Aneurysm Of Sinus Research Articles

Single-center Surgical Outcomes of Arteriovenous Fistula Aneurysms in Patients with Chronic Renal Failure

Single-center Surgical Outcomes of Arteriovenous Fistula Aneurysms in Patients with Chronic Renal Failure

Abstract 323: Lyme Neuroborreliosis Presenting with CNS Vasculitis, Subarachnoid Hemorrhage, and Rupture of a PICA Aneurysm: A Case Report

Background Lyme disease, caused by Borrelia burgdorferi, is a tick‐borne illness that commonly manifests as lymphocytic meningitis, cranial neuritis, and radiculoneuritis. Central nervous system (CNS) vasculitis is an exceedingly rare complication of Lyme neuroborreliosis (LNB), often presenting with stroke or transient ischemic attack, and less frequently with cerebral venous sinus thrombosis, intracerebral hemorrhage, or aneurysm. To date, the literature includes only one report of LNB‐associated CNS vasculitis presenting with subarachnoid hemorrhage (SAH) and rupture of a basilar aneurysm. Objective: We report an exceptionally rare case of LNB‐associated CNS vasculitis manifesting as SAH and a dysplastic posterior inferior cerebellar artery (PICA) aneurysm. Methods A 67‐year‐old male with a history of seizure disorder, migraine, and hypertension presented with the worst headache of his life. He subsequently experienced neurological decline, requiring intubation for airway protection. CT imaging revealed diffuse intraventricular hemorrhage with hydrocephalus involving the 3rd and 4th ventricles, along with SAH in the bilateral sylvian and interhemispheric fissures. The patient's Hunt and Hess grade was 4, and the Modified Fisher score was 4. An emergent external ventricular drain (EVD) was placed. A diagnostic cerebral angiogram (DSA) showed a severely dysplastic PICA with multiple areas of ectasia and a 3.5 times 1.5 mm saccular aneurysm, which was successfully treated with endovascular coiling. The hospital course was complicated by aspiration pneumonia and a urinary tract infection, managed with ceftriaxone. The patient also experienced recurrent high‐grade fevers, suspected to be of central origin, although cerebrospinal fluid (CSF) analysis was negative for infection. One month into hospitalization, neurological examination revealed bilateral ataxia, gait instability, and mild dysphasia. Follow‐up CTA demonstrated no residual flow in the left PICA aneurysm, and CT imaging showed resolution of the SAH. During rehabilitation, the patient's ataxia and gait instability worsened, and he developed horizontal nystagmus and diplopia. Additionally, a patchy red rash developed, which responded to dupilumab. A repeat DSA at 6 months revealed bilateral posterior cerebral artery (PCA) beading and stenosis with ectatic segments and reduced flow, consistent with PCA vasculitis. Further investigation disclosed a history of Lyme disease 8 years prior, characterized by fever, headache, and chills, and treated with doxycycline. Repeat CSF analysis showed a protein level of 74 mg/dL, a CSF Lyme index of 1.4, and the presence of 4 IgG bands. Initial CSF negativity was attributed to the partial course of ceftriaxone administered in hospital. The patient was ultimately diagnosed with LNB and treated with a 28‐day course of 2 g ceftriaxone. Infectious and rheumatologic workups were otherwise negative. Conclusion In cases of non‐traumatic SAH associated with CNS vasculitis or aneurysm, where infection and other secondary causes are considered, Lyme neuroborreliosis should also be evaluated as a potential underlying condition, especially in patients with a clinical history suggestive of prior Lyme disease.

