Traumatic Pseudoaneurysm Research Articles

Initial experience with Pipeline embolization of intracranial pseudoaneurysms in pediatric patients.

Flow-diverting devices have been used successfully for the treatment of complex intracranial vascular injuries in adults, but the role of these devices in treating iatrogenic and traumatic intracranial vascular injuries in children remains unclear. The authors present their experience using the Pipeline embolization device (PED) for treating intracranial pseudoaneurysms in children. This single-center retrospective cohort study included pediatric patients with traumatic and iatrogenic injuries to the intracranial vasculature that were treated with the PED between 2015 and 2021. Demographic data, indications for treatment, the number and sizes of PEDs used, follow-up imaging, and clinical outcomes were analyzed. Six patients with a median age of 12 years (range 7-16 years) underwent PED placement to treat intracranial pseudoaneurysms. There were 3 patients with hemorrhagic presentation, 2 with ischemia, and 1 in whom a growing pseudoaneurysm was found on angiography. Injured vessels included the anterior cerebral artery (n = 2), the supraclinoid internal carotid artery (ICA, n = 2), the cavernous ICA (n = 1), and the distal cervical ICA (n = 1). All 6 pseudoaneurysms were successfully treated with PED deployment. One patient required re-treatment with a second PED within a week because of concern for a growing pseudoaneurysm. One patient experienced parent vessel occlusion without neurological sequelae. Use of the PED is feasible for the management of iatrogenic and traumatic pseudoaneurysms of the intracranial vasculature in children, even in the setting of hemorrhagic presentation.

Multiple Stenting without Coils for Traumatic Pseudoaneurysm of Supraclinoid Internal Carotid Artery: Two Case Reports

Traumatic intracranial pseudoaneurysm (TIPA) is a very rare disease that is difficult to diagnose and treat and has high mortality and morbidity. Various treatment methods, such as microsurgery and endovascular treatment, have been proposed because TIPA accompanies traumatic brain injury. It is necessary to consider the location and characteristics of the TIPA and the patient's condition. According to previous reports regarding the endovascular treatment of TIPA, most cases were treated with stent-assisted coil embolization. Unlike previous studies, however, we would like to share our experience of two cases successfully treated by overlapping three closed-cell self-expandable stents without coils.

Traumatic Supratrochlear Artery Pseudoaneurysm With Spontaneous Resolution

Background: Traumatic pseudoaneurysm of the supratrochlear artery is a rare lesion. It manifests, as a painless mass, in the frontal region following trauma. The unusual incidence and confusing presentation require the clinicians to thoroughly understand its presentation and diagnosis. Diagnosis is typically made on history and physical examination, but it can be confirmed by duplex ultrasound. Definitive treatment is surgical resection of the aneurysm after proximal and distal ligation of the vessel. However, in some cases, follow-up is recommended because there is a possibility of spontaneous relapse. Case Presentation: We present a case of traumatic pseudoaneurysm of the supratrochlear artery, which developed a few weeks after blunt trauma to the forehead. The radiologist reported a pseudoaneurysm originating with a narrow stalk of the supratrochlear artery. In the patient’s followup after three months, the patient’s mass became very small, and in the follow-up after five months, the mass completely disappeared. Conclusion: Pulsatile and or soft-tissue masses that are continuous with an artery with a history of trauma should be considered pseudoaneurysm. Color Doppler sonography is a convenient and noninvasive modality in diagnosis. If the pseudoaneurysm of the supratrochlear artery is small and contains thrombosis, waiting and seeing might be an effective option.

S2601 Gastroepiploic Pseudoaneurysm: A Shocking Complication of PEG Tube Placement

