Multiple Pseudoaneurysms Research Articles

Multiple pseudoaneurysms caused by Brucella infection.

Multiple pseudoaneurysms caused by Brucella infection.

Mucoid Vasculopathy Complicated by Multiple Giant Pseudoaneurysms Following Bentall Procedure

Mucoid Vasculopathy Complicated by Multiple Giant Pseudoaneurysms Following Bentall Procedure

Treatment For Infected Frozen Elephant Trunk Prosthesis Caused by Propionibacterium acnes: A Surgical Challenge.

In this article, we present the case of a 47-year-old man who underwent Bentall-Bono procedure and frozen elephant trunk prosthesis implantation due to severe aortic regurgitation and aortic dilatation with a second-time endovascular stent-graft repair in descending aorta. Over eight years, a subacute graft infection by Propionibacterium acnes was developed, culminating in cardiogenic shock secondary to severe aortic regurgitation due to a complete aortic root dehiscence because of multiple aortic pseudoaneurysms. The patient underwent emergency surgery in which the replacement of the graft by a biological valve tube was performed accompanied by a complete debranching of the three supra-aortic vessels.

Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case report

BackgroundDelayed post-traumatic bleeding at various sites is known due to vascular abnormalities related to structural changes in the vessel walls, in the form of pseudo aneurysms and arteriovenous malformations. Delayed epistaxis following facial trauma is a distinct entity that presents as recurrent episodes of bleeding from the nose. History of trauma is important to differentiate it from idiopathic intractable epistaxis, the management of which is less dramatic in the beginning in the form of endoscopy and electrocauterization. However, uncontrolled post-traumatic delayed epistaxis usually requires embolization. We report a rare case of intractable epistaxis associated with multiple pseudoaneurysms (PA), due to bleeding inside concha bullosa, where even embolization was unsuccessful.Case presentationA 25-year-old male patient presented to casualty and was referred to the Otorhinolaryngology department for recurrent profuse bleeding from left nasal cavity, where conservative measures like nasal packing, and electrocauterization did not help. Patient had a history of fall from height with facial bone fractures 1 month back. Angiography revealed blush with dilatation (pseudoaneurysms) in the nasal branches of internal maxillary arteries, ascending pharyngeal and labial arteries and embolization was done in the Interventional Radiology Department. Post-embolization, the patient again developed massive epistaxis. The patient was explored under general anaesthesia, to find out the site of bleed by nasal endoscopy. Collected blood was found in the left concha bullosa. Conchoplasty of the left middle turbinate was done with cauterization of bleeding vessels. The patient had no further epistaxis and was discharged in stable condition. He is asymptomatic for the last 6 months.ConclusionPost-traumatic pseudoaneurysms is a rare cause of delayed epistaxis following nasal trauma. Angiography helps in the localization of the source of bleeding inside nasal cavity and can identify pseudoaneurysmal dilatations of vessels. Our case highlights the importance of hidden bleeding points inside concha bullosa as a source of intractable epistaxis unresponsive to embolization.

Multiple cystic artery pseudoaneurysms in a COVID-19 patient

Cystic artery pseudoaneurysm are very rare and less than one hundred cases have been reported around the world. Usually, they are consequences of laparoscopic cholecystectomy or can be found after an episode of cholecystitis. The most common clinical presentation is with right upper quadrant pain and haemobilia or other signs of upper gastrointestinal bleeding. The treatment usually involves urgent angioembolization followed by cholecystectomy. We presented the case of an 81-year-old male who, during the recovery in our hospital for COVID-19 disease, showed a septic state with fever and right upper quadrant pain. The patient underwent an abdomen CT scan that showed a 16 mm pseudoaneurysm of cystic artery. The angioembolization was performed with the finding of multiple pseudoaneurysms of hepatic and cystic artery. The aim of our case report was to show this rare pathological condition and to clarify the best management possible, especially in patients with multiple comorbidities.

Cryopreserved Arterial Allografts Versus Rifampin-Soaked Dacron for the Treatment of Infected Aortic and Iliac Aneurysms

