Concomitant Pseudoaneurysm Research Articles

Characteristics and Predictors of Outcome of Pseudoaneurysms Associated With Vertebral Artery Dissections: A 310-Patient Case Series.

Vertebral artery dissections (VADs) are a common cause of stroke in young patients and can result in various secondary effects, including pseudoaneurysm formation. To identify differences in predisposing factors and outcomes for VADs with and without concomitant pseudoaneurysms. We retrospective chart reviewed patients who presented to our institution at the time of VAD with at least a 3-mo clinical follow-up. Demographics, VAD characteristics, treatment, and outcomes represented as modified Rankin scale (mRS) scores were collected. Of 310 patients with a VAD included in this study, 301 patients had an identified pseudoaneurysm status, with 54 pseudoaneurysm-associated VADs and 247 VADs not associated with pseudoaneurysm. VAD patients with associated pseudoaneurysms were more likely to be female (P<.004), have bilateral VADs (P<.001), and have fewer vertebral artery segments affected (P=.018), and less likely to have stroke (P<.008) or occlusion of the vertebral artery (P<.001). There was no difference in the proportion of patients treated with antiplatelet agents (P=.12) or anticoagulants (P=.27) between the groups. VAD patients with associated pseudoaneurysms were more likely to have a higher mRS at 3-mo follow-up (P=.044) but not discharge (P=.18) or last follow-up (P=.05). VAD patients with pseudoaneurysms were equally likely to have resolution of occlusion (P=.40) and stenosis (P=.19). Demographics and clinical and radiological characteristics of VADs associated with pseudoaneurysms are different from those without associated pseudoaneurysms. Vertebral artery dissections with concomitant pseudoaneurysms are neither associated with worse functional nor radiographic outcomes.

Concurrent congenital pseudoaneurysm of mitral-aortic intervalvular fibrosa and left sinus of Valsalva aneurysm

Either the pseudoaneurysm of mitral-aortic intervalvular fibrosa or the aneurysms of Valsalva are rare cardiac conditions. Concomitant diagnosis in the same patient is extremely rare with only one case report. Herein, we described an extremely rare case of concomitant pseudoaneurysm of mitral-aortic intervalvular fibrosa and aneurysm of left sinus of Valsalva in 21-year-old black man admitted with new-onset of heart failure (NYHA class III) diagnosed by transesophageal echocardiography. Despite medical therapy optimization for heart failure, the patient died waiting for cardiac surgery. Regarding the case, we discussed possible etiology, clinical presentation and the role of echocardiography in the diagnosis and surgical approach of this very rare association.

Endovascular reconstruction of extracranial traumatic internal carotid artery dissections: a systematic review.

Extracranial internal carotid artery dissection (ICAD) is a potential source of morbidity and mortality in trauma patients and requires high degree of suspicion for diagnosis after the initial presentation. Occasionally, if standard therapy is contraindicated, endovascular reconstruction is a treatment option. The aim of this systematic review was to report clinical and radiographic outcomes following endovascular repair of ICAD of traumatic and iatrogenic etiology. A comprehensive systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched. Twenty-four studies comprising 191 patients (204 lesions) were included; 179 underwent traditional carotid artery stenting (CAS), whereas 12 patients underwent flow diversion with the pipeline embolization device (PED). In total, 75.7% of the CAS group and 66.6% of the PED group presented with ICAD-related symptomatology. Concomitant pseudoaneurysms were identified in 61.9% and 78.5% of lesions in the CAS and PED group, respectively. Adverse event rates among CAS-treated lesions after 30-day follow-up were below 2.2% for stroke, transient ischemic attack, and mortality. During follow-up in the CAS group, there was no incidence of ICAD-related stroke or death and 2.2% of patients underwent a repeat CAS procedure. In the PED group, no patient suffered stroke or death in the reported follow-up. In the PED cohort, there was an adequate occlusion rate and no patient had to be retreated. Endovascular reconstruction of traumatic or iatrogenic ICAD appears safe. This approach demonstrated acceptable short- and long-term clinical and radiographic outcomes in both groups.