Application of prophylactic flow restriction in brachiocephalic arteriovenous fistulas

To investigate the effects of prophylactic flow restriction for brachiocephalic arteriovenous fistula on postoperative high-flow-related complications and patency rate in patients undergoing hemodialysis. Clinical data of patients with end-stage renal disease who underwent brachiocephalic arteriovenous fistula surgery for hemodialysis from February 2017 to May 2022 in Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were retrospectively analyzed. During surgery, a 4-5 mm vascular suture loop was placed around the vein near the anastomosis as a flow restriction device in 43 patients (flow restriction group), while 42 patients did not receive the prophylactic flow restriction ring (control group). All patients were followed up for 1 to 5 years. The incidence rates of complications related to the hemodialysis access pathway, including distal ischemia syndrome, the formation of arteriovenous fistula aneurysms, thrombus, high-flow congestive heart failure, anastomosis of the vein within 1 cm of the anastomosis and cephalic arch stenosis, were compared between the two groups. The natural blood flow rate of the arteriovenous fistula, anastomosis size, the internal diameter of the vein near the anastomosis, primary patency rate, assisted primary patency rate, and secondary patency rate of the arteriovenous fistula, were also evaluated and compared between the two groups. Logistic regression analysis was used to investigate the factors affecting arteriovenous fistula patency rates, as well as the impact of the flow-restricting ring on postoperative factors. Ultrasound measurements showed that the internal diameter of the vein at the site of the flow restriction ring in the flow restriction group was (3.7±0.6) mm at three months postoperatively, which was significantly smaller than the internal diameter of the narrowest part of the vein near the anastomosis in the control group [(4.1±1.0) mm, t=－2.416, P<0.01]. The postoperative anastomotic diameter and natural blood flow rate of the arteriovenous fistula in the flow restriction group were both significantly lower than those in the control group (both P<0.05). Furthermore, the incidence rates of various complications in the flow restriction group were significantly lower than those in the control group (all P<0.05). At 6, 12, and 24 months postoperatively, the primary patency rate and assisted primary patency rate in the flow restriction group were significantly higher than those in the control group (both P<0.05), while there was no significant difference in secondary patency rates between the two groups (P>0.05). Binary logistic regression analysis indicated that age, diabetes, and natural blood flow rate of the arteriovenous fistula at 3 months postoperatively were independent risk factors for primary patency rate, while the flow restriction for brachiocephalic arteriovenous fistula was an independent protective factor for primary patency rate (P<0.01 or P<0.05). The application of flow restriction was negatively correlated with anastomotic diameter at 6 and 12 months, natural arteriovenous fistula blood flow, and the incidence rates of cephalic arch stenosis and aneurysm formation (all P<0.05). The prophylactic constriction during brachiocephalic arteriovenous fistula surgery in patients undergoing hemodialysis can limit the size of the anastomosis and postoperative arteriovenous fistula blood flow, reducing complications such as cephalic arch stenosis and high-flow heart failure, and increasing primary patency rates of arteriovenous fistula and delay the reintervention of the fistula.

Impact of arteriovenous fistula aneurysms on a UK dialysis populations’ perception of vascular access

BackgroundClinically-oriented outcome measures are increasingly being recognized as lacking in consideration of factors important to patients. There is an emerging move of guideline bodies advocating a more patient-centred approach. Aneurysms in autogenous arteriovenous fistula (AVF) can be considered unsightly and a constant reminder for patients of their dependence on dialysis. However, their impact on patient’s perception has not previously been reported.MethodsBetween April 2017–18, the Vascular Access Questionnaire (VAQ) was administered to prevalent haemodialysis patients across ten dialysis units via structured interviews, as part of a quality improvement project. Data for the subgroup of patients with aneurysmal AVF (categorised as per classification by Valenti et al.), were retrospectively evaluated and compared to the wider cohort.ResultsData were collected for 539 patients (median age: 66 years; 59% male), of whom 195 (36%) had aneurysmal AVF, with Type 2 morphology (cannulation site) being the most common (75%). Duration of AVF was found to be significantly associated with aneurysmal development, with estimated likelihoods of 11%, 43% and 61% after one, five and ten years, respectively. Interestingly, patients with diabetes had a significantly lower prevalence of aneurysmal development than those that were non-diabetic (25% vs. 43%, p < 0.001). Overall VAQ scores were not found to differ significantly by aneurysm status (p = 0.816) or across morphology types (p = 0.277). However, patients with aneurysmal AVF were significantly more concerned with the appearance of their AVF (p < 0.001) than the wider cohort. Despite this, patients with aneurysmal AVF gave significantly higher scores for satisfaction and ease of use and lower scores for bruising and clotting (p < 0.05).ConclusionsAneurysmal AVF are often cited as an important factor by patients for not proceeding with fistula formation. In this evaluation of patient reported experiences, those with aneurysmal AVF reported high satisfaction levels. This may help clinicians highlight positive patient reported outcomes of aneurysmal AVF during preprocedural consent processes.