Infected aortic and iliac artery aneurysms are challenging to treat. Cryopreserved arterial allografts (CAAs) or rifampin-soaked Dacron (RSD) are standard options for in situ reconstruction. Our aim was to compare the safety and effectiveness of CAA versus RSD for these complex pathologies. This is a retrospective review of infected iliac, abdominal, and thoracoabdominal aortic aneurysms treated with either CAAs or RSD between 2002 and 2022 at our institution. The diagnosis was confirmed by intraoperative, radiologic, or microbiological evidence of aortic infection. Perioperative events, 30-day and long-term mortality, reinfection, and reintervention were analyzed. Thirty patients (17 CAA, 13 RSD) with a mean age of 61 and 68years, respectively, were identified. The infected aneurysm was most commonly suprarenal or infrarenal. Culture-negative infections were present in 47% of the CAA group and 54% in the RSD group. Early major morbidity was 57% and 54% for the CAA and RSD, respectively. Thirty-day mortality was similar between groups (18% vs. 23% CAA vs. RSD, P ≥ 0.99). Median follow-up was longer in the RSD group (14.5months vs. 13months). Overall survival at 1 and 5years was 80.8% and 64.8% in the CAA group and 69.2% and 57.7% in the RSD group. Reinterventions only occurred with CAA repairs and indications included graft occlusion (2), multiple pseudoaneurysms and reinfection (1), and hemorrhagic shock caused by graft rupture (1). Freedom from reintervention at 1 and 3 years was 87.5% and 79.5% (CAA group) versus 100% and 100% (RSD, P=0.06). Freedom from reinfection at 1year was 100% in both groups, while at 3 years it was 90.9% for the CAA group and 100% for the RSD group (P=0.39). Infected aortic and iliac aneurysms have high early morbidity and mortality. CAA and RSD had similar outcomes in our series; CAA trended toward higher reintervention rates. Both remain viable options for complex scenarios but require close surveillance.

Multiple Hepatic Artery Pseudoaneurysms With Eosinophilia

Multiple Hepatic Artery Pseudoaneurysms With Eosinophilia

S3319 An Unusual Presentation of Segmental Artery Mediolysis

Introduction: Segmental Arterial Mediolysis (SAM) is a rare non-atherosclerotic and non-inflammatory disease that often mimics vasculitis. It most commonly affects celiac artery and superior mesenteric artery. Here we describe an unusual presentation of SAM in an elderly woman. Case Description/Methods: A 65-year-old female with history of smoking presented with sudden onset dull epigastric pain, radiating to the back, nausea, vomiting and decreased oral intake for three days. Review of system was negative for other symptoms. Vital signs upon presentation were blood pressure 140/87 mm Hg, heart rate 92 beats per minute, respiratory rate 16 per minute and saturating 96% on room air. Physical examination revealed epigastric tenderness without rebound tenderness or guarding. Initial labs showed WBC 15,200/mL, CRP 9.4 mg/L and ESR 92 mm/hour. LFTs revealed AST 2173 U/L, ALT 2013 U/L, total bilirubin 0.6 mg/dl, albumin 3.7 and INR 1.1 Further labs ruled out infectious etiology for her presentation. Rheumatologic work up was negative for ANA, ANCA or abnormalities in complement proteins. Computed tomographic angiography (CTA) of the abdomen demonstrated multiple large aneurysms involving bilateral hepatic arteries with diffuse irregularity and ectasia of the hepatic arterial system and blood products surrounding the left hepatic artery aneurysm. (Figure A) She subsequently underwent coil embolization of left hepatic artery. (Figure B) The procedure was complicated by complete occlusion of left hepatic artery and spontaneous thrombosis of right hepatic artery upon catheterization. CTA abdomen after procedure showed reconstitution of flow within hepatic arterial supply via collaterals. Post procedure investigations revealed down trending inflammatory markers and transaminitis with levels returning to baseline within a week. Discussion: To the best of our knowledge, this is the first reported case with multiple pseudoaneurysms involving both hepatic arteries. Although, in our case, histologic confirmation was not done, clinical presentation, laboratory findings and radiologic pattern, led to the diagnosis of SAM. Early detection is the key in the prognosis of SAM, as clinical course tends to be unpredictable and complications of vascular injury including stenosis, dissection, aneurysm or rupture may occur.Figure 1.: A) Computed tomographic angiography (CTA) of the abdomen demonstrated left hepatic artery aneurysm (arrowhead) and right hepatic artery aneurysm (arrow). B) Angiogram showing coil embolization of left hepatic artery (arrow).

AN UNUSUAL PRESENTATION OF A PULSATILE NECK MASS

AN UNUSUAL PRESENTATION OF A PULSATILE NECK MASS

A rare case report of trauma manifesting as multiple pseudoaneurysms of internal carotid artery and ipsilateral carotid cavernous fistula

Carotid cavernous fistula is commonly caused by head trauma. Carotid cavernous fistula may be associated with intracavernous aneurysm of internal carotid artery, but occurrence of aneurysm at other site is rare. Management becomes complicated when carotid cavernous fistula is associated with aneurysm. Carotid cavernous fistula and aneurysm are managed by endovascular coiling with or without stenting. The management is more complicated if aneurysm is in cervical internal carotid artery along with carotid cavernous fistula. The decision to first obliterate what varies according to patient and doctor. We are reporting one of the rarest case of post-traumatic cervical internal carotid artery pseudo-aneurysms with carotid cavernous fistula following blunt head-neck injury and evidence based management strategies in such cases.

