Spontaneous Rupture Of Aneurysm Research Articles

Spontaneous Rupture of Splenic Artery Aneurysm: A Case Report and Review of the Literature

Introduction: Splenic artery aneurysms are uncommon and typically asymptomatic. However, they pose a high risk of mortality if they rupture. Case Report: This case report describes the occurrence of a spontaneous rupture of a splenic artery aneurysm in a 55-year-old man with no known previous diseases, no trauma history, and no risk factors for developing an aneurysm who applied to the emergency department with abdominal pain. The diagnosis was determined with an urgent abdominal computed tomography angiography scan. The patient received urgent surgical intervention consisting of splenectomy and excision of the splenic artery aneurysm. Conclusion: The rupture of a spontaneous splenic artery aneurysm is a rare and fatal disease that necessitates urgent diagnosis and treatment. Spontaneous splenic artery aneurysm usually develops without any noticeable symptoms and is frequently discovered by chance. In the event of a rupture, it can lead to abrupt abdominal pain and hypovolemic shock and the mortality rate is high. Ultrasound, Computed Tomography, Magnetic Resonance Imaging, and abdominal aortic arteriography are the methods of imaging that are used to diagnose splenic artery aneurysms. The key elements in patient management include prompt resuscitation, diagnostic imaging, surgical consultation, and subsequently performing a laparotomy. In our case, the diagnosis was determined using emergency contrast-enhanced Computed Tomography and was treated with open surgery, specifically splenectomy and excision of the splenic artery aneurysm.

Spontaneous rupture of an ovarian artery aneurysm complicated by postpartum hypertensive disorders of pregnancy after caesarean section: a case report and literature review

BackgroundThe spontaneous rupture of an artery aneurysm during the perinatal period is considered a serious complication associated with the physiological alteration by pregnancy and delivery. The rupture of an ovarian artery aneurysm is rare and leads to rapid retroperitoneal hemorrhage. Here, we report one case complicated by postpartum hypertensive disorder of pregnancy associated with massive bleeding into retroperitoneal cavity by the spontaneous rupture of ovarian artery aneurysm after caesarean section, and reviewed previous literature.Case presentationA 41-year-old Japanese woman was referred to our hospital four days after undergoing cesarean delivery because of hemorrhagic shock with abdominal and right flank pain. Contrast-enhanced computed tomography revealed a large retroperitoneal hematoma. Angiography showed a ruptured right ovarian artery aneurysm, anastomosing with a dilated uterine artery. She was successfully treated with transcatheter arterial embolization. She was diagnosed with postpartum hypertensive disorder of pregnancy 3 days after the embolization.ConclusionThe rupture of ovarian aneurysm can occur during the perinatal period, although it has not been widely understood among obstetricians. Multiparity and hypertensive disorder of pregnancy might be risk factors for the rupture of an ovarian aneurysm. Early diagnosis and therapy, such as transcatheter arterial embolization in preparation for an emergency laparotomy, are crucially important for the management of this fatal disease.

Acute kidney injury in subarachnoid hemorrhage: Exploring its clinical significance and prognostic implications

ObjectivesSubarachnoid hemorrhage (SAH) from spontaneous aneurysm rupture is a debilitating condition with high morbidity and mortality. Patients with SAH remain understudied, particularly concerning the evaluation of incidence and consequences of subsequent acute kidney injury (AKI). In this study, we aim to explore the risk factors and outcomes of AKI in SAH patients. Materials and MethodsInternational Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to query the National Inpatient Sample (NIS) for patients with a diagnosis of SAH between 2010-2019. Subgroup analysis was stratified by AKI diagnosis during the same hospitalization. AKI and non-AKI groups were assessed for baseline clinical characteristics, interventions, complications, and outcomes. Descriptive statistics, multivariate regressions, and propensity score-matching were performed using IBM SPSS 28. ResultsOf 76,553 patients diagnosed with nontraumatic SAH between 2010-2019, 10,634 (13.89 %) had a comorbid diagnosis of AKI. SAH patients with AKI were older (p < 0.01) and more often obese (p < 0.01) compared to the non-AKI group. A multivariate regression found the diagnosis of AKI to be independently correlated with poor functional outcome (p < 0.001), above average length of stay (p < 0.001), and in-hospital mortality (p < 0.001) when controlling for age, SAH severity, and other comorbidities. ConclusionsThis study showed significant association between AKI and adverse outcomes in SAH patients, and a correlation between AKI and heightened complication rates, poor functional outcome, extended hospital stays, and elevated mortality rates. Early detection of AKI in SAH patients is vital to improve their chances of recovery.

Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study

BackgroundSubarachnoid hemorrhage (SAH) patients with cerebral autoregulation (CA) impairment at an early post-SAH period are at high risk of unfavorable outcomes due to delayed cerebral ischemia (DCI) or other complications. Limited evidence exists for an association between early-stage CA impairments and SAH patient outcomes. The objective of this prospective study was to explore associations between CA impairments detected in early post-SAH snapshot examinations and patient outcomes.MethodsThe pilot observational study included 29 SAH patients whose CA status was estimated 2–3 days after spontaneous aneurysm rupture and a control group of 15 healthy volunteers for comparison. Inflatable leg recovery boots (reboots.com, Germany) were used for the safe controlled generation of arterial blood pressure (ABP) changes necessary for reliable CA examination. At least 5 inflation‒deflation cycles of leg recovery boots with a 2–3 min period were used during examinations. CA status was assessed according to the delay time (∆TCBFV) measured between ABP(t) and cerebral blood flow velocity (CBFV(t)) signals during artificially induced ABP changes at boot deflation cycle. CBFV was measured in middle cerebral artery by using transcranial Doppler device.ResultsStatistically significant differences in ∆TCBFV were found between SAH patients with unfavorable outcomes (∆TCBFV = 1.37 ± 1.23 s) and those with favorable outcomes (∆TCBFV = 2.86 ± 0.99 s) (p < 0.001). Early assessment of baroreflex sensitivity (BRS) during the deflation cycle showed statistically significant differences between the DCI and non-DCI patient groups (p = 0.039).ConclusionsA relatively small delay of ∆TCBFV <1.6 s between CBFV(t) and ABP(t) waves could be an early warning sign associated with unfavorable outcomes in SAH patients. The BRS during boot deflation can be used as a biomarker for the prediction of DCI.Trial registrationClinicalTrials.gov Identifier: NCT06028906. Registered 31 August 2023 - Retrospectively registered, https://www.clinicaltrials.gov/study/NCT06028906.

Fístula arteriovenosa ilíaca à direita por rotura de aneurisma e aneurisma de artéria ilíaca esquerda: tratamento híbrido

Abstract An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar and inferior mesenteric arteries because of the need to simultaneously exclude the hypogastric arteries. Dynamic fluid balance phenomena provoked by closure of the AVF are described. The patient had a benign postoperative course with normalization of the severe hemodynamic changes presented prior to the intervention and resolution of respiratory symptoms attributed to pulmonary arterial hypertension.

ODP324 Internal Carotid aneurysm inside a pituitary macroadenoma: case study and literature review

