Multiple Artery Aneurysms Research Articles

Rapid progression of multiple splanchnic artery aneurysms

A 62-year-old man with a complex medical history that included long-standing muscular dystrophy presented with moderate-to-severe epigastric and mid-back pain. Family history was noncontributory. The patient worked as a full-time computer instructor. He was a social drinker and denied a history of cigarette smoking or illicit drug use. At initial presentation, vital signs were normal except for a blood pressure of 148/105 mm Hg. Physical examination revealed moderate epigastric tenderness without rebound or guarding. Laboratory findings were unremarkable, and the hemoglobin was 12.4 g/dL (hematocrit, 37%). A computed tomography of the abdomen and pelvis demonstrated a retroperitoneal hemorrhage that involved the mesenteric circulation. A mesenteric arteriogram (Fig 1) was performed that revealed high-grade stenosis of the celiac artery origin with retrograde filling via superior mesenteric artery (SMA) collaterals as well as aneurysms of the celiac artery trifurcation and inferior pancreaticoduodenal artery (IPDA) without evidence of active bleeding. No therapeutic intervention was undertaken, and the patient was stabilized and discharged home. Three weeks later, he was admitted with recurrent abdominal pain, and a repeat arteriogram (Fig 2) showed significant increase in the size and number (13 in total) of splanchnic artery aneurysms that involved the celiac trunk, branches of the SMA that included the anterior and posterior branches of IPDA and gastroepiploic arteries, and splenic and right renal arteries. No risk for splanchnic artery aneurysms was identified, and evaluation for vasculitis or mycotic etiology was negative. Also, we could not identify any reports of an association between our patient's muscular dystrophy and the development of splanchnic artery aneurysms. Therapeutic intervention was neither feasible nor attempted given the patient's vascular anatomy and overall health. At follow-up, 4 months since the last arteriogram, the patient remains hemodynamically stable in his usual state of health. Fig 2Follow-up mesenteric arteriogram performed 3 weeks after the initial study (as observed in Fig 1), which revealed splanchnic artery aneurysms that involve the celiac trunk, branches of the SMA that include the anterior and posterior branches of IPDA, and gastroepiploic arteries, as well as splenic and right renal arteries. View Large Image Figure Viewer Download Hi-res image This section features outstanding photographs of clinical materials selected for their educational value or message, or possibly their rarity. The images are accompanied by brief case reports (limit 2 typed pages, 4 references). Our readers are invited to sumit items for consideration.

Bleeding spinal artery aneurysms

The authors report a case of acute subarachnoid hemorrhage due to the rupture of multiple anterior spinal artery aneurysms. In view of the clinical and radiological findings, surgery was excluded and a wait-and-see policy was followed. A magnetic resonance imaging study performed 3 months after presentation and an angiographic study performed 6 months after presentation confirmed spontaneous regression of the aneurysms and preservation of blood flow through the anterior spinal artery.

Multiple arterial aneurysms in the mediastinum

Department of Vascular and Endovascular Surgery, University of Heidelberg - Heidelberg--> - GERMANY (Kotelis, Drosos)

Generalized dilating diathesis in patients with popliteal arterial aneurysm

Aim of this study was to analyse the relationship between popliteal artery aneurysm (PAA) and generalized arteriomegaly. In this consecutive serie, thirty-three patients (1 woman, mean age 69.7 +/- 9.6 years) undergoing PAA repair between 1996 and 2000 agreed to participate in a duplex screening program to assess the diameters of the infrarenal abdominal aorta, common and external iliac, common and superficial femoral and contralateral popliteal arteries as well as common carotid and brachial arteries. The prevalence of arteriomegaly and aneurysmal disease, respectively, was as follows: abdominal aorta 15/33 (45.5%) and 8/33 (24.2%), common iliac artery 34/66 (51.5%) and 23/66 (34.8%), common femoral artery 55/66 (83.3%) and 7/66 (10.6%) as well as contralateral popliteal artery 7/33 (21.2%) 15/33 (45.5%). Significantly larger carotid artery diameters were found comparing PAA patients with age- and body surface adjusted healthy controls (p < 0.001). Furthermore, patients with multiple peripheral arterial aneurysms had significantly larger diameters of the brachial (p < 0.02) and external iliac (p < 0.005). Our findings support the hypothesis of a diathesis for a generalized arteriomegaly with a predilection for further aneurysms of the abdominal aorta, iliac arteries, femoral and contralateral popliteal arteries in patients with PAA.