Introduction: Percutaneous gastrostomy (PEG) tubes are commonly used for enteric feeds and medication administration. While considered safe and routine, PEG tube placement is not without its complications. Here we present a rare case of hemorrhagic shock secondary to traumatic pseudoaneurysm formation after PEG tube placement. Case Description/Methods: A 52-year-old male with atrial fibrillation on apixaban and a recent stroke with PEG tube placement 1 month prior to arrival presented to the hospital with multiple episodes of hematemesis. CT angiography of the abdomen was unremarkable and negative for signs of active bleeding. Antiplatelets were held and anticoagulation was reversed with prothrombin complex concentrate. Esophagogastroduodenoscopy showed signs of erosive esophagitis with proper PEG tube placement but without signs of active bleeding. Hematemesis re-occurred less than 24 hours after anticoagulation was resumed, with subsequent development of hemorrhagic shock. Visceral arteriogram revealed a right gastroepiploic artery pseudoaneurysm, which likely developed from trauma during recent PEG placement. The patient stabilized after coil embolization and blood transfusion. He was then safely resumed on anticoagulation without further bleeding. Discussion: GI bleeding associated with PEG placement occurs in 0.6-1.2% of cases, and usually occurs at the gastrostomy tract or from gastric ulceration. Bleeding related to pseudoaneurysm formation is exceedingly rare with only a handful of case reports documenting such occurrence. While contrast enhanced imaging may aid in the diagnosis, small pseudoaneurysms may not be detected with noninvasive angiographic studies (as was the case here). Given this potentially life-threatening complication, clinicians must consider pseudoaneurysm formation as part of their differential for GI bleed after recent PEG placement especially if endoscopic evaluation is unrevealing.

두개저 골절 후 지연성으로 발생한 천측두동맥의 혈전성 가성동맥류

Pseudoaneurysms usually occur as a result of blood vessel wall injury. Only a few cases of traumatic pseudoaneurysm have been reported developing in superficial temporal artery (STA). A 79-year-old male patient came to clinic for growing scalp mass after traumatic brain injury, with history of skull base fracture three months prior to admission. The mass was pulsatile with overlying skin ulceration, located on the right parietal area. 3D-head computed tomography angiography was done to evaluate the growing scalp mass. The mass was diagnosed as a partially thrombosed traumatic pseudoaneurysm. Surgical treatment was planned and underwent ligation of STA followed by en-bloc removal of aneurysm. Herein, we report our experience on the rare case of traumatic pseudoaneurysm of STA after skull base fracture which was diagnosed correctly and treated successfully.

CASE REPORT: HEPATIC ARTERY ANEURYSM.A RARE VISCERAL ANEURYSM

Hepatic artery aneurysm (HAA) is a rare disease (0.002%– 0.4%) but is a clinically important phenomenon [1]. HAAs are traditionally the second most common visceral aneurysms with an incidence of 20% and have the highest (44%) reported rate of rupture [2]. The clinical manifestations depending on the size of the aneurysm include epigastric pain, obstruction of biliary tract, rupture and death [3]. Imaging modalities like computed tomography (CT) and CT angiography have a valuable role in the early detection of HHA, its complications, and selecting appropriate treatments depending on the size and location of the aneurysms [4].The etiology of visceral artery aneurysms is mostly atherosclerotic. Trauma and inflammation may cause pseudoaneurysm formation, such as in case of an acute pancreatitis causing periarterial inflammation or vessel erosion from an adjacent pseudocyst[5,6]. Other conditions which are associated with hepatic artery aneurysms are medial degeneration, fibromuscular dysplasia and vasculitis [7]. Atherosclerotic aneurysms are typically extrahepatic while traumatic aneurysms or pseudoaneurysms are more commonly intrahepatic [8].

Delayed Traumatic Superficial Femoral Artery Pseudoaneurysm and Arteriovenous Fistula Over the Left Lower Limb

A pseudoaneurysm is a pulsating, encapsulated hematoma in communication with a ruptured vessel (1); there is an accumulation of blood between the tunica media and tunica adventitia layers of the vessel. We report a case of a young male with complaints of swelling, skin discoloration, and a tingling sensation of the left lower limb. A peripheral angiography was performed, which revealed an arteriovenous fistula at the middle of the left superficial femoral artery. The patient underwent a left superficial femoral artery pseudoaneurysm excision and repair. In this case report, we discuss the presenting clinical features, methods of evaluation, and the management of the superficial femoral artery pseudoaneurysm accompanied with arteriovenous fistula.

Sophocles and the Wound of Philoctetes.

The dramatic story of the Greek hero Philoctetes encompasses a psychological concept of healing and a chronic wound that can be understood as a chronically infected traumatic pseudoaneurysm.