Abstract BACKGROUND: Coexisting pituitary adenoma (PA) and intracranial aneurysms (IA) is relatively frequent. However, the finding of an aneurysm inside a PA is extremely rare. We report a patient with pituitary macroadenoma with an embedded internal carotid artery (ICA) aneurysm, who presented with anterior hypopituitarism. CLINICAL CASE: 73 y. o. black female presented after a fall secondary to orthostastic hypotension. In the ER her BP was 78/50 mmHg, HR 76/min sinus rhythm. She reported fatigue, presyncope, and 20 lbs weight loss in the preceding 3 months. CT head without contrast showed a sellar mass. Pituitary MRI confirmed a 20×24×29 mm sellar mass consistent with a macroadenoma extending laterally to both cavernous sinuses with bilateral encasement of ICAs, superiorly elevating optic chiasm, and mild extension to the left Meckel's cave. The study also incidentally showed a &amp;gt; 5 mm ICA aneurysm embedded within the macroadenoma. Diagnostic cerebral angiogram demonstrates a medially directed left superior hypophyseal ICA aneurysm measuring 5.4×4. 0 mm with a 3.5 mm neck. The patient denied headaches, peripheral vision loss, or polyuria. On examination her weight was 154 lbs, height 5'6", normal visual field testing, and no neurologic deficits. Endocrine testing was consistent with anterior hypopituitarism: ACTH 17 pg/mL (10-48), Cortisol 4.7 mcg/dL (6-18.4), TSH 1.4 mIU/L (0.4- 4. 0), FT4 0.7 (0.7-1.9 ng/dL), IGF1 7 ng/mL (55-162), Prolactin 38.3 ng/mL (4.8- 23.3), and FSH 6.6 IU/mL (20-138). Clinical improvement followed hydrocortisone and levothyroxine replacement. Patient was discharged home with a plan for outpatient endocrine follow up and subsequent endovascular intervention. Unfortunately, she presented a few weeks later with pulmonary embolism, for which she was treated with Eliquis. Given high risk of bleeding, the plan for endovascular embolization was postponed. Patient was educated about sick day rules and is set for routine endocrine visit and periodic MRI surveillance of the macroadenoma. DISCUSSION: intracranial aneurysms appear to occur more frequently in association with PAs than among the general patient population. In 2 cohort of patients with PA, 5.4-7.3% had coexisting IAs, the majority of which are outside the pituitary region. However, the presence of an aneurysm embedded within a PA, as in our case, is very rare, and most are discovered by accident. In such cases, although spontaneous aneurysm rupture or pituitary apoplexy is extremely rare, misdiagnosis of the embedded aneurysm can potentially result in catastrophic outcomes if it is not appropriately recognized and addressed prior to pituitary surgery. Cerebral angiography with embolization or coiling of the aneurysm prior to hypophysectomy can decrease the risk of perioperative rupture or bleeding. In our case, given the risk of bleeding while on anticoagulation therapy, the plan for endovascular intervention was postponed. Presentation: No date and time listed

Spontaneous non-traumatic splenic artery aneurysm rupture : endovascular treatment with a Covera covered stent

Spontaneous non-traumatic splenic artery aneurysm rupture : endovascular treatment with a Covera covered stent

Spontaneous Rupture of Ovarian Artery Aneurysm in a Postmenopausal Woman: A Case Report and Literature Review.

Spontaneous rupture of an ovarian artery aneurysm is an extremely rare, life-threatening disease and has been reported to be most highly associated with pregnancy. The current study presents a case of intraperitoneal and retroperitoneal hematoma caused by spontaneous rupture of a right ovarian artery aneurysm in a 56-year-old woman. A 56-year-old woman visited the emergency room with right lower quadrant abdominal pain. Contrast-enhanced computed tomography showed a large retroperitoneal and intraperitoneal hematoma and active extravasation of contrast medium in the right retroperitoneum. Consequently, transcatheter arterial embolization was successfully performed. Spontaneous rupture of an ovarian artery aneurysm should be suspected in multiparous women with abdominal or flank pain even if it is unrelated to pregnancy. Suspicion of this entity is needed for earlier diagnosis and management.

Case Report: Spontaneous Rupture of Inferior Epigastric Artery Masquerading as Inguinal Hernia.

IntroductionSpontaneous rupture of an inferior epigastric artery aneurysm is rare with very few cases reported in the medical literature. Although surgical options are available, this case was managed conservatively with outpatient management.Case ReportA 29-year-old male presented with right groin pain and swelling that was initially felt to be consistent with an incarcerated inguinal hernia. Further evaluation revealed spontaneous rupture of an inferior epigastric artery aneurysm. The patient was treated conservatively and was ultimately discharged home from the emergency department.ConclusionDue to the similar clinical presentations, it was important to consider a broad differential to ultimately arrive at the correct diagnosis. In some reported cases of spontaneous epigastric artery aneurysm, surgical intervention was required for control of the bleeding. In our patient, however, conservative management was employed, and the patient was able to be safely discharged with close outpatient follow-up.

