Post-traumatic Pseudoaneurysm Research Articles

Traumatic middle meningeal artery aneurysm: a case report

IntroductionTraumatic intracranial aneurysms are rare, making up about 1% of all intracranial aneurysms. They can happen due to direct injury or blunt force, with the middle cerebral artery being the most frequent site.The middle meningeal artery (MMA) is the main artery that supplies the cranial dura mater, and, because of its location, is susceptible to damage after trauma. This article reported an unusual case of giant post-traumatic MMA pseudoaneurysm. CaseA 45 year-old man was referred to our department with a history of craniectomy. He complained of non-specific headache, but neurological examination was normal. A follow-up brain CT scan identified a right temporal fossa hyperdense mass. Digital subtraction angiography diagnosed a traumatic MMA aneurysm. The patient was treated with preoperative aneurysm embolization and surgical resection. DiscussionTraumatic MMA aneurysm is a rare presentation after head trauma. It can manifest as epidural hematoma, subdural hematoma or intraparenchymal hematoma, and sometimes resembles the present case, which was discovered incidentally. ConclusionPseudoaneurysm is a rare complication of MMA trauma, with late presentation. It should be considered in patients with history of traumatic brain injury and temporal fossa extra-axial mass lesion with vascular characteristics.

Post-Traumatic Renal Artery Pseudoaneurysm Managed Successfully with Angioembolization

Renal artery pseudoaneurysm is a rare complication of blunt renal trauma. Super-selective angioembolization is aminimally invasive, effective procedure to manage traumatic renal artery pseudoaneurysm, in patients who are hemodynamicallystable. We report our experience in the management of patients with post-traumatic bleeding pseudoaneurysm withangioembolization. Materials and methods: We retrospectively reviewed the inpatient and outpatient records and imagingdata of our hospital, of all patients with history of blunt injury to kidneys, admitted with massive hematuria and underwentangioembolization to control the bleeding. Results: During the study period, 3 patients (all male) with a mean age of 26.66 yearspresented to us with blunt injury abdomen. Contrast computed tomography (CT) revealed Grade IV renal injury in 2 patientsand Grade V injury in 1 patient. Focal intensively enhancing areas were noted at the site of renal parenchymal lacerationssuggestive of pseudoaneurysms. Super-selective catheterization was performed and embolization done using 50% N-butyl-2-cyanoacrylate (NBCA) + Lipiodol. Conclusions: Angioembolization, a radiographic intervention, is an effective and minimallyinvasive technique to stop active bleeding from renal artery pseudoaneurysms.

FAUX ANEVRISMES POSTTRAUMATIQUES DE L’ARTERE FEMORALE SUPERFICIELLE : A PROPOS DE TROIS CAS OPERES

Post-traumatic superficial femoral artery pseudoaneurysm are rare. The aim of their treatment is to exclude the pseudoaneurysm from the arterial circulation while maintaining distal vascularization of the limb. That can be done by open surgical repair or by endovascular procedure. We report three cases of post-traumatic pseudoaneurysm of the superficial femoral artery operated on in our centre. The authors want to present three surgical treatment modalities for post-traumatic pseudoaneurysm, of the superficial femoral artery, namely direct suture, bypass using an inverted saphenous vein graft and ligation of the superficial femoral artery.