Hemobilia due to hepatic artery aneurysm as the presenting sign of fibro-muscular dysplasia

Fibro-muscular dysplasia (FMD) is a rare but well documented disease with multiple arterial aneurysms. The patients, usually women, present with various clinical manifestations according to the specific arteries that are affected. Typical findings are aneurysmatic dilatations of medium-sized arteries. The renal and the internal carotid arteries are most frequently affected, but other anatomical sites might be affected too. The typical angiographic picture is that of a "string of beads". Common histological features are additionally described. Here we present a case of a 47-year-old woman, who was hospitalized due to intractable abdominal pain. A routine work-up revealed a liver mass near the portal vein. Before a definite diagnosis was reached, the patient developed massive upper gastrointestinal bleeding. In order to control the hemorrhage, celiac angiography was performed revealing features of FMD in several arteries, including large aneurysms of the hepatic artery. Active bleeding from one of these aneurysms into the biliary tree indicated selective embolization of the hepatic artery. The immediate results were satisfactory, and the 5 years follow-up revealed absence of any clinical symptoms.

Multiple peripheral arterial and aortic aneurysms in Behcet’s syndrome—a case report

Behcet's syndrome is an inflammatory disorder of unknown cause, characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Behcet's syndrome with predominant vascular involvement is known as vasculo-Behcet. Arterial complications occur in only 1 to 7% of patients with Behcet's syndrome. In most reports, arterial lesions are isolated. We report a case of Behcet's syndrome that, over 6 years, developed multiple aneurysms in peripheral arteries and aorta without any coexisting venous thrombosis. An increased awareness of Behcet's syndrome and its vascular complications is essential. This is highlighted by the fact that our patient had to undergo four surgeries and many years of diagnostic uncertainty before reaching at the final diagnosis.

Ruptured femoropopliteal artery aneurysms in von Recklinghausen neurofibromatosis

A 38-year-old woman with neurofibromatosis type 1 was referred for massive swelling of the left thigh, pain, and anemia. Angiography demonstrated three saccular aneurysms of the femoropopliteal artery. The largest measured 3 cm in diameter. Resection of the aneurysms and femoropopliteal interposition grafting using reversed saphenous vein was performed through a medial surgical approach. Arterial involvement in neurofibromatosis is a well known but infrequent occurrence. Stenotic lesions predominate. Aneurysmal defects are less common, and rupture of peripheral arteries is exceptional. Neurofibromatous invasion and dysplasia of the tunica media of the femoropopliteal vessel were confirmed by means of pathologic study. We think this is the second reported case of a femoropopliteal artery aneurysm and rupture associated with neurofibromatosis.

A rare complication of a common operation: hepatic artery pseudo aneurysm following cholecystectomy report of a case

Vascular injuries following cholecystectomy are a known entity though the incidence is low. More frequently we are seeing cases of right hepatic artery pseudo aneurysm post cholecystectomy after the advent of the laparoscopic approach. We report a case of multiple right hepatic artery aneurysms as a complication of cholecystectomy in a 71-year-old patient. The diagnosis was confirmed by angiogram, and the patient was treated successfully with coil embolisation. Though it is a rare complication, early diagnosis and treatment of postoperative pseudo aneurysm is essential to prevent life threatening bleeding.

Multiple peripheral middle cerebral artery aneurysms associated with Behcet’s disease

We report a 19-year-old woman with Behcet's disease who suffered a subarachnoid hemorrhage and had bilateral peripheral middle cerebral artery aneurysms. After steroid therapy for 3 days, the smaller aneurysm disappeared. The larger aneurysm was excised and the artery reconstructed using a superficial temporary artery graft. Histological examination showed vasculitis restricted to the wall of the aneurysm. This is the first report of arterial reconstruction for an aneurysm associated with Behcet's disease. Steroid therapy before the operation may facilitate repair of the arterial wall.

