Multiple Artery Aneurysms Research Articles

Guidewires as Embolic Agents? Embolotherapy of Large Splenic Artery Aneurysms

AbstractSplenic artery aneurysms are among the more frequently diagnosed intra-abdominal aneurysms and are not infrequent in patients with raised portal venous pressure often requiring endovascular or surgical therapy. A 36-year-old female patient with Non-cirrhotic portal fibrosis and portal hypertension was diagnosed with multiple large splenic artery aneurysms for which she was initially operated which resulted in substantial blood loss during dissection that required embolotherapy. Initial attempts at coil embolization proved unsuccessful due to the wide aneurysmal neck and flow characteristics. Following which the aneurysmal sac was packed with multiple guidewires to act as a scaffold for further coil embolization. Subsequently, hemostasis was achieved and the patient underwent splenectomy later thereby demonstrating that embolization of large aneurysms can be accomplished with reasonable efficacy using guidewires.

Complex Aortic Aneurysm Associated with Multiple Splanchnic Arterial Aneurysms and A Giant Coronary Artery Aneurysm

A 50-year-old male diabetic, hypertensive and chronic smoker presented with complex aortic, splanchnic aneurysms with impending rupture of iliac artery aneurysm, underwent coiling of celiac artery, internal iliac artery, and fenestrated/chimney endovascular aortic repair. One month later, the patient landed in an emergency due to bleeding complications of common hepatic artery and gastroduodenal artery aneurysms, which were managed successfully using endovascular techniques. The mayhem of progressive nature of the disease in the patient continued as he had left lower limb ischemia due to occlusion of the iliac artery and iliac limb of the aortic graft device as he continued to smoke. All of the above sequences of events occurred over a period of 5 years. He also developed a giant aneurysm of left anterior descending of 6.8 cm diameter, which had to be repaired by open surgical technique. The patient has been followed up for 6 years since his first presentation, and he was managed successfully from all the catastrophe of events using endovascular techniques. Giant coronary artery aneurysm with previous aneurysms at multiple sites is quite unusual and rare. Currently, there is no consensus regarding the clinical characteristics, diagnostic method, and the treatment of these cases.

Circulating microRNA in patients with popliteal and multiple artery aneurysms

BackgroundPatients with popliteal artery aneurysm (PA) often have multiple aneurysms, such as bilateral disease or a concomitant abdominal aortic aneurysm (AAA). microRNAs (miRs) are regulators of biological processes and have been investigated as biomarkers for AAA. The aim of this study was to explore if the presence of multiple aneurysms and/or location correlated with miR levels in blood. MethodsUsing quantitative polymerase chain reaction, 23 miRs were analyzed in plasma from 183 patients with PA. ResultsFifteen of the miRs were associated with the number and/or location of aneurysms (1.3- to 2.1-fold changes). Levels of miR-93 (1.4-fold) and miR-215 (1.6- to 1.9-fold) were changed in all compared groups. MiR-24 and miR-23a were altered in those with AAA (1.4- and 1.5-fold, respectively) or bilateral PA (1.5- and 1.4-fold, respectively), compared with in those without. MiR-145 were significantly altered (1.7-fold) in those with isolated PA and AAA, whereas miR-326 were altered in those with bilateral (2.3-fold) and isolated PA (1.9-fold). ConclusionsDifferent miRs seem to be important or to be markers for different subgroups of patients with PA. The identified miRs target vascular smooth muscle cell proliferation and vascular inflammation. Further studies are needed to increase the understanding of the pathogenesis of aneurysmal disease.

Living donor liver transplantation for idiopathic portal hypertension with extrahepatic portal vein stenosis and splenic artery aneurysms: a case report and review of the literature

BackgroundIdiopathic portal hypertension (IPH) generally has a good prognosis and rarely results in liver transplantation. Furthermore, there are few reports of living donor liver transplantation (LDLT) for IPH with extrahepatic portal vein stenosis.Case presentationWe report the case of a 51-year-old female patient diagnosed with IPH more than 20 years ago. She suffered severe jaundice, massive ascites, and encephalopathy at the time of her visit to our hospital. The patient’s extrahepatic portal vein showed a scar-like stenosis, and the portal flow was completely hepatofugal. Collateral circulation such as the splenorenal shunt was well developed, and multiple splenic artery aneurysms up to 2 cm were observed in the splenic hilum. Her Model for End-Stage Liver Disease score increased to over 40 because of renal dysfunction, requiring temporary dialysis. We performed LDLT using her husband’s right lobe graft and splenectomy. The extrahepatic stenotic portal vein was completely resected, and the superficial femoral vein (SFV) graft collected from the recipient’s right leg was used for portal reconstruction as an interposition graft. Although the clinical course after LDLT had many complications, the patient was discharged on postoperative day 113 and has been fine for 2 years after LDLT. Histopathologically, the explanted liver had obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal cirrhosis.ConclusionThis case showed that severe IPH is occasionally associated with extrahepatic portal vein stenosis and can be treated with LDLT with portal vein reconstruction using an interposition graft. It was also suggested that the SFV is a useful choice for the interposition graft.