Ruptured coronary sinus aneurysm in pregnancy combined with cardiogenic shock and elevated V1 and aVR ST segments: Case report.

Sinus of Valsalva aneurysm (SOVA), a rare cardiac malformation, is usually congenital and rarely acquired and most commonly occurring in the right coronary sinus. The clinical presentation of patients with SOVA varies. It is usually asymptomatic when it has not ruptured, and when it compresses neighboring structures or ruptures, it can lead to heart failure or shock, at which point urgent surgical intervention is usually required. Rupture of the sinus of Valsalva aneurysm (RSOVA) during pregnancy is really hard to come by, especially if the clinical presentations resemble that of an acute myocardial infarction. This report describes a pregnant woman with severe chest pain and hypotension with aVR and V1 ST-segment elevation due to RSOVA. Effects of RSOVA on the fetus, disease survival, and prognosis. RSOVA. Open SOVA repair. The patient's blood pressure returned to normal range and clinical symptoms disappeared after the surgery. After 3 months of follow-up, the patient was hemodynamically stable without chest discomfort, and an echocardiogram showed a normal aortic sinus. Progressive aneurysm dilatation or rupture has a poor prognosis. A thorough history and physical examination are fundamental, with echocardiography being the initial diagnostic tool of choice, and other ancillary tests (e.g., computed tomography) being used to complement and confirm the diagnosis. Surgery remains the current treatment of choice for patients with RSOVA, while the continuation of pregnancy in pregnant patients with RSOVA remains a case-by-case measure.

Valsalva Aneurysm of Right Sinus: A Case Report and Review of Literature

In this case report, we describe the diagnostic modality of sinus of Valsalva aneurysm (SOVA) in combination with congenital cardiac defect, aortic valve involvement, and conduction abnormality in a 19-year-old patient. Aim of article was to understand the importance of clinicians being cautious about SOVA presenting in young patients, despite cases being rare, and that SOVA requires a thorough SOVA diagnostic approach. We further provide a review of literature highlighting and comparing the treatment options for both unruptured and ruptured SOVAs. The patient presented for examination due to tachycardia and palpitations. A murmur was heard, and the patient was found to have an atrioventricular nodal reentry tachycardia. Echocardiographic evaluation, magnetic resonance imaging, and computed tomography angiography confirmed an aneurysmally dilated aortic root, aortic regurgitation, and ventricular septal defect. Surgical intervention was indicated; however, the patient refused to undergo surgery.

Aneurysms of Aortic Sinus of Valsalva Dissecting through the Interventricular Septum With Rupture into the Left Ventricle: Case Series and Literature Review.

Aneurysm of Aortic sinus of Valsalva (ASOV) dissecting into the interventricular septum (IVS) and rupturing into the left ventricle (LV) is a rare clinical diagnosis. Systemic inflammatory diseases like tuberculosis can aggravate this condition. We describe three cases of ASOV dissecting into the IVS and rupturing into the LV. All three patients underwent surgical intervention; two had a successful outcome. A literature review was conducted and19 previously reported cases were studied. The extent and direction of septal dissection determined the associated cardiac valvular and rhythm problems. Patch closure of the mouth of the aneurysm is the surgical method of choice. In the presence of multiple sinus tracts or if there is recurrence after surgical closure, aortic sinus or root replacement techniques have better outcomes.

An observational study of symmetrical VSD occluder for transcatheter closure of ruptured sinus of Valsalva aneurysm.