Posterior Tibial Artery Pseudoaneurysm with Arteriovenous Fistula: Impact of Duplex Ultrasound on Diagnosis and Treatment

Post traumatic peripheral vascular injuries resulting in pseudoaneurysm (PSA) or arterial venous fistula (AVF) are rarely reported and may occur independently, or less commonly, concomitantly, following lower extremity fractures, penetrating or blunt trauma, and sports-related or orthopedic injuries. 1 Concomitant traumatic PSA and AVF requires accurate imaging and evaluation of hemodynamics for accurate diagnosis and treatment. Modalities for PSA repair include ultrasound-guided occlusion (thrombin injection), endovascular repair (coils, stents), and open surgical procedures (repair, ligation). A coexisting AVF can potentially impact the efficacy and safety of these options. This case demonstrates the important role of duplex ultrasound in the diagnosis and treatment algorithm of traumatic PSA.

Long-Term Results of Neomedia Sinus Valsalva Repair in 489 Patients With Type A Aortic Dissection

Acute type A aortic dissection frequently occurs in patients with normally sized aortic roots. The aim of this investigation was to describe the durability of aortic valve resuspension and root repair with a novel technique of reconstruction in type A dissection. From 1993 to 2013, among 629 patients operated on for acute type A dissection 489 (62% male, median age 62 years (53; 73) underwent aortic valve resuspension and reinforcement of the sinus of Valsalva with a Teflon felt neomedia. The median follow-up time was 4.1 years (1.3; 6.8) (2075 patient-years). In-hospital mortality was 11% (56/489). Survival was 69%±2%, 50%±3%, and 36%±5% at 5, 10, and 15 years, respectively. Freedom from moderate or severe aortic regurgitation was not influenced by the aortic regurgitation grade at the initial operation (p=0.131). Freedom from proximal aortic reoperation was 96%±1%, 92%±2%, and 89%±4% at 5, 10, and 15 years, respectively. Seventeen patients (3%) required proximal reoperation: 10 for aortic regurgitation, including 3 with concomitant pseudoaneurysm and 2 with root aneurysm; 6 for pseudoaneurysm; and 1 for graft infection. Aortic root neomedia reconstruction and valve resuspension can be successfully performed in the majority of patients with type A dissection. The in-hospital mortality is low, and the results are durable.

Delayed presentation of traumatic infrapopliteal arteriovenous fistula and pseudoaneursym in a 10-year-old boy managed by coil embolization

Blunt traumatic arteriovenous fistulae of the extremities are rare in children. We report the case of a 10-year-old boy with a traumatic infrapopliteal arteriovenous fistula and concomitant pseudoaneurysm diagnosed 2 months after he was struck by a car. It was definitively managed with coil embolization. Postprocedure, the vascular anatomy of the patient's right calf was well preserved. He had complete resolution of his symptoms immediately after the intervention and continues to do well 6 months later.

Late Concomitant Pseudoaneurysm and Arteriovenous Fistula of the Subclavian Artery: A Developing Country Perspective

Concomitant subclavian artery pseudoaneurysm and arteriovenous (AV) fistula has been rarely reported. We report a case of late concomitant pseudoaneurysm and AV fistula of the subclavian artery caused by a gunshot wound. Open surgical approach with an infraclavicular approach was used; subclavian artery was repaired with a Gortex interposition graft and subclavian vein was ligated. The postoperative course was uneventful. In developing countries, where the endovascular expertise is unavailable or if the lesion is large, open surgical approach provides similar results as an endovascular approach.

Endovascular Management of an Arteriovenous Fistula and Concomitant Pseudoaneurysm in an Intravenous Drug Abuser

An interesting case of an intravenous drug abuser who had endovascular management of an arteriovenous fistula and concomitant pseudoaneurysm, resulting from recurrent puncture of the femoral artery is reported in this study.

CT of acute lower GI bleeding in chronic cholecystitis: concomitant pseudoaneurysm of cystic artery and cholecystocolonic fistula

Acute lower gastrointestinal (GI) bleeding is a potentially dangerous situation because the patient may go into shock, and early detection of the bleeding site is necessary to make a haemostatic procedure. Pseudoaneurysm of the cystic artery is a well-characterized vascular abnormality induced by an inflammatory process such as pancreatitis, cholecystitis or injury after cholecystectomy, and commonly presented as haemobilia, haematemesis or melaena.1–3 In the present case, acute lower GI bleeding caused by cystic arterial pseudoaneurysm occurred because of concomitant cholecystocolonic fistula.