Multiple Giant Superior Mesenteric Artery Branch Aneurysms

Mesenteric arterial branch aneurysms are rare. Giant, multiple, mesenteric branch artery aneurysms are even more uncommon, and only a few reports exist in the literature. We describe a 73-year-old asymptomatic female found to have an abdominal bruit and subsequently diagnosed with multiple mesenteric branch artery aneurysms by computed tomography and angiography. In addition, the patient was found to have celiac artery occlusion at its origin. Risk factors include hypertension, hyperlipidemia, grandmultiparity, and tobacco dependence. She was treated successfully with open surgery including ligation of multiple branch aneurysms and vein bypass reconstruction to preserve hepatic and mesenteric artery flow. Our purpose is to review this uncommon entity in terms of diagnosis, etiology, treatment options, and literature review.

What Does It Take to Diagnose Behçet Disease?

Behçet disease is a systemic inflammatory disease of unknown etiology initially described as a triad of recurrent oral ulcers, genital ulcers, and hypopyon uveitis affecting young male adults. Internationally agreed diagnostic criteria have been proposed to assist in the diagnosis. We present the case of a 26-year-old African-American male who presented with right brachial plexopathy due to axillary aneurysm. Further evaluation revealed the presence of a common carotid artery aneurysm, superior vena cava, and left subclavian vein thrombosis. A few months later, he developed severe bilateral panuveitis with hypopyon, retinal vasculitis, and optic nerve inflammation. Although our patient had no recollection of oral or genital ulcers, the constellation of deep vein thrombosis, multiple arterial aneurysms, bilateral panuveitis, positive pathergy skin test, and elevated inflammatory markers led to the working diagnosis of Behçet disease. Arterial involvement occurs in 3%-5% of patients with Behçet disease and may manifest as either true or false aneurysms. Deep vein thrombosis is the most common venous manifestation and involvement of venae cavae and their tributaries is not uncommon. Anterior and posterior uveitis and retinal vasculitis not only have a prognostic value in Behçet disease but in this particular case supported the diagnosis. In conclusion, incomplete forms of Behçet vasculitis exist and clinicians should be alert to atypical presentations of the disease.

Intercostal artery aneurysms complicating thoracic aortic coarctation: Diagnosis with magnetic resonance angiography

The case report of a 46-year-old woman diagnosed with complete aortic coarctation and multiple intercostal artery aneurysms using 'ultrafast time-resolved' multiphase contrast-enhanced magnetic resonance angiography and conventional single-phase, high-resolution breath-hold contrast-enhanced magnetic resonance angiogram techniques is presented. A review of intercoastal artery aneurysms occurring in conjunction with aortic coarctation and the various contrast-enhanced magnetic resonance angiography techniques currently available is provided.

Multiple Aneurysms

Idiopathic aneurysms, occurring at multiple sites throughout the arterial tree, are rare. This report describes a case of multiple asymptomatic arterial aneurysms of uncertain origin, involving the aorta and lower limb vasculature, in a 70 year old man. The clinical presentation, vascular reconstruction and a brief review of the literature are described.

Intrathecal aspergillosis and fusiform arterial aneurysms in an immunocompromised child: a clinico-pathological case report

We describe a 12-year-old boy with subarachnoid hemorrhage. Cerebral angiography revealed multiple fusiform intracranial arterial aneurysms. Surgical therapy other than ventricular drainage was not feasible due to the extent and pattern of pathological changes. Aspergillus antigen was found in the cerebrospinal fluid (CSF). However, cultures of urine, CSF, and samples from the upper airways were negative for Aspergillus and other fungi. The boy was immunocompromised due to prophylactic antibiotic therapy for recurrent pneumonia and continuous steroid therapy for his hemolytic anemia. There were Aspergillus antigens but no evidence of ongoing infection with the fungus was found. The patient suffered recurrent intraventricular hemorrhage and died on the 31st day after admission. Pathological examination showed multiple fusiform aneurysms, hypertrophy of the intima, and destruction of the internal elastic membrane of the cerebral arteries. No fungus infiltration was detected. We speculate that the patient had previously had an Aspergillus infection, causing segmental destruction of the internal elastic membrane. However, we cannot rule out noninfectious vasculitis as possible etiology. In the immunocompromised child, fusiform segmental intracranial arterial aneurysms may be secondary to the destruction of the internal elastic membrane by fungus infection. The condition may present with aneurysm rupture and subarachnoid hemorrhage. In this patient group, surgical therapy is rarely an option and the prognosis is poor.