This study evaluated the immediate and 1-year postoperative outcomes of 14 patients with ruptured Valsalva aneurysmal sinus (RSVA) using symmetric ventricular septal defect (VSD) occluder for transcatheter closure (TCC). The sites of rupture were from the non-coronary sinus to the right atrium (RA) in 10 cases (71.4%), the right coronary sinus (RCS) to the RA in 3 cases (21.4%) and the RCS to the right ventricle in 1 case (7.2%). The defects (5-11 mm) were closed with a symmetrical VSD device. During the follow-up (12 months), the enlarged heart of the patients had significantly shrunk and the NYHA improved after closure. In 1 case, a moderate residual shunt was present and the patient suffered from hemolysis at 2 h after the operation, and 1 patient was transferred to surgery for aortic regurgitation 1 year after the initial treatment of RSVA. In conclusion, the TCC of RSVA with the China made symmetrical VSD occluder is safe and effective.

Salvage of brachiocephalic aneurysmatic fistulas, using ePTFE graft with a minimally invasive approach.

In this study, we evaluated our surgical approach in requiring surgical treatment of brachiocephalic arteriovenous fistula (AVF) aneurysms for salvage of AVF. Between 2012 and 2022, 20 patients (16 men, 4 women; mean age 54.5 years) who were surgically treated for a brachiocephalic AVF aneurysm in our Cardiovascular Surgery Clinic were evaluated retrospectively. These 20 patients were operated on for aneurysm thrombosis and fistula failure in 16 patients, sudden rupture and severe bleeding in 3 patients, cosmetic reasons, and anxiety in 1 patient. These aneurysms were ligated and divided from distal and proximal cephalic veins. Then, a 6 mm dialysis graft was interposed between the well-developed cephalic vein distal and proximal to the aneurysm with small skin incisions. All patients were taken to dialysis via this dialysis graft 24 h after the procedure without any problem. All patients were discharged after dialysis. After surgery, no catheterization or any other additional procedure was required for hemodialysis. No complications, such as infection, hematoma, neurological damage, or ischemia, were observed after the surgical procedure. The mean postoperative follow-up was 12 months. In brachiocephalic AVF aneurysms requiring surgical treatment, hemodialysis can be continued with a graft placed in the same arm in this technique.

Young Healthy Man with Mixed Aortic and Mitral Valve Disease and Aneurysm of Sinus of Valsalva Causing Acute Antero-Lateral Myocardial Infarction, Cardiogenic Shock and Left Ventricular Failure: Lessons Learned

Young Healthy Man with Mixed Aortic and Mitral Valve Disease and Aneurysm of Sinus of Valsalva Causing Acute Antero-Lateral Myocardial Infarction, Cardiogenic Shock and Left Ventricular Failure: Lessons Learned

A CFD-based framework to evaluate surgical alternatives in cerebral aneurysms

ABSTRACT Computational Fluid Dynamic (CFD) simulations on patient-specific geometries may guide the choice between alternative surgical interventions, especially in the case on non-conventional treatments. We propose and formalise a CFD-based framework to evaluate alternative surgical interventions. It provides surgeons with the CFD analyses of different surgical options, so that they may decide the best strategy based on quantitative haemodynamic parameters for each surgical alternative. The proposed framework is largely automatised and, when it necessarily requires the intervention of a human operator due to the patient-specific nature, this intervention is well-formalised to reduce inter-operator variability and guarantee reproducibility. To provide preliminary evidence on the effectiveness of the framework, we present its application to complex Intracranial Aneurysms (IAs), which involve less than 5% of brain aneurysms, but are usually at a high risk of rupture and often show unexpected response to therapy. Complex IAs include aneurysms that cannot be treated with conventional therapies, such as neck clipping, sac coiling or stenting, while instead their treatment requires the sacrifice of the parent artery. In particular, we refer to a giant cavernous sinus aneurysm inside the left internal carotid artery. Results show the ability of the framework to provide haemodynamic quantitative evaluations, which can be useful additional information for the neurosurgeon towards optimal surgical planning.