Ruptured Epiploic Artery Aneurysm Associated With Fibromuscular Dysplasia

A 69 year old woman presented with severe abdominal pain and haemodynamic instability. Computed tomography (CT) angiography demonstrated multiple ectasia of the visceral arteries and a massive haemoperitoneum. An exploratory laparotomy was performed. Multiple epiploic artery aneurysms with a string of beads aspect were found (A), one of which had ruptured. Total omentectomy was performed, and she was discharged from hospital after one week. Histopathological analysis of the epiploic arteries indicated fibromuscular dysplasia with intimal thickening (B, red asterisk) with no lesion of the vein (B, blue asterisk). Annual surveillance with a whole body CT scan has been arranged.Image 1

Neonatal Kawasaki disease with multiple arterial aneurysms: a case report

BackgroundKawasaki disease (KD) is a medium vessel vasculitis that typically occurs in children aged between 6 months and 5 years. It is extraordinarily rare in the neonatal period. KD-related systemic artery aneurysms (SAAs) have never been reported in neonates.Case presentationA male infant was transferred to our institution for persistent high-grade fever lasting 16 days. Symptoms started at day 14 of life, and he was admitted to a children’s hospital on the second day of fever. Physical examination at the time found no signs suggestive of KD. The only laboratory parameters which were of significance were values suggestive of systemic inflammation. However, his fever persisted and inflammatory markers continued to rise despite 2 weeks of antibiotic therapy. KD as a noninfectious cause of fever was considered when he came to our institution, and echocardiographic findings of left and right medium coronary artery aneurysms (CAAs) confirmed our suspicions. Full-body magnetic resonance angiography also revealed bilateral axillary artery aneurysms. Administration of intravenous gamma globulin resulted in rapid improvement. His fever resolved on the next day and CAAs and SAAs regressed to normal at 6 months and 3 months after diagnosis, respectively.ConclusionThis unique case of incomplete KD highlights the importance of considering KD in neonates with unexplained prolonged fever and reinforces the need to remain vigilant for SAAs in KD.

Nonclassical Cause of Obstructive Jaundice: A Case Report of Multiple Visceral Arterial Aneurysms in a Young Patient

Multiple visceral artery aneurysms are relatively rare; the rarest are superior mesenteric artery and gastroduodenal artery aneurysms. The clinical presentation depends on the size and site of the aneurysm. We report the case of a 33-year-old man with recurrent episodes of obstructive jaundice and weight loss. Computed tomography with contrast revealed scattered hepatic arterial aneurysms with two other aneurysms along the course of the left gastro-duodenal and superior mesenteric artery. Investigations to determine the etiology were negative, but the patient had a history of smoking and substance abuse. Angiography revealed an occluded feeding artery. The patient developed multiorgan failure, leading to cardiac arrest and died. Diagnosing multiple visceral artery aneurysms needs a high index of suspicion; early diagnosis enables early intervention, which can reduce the high mortality of this condition.

Systemic aneurysms in a pediatric patient with congenital atrophoderma of Pasini and Pierini

Background: Idiopathic Atrophoderma of Pasini and Pierini (IAPP) is a rare dermatological disease that has histopathological and epidemiological differences from morphea and linear atrophoderma of Moulin. Case Presentation: This is the first case, to the authors’ knowledge, describing multiple systemic arterial aneurysms in a patient with IAPP. Conclusion: More longitudinal studies are needed for patients with IAPP to determine if patients with congenital IAPP inherit a risk of developing arterial aneurysms later in life.