EMBOLIZATION FOR THE TREATMENT OF DELAYED HEMATURIA RENAL ARTERY PSEUDOANEURYSM FOLLOWING BLUNT TRAUMA

Background: The occurrence of a renal artery pseudoaneurysm after blunt renal trauma is an infrequent complication. The occurrence of delayed bleeding is typically observed within a period of 2 to 3 weeks following an injury and is commonly attributed to the presence of an arteriovenous malformation (AVM) or pseudoaneurysm. They are frequently observed in cases of injuries of greater severity or trauma that penetrates the body. The application of angiographic catheterization is efficacious in the detection of pseudoaneurysms in the renal artery. The management of renal pseudoaneurysms necessitates the consideration of distinct clinical associations, including the location and size of the lesion as well as the presence of symptoms.
 Objective: The objective of this study is to provide a detailed account of the use of an angiographic catheter and embolization in the treatment of a patient afflicted with a post-traumatic renal artery pseudoaneurysm.
 Materials and Methods: Conducting a literature review and medical records.
 Results: A case of renal artery pseudoaneurysm is presented. A male individual aged 33 sought medical attention at the emergency department following a motorcycle collision and exhibited symptoms of pain in the right flank region. The individual underwent a medical intervention involving the placement of a double J stent. After a period of nearly fourteen days, the individual reported experiencing hematuria. The abdominal CT scan revealed a renal injury on the right side with an AAST grade of 4, while the renal CTA demonstrated the presence of a pseudoaneurysm. A pseudoaneurysm was observed at the renal poles on the right side through the use of an angiographic catheter. The procedure of selective embolization utilising coils was executed on the renal arteries located at the lower and middle poles of the right kidney.
 Conclusion: The occurrence of renal artery pseudoaneurysms is infrequent; however, it is a grave complication that may arise from renal trauma. The accurate diagnosis and effective management of pseudoaneurysms are of paramount importance due to their potential to cause severe and potentially fatal complications if left untreated. The diagnostic process for pseudoaneurysms heavily relies on the involvement of the general radiologist. Interventional radiology provides alternative minimally invasive procedures that are linked to reduced morbidity and mortality rates and have replaced surgical interventions in the management of certain conditions.
 Keywords: pseudoaneurysm, angiographic catheter, embolization

Endovascular treatment of large posttraumatic false aneurysm of the S2 segment of the subclavian artery: clinical case and literature review

Introduction. Pseudoaneurysms of the subclavian artery are a rare pathology and most frequently occur due to trauma. According to the current literature, subclavian artery aneurysms account for 1 % of all peripheral artery aneurysms. This pathology, although rare, may be accompanied by the risk of rupture, thrombosis, or distal embolism of the arterial lumen. Objective. To demonstrate a clinical case of a patient with successful treatment of subclavian artery pseudoaneurysm by means of modern minimally invasive endovascular technique. Material and methods. The article presents our clinical case with the use of endovascular technique for the treatment of large posttraumatic pseudoaneurysm of the S2 segment of the left subclavian artery using the Bard LifeStream balloon stent graft.Discussion. Currently, direct surgery is considered to be the gold standard of treatment in extracranial aneurysms. Meanwhile, availability of minimally invasive methods allows minimizing the risk by performing endovascular treatment and thus reducing the risk of foreign bodies and infectious complications associated with a large volume of surgical intervention in direct surgery, reducing damage to the brachial plexus, decreasing the number of beddays, and contributing to early rehabilitation measures. The strategy of choice in favor of endovascular treatment should be individual for each patient taking into account such factors as localization, aneurysm size, compression of nearby cranial nerves, and concomitant pathology with high risk of open surgical treatment. Conclusions. Careful selection of patients for endovascular technique will ensure good long-term outcome using all advantages of this technique. At present, it is still relevant and crucial to minimize complications and iatrogenic postoperative lesions in patients with this disease. For this reason, endovascular surgeries should be performed at the stage of specialized medical care by an experienced surgeon.Key words: subclavian artery, false aneurysm, posttraumatic aneurysm, stent graft, endovascular treatment, open surgery, minimally invasive surgery.

Spinal cord ischemia during endovascular repair of the thoracic aorta

Background and objectives: This work aims to analyze the incidence of medullary ischemia (MI) and identify the factors contributing to its development during endovascular repair of the descending thoracic aorta in patients requiring complete coverage. Material and methods: A retrospective study. Between April 1999 and December 2014, 176 thoracic aortic endovascular repairs were performed. Sixty-two patients (48 male and 14 female) were treated with thoracic stents from the aortic arch to the celiac trunk due to thoracoabdominal aneurysms (n = 13), aortic dissections (n = 42), intramural hematomas (n = 4), post-traumatic pseudoaneurysms (n = 2) and aortic ulcers (n = 1). All procedures were performed under general anesthesia with strict invasive blood pressure control. Cerebrospinal fluid drainage was performed in 5 patients. Results: The success rate of stent placement was 96.7%, and mortality was 4.84%. The incidence of spinal cord ischemia was 4.84% (3 patients, one in the immediate postoperative period and two during follow-up). Permanent paraplegia was observed in 1.6%. Overall survival (Kaplan-Meier) at 1, 3, and 6 years was 76%, 69.1%, and 64.32%, respectively. Conclusions: thoracic aortic coverage is an effective procedure with a high probability of success. Our study identified a previous procedure on the abdominal aorta and a thromboembolic aortic event as risk factors for developing medullary ischemia in patients requiring complete coverage of the thoracic aorta. In this study, full coverage of the thoracic aorta and left subclavian artery alone are not predictors of paraplegia.