Sacrificing Internal Carotid Artery-External Carotid Artery-Radial Artery-Middle Cerebral Artery Bypass for the Treatment of Complex Intracranial Artery Cavernous Sinus Aneurysms.

The treatment of complex intracranial aneurysms has always been a great challenge in neurosurgery. Craniotomy has a high risk of clipping, there is a risk of rupture at any time, endovascular embolization is relatively low risk, but expensive and easy to relapse, the best treatment needs to be further discussed. Cavernous sinus aneurysms with pituitary adenomas are rare. This case reports a case of complex intracranial aneurysms. Chief complaints are: (1) blepharoptosis with blurred vision for 1 year, (2) headache for 3 days, and (3) digital subtraction angiography showed right internal carotid artery cavernous sinus aneurysm. Combined with the patient's condition and family condition, the external carotid artery-radial artery-middle cerebral artery bypass was selected. After surgical treatment, the symptoms of the patients were improved, the postoperative recovery was good, and the condition was stable. After follow-up, the patient's brain computed tomography showed intra-aneurysm thrombosis.

Effectiveness and Safety of Different Patch Materials for Supravalvar Aortic Stenosis (Middle-Term Outcomes).

To determine the effectiveness and safety of different patch materials in the treatment of pediatric patients with congenital supravalvular aortic stenosis (SVAS). 218 consecutive SVAS patients (age 14 years) who underwent surgery from Beijing Fuwai and Yunnan Fuwai hospital between 2002 and 2020 were included. Patients were divided into the pericardium patch group (133 (61.0%)), modified patch group (43 (19.7%)) and artificial patch group (42 (19.3%)). The primary safety endpoint was patch-related adverse complications (post-operation patch hemorrhage or aortic sinus aneurysm at 2-year follow-up). The primary effectiveness outcome was the re-operation or restenosis at 2-year follow-up. Multivariable cox regression was used to obtain the hazard ratio (HR). The median age at operation was 43.5 months (IQR 24.0-73.0). Only three patients had patch-related adverse complications, and no difference existed among the three groups (p = 0.763). After a median follow-up of 24.0 months (IQR 6.0-48.0), patients with a pericardium patch had a lower re-operation or restenosis rate compared with the other two groups (pericardium patch vs modified patch, HR = 0.30, 95% CI 0.12-0.77; pericardium patch vs artificial patch, HR = 0.33, 95% CI 0.13-0.82), even in the main subgroup and sensitivity analysis. In pediatric patients, the safety of autologous pericardium patch is acceptable, along with lower rates of middle-term re-operation or restenosis. http://www.chictr.org.cn, number: ChiCTR2300067851.

A Case of Large Arteriovenous Fistula Aneurysm at Elbow

Abstract Arteriovenous (AV) fistula aneurysms are a late-onset complication of surgically created dialysis access sites. They can be of two types: true or false aneurysms (pseudoaneurysms). They can be managed either by endovascular or surgical techniques. We report a patient who presented with an expanding, painful AV fistula aneurysm at the left elbow along with features of left arm and forearm cellulitis. The fistula was ligated and the aneurysm was excised. Postsurgery, the left radial pulse was palpable. Follow-up postsurgery showed a healthy surgical scar with complete resolution of the left upper limb swelling.

Surgical treatment of false aneurysm of the right coronary sinus in a patient with Takayasu syndrome

Surgical treatment of false aneurysm of the right coronary sinus in a patient with Takayasu syndrome

Unusual Presentation of Heart Failure Secondary to Ruptured Aneurysmal Sinus of Valsalva: A Case Report

Unusual Presentation of Heart Failure Secondary to Ruptured Aneurysmal Sinus of Valsalva: A Case Report

Valsalva sinus aneurysm leading to spontaneous closure in congenital ventricular septal defect

Valsalva sinus aneurysm leading to spontaneous closure in congenital ventricular septal defect

Multi-modality imaging diagnosing 'wandering non-coronary Valsalva sinus aneurysm'.