Spontaneous Retroperitoneal Hemorrhage Secondary to Chronic Celiac Axis Compression Treated with Embolization Utilizing Cone Beam CT

Median arcuate ligament syndrome (MALS) is a rare and often misdiagnosed vascular pathology. In this paper, we discuss a 51-year-old female with MALS presenting with hypotension due to retroperitoneal hemorrhage. Currently, there is no consensus regarding the optimal treatment approach for such patients. This case report demonstrates the utility of conventional mesenteric angiography, cone beam CT with 3D reconstruction, and selective mesenteric transarterial embolization as an effective treatment approach for patients with spontaneous aneurysm rupture in MALS.

Post-traumatic aneurysmal rupture involving the circle of Willis affected by fibromuscular dysplasia. A case report and systematic review

The fatal rupture of a saccular aneurysm at the junction between the left anterior cerebral artery and anterior communicating artery affected by fibromuscular dysplasia (FMD) is a rare condition. Here is reported the case of a subject involved in a road traffic accident a few minutes before the death, which opened the debate on the real cause of death in a forensic setting. By autopsy, the examination of the brain revealed subarachnoid haemorrhage with flooding of the ventricles due to the breached saccular aneurysm of the junction between the left anterior cerebral artery and anterior communicating artery, in FMD mainly affecting the circle of Willis arteries. A spontaneous aneurysmal rupture was excluded on the basis of probabilistic analysis, in the presence of alternative hypotheses that could explain the facts. The passenger's delayed loss of consciousness may be explained as much by a hypertension-linked rupture of the aneurysm triggered by the emotional stress experienced, as by the traumatic shaking/impact of the aneurysm against the bony skull structures, in a subject predisposed to aneurysm frailty due to FMD. Overall, the concausal role of both the road traffic accident, typified by high kinetic energy, and the presence of a pre-existing aneurysmatic weakness due to FMD is fully recognized. The identification of anatomical variants, jointly with uncommon diseases at the examination of the brain base arteries in any case of isolated basal subarachnoid haemorrhage, may avoid wrong legal consequences even when the cause of death seems to be obviously of simple traumatic origin.

Postpartum Spontaneous Rupture of an Ovarian Artery Aneurysm: A Case Report and Review

This study reported a case of spontaneous rupture of an ovarian artery aneurysm 4 days following cesarean section. The patient mainly presented with a consistent low-grade fever and did not have symptoms, such as severe abdominal or flank pain, as is common in other similar cases. Enhanced magnetic resonance imaging revealed a massive retroperitoneal hematoma; angiography confirmed that there was a rupture in an ovarian artery aneurysm. A selective embolization was performed successfully.

Spontaneous rupture of splenic artery aneurysm in pregnancy: A case report and review of the literature

Introduction: Splenic artery aneurysms (SAAs) are the most common (60%) of visceral artery aneurysms with the possibility of rupture. SAA rupture is associated with 20% mortality, which increases disproportionately to 75% in pregnant women, with fetal the mortality rate of 95%. Aim: We present a discussion based on the case report with a review of the literature on ruptured SAA in pregnancy as well as possible treatment options, complications and prognosis. Case study: Patient, 40-year-old pregnant woman, gravida 2, para 1, 33 week of pregnancy, with ruptured SAA, underwent cesarean section, splenectomy, and hypovolemic shock treatment. The outcomes of the mother and neonates were good. Postoperative recovery was complicated by right-sided pneumothorax. Results and discussion: 87% of patients with SAA are females. In our analysis of cases, with ruptured SAA in pregnancy, the parity may be the factor that influences the maternal and fetal outcomes. In third trimester of pregnancy (as in our case study) the most often mistaken indication for laparotomy was a suspected placental abruption. Conclusions: Ruptured SAA during pregnancy should be considered as one of the non-obstetric causes of intraabdominal bleeding. Careful observation of the patient from the onset of symptoms is a key approach that increases maternal and fetal survival.