CT-Guided Percutaneous Thrombin Injection of Posttraumatic Aortic Branch Pseudoaneurysm

AbstractA pseudoaneurysm of an aortic branch artery is a potentially life-threatening uncommon occurrence, which may result in retroperitoneal hemorrhage. Imaging-guided percutaneous thrombin injection has a high technical success and effectiveness rate for treating pseudoaneurysms of the femoral, iliac, and popliteal arteries. We present a case of a retroperitoneal hemorrhage in a patient with a periaortic branch pseudoaneurysm, potentially from an avulsed lumbar artery. Anatomy prevented fixation with a covered stent; the comorbidities eliminated safe surgical repair, and endovascular embolization was not an option due to the avulsion. Computed tomography (CT) fluoroscopy-guided thrombin injection provided a safe, successful embolization with no postprocedural complications.

Penetrating carotid artery injury by air rifle: a case report

BackgroundAir rifle injuries can cause significant vascular injuries. This air rifle injury has resulted in a penetrating neck trauma traversing the common carotid artery. There is debate around the need for radiological investigation, the most appropriate investigational modality, and the need for surgical exploration versus a conservative approach. This case report aims to exemplify a successful approach to managing Penetrating Carotid Injuries (PCI) while shedding light on the rationale behind the management decisions.PresentationAn 18-year-old Caucasian man arrived at the hospital following an air rifle injury to the right side of the neck, with active bleeding and a moderate haematoma displacing the trachea. He was haemodynamically stable, with a Glasgow Coma Scale (GCS) of 15 and no evidence of bruit. Computed Tomography Angiography (CTA) showed Right common carotid (CCA) artery injury with associated post-traumatic pseudoaneurysm. The pellet trajectory traverses the right superior thyroid gland. A duplex ultrasound scan (USS) confirmed two areas of arterial blush at the right CCA. Management involved neck exploration under General Anaesthesia (G.A.), repair of right CCA, bullet extraction, and wound washout. He received antibiotics for ten days and a single agent of antiplatelets for three months and was discharged two days postoperatively with no complications. He was followed up for eight months with no evidence of any trauma sequelae.ConclusionPenetrating carotid artery injuries are a serious concern. The small-sized pellets carry the risk of embolization. Therefore, neck exploration remains the gold standard treatment for PCI. Appropriate operative planning is crucial and can be optimised using radiological diagnostic modalities in haemodynamically stable patients. CTA is a non-invasive, swift, and adequate alternative to arteriography, providing valuable diagnostic information on vascular and aerodigestive injuries and bullet trajectory. This enables appropriate preparedness to achieve excellent outcomes in such critical cases.

Percutaneous treatment of post-traumatic pulmonary artery pseudoaneurysm

Percutaneous treatment of post-traumatic pulmonary artery pseudoaneurysm

Post-Traumatic Pseudoaneurysm of Superficial Branch of Radial Artery: A Case Report and Literature Review

Post-Traumatic Pseudoaneurysm of Superficial Branch of Radial Artery: A Case Report and Literature Review

A RARE PRESENTATION OF DELAYED EPISTAXIS: POST TRAUMATIC INTERNAL CAROTID ARTERY PSEUDOANEURYSM AT A TERTIARY CARE CENTRE IN EASTERN NEPAL

Epistaxis is a common ENT emergency. Various causes are mucosal trauma, anticoagulants and bleeding disorders. Vascular causes and trauma accounts for less than 5% causes. A 25-year-old man presented to emergency with intractable epistaxis. He had sustained road traffic accident 5 months back. His previous CT scan showed multiple facial bones fracture along with sinuses (frontal, maxillary and sphenoid sinus on right para clinoid area) fracture. Initial CT angiography showed no vascular defects. The latest episode of epistaxis was massive and he underwent nasal endoscopy and packing of nose. Pulsatile sphenoidal polyp was visualized, along with transmitted pulsations in the sphenoid sinus on the right side. Subsequent Magnetic Resonance Angiography (MRA) showed a 12x4 mm pseudoaneurysm of clinoidal portion of Internal Carotid Artery on the right side. Post-traumatic Pseudoaneurysm of the Internal Carotid Artery may be the differential diagnosis in traumatic epistaxis, especially the delayed type. If pseudoaneurysm is suspected, CT or MRI angiography should be performed immediately.