Multiple mirror-like intracranial aneurysms. Report of a case and review of the literature

While multiple intracranial arterial aneurysms occur in 26.4% of patients with aneurysms, in our practice bilateral mirror-like aneurysms are encountered in 9.4% of patients. Multiple mirror aneurysms in the same patient are exceedingly rare. We report a case of mirror-like middle cerebral artery aneurysms associated with mirror-like posterior inferior cerebellar arteries aneurysms and discuss their significance. Although an exceptional finding, multiple mirror-like aneurysms may shed light on the vulnerability of different arterial segments to specific diseases.

Multiple Hepatic Artery Aneurysms: Use of Transcatheter Embolization for Rupture

Aneurysmal disease of the hepatic artery is a rare and potentially life-threatening entity. Aneurysms occur anywhere along the hepatic artery and its branches, but they have a predilection for occurring as a solitary lesion of the common or right hepatic artery. Diffuse intrahepatic hepatic artery aneurysm is the rarest form and is especially challenging. Treatment of these lesions has been described in only a few case reports. We present a patient with ruptured intrahepatic hepatic artery aneurysms treated by percutaneous transcatheter embolization.

Aortoceliac Artery Bypass Using an Anastomosis Device with a Saphenous Vein Graft from the Supraceliac Aorta

We describe the clinical experience of application of an aortic anastomotic device for aortoceliac artery bypass with a saphenous vein graft from the supraceliac aorta.A 53-year-old female with celiac artery occlusion and multiple superior pancreaticoduodenal artery aneurysms had an aortoceliac artery bypass surgery using the aortic anastomosis device. Coil embolization of the aneurysms was performed via the superior mesenteric artery. The postoperative angiogram revealed good graft patency and complete aneurysm embolization. This device can be considered for application in various anastomotic situations.

Aortoceliac Artery Bypass Using an Anastomosis Device with a Saphenous Vein Graft from the Supraceliac Aorta

We describe the clinical experience of application of an aortic anastomotic device for aortoceliac artery bypass with a saphenous vein graft from the supraceliac aorta.A 53-year-old female with celiac artery occlusion and multiple superior pancreaticoduodenal artery aneurysms had an aortoceliac artery bypass surgery using the aortic anastomosis device. Coil embolization of the aneurysms was performed via the superior mesenteric artery. The postoperative angiogram revealed good graft patency and complete aneurysm embolization. This device can be considered for application in various anastomotic situations.

Idiopathic renal artery and infrarenal aortic aneurysms in a 6-year-old child: Case report and literature review

Multiple arterial aneurysms are distinctly rare in the pediatric population. Most arterial aneurysms in children are secondary to infections, trauma, arteritides, collagen vascular diseases, and other causes. True idiopathic aneurysms are the least common and less than a dozen reports of multiple idiopathic aneurysms have been published. We present a case of an idiopathic, symptomatic renal artery aneurysm with fistulization to the renal vein and a concomitant abdominal aortic aneurysm in a 6-year-old boy. The diagnostic workup, surgical treatment, pathologic findings, and a review of the literature are presented.

Gastrointestinal Bleeding as the Initial Manifestation of a Polyarteritis Nodosa-Associated Hepatic Artery Aneurysm-Duodenal Fistula

The authors report an unusual case of upper gastrointestinal bleeding from a hepatic artery aneurysm-duodenal fistula in a 21-year-old male. Arteriography revealed multiple visceral artery aneurysms. Biopsy of the hepatic artery aneurysm (HAA) revealed focal areas of necrosis, medial degeneration, fibrosis, and giant cells. The necrotizing vasculitis plus the multiple visceral aneurysms were highly suggestive of polyarteritis nodosa (PAN). This report reviews the pathophysiology and management of PAN and the diagnosis and management of HAA.