Acute renal artery stenting recovered renal function after spontaneous rupture of renal artery aneurysm – case report

PurposeRenal artery aneurysms (RAAs) are a rare vascular pathology with an estimated prevalence of 0.1% to 2.5%. Rupture of RAA is an extremely unusual cause of acute flank pain and haemodynamic instability with acute kidney failure and high mortality rate (20%).Case reportA 37-year-old male with no relevant history presented to the Emergency Room with acute right flank pain. Initial examination revealed BP 90/60 mm Hg and tachycardia. Initial blood testing was unremarkable, with a haemoglobin level of 9.4 g/dl. Urinalysis revealed moderate blood. Ultrasound (US) examination depicted aneurysm of the right renal artery 6 x 6 cm, with signs of blood extravasation visible in colour and power Doppler. The patient was referred for urgent computed tomography angiography, which revealed active bleeding from the ruptured aneurysm with haematoma spreading into the right retroperitoneum. He was subjected to emergency endovascular treatment. The patient was treated by successful implantation of a Viabahn stent (GORE, Daleware, USA). Selective nephrography revealed lack of flow through one of the segmental arteries resulting from vasospasm due to the placement of the guiding wire necessary for safe stent implantation.ConclusionsThe authors present a rare case of spontaneous RAA rupture in a young male successfully treated with endovascular methods. Stent implantation required selective catheterisation of segmental arteries of the kidney, which resulted in the loss of one of them. However, control Doppler US disclosed no ischaemia and successful exclusion of the aneurysm.

Use of Stent Graft for the Management of Spontaneous Rupture of Hepatic Artery Aneurysm in a Patient with Variant Arterial Anatomy

Use of Stent Graft for the Management of Spontaneous Rupture of Hepatic Artery Aneurysm in a Patient with Variant Arterial Anatomy

Another cause of cardiac tamponade: ruptured coronary artery aneurysm

BackgroundCoronary artery aneurysm can be defined as an abnormal dilatation of the coronaries. In recent years, the disease has been frequently encountered during surgical procedures such as percutaneous coronary intervention (PCI) and coronary computed tomography angiography (CCTA).Case presentationWe reported a case of cardiac tamponade due to spontaneous rupture of coronary artery aneurysm in a 53-year-old Chinese man, who had collapsed and died at home after returning from work. Autopsy revealed a cardiac tamponade with ruptured aneurysm of the left circumflex artery.ConclusionThis case highlights the need to consider ruptured coronary aneurysm as a differential diagnosis when cardiac tamponade is encountered during autopsy.

The frontal skull Hounsfield unit value can predict ventricular enlargement in patients with subarachnoid haemorrhage

Hydrocephalus is a common complication following subarachnoid haemorrhage (SAH) arising from spontaneous aneurysm rupture. The Hounsfield unit (HU) value from computed tomography scans may reflect bone mineral density, which correlates with body mass index, which in turn is related to post-SAH ventricle size changes. We herein investigated potential associations between frontal skull HU values and ventricle size changes after SAH. HU values from four different areas in the frontal bone were averaged to minimize measurement errors. The bicaudate index and Evans ratio were measured using both baseline and follow-up CT images. CT images with bicaudate index >0.2 and Evans ratio >0.3 simultaneously were defined as indicating ventriculomegaly. We included 232 consecutive patients with SAH due to primary spontaneous aneurysm rupture, who underwent clipping over almost a 9-year period at a single institution. The first tertile of frontal skull HU values in older patients (≥55 years) was an independent predictor of ventriculomegaly after SAH, as compared to the third tertile in younger patients (hazard ratio, 4.01; 95% confidence interval 1.21–13.30; p = 0.023). The lower frontal skull HU value independently predicted ventricular enlargement post-SAH, due to the potential weak integrity of subarachnoid trabecular structures in younger patients.