Wilson Disease With Giant Splenic Artery Aneurysms Caused by Fibromuscular Dysplasia During Living Donor Liver Transplantation: A Case Report

Liver cirrhosis can cause splenic artery aneurysms (SAA) that pose a threat to patients undergoing liver transplantation. However, liver transplantation with multiple visceral artery aneurysms including giant SAA caused by arterial fragility has never been reported. We describe a 36-year-old man with decompensated liver cirrhosis due to Wilson disease that was complicated by giant SAA and multiple aneurysms in the bilateral renal arteries caused by fibromuscular dysplasia (FMD). The maximal diameter of the triple snowball-shaped SAA was 11 cm. We planned a 2-stage strategy consisting of a splenectomy with distal pancreatectomy to treat the SAA and subsequent living donor liver transplantation (LDLT) to address the liver cirrhosis. This strategy was selected to prevent fatal postoperative infectious complications caused by the potential development of pancreatic fistula during simultaneous procedures and to histopathologically diagnose the arterial lesion before LDLT to promote safe hepatic artery reconstruction. However, a postoperative pancreatic fistula did not develop after a splenectomy with distal pancreatectomy, and the pathologic findings of the artery indicated FMD. The patient underwent ABO-identical LDLT with a right lobe graft donated by his brother. Other than postoperative rupture of the aneurysm in the left renal artery requiring emergency interventional radiology, the patient has remained free of any other arterial complications and continues to do well at 2 years after LDLT.

2209 Abdominal Arterial Aneurysms in a Patient With Budd-Chiari Syndrome

INTRODUCTION: Budd-Chiari syndrome (BCS) is defined as hepatic venous outflow tract obstruction. Chronic BCS eventually leads to post-sinusoidal hypertension resulting in the symptoms of the disease. There have been case reports of BCS leading to intra-abdominal bleeding from ectopic varices, however, these are cases of venous bleeding. Here, we report a unique case of a Chinese woman with BCS presenting with bleeding from arterial aneurysms. CASE DESCRIPTION/METHODS: A 61-year-old woman with BCS requiring multiple prior porto-systemic shunting procedures was brought by EMS for coffee ground emesis. At the ED, she was stuporous and developed bloody emesis and hypotension. She was intubated and transferred to the ICU. Exam was remarkable for abdominal distention (AD) with a fluid wave. Labs showed leukocytosis; prolonged coags, elevated troponins, lactate, LDH and decreased fibrinogen and haptoglobin. FAST showed intra-abdominal free fluid. EGD showed grade II varices in the esophagus that were banded. However, the patient continued to deteriorate with increasing AD. CT-AP revealed a cirrhotic liver with occluded left and middle hepatic veins and extravasation of contrast near the greater curvature of the stomach into a LUQ hematoma (Figure 1). IR embolized the left gastric artery and identified aneurysms along a branch of the SMA (Figure 2) in addition to an aneurysm at the celiac artery origin (Figure 3). On the 2nd post-op day, the patient again developed hypotension with AD. Attempted embolization of the SMA branch was unsuccessful. On the 5th post-op day, the family agreed to withdrawal of life support and the patient was extubated and vasopressors were stopped. The patient passed away in a few hours. DISCUSSION: Chronic BCS presents with complications of cirrhosis; i.e., ascites and rupture of esophageal varices, like in our patient. On CTA, both the hepatic veins and part of the IVC were occluded. In fact, 31% of BCS patients have outflow occlusion at both these locations. However, in our patient, CTA revealed aneurysms in the celiac artery and distal portions of an SMA branch along with left gastric artery bleeding. Multiple arterial aneurysms have been associated with disorders such as PAN, Behcet's, Ehler-Danlos etc. By comparison, there have not been many reports of multiple idiopathic arterial aneurysms in adults. Several of these possible causes were unable to be worked up for due to the acute presentation, although our patient’s history was not typical for these diseases.

Multiple Splenic Artery Aneurysms in a Patient With Fontan Circulation.

Multiple Splenic Artery Aneurysms in a Patient With Fontan Circulation.

Novel pathogenic TGFBR1 and SMAD3 variants identified after cerebrovascular events in adult patients with Loeys-dietz syndrome

IntroductionLoeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder due to heterozygous pathogenic variants in transforming growth factor beta (TGFβ) signaling-related genes. LDS types 1–6 are distinguished depending on the involved gene. LDS is characterized by multiple arterial aneurysms and dissections in addition to variable neurological and systemic manifestations.Patient 1: a 68-year-old man was admitted due to an aphasic transient ischemic attack (TIA). Brain CT-scan and CT angiography revealed a chronic and asymptomatic right vertebral artery dissection. Stroke diagnostic panel was unremarkable. His history showed mild stroke familiarity. At age of 49, he was treated for dissecting-aneurysm of the ascending aorta and started anticoagulation therapy. Seven years later, he underwent surgery for dissecting aneurysm involving aortic arch, descending-thoracic aorta, left subclavian artery, and both iliac arteries. Patient 2: a 47-year-old man presented a left hemiparesis due to right middle cerebral artery (MCA) and anterior cerebral artery (ACA) occlusion caused by right internal carotid artery (ICA) dissection after sport activity. Despite i.v. thrombolysis and mechanical thrombectomy, he developed malignant cerebral infarction and underwent decompressive hemicraniectomy. Digital subtraction angiography showed bilateral carotid and vertebral kinking, aneurysmatic dilatation on both common iliac arteries and proximal ectasia of the descending aorta. His father and his uncle died because of an ischemic stroke and a cerebral aneurysm rupture with a subarachnoid hemorrhage (SAH), respectively. Discussionin both cases, considering the family history and the multiple dissections and aneurysms, LDS molecular analysis was performed. In patient 1, the novel NM_005902.3 (SMAD3): c.840T > G; p.(Asn280Lys) likely pathogenic variant was identified, thus leading to a diagnosis of LDS type 3. In patient 2, the novel NM_004612.2 (TGFBR1): c.1225T > G; p.(Trp409Gly) likely pathogenic variant was found, allowing for a diagnosis of LDS type 1. ConclusionLDS is characterized by genetic and clinical variability. Our report suggests that this genetically-determined connective tissue disorder is probably underestimated, as it might firstly show up with cerebrovascular events, although mild systemic manifestations. These findings could lead to identify people at risk of severe vascular complications (i.e., through genetic consult on asymptomatic relatives), in order to perform adequate vascular assessments and follow-up to prevent complications such as stroke.

Multiple Giant Splenic Artery Aneurysms with Hypersplenism and Portal Hypertension: A Case Report.

Multiple giant splenic artery aneurysms (>10 cm in diameter) are rare. We report a patient presenting with these aneurysms who had also associated portal hypertension and massive splenomegaly. Almost all the aneurysms were sealed by endovascular means at the first stage. Later, for the residual aneurysms at splenic hilum and enlarged spleen, splenectomy was performed. She made an uneventful recovery.

Thoracoscopic Bronchial Artery Resection for Multiple Bronchial Artery Aneurysms

We describe a 36-year-old asymptomatic female with multiple bronchial artery aneurysms (BAAs) and a bronchial artery (BA) to pulmonary artery (PA) fistula. She was treated with thoracoscopic BA resection without lobectomy in lieu of catheter embolization as first-line treatment. The configuration of the BA and the location of the BAAs were clearly visualized using three-dimensional computed tomography (3DCT); therefore, the segment of the BA to resect was assessed preoperatively and complete resection of all BAAs was performed. Preoperative BA angiography delineated the BA to PA fistula, and guided surgical decision-making.

Endovascular management of unruptured intercostal artery aneurysms

BackgroundIntercostal artery aneurysms are rare vascular abnormalities that are typically diagnosed following rupture in patients with predisposing conditions. Our report is the first to document a patient with unruptured intercostal artery aneurysms in the absence of any associated disease.Case presentationA 70-year-old male with prostatic adenocarcinoma was incidentally discovered to have multiple unruptured aneurysms of his intercostal arteries. Three of the aneurysms were embolized utilizing microcoils and glue. At six-month follow-up the patient remained asymptomatic.ConclusionWe demonstrate successful endovascular management of a unique case of multiple idiopathic unruptured intercostal artery aneurysms. Appropriate diagnosis and prompt treatment of these rare vascular lesions is essential in preventing the potentially catastrophic consequences of rupture.

A case of renal artery and multiple splenic artery aneurysms managed by heterotopic renal autotransplantation with splenectomy and proximal splenorenal shunt

A 30-year-old female was incidentally detected to have multiple splenic artery aneurysms and a large left renal artery aneurysm along with portal hypertension and splenomegaly during her prenatal workup. She was successfully managed by splenectomy, proximal splenorenal shunt, excision of left renal artery aneurysm, bench reconstruction of the left renal artery with saphenous vein graft, and renal autotransplantation in the right iliac fossa.

Spontaneous Recovery of Multiple Hepatic Artery Aneurysms with Segmental Arterial Mediolysis

Spontaneous Recovery of Multiple Hepatic Artery Aneurysms with Segmental Arterial Mediolysis

Sa1270 AN UNUSUAL CAUSE OF OVERT, OBSCURE GI BLEED: A REMINDER TO THINK OUTSIDE THE BOX (OR LUMEN)