Late endovascular coil migration following traumatic pulmonary artery pseudoaneurysm embolization: case report

BackgroundPercutaneous vascular interventions are performed for the treatment of haemoptysis and involve embolization of bronchial arteries, pulmonary arteries and pulmonary arteriovenous malformations. There are isolated reports of embolization of pseudoaneurysms forming in the pulmonary vasculature. The migration of components of the coils used in the embolization of vascular pulmonary pathologies is rare.Case presentationA 46-year-old man presented to the emergency department with cough, haemoptysis, and expectoration of lengths of metal wire. He had an episode of coughing out a wire about a year prior to his admission to our hospital, which he attributed to be present in the can of coke he had consumed at that time and did not report it to the doctors. His past medical history was significant for stab injury to the right chest 17 years ago, for which he underwent right thoracotomy and exploration for bleeding. Injury to the lung parenchyma was noted and repair was performed by suturing the defect. Post operatively the CT scan demonstrated development of pulmonary artery pseudoaneurysm. We report a case of a patient expectorating coils 17 years after embolization of this traumatic pulmonary artery pseudoaneurysm. Radiological imaging demonstrated coils in the perihilar area of the lung parenchyma and in the tracheobronchial lumen. Operative intervention was used to remove the coils.ConclusionsAlthough percutaneous catheter based vascular interventions have emerged as safe and effective procedures, the long-term complications such as coil migration, recanalization and need for further embolization ought to be considered and patients need to be counselled and followed-up accordingly. To the best of our knowledge, this is the first case of migrated coil post embolization of post-traumatic pulmonary artery pseudoaneurysm. Ultimately, the management of endobronchial coil migration post embolization, be it surgical or bronchoscopic, should be decided on a case-by-case basis, considering the patient’s symptoms and the risk fatal complications.

Traumatic Pseudo-aneurysm of the Hepatic Artery in a 12 Year Old Child, Case Report and Literature Review

Background: COVID 19 pandemic has caused additional challenges and insurmountable psychosocial impact for patients with opioid use disorders. The particularly challenging group include those seeking treatment with medication for OUD patients. This article discusses the bi-directional effects between opioid use disorder patients and covid 19. Method: PubMed and Google Scholar were searched with the following keywords- “COVID-19”, “opioid use disorder”, “pandemic”, “behavioural addiction”, “opioid”, “opioid agonist therapy”. Results: People with opioid use disorder are at a heightened risk of acquiring and increased severity of COVID 19 infections due to compromised immunity, homelessness or housing instability, lockdown and social distancing leading to failure of rehabilitation strategies, mucociliary dysfunction, cardiopulmonary morbidities, etc. Conclusion: COVID 19 pandemic and opioid use disorder is on the verge of the collision so every effort must be taken by the government and health care sector to prevent a big wave of opioid overdose and relapse in our community..

Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation.

There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non-flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%-5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

Traumatic intracranial aneurysms associated with traffic accidents and endovascular management options

Traumatic intracranial pseudoaneurysms are rare complications of head injuries following traffic accidents, occurring in less than 1% of all cerebral aneurysms. Most cases are associated with fracture of the skull. Rupture of these traumatic aneurysms occur in up to 50% of all cases and are typically delayed from days to weeks following the initiating trauma. Traumatic pseudoaneurysms are often called a pulsating hematoma, which occurs when the arterial wall is ruptured by trauma and bleeding is confined only by the adventitia or surrounding tissues. Unlike the structure of a true aneurysm, that has all anatomical layers, the wall of a traumatic intracranial pseudoaneurysm is composed mainly of blood clot and a small amount of fibrous tissue. Difficult diagnosis, delayed presentation and poor outcomes contribute to overall prognosis of these traumatic intracranial aneurysms.&#x0D; We investigated the patients with traumatic intracranial aneurysms developed after traffic accidents and treated with endovascular embolization in our Institution, with a review of literature and discussion of management options.&#x0D; As traumatic intracranial aneurysms may present both diagnostic challenges and surgical difficulties, especially after polytrauma cases, rarely being appropriate for conservative treatment, early and precise diagnosis with cerebral angiography and prompt treatment are essential for good prognosis. Due to its nature to be fragile and prone to rupture, careful and precise endovascular embolization is thus a method of choice for treatment of these pseudoaneurysms.