Opinion: Maternal Morbidity Associated with Splenic Artery Rupture and Retroperitoneal Haematomas (RPH) in Pregnancy

Recently a case report was published in Global Journal of reproductive medicine by Mulla AA et al. [1] on Spontaneous Rupture of splenic artery aneurysm. There need to be increased awareness about such cases in obstetric population because the incidence of splenic artery rupture in pregnancy is low and also may be not many cases are reported in literature. The finding of inquest [2] in the death of pregnant women revealed that eight deaths occurred in Australia from year 2000-2012 due to splenic artery rupture in pregnant women and main reason was that it was late and misdiagnosed. A review on 21 cases of retroperitoneal haematoma in obstetrics highlighted the fact that splenic artery rupture is one of the important causes of retroperitoneal haematoma and presentation can be confusing posing a diagnostic dilemma for clinicians .

Abstract WP77: Effect of Concurrent Coil Embolization on Delayed Spontaneous Aneurysm Rupture Following Flow Diverter Placement

Objective: Delayed spontaneous aneurysm rupture is an uncommon but well recognized complication following flow diverter placement for the treatment of intracranial aneurysms. Concurrent coil embolization of the aneurysm along with flow diverter deployment is commonly used, under the assumption that coiling reduces the risk of delayed rupture. However, concurrent coiling adds expense and time to the procedure, and it is not known whether concurrent coiling actually reduces the risk of delayed rupture. Methods: This is a retrospective case-control study. Twelve centers provided data on patients with unruptured internal carotid artery aneurysm ≥10mm undergoing treatment with flow diversion. Cases were identified as those experiencing delayed spontaneous aneurysm rupture ≤ 30 days after treatment and each case was matched to five control patients not experiencing rupture. The rate of coil placement as well as data on demographics, medical history, aneurysm characteristics, and procedural details were collected. Results: Seven cases of delayed spontaneous rupture were identified, four of which were fatal. The interval between procedure and rupture ranged from 0-10 days, with a mean of 2.7 days. Cases and controls did not differ significantly in sex, smoking history, family history of aneurysm, aneurysm laterality, or size. Patients with delayed ruptures were more likely to have aneurysm occlusion at the end of the case (p=0.049). The rate of coil usage was 22% for both cases and controls. The odds ratio that coils protect against delayed rupture is 1.00 [CI 0.24, 4.96]. Conclusions: This study suggests that concurrent coil embolization does not reduce the risk of delayed rupture of aneurysms treated with flow diversion.

Treatment of Intracranial Aneurysms With the SILK Embolization Device in a Multicenter Study. A Retrospective Data Analysis.

BACKGROUNDFlow-diverter technology has become an important stent-based embolization tool in the treatment of complex cerebrovascular pathology. We report here the experience of 4 Spanish centers with using the SILK flow-diverter (SFD) device.OBJECTIVETo evaluate the safety and efficacy of using the SFD in the endovascular treatment of intracranial aneurysms with complex morphology.METHODSWe retrospectively examined a prospectively maintained database of patients treated with SFD devices between July 2008 and December 2013 at 1 of 4 institutions in Spain. Data regarding patient demographics, aneurysm characteristics, and technical procedure were analyzed. Angiographic and clinical findings were recorded during the procedure and at 12 months postoperatively.RESULTSA total of 175 SFD devices were implanted in 157 patients (women/men: 119/38; mean, median, and range of age: 56.2, 56.7, and 19-80 years, respectively), who were treated in a delayed manner (3-6 months from the event) for 180 aneurysms (165 unruptured and 15 ruptured). Adverse events (acute and delayed) were observed in 28.7% of cases (45/157), and most were resolved (19.1%; 30/157). Six months after the procedure, total morbidity and mortality were 9.6% (15/157) and 3.2% (5/157), respectively. Long-term imaging follow-up showed complete occlusion, neck remnants, and residual aneurysm in 78.1% (100/128), 14.0% (18/128), and 7.8% (10/128) of cases, respectively.CONCLUSIONSThe SFD device is an effective tool for the treatment of challenging aneurysms, and allows complete occlusion within a year of the procedure in most patients, with morbidity and mortality comparable to those previously reported for similar devices.