A 64-year-old man with a history of clinically diagnosed hereditary hemorrhagic tenalgiectasias (HHT) presented with one year of recurrent hematochezia requiring transfusion of a total of over 130 units of RBCs. Workup included multiple prior upper endoscopies, colonoscopies, capsule endoscopy and two double balloon enteroscopies (DBE) with findings of several small non-bleeding arteriovenous malformations that were treated with argon plasma coagulation but no lesion to explain the severity of his bleeding episodes. He presented with another episode of overt bleeding which resulted in hypotension and severe anemia with a hemoglobin of 5.4 g/dL. At that time he complained of sharp abdominal pain that often preceded the episodes of bleeding. Lipase was elevated at 318 U/L. Both upper endoscopy and capsule endoscopy were unremarkable. CT angiogram (CTA) showed extravasation of blood into the duodenum but no clear source for embolization. Inpatient DBE showed blood extruding from the ampulla. This prompted a hepatic arteriogram, which showed diffusely abnormal visceral arteries with a severe beaded appearance, and multiple arterial aneurysms including a 9x6 mm pseudoaneurysm of the gastroduodenal artery (GDA) that was embolized. Following embolization, the bleeding ceased and the patient was discharged shortly thereafter. On follow up over a year later, the patient has had no recurrent GI bleeding. The findings of abnormal vasculature seen on CTA brought the diagnosis of HHT into question, and subsequent genetic testing for HHT was negative. He is currently being worked up for other systemic vascular diseases that could account for his abnormal beaded vasculature with diffuse aneurysms, with particular concern for vascular Ehlers-Danlos syndrome. Hemosuccus pancreaticus, defined as bleeding from the pancreatic duct, is a rare cause of GI bleeding that is most often caused by communication of a splanchnic artery pseudoaneurysm with the pancreatic duct, either by erosion or fistula formation. Pseudoaneurysms occur as a result of vascular injuries or erosions such as in trauma or inflammation. They often form as a result of pancreatitis but have been reported to occur secondary to congenital vascular abnormalities. GDA pseudoaneurysm is a very rare entity, representing only 1.5% of visceral artery aneurysms. This case of a patient with recurrent obscure, overt GI bleeding ultimately found to be secondary to a GDA pseudoaneurysm, caused by either pancreatitis or possibly a rare vascular abnormality, illustrates the importance of maintaining a broad differential diagnosis in cases of obscure GI bleeding. Though small bowel hemorrhage is the source of bleeding in the majority of cases of obscure GI bleeding, it is essential to consider extra-luminal etiologies in order to prevent a significant delay in diagnosis and treatment.Blood extruding from the ampulla visualized on double balloon enteroscopyView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Vascular Ehlers-Danlos Syndrome Presenting as a Pulsatile Neck Mass: a Case Report and Review of Literature

Ehlers-Danlos syndrome refers to a spectrum of connective tissue disorders typically caused by mutations in genes responsible for the synthesis of collagen. Patients with Ehlers-Danlos syndrome often exhibit hyperflexibility of joints, increased skin elasticity, and tissue fragility. Vascular Ehlers-Danlos (vEDS) is a subtype of Ehlers-Danlos syndrome with a predilection to involve blood vessels. As such, it often manifests as vascular aneurysms and vessel rupture leading to hemorrhage. There are few reports describing primary prevention of aneurysms in the setting of undiagnosed, suspected vEDS. We present a case of a 30-year-old woman who presents with a pulsatile neck mass found to have multiple arterial aneurysms on imaging, hyperflexibility, and characteristic facial features consistent with vEDS. As described in this case, management of a suspected connective tissue disorder is a multidisciplinary approach including vascular surgery, medical therapy, and genetic testing to confirm the diagnosis. We review literature regarding the care of patients with vascular Ehlers-Danlos as it might pertain to hospitalized patients.

Enfermedad multianeurismática: a propósito de un caso

Introduction: Multiple artery aneurysms are a rare pathological condition which may be caused by different etiologies. Therefore, its location, morphology and clinical presentation may vary in a case to case basis. Case report: A 51-year-old woman, prior history of dyslipedemia presents with upper abdominal pain. Abdominal tomographic scans showed aneurysm of the pancreaticduodenal artery and retroperitoneal hematoma. Emergent surgical evacuation of the hematoma was performed, with no other findings. In the postoperative period, the patient suffers hypertensive crisis and a new tomographic scan is conducted observing multiple dilations in different visceral arteries. The patient is treated conservatively and is being studied for a possible vasculitis. Discussion: Multi-aneurysmatic artery disease is a very rare entity, its etiology is determined by clinical and histopathological correlation. Although establishing a diagnosis in which the clinical presentation completely corresponds, is a real challenge. Unlike degenerative aneurysms due to atherosclerosis, multi-aneurysmatic disease commonly involves visceral arteries. Open surgery is considered safe treatment option and should be established in the segments causing symptoms. Endovascular treatment is less invasive, being the technique of choice in patients with high comorbidity and in cases of complicated surgery with rupture.