomy. We describe three cases of aortic arch aneurysms with an anomalous vertebral artery, and discuss the different approaches available depending upon the anatomy.

Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary.

PET-CT で&lt;sup&gt;18&lt;/sup&gt;F-FDG 異常集積を認めた炎症性腹部大動脈瘤に対してEVAR を施行した1治験例

要旨：炎症性動脈瘤の診断は，血液生化学検査と造影CT など画像所見が有用とされている。今回我々は体重減少などを主訴に受診した患者に対して，悪性腫瘍を鑑別するためにPET-CT を施行し，腹部大動脈瘤外壁に一致した炎症が判明，さらにEVAR により炎症反応の改善と症状の消失を認め，PET-CT による評価で瘤壁の炎症が低下した症例を経験した。炎症性大動脈瘤に対するEVAR の有用性を文献的考察とともに報告する。

One case of abdominal aortic aneurysm with massive bleeding during emergency Operation

One case of abdominal aortic aneurysm with massive bleeding during emergency Operation

成人先天性心疾患における大動脈基部拡大および上行弓部大動脈瘤の経験

〔背景〕成人先天性心疾患（ACHD）の増加に伴い，ACHDを有する胸部大動脈瘤症例（TAA）が増加している．当院での10年の症例を検討した．〔対象〕2002年から2011年まで，当科で施行したACHDを有するTAAの15例．〔結果〕男性13名，女性2名，再手術時年齢33.3±10.8歳．先天性心疾患は，TOF 5例，congenital AS 4例，VSD 3例，CoA complex 1例，poly/DORV 1例，poly/corrected TGA 1例．大動脈基部拡大12例，上行大動脈瘤3例，ARの合併を10例に認めた．13例は待機的手術，2例が緊急手術で，II型急性大動脈解離およびKonno patchが離脱した症例であった．術式はBentall手術（＋部分弓部置換術）13例，上行大動脈置換＋AVR 1例，上行/部分弓部大動脈置換1例であった．手術時間572.8±101.4分，人工心肺時間295.8±100.2分，大動脈遮断時間188.1±58.8分．術後30日以内の死亡は認めなかった．MRSA敗血症による病院死亡を1例に認めたがその他の症例は全例が軽快退院，ICU滞在日数9.4±10.1日，在院日数34.4±18.2日であった．〔結語〕ACHDを有するTAA症例ではTOFが最多であった．ACHDを有するTAA症例の手術成績は良好であった．

Mycotic aortic aneurysm due to intravesical BCG immunotherapy: Clinical manifestations and diagnostic challenges

A live, attenuated form of Mycobacterium bovis, bacillus Calmette–Guérin (BCG), is commonly used as intravesical immunotherapy for non-invasive urothelial bladder carcinoma. While complications are rare, dissemination can occur. A case of mycotic aortic aneurysm following BCG administration with recovery of Mycobacterium bovis in culture is reported. A review of the published experience with this problem is also presented.

The “Open” Chimney Graft Technique for Juxtarenal Aortic Aneurysms with Discrepant Renal Arteries

A straightforward original Chimney Graft (CG) protocol has been developed at our institution in selected cases of juxtarenal aortic aneurysm (JRAA). The aim of this study was to present our clinical experience of consecutive series with use of uncovered self-expanding stent (SES) as "Open Chimney" (OCh) in the endovascular repair (EVAR) of JRAA. A standard endograft with suprarenal fixation struts is delivered with its proximal covered edge just below the highest RA in JRAA presenting the ostium of the two renal arteries at a different aortic level and the distance between the highest renal artery and the beginning of the aneurysm (improved landing zone) ≥10 mm. The low-lying renal artery is maintained patent by the OCh graft (standard SES) delivered from left brachial access (6 Fr). All clinical, anatomical, and operative data were prospectively collected and retrieved for the study analysis. From July 2010 to November 2012, OCh EVAR was offered to 22 consecutive patients considered unfit for JRAA open repair. All procedures were technically successful with aneurysm exclusion and patent OCh graft. One small perioperative type Ia endoleak spontaneously disappeared at the 3-month CT control. One patient died because of acute decompensated heart failure. One patient presented a left hemispheric stroke. The median follow-up of 18 months (range 7-35) showed aneurysm exclusion in all patients without type I and III endoleaks, SES stenosis, and/or renal impairment. OCh-EVAR is a straightforward technique that can be employed in selected cases of JRAA, avoiding the more complex and expensive fenestrated EVAR.

PS2-8: ePhenotyping for Abdominal Aortic Aneurysm

Background/Aims A large volume of clinical data is captured in electronic medical records (EMRs), and feasibly extracting the data to define clinical phenotypes is valuable to health care research. We designed an algorithm to define abdominal aortic aneurysm (AAA) cases and controls. We implemented the algorithm using our institutional warehouse and propose using the HMORN Virtual Data Warehouse (VDW) to replicate our findings.

Long-Term Outcome of Patients With Aortic Aneurysms Taking Low-Dose Aspirin

BackgroundLimited studies evaluated the association between low-dose aspirin use and abdominal aortic aneurysm (AAA), thoracoabdominal aortic aneurysm (TAAA), and thoracic aortic aneurysm (TAA) treatment. We conducted this study to investigative...

AB0906 Prevalence and characteristics of coronary disease and cardiovascular risk factors in a cohort of patients with spondyloarthropathies and biologic therapy

BackgroundWe performed a descriptive study of our patients with spondyloarthropathies (SpA) in biologic therapy attending to the presence of coronary disease and cardiovascular risk factors.MethodsPatients with spondyloarthropathies and anti-TNF treatment...