Unusual Intracerebral Hemorrhage Secondary to Delayed Posttraumatic Middle Meningeal Artery Pseudoaneurysm, Successfully Treated by Endovascular N-Butyl Cyanoacrylate Embolization

AbstractPseudoaneurysm of the middle meningeal artery, presenting as a delayed sequela of trauma, being a rare entity, may sometimes present as an acute intraparenchymal hemorrhage, with a risk of rerupture and mortality. The optimal management in acute settings remains undetermined. We, hereby, report a case of elderly gentleman with a history of a road traffic accident. Noncontrast computed tomography (NCCT) brain was reported to have left parietal hemorrhagic contusion without any mass effect. The patient was managed conservatively without any major neurological deficits. After 7 months, the patient presented with severe headache, altered sensorium, and right hemiparesis. NCCT brain showed acute left thalamocapsular hemorrhage with minimal subarachnoid hemorrhage with associated mass effect and impending herniation. Considering the fall in patient's baseline Glasgow comma scale response, pupillary asymmetry, and CT findings, immediate decompression and hematoma evacuation were advised. In view of atypical morphology, the patient was planned for urgent digital subtraction angiography prior to the surgery to rule out the ruptured aneurysm or pial arterio-venous fistula. Selective angiography of the left external carotid artery demonstrated a dissecting pseudoaneurysm feeding from the middle meningeal artery (MMA), which was embolized using n-butyl cyanoacrylate (NBCA). Postprocedure DynaCT revealed the left temporal bone fracture, indicating this pseudoaneurysm to be most likely posttraumatic delayed sequelae. Postembolization, the patient underwent surgical decompression and excision of hematoma. Patient's neurological status gradually improved and was discharged with the minimal deficit. Our case highlights the importance of awareness of the posttraumatic MMA pseudoaneurysm as an uncommon but treatable entity, which can be easily diagnosed using cerebral angiography and amenable to safe and effective endovascular embolization using NBCA.

Detection of post-traumatic abdominal pseudoaneurysms by CEUS and CT: A prospective comparative global study (the PseAn study)-study protocol.

The success of non-operative management in trauma increased with the availability of new-generation CT scan machines, endoscopy, and angiography, becoming the standard of care in hemodynamically stable trauma patients with abdominal solid organ injuries, with a success rate of 78% to 98%. Post-traumatic pseudoaneurysms (PAs) can develop at any region of an injured artery and they may cause delayed bleeding in splenic or hepatic trauma, with an incidence in patients treated with NOM of 2%-27% and 1.2%-6.1% respectively. Diagnosis is made by angiography, contrast-enhanced computer tomography (CT), or Doppler Ultrasound (US) while the use of contrast-enhanced ultrasound (CEUS), has increased in recent years although few data are available about CEUS feasibility in the follow-up setting. The PseaAn study has been designed to assess the role of CEUS in the follow-up of abdominal trauma by defining its sensitivity, specificity and predictive values compared with abdominal CT scan. The PseAn study is a multi-centric international diagnostic cross-sectional study initiated by the Level I Trauma Center of the Niguarda Ca' Granda Hospital in Milan, Italy. To study the role of CEUS in detecting post-traumatic splenic, hepatic, and renal PAs compared with the gold standard of CT with intravenous contrast at different follow-up time points, and whether it can replace CT scan in the follow-up of solid organ injuries, patients with OIS III and above will undergo a follow-up with both a CEUS and CT scan to detect post-traumatic parenchymal pseudoaneurysm within two to five days from injury. The use of CEUS in the follow-up of abdominal trauma follow-up (particularly blunt trauma) has increased, to minimise the use of ionizing radiation and contrast media and encouraging results have been published during the last decade showing that CEUS is an accurate technique for evaluating traumatic lesions of solid abdominal organs. Conclusions We think that CEUS, which is underused worldwide, is a useful and safe tool that may replace CT scan in follow-up with the major advantage of reduced radiation. Our current study may give stronger evidence to support this view.

Post-traumatic Pseudoaneurysm of Hepatic Artery (Case Report and Literature Review)

Pseudoaneurysm (PA) of the hepatic artery is a rare complication of abdominal trauma, iatrogenic injuries (biopsy, endoscopic cholecystectomy, liver transplantation), infections, tumors, vasculitis, acute and chronic pancreatitis. This case report presents a life-threatening complications in a patient who underwent surgery for liver lesion. Due to the use of CT angiography, it was possible to determine the cause of bleeding from the upper gastrointestinal tract, evaluation the localization of pseudoaneurysm and treated with elective management.