Multi-modality imaging diagnosing 'wandering non-coronary Valsalva sinus aneurysm'.

Midterm outcomes of arteriovenous fistula aneurysm repair with simultaneous inflow revision or outflow tract revascularization

ObjectiveThe aim of this study was to investigate the 2-year outcomes of extensive revisions aimed at simultaneously addressing arteriovenous fistula (AVF) aneurysms, outflow stenosis, and/or high flow volumes. MethodsThis was a retrospective cohort study in a tertiary referral center. The study population comprised hemodialysis patients with aneurysmal AVFs requiring revision. Subjects were eligible if they were ≥18 years of age and had aneurysm repair associated with inflow revision or treatment of outflow lesions. Patients were followed-up for a minimum of 2 years, and the primary outcome measure was cumulative patency. ResultsOur cohort comprised 93 patients with a mean age of 56 ± 12 years. The most frequent access type was brachiocephalic fistula (61%), and the median access age at the time of revision was 66 months (interquartile range, 46-93 months). The median access flow volume was 2300 ml/min (interquartile range, 1281-2900), and 31 subjects (33%) presented aneurysms associated with both high flow and venous obstruction. Aneurysm repair consisted of aneurysmorraphy in the overwhelming majority (95%). Inflow revision was performed in a total of 49 cases (53%), and outflow tract obstruction was treated in 71 patients (72%), with 27 patients (29%) receiving a simultaneous 3-component revision. At 2 years, the primary, primary assisted, and cumulative patencies were 60% ± 1%, 91% ± 3%, and 94% ± 3%, respectively. The most frequent indication for first-time reinterventions was outflow tract stenosis (24%). Aneurysm recurrence was observed in 13 subjects (14%) during the entire follow-up and was responsible for reinterventions in seven of them (8%), with a 2-year freedom from aneurysm-related reintervention rate of 95% ± 3%. ConclusionsExtensive AVF revision with simultaneous aneurysm repair, inflow revision, and outflow tract revascularization is feasible, safe, and associated with favorable 2-year patency rates.

Abstract 12143: Hearing is Believing: A Case of a Ruptured Sinus of Valsalva Aneurysm

A 36-year-old previously active and healthy male was referred to our Adult Congenital Heart Disease clinic with worsening exertional dyspnea and intermittent palpitations over the past 6 months. He had recently been diagnosed with a membranous ventricular septal defect (VSD) and membranous septal aneurysm at another hospital, although images were not available for review.On physical exam, a continuous cardiac murmur was noted which prompted reconsideration of the diagnosis, with highest suspicion of ruptured sinus of Valsalva aneurysm (SVA). An urgent cardiac CT was obtained, which showed a large, mobile right SVA protruding into and partially obstructing the right ventricular outflow tract (RVOT), with pulmonic regurgitation and dynamic closure of a supracristal VSD (Figure 1A). A margin of the SVA was ill-defined and suspicious for rupture, although no definite communication was seen. An expedited TTE showed findings consistent with SVA rupture (Figure 1B), and he was admitted for surgery soon thereafter. Intra-operatively (Figure 1C), SVA rupture into the RVOT was confirmed by direct inspection; the SVA tissue was resected, the defect closed with a fresh autologous pericardial patch, and the VSD was closed with pledgeted sutures. Post-operatively, there was no leakage around the patch margin and only trace aortic regurgitation.A ruptured SVA causes continuous shunting from the aorta into an adjacent cardiac chamber and if left unrecognized, can lead to right heart failure, arrhythmia, and potentially sudden death, emphasizing the need for early identification. Echocardiography may show an aneurysmal sinus of Valsalva with a continuous (with accentuation in diastole) high-velocity, turbulent flow-jet into an adjacent cardiac chamber, and holodiastolic aortic flow reversal; a VSD is often present. Cross-sectional imaging is also important for diagnosis and surgical planning. A comprehensive physical exam is crucial to mitigate the risk of misdiagnosis.