Multiple posttraumatic pseudoaneurisms of the spleen in a 13-year old child

Introduction. Until now, there is an ongoing controversy regarding the curative strategy in spleen pseudoaneurysms which are detected by CT imaging.Purpose. To present a diagnostic and curative algorithm for treating spleen injury complicated by multiple pseudoaneurysms in a 13-year-old child.Observation. A 13-year-old boy was injured in a traffic accident (a cyclist hit by a car) and was admitted to the hospital by an ambulance with brain concussion, abrasions and bruises of soft tissues. On the second day after the injury, the child complained of the pain in the left lumbar region. Multiphase spiral computed tomography (MSCT) revealed damage of the lower pole of the spleen with formation of multiple round hyperdense formations in the arterial phase disappearing in the portal phase. Ultrasound examination revealed multiple hypoechoic zones up to 8 mm in diameter in the lower pole of the spleen, in which blood flow was seen at the color Doppler mapping (CDM). Diagnosis: closed trauma of the spleen, Grade 4 (AAST). Multiple pseudoaneurysms of the lower pole of the spleen. Repeated MSCT on the 6th day after the injury registered disappearance of pseudoaneurysms, like it was at the ultrasound examination. In six months after the injury, there were no complaints; spleen structure at ultrasound examination corresponded to age normal parameters.Conclusion. The presented clinical observation demonstrates the success of conservative treatment of spleen injury complicated by the formation of multiple pseudoaneurysms.

A Rare Case of Multiple Uterine Artery Pseudoaneurysms after Hysteroscopic Myomectomy

A 33-year-old para 2 presented with heavy vaginal bleeding on postoperative day 4 after an uncomplicated hysteroscopic myomectomy of 2 posterior submucosal fibroids (3 cm, 1 cm). Her history was notable for a term cesarean delivery 5 years earlier, a hysteroscopic myomectomy 3 years earlier, and a vaginal breech delivery 1 year earlier. Her vital signs were stable and abdominal examination was unremarkable. Pelvic examination revealed 10 cc of pooled blood upon speculum insertion. The cervical os was closed without significant active bleeding.

Beh\xe7et\u2019s disease: successful aortic root reconstruction in severely dilated aortoventricular junction after aortic valve replacement with novel surgical method \u2013 case report

BackgroundBehçet’s disease is an auto-inflammatory disorder categorized as a primer systemic vasculitis of unknown aetiology. Genetic factors, infectious agents and the irregularity of T-cell homeostasis are presumed to be responsible for the emergence of Behçet’s disease. Characteristic symptoms are multisystemic. Although cardiovascular involvement is rare, it should be noted due to the difficulty of surgical treatment options.Case presentationOur 44-year-old male patient underwent aortic valve replacement due to aortic regurgitation. At the 15-month follow-up, echocardiography showed detachment of the prosthetic valve and in the aortic root, multiple pseudo-aneurysms were identified. We performed an aortic root reconstruction with a Bentall procedure using a special „skirted” conduit to reduce strain in the suture line between the conduit and the extremely dilated left ventricular outflow tract.ConclusionsThe surgical treatment of cardiovascular manifestations of Behçet’s disease remains challenging. This new technique may be beneficial in well-selected cases where the annulus of the aorta is extremely dilated or annular tissue disorder is present.

The Use of Omniflow Biosynthetic Prosthesis to Treat a Patient with Multiple Pseudoaneurysms Secondary to an Infected Axillo-Bifemoral PTFE Graft

The Use of Omniflow Biosynthetic Prosthesis to Treat a Patient with Multiple Pseudoaneurysms Secondary to an Infected Axillo-Bifemoral PTFE Graft

Bedside Duplex Ultrasonography Identifies Multiple Pseudoaneurysms in a Penetrating Extremity Trauma

A 14-year-old boy sustained an accidental self-inflected stab wound to the calf injuring both the posterior and anterior tibial arteries. On physical examination, pedal pulses were palpable and no obvious sign of arterial injury was identified. It was only after noninvasive duplex ultrasonography that multiple pseudoaneurysms were identified. The patient was taken to the operating room where reversed saphenous vein interposition grafts were used to repair both injuries. Therefore, use of bedside vascular duplex ultrasonography has the ability to expedite patient care.