Abstract WP171: Incidence And Outcomes Of Pseudoaneurysm In Pediatric Patients With Blunt Cerebrovascular Injury

Objective: Pseudoaneurysm is a rare manifestation of blunt cerebrovascular injury (BCVI) in pediatric patients and carries a high risk of both ischemic stroke and rupture. There is a paucity of data regarding the incidence, prognosis and best practice in management in children. The aim of this study is to describe the history and outcomes of children with traumatic cerebrovascular pseudoaneurysm. Methods: Patients between the ages of 0 and 18 years were identified from the prospectively enrolled trauma registry at a tertiary care pediatric hospital between January 1, 2011 and July 1, 2021 who presented with head and/or neck blunt trauma, had available cerebrovascular imaging and a diagnosis consistent with BCVI. Retrospective chart review was performed to identify patients with pseudoaneurysm formation. Results: Twenty patients were identified with diagnosis of BCVI and of those, six developed pseudoaneurysm. Twelve of the fourteen other BCVIs included the internal carotid artery, while two involved vertebral arteries. All pseudoaneurysms were of the internal carotid artery. Pseudoaneurysm was diagnosed at a median interval of 5 days from initial injury (range 1 day to 6 weeks). Other BCVIs were all diagnosed within the first 2 days of hospitalization. Treatment for pseudoaneurysm included a course of antiplatelet therapy in all. Three patients were initially treated with anticoagulation with subsequent transition to antiplatelet therapy. Endovascular intervention was performed in two patients. 2 patients suffered arterial ischemic stroke. All 6 patients were living and discharged home with favorable neurologic outcomes based on Glasgow Outcome Scale with median follow-up time of 7 months. Conclusions: In this retrospective cohort, pseudoaneurysm was observed in 30% of pediatric patients with BCVI, which is higher than previously reported. Treatment of pseudoaneurysm was variable, but all patients had favorable neurologic outcomes. Compared to other forms of BCVI, pseudoaneurysm was identified following a longer period of time from initial injury. Further studies are needed to identify risk factors for pseudoaneurysm and to inform the need and timing for serial imaging in identifying pseudoaneurysms given potential treatment implications.

Low-profile visualized intraluminal support stent for the endovascular treatment of traumatic intracranial internal carotid artery pseudoaneurysms.

Optimal treatment strategies for traumatic intracranial internal carotid artery (ICA) pseudoaneurysms are controversial. The low-profile visualized intraluminal support (LVIS) device is a braided stent with a metal coverage rate between traditional laser cut stents and flow diversion devices. We report here our therapy strategy using the LVIS stent-assisted coiling for treatment of traumatic intracranial ICA pseudoaneurysms. Patients with traumatic intracranial ICA pseudoaneurysms treated by the LVIS stent-assisted coiling in our center between January 2015 and June 2021 were reviewed. The complications, radiographic, and clinical outcomes of these patients were analyzed. A total of 12 patients with 12 pseudoaneurysms were included. The mean maximum aneurysm diameter was 6.2 ± 3.1mm. Nine patients had a subarachnoid hemorrhage; five patients with Hunt-Hess grade III and four patients with grade IV. All procedures were successfully performed without intraoperative complications. Immediate postoperative angiogram showed that six (50%) aneurysms were Raymond grade 1, four (33.3%) were grade 2, and two (16.7%) were grade 3. Postoperative multiple cerebral infarction occurred in two patients because of vasospasm. Of the ten patients with angiographic follow-up (mean, 29.9months), two received additional coiling because of recanalization of the pseudoaneurysm, and all aneurysms were completely obliterated at the last examination of the patients. During the clinical follow-up period (mean, 26.8months), the overall mortality and morbidity were 25% (3/12) and 8.3% (1/12), respectively. LVIS stent-assisted coiling was a feasible approach for the treatment of traumatic ICA pseudoaneurysms.

Traumatic Visceral Venous Pseudoaneurysm

The natural history of traumatic visceral venous pseudoaneurysm (VVP) is largely unknown, and hence, there is a lack of consensus for their management. This review aims to determine the management and outcomes of these injuries. A review of the reported cases over the last 25 years was performed. Only 32 cases were found, 24 abdominal, and 8 thoracic. Traumatic abdominal VVPs were largely managed nonoperatively, while majority of traumatic thoracic VVPs underwent intervention. Hemodynamic instability was the most common cause for intervention. No uniformity was noted for follow-up imaging of these injuries.

Ruptured traumatic pseudoaneurysm of the middle meningeal artery presenting delayed intracerebral hematoma

Ruptured traumatic pseudoaneurysm of the middle meningeal artery presenting delayed intracerebral hematoma

Traumatic Pseudoaneurysm of the Renal Artery on Ectopic Kidney

The ectopic pelvic kidney is defined as a kidney placed atypically due to abnormal migration from the fetal pelvis during development embryological. Ectopic kidneys can be more exposed to trauma, since they are in a less protected anatomical position. Today, these anomalies are generally noted as fortuitous discoveries during the initial assessment by ultrasound or computed tomography (CT scan). A post-traumatic renal artery pseudoaneurysm rarely occurs after abdominal trauma blunt. Common symptoms include acute hematuria, abdominal pain, a lump pulsatile in the abdomen or flank, or arterial hypertension. We report the case of a patient with post traumatic renal artery pseudoaneurysm on two fortuitously discovered ectopic pelvic kidneys

Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries.

Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outcome is. Methods: We analyzed data on 65 polytraumatized patients with blunt aortic injuries. The following scores were calculated: injury severity score (ISS), new injury severity score (NISS), trauma and injury severity score (TRISS), revised trauma score coded (RTSc) and acute physiology and chronic health evaluation II (APACHE II). Subsequently, their predictive value was evaluated using Spearman´s and Kendall´s correlation analysis, logistic regression and receiver operating characteristics (ROC) curves. Results: A proportion of 83% of the patients suffered from a thoracic aortic rupture or rupture with concomitant aortic wall dissection (54/65). The overall mortality was 24.6% (16/65). The sensitivity and specificity were calculated as the area under the receiver operating curves (AUC): NISS 0.812, ISS 0.791, APACHE II 0.884, RTSc 0.679 and TRISS 0.761. Logistic regression showed a slightly higher specificity to anatomical scoring systems (ISS 0.959, NISS 0.980, TRISS 0.957, APACHE II 0.938). The sensitivity was highest in the APACHE II with 0.545. Sensitivity and specificity for the RTSc were not significant. Conclusion: The predictive abilities of all scoring systems were very limited. All scoring systems, except the RTSc, had a high specificity but a low sensitivity. In our study population, the RTSc was not applicable. The APACHE II was the most sensitive score for mortality. Anatomical scoring systems showed a positive correlation with the amount of transfused blood products.

Post traumatic pseudoaneurysm of the superficial temporal artery in child

Aneurysms of the superficial temporal artery (STA) were first described in 1740, yet it remains a very uncommon post traumatic entity usually associated with sporting activities in young men or recurrent falls in older patients. A 10-year-old boy presented 4 weeks after blunt trauma to the head with a slowly enlarging left temporoparietal swelling. Clinical examination revealed a pulsatile and expansive mass of 4 cm with discoloration of the overlying skin. The ultrasound revealed a pseudoaneurysm of the left anterior superficial temporal artery. Excision was performed under general anesthesia. The mass was exposed, and the proximal and distal branches were ligated. The lesion was entirely removed and hemostasis was easily obtained. Histological examination showed a lesion consistent with pseudoaneurysm. The diagnosis of aneurysms or pseudoaneurysms of the STA can usually be made based on a thorough patient history and physical examination. They are easily treated with few long-term consequences. However, left untreated theses lesions can rupture leading to significant hemorrhage or cause compression of neighboring vessels and nerves. Treatment involves external compression, thrombin injection or surgical resection.

The diagnosis of delayed expanding traumatic pseudoaneurysm of thoracic aorta caused by self-inflicted penetrating injury with crossbow bolt: A case report.

Introduction and importancePenetrating chest trauma caused by a crossbow bolt is very rare. Herein, we report a successfully treated patient who attempted suicide by directing a crossbow to the chest cavity and developed an expanding pseudoaneurysm of the thoracic aorta during eight-day follow up.Case presentationA 51-year-old male was admitted to the emergency department after firing a crossbow bolt twice into his left chest. At admission, the patient was hemodynamically stable and maintaining oxygenation. The bolt had already been removed from the body. Contrast-enhanced computed tomography (CT) revealed a cavity pseudoaneurysm 2.5 mm in size in the aortic arch. Three-dimensional reconstruction of the CT demonstrated wound tracts showing probable damage by the bolt. The patient was admitted to the emergency department for careful observation and transferred to the psychiatric ward on day two. Follow-up contrast-enhanced CT on day eight demonstrated rapid expansion of the pseudoaneurysm from 2.5 mm to 4.0 mm in size. We performed thoracic endovascular aortic repair (TEVAR) on day 13. The patient was uneventfully discharged on the 20th hospital day.Clinical discussionEmergency physicians should be aware that damage to the surrounding tissue may be accompanied by delayed expansion of an aortic pseudoaneurysm, even if the bolts do not cause direct aortic wall injury.ConclusionThis case suggests that understanding the injury mechanism, confirming the tract of the bolts, and carefully exploring traumatic pseudoaneurysm can lead to a less invasive operation due to early detection.