Posttraumatic pseudoaneurysm of the internal carotid artery extracranial segment due to chronic intimal transection - case report

Introduction. Carotid artery pseudoaneurysms can refer to pseudoaneurysms involving any segment of the carotid arteries. Post?traumatic internal carotid artery pseudoaneurysm dilatation due to intimal transection is extremely rare entity that requires detailed clinical examination and multiple diagnostic modalities to confirm the diagnosis. The aim of the study is to present rare entity of posttraumatic extracranial internal carotid artery pseudoaneurysm dilatation due to intimal transection, diagnostic algorithm and diagnostic findings. Case Report. The patient was a 30-year-old, previously healthy, female who came to see a cardiologist due to intermittent tachycardia, which first appeared a week before the examination. Duplex ultrasound was performed, and aneurysm of extracranial segment of internal carotid artery was found. The patient had severe neck trauma due to bicycle accident in childhood, which was treated at home, without medical examination. Further computed tomography angiography and magnetic resonance angiography were performed. All imaging findings were in favor of chronic arterial wall small pseudoaneurysmal dilatation, with intimal transection, without signs of acute trauma. Based on the above, a decision was made to continue conservative treatment in accordance with the recommendations of current guidelines. Periodic clinical diagnostic follow-up was performed. After the applied therapy, the complaints in terms of intermittent tachycardia disappeared completely. Conclusion. Formation of extracranial internal carotid artery pseudoaneurysm due to intimal transection is a rare entity, and requires multiple imaging findings in order to evaluate if the trauma is acute or chronic. In most cases, chronic pseudoaneurysm does not require surgical intervention. It requires conservative medical treatment and diagnostic follow-up.

A Case of Tibial Nerve Palsy Caused by a Posttraumatic Pseudoaneurysm

A Case of Tibial Nerve Palsy Caused by a Posttraumatic Pseudoaneurysm

Successful outcome in posttraumatic superficial femoral artery pseudoaneurysm following distal femur fracture

Successful outcome in posttraumatic superficial femoral artery pseudoaneurysm following distal femur fracture

Post-traumatic Pseudoaneurysm of a Branch of Facial Artery

Pseudoaneurysm which is also known as a false aneurysm is caused by extravasation of blood from the injured vessel wall which is contained by the surrounding soft tissue. It does not contain any layer of the vessel wall and can expand as more and more blood collects. We are reporting a case of an 18-year-old Indian gentleman who presented with complaint of left neck swelling after being involved in a motor vehicle accident. Examination showed a softly pulsating swelling at the angle of the left mandible. CT angiogram revealed a pseudoaneurysm of a branch of the left facial artery. The pseudoaneurysm was embolized by using histoacryl glue. Pseudoaneurysm should be considered as a differential diagnosis in patients with a pulsatile mass after trauma.

Traumatic Internal Carotid Artery Aneurysm with a Concomitant Carotid Cavernous Fistula

Post-traumatic sphenoid sinus pseudoaneurysm arising from the cavernous segment of the internal carotidartery (ICA) is rare, and even rarer occurrence is an associated carotid-cavernous fistula (CCF). Here we presentthe case of a young male patient presenting with intractable epistaxis due to a post-traumatic sphenoid sinuspseudoaneurysm of the internal carotid artery and a simultaneous carotid-cavernous fistula.
 How to cite this: Ibrahim MI, Nisar T, Tanveer A, Suhail S, Khan R, Ahmed. Traumatic Internal Carotid Artery Aneurysm with a Concomitant Carotid Cavernous Fistula. Life and Science. 2022; 3(4): 200-202. doi: http://doi.org/10.37185/LnS.1.1.252

Delayed presentation of superficial femoral artery (SFA) pseudo aneurysm three month following trauma

This case report describes a rare delayed presentation of posttraumatic pseudoaneurysm of superficial femoral artery (SFA). A 22-year-old man presented with a painful expanding mass over the anteromedial aspect of the distal thigh three months after a motor traffic crash. The lump was tender and pulsatile on examination. CT angiogram revealed a pseudoaneurysm of distal SFA. Open surgical repair was done and the recovery was uneventful. It is to emphasize that absence of physical signs of vascular injury on immediate assessment following trauma does not exclude vascular injury and it can manifest as pseudoaneurysms even after months.