Management of hemodynamically unstable, ruptured multiple hepatic artery pseudoaneurysms by open surgery combined with endovascular embolization

Hepatic artery pseudoaneurysm is a type of visceral artery aneurysm, which may cause life-threatening situation if the diagnosis and treatment are delayed after rupture. Increased clinical awareness and aggressive, definitive management are necessary in obtaining optimal outcomes. In general, surgery is the preferred treatment for extrahepatic lesions, whereas embolization is appropriate for intrahepatic aneurysms. However, exploratory laparotomy for vascular ligation or anastomosis is the only way in emergency if the hemodynamic status is unstable. Since the cases of ruptured pseudoaneurysm in both intra- and extra-hepatic artery is rare, we present a case of ruptured hepatic artery pseudoaneurysms with hemorrhagic shock rescued by surgery to stabilize the patient, followed by angioembolization to manage the multiple hepatic aneurysms and provide a review of the current literature on this topic, focusing on appropriate decision-making under multidisciplinary management.

Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report

BackgroundPulmonary artery aneurysms constitute <1% of aneurysms occurring in the thoracic cavity. Congenital cardiac defects are responsible for the majority (>50%) of cases, however, pulmonary artery aneurysm is a rare sequelae of pulmonary tuberculosis reported in about 5% of patients with chronic cavitary tuberculosis on autopsy. The natural history of this potentially fatal condition remains poorly understood and guidelines for optimal management are controversial.Case presentationA 24-year-old man, a nursing student of African descent, was referred to us from an up-country regional hospital with a 4-week history of recurrent episodes of breathlessness, awareness of heartbeats and coughing blood 3 weeks after completing a 6-month course of anti-tuberculosis drugs. A physical examination revealed conjuctival and palmar pallor but there were no stigmata of connective tissue disorders, systemic vasculitides or congenital heart disease. An examination of the cardiovascular system revealed accentuated second heart sound (S2) with early diastolic (grade 1/6) and holosystolic (grade 2/6) murmurs at the pulmonic and tricuspid areas respectively. Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia. A chest radiograph revealed bilateral ovoid-shaped perihilar opacities while a computed tomography scan showed bilateral multiple pulmonary artery pseudoaneurysms with surrounding hematoma together with adjacent cystic changes, consolidations, and tree-in-bud appearance. Our patient refused to undergo surgery and died of aneurismal rupture after 9 days of hospitalization.ConclusionsThe presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm. Furthermore, despite of its rarity, early recognition and timely surgical intervention of pulmonary artery aneurysm is crucial to reducing morbidity and preventing the attributed mortality.

Development of Multiple Visceral Artery Pseudoaneurysms Following Pancreatic Injury from Penetrating Trauma

Development of Multiple Visceral Artery Pseudoaneurysms Following Pancreatic Injury from Penetrating Trauma

Radiologic Assessment of Native Renal Vasculature: A Multimodality Review.

A wide range of clinically important anatomic variants and pathologic conditions may affect the renal vasculature, and radiologists have a pivotal role in the diagnosis and management of these processes. Because many of these entities may not be suspected clinically, renal artery and vein assessment is an essential application of all imaging modalities. An understanding of the normal vascular anatomy is essential for recognizing clinically important anatomic variants. An understanding of the protocols used to optimize imaging modalities also is necessary. Renal artery stenosis is the most common cause of secondary hypertension and is diagnosed by using both direct ultrasonographic (US) findings at the site of stenosis and indirect US findings distal to the stenosis. Fibromuscular dysplasia, while not as common as atherosclerosis, remains an important cause of renal artery hypertension, especially among young female individuals. Fibromuscular dysplasia also predisposes individuals to renal artery aneurysms and dissection. Although most renal artery dissections are extensions of aortic dissections, on rare occasion they occur in isolation. Renal artery aneurysms often are not suspected clinically before imaging, but they can lead to catastrophic outcomes if they are overlooked. Unlike true aneurysms, pseudoaneurysms are typically iatrogenic or posttraumatic. However, multiple small pseudoaneurysms may be seen with underlying vasculitis. Arteriovenous fistulas also are commonly iatrogenic, whereas arteriovenous malformations are developmental (ie, congenital). Both of these conditions involve a prominent feeding artery and draining vein; however, arteriovenous malformations contain a nidus of tangled vessels. Nutcracker syndrome should be suspected when there is distention of the left renal vein with abrupt narrowing as it passes posterior to the superior mesenteric artery. Filling defects in a renal vein can be due to a bland or tumor thrombus. A tumor thrombus is most commonly an extension of renal cell carcinoma. When an enhancing mass is located predominantly within a renal vein, leiomyosarcoma of the renal vein should be suspected. ©RSNA, 2017.

Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores.

To describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores. The medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization. Twenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92%) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n=5) or without (n=20) AV fistulae. Sixteen patients (64%) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56%). Clinical success was achieved after one (n=22) or two (n=3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR. A majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.