Vein Aneurysm Research Articles

Galen's Ampulla Aneurysm: A Case Report

Introduction: Galen's vein aneurysm is a rare complex intracranial arteriovenous malformation, associating pseudo-aneurysmal dilation of Galen's ampulla with one or more arteriovenous fistulas. The prognosis is often poor, with high mortality and a risk of neurological sequelae. Objective: To support the role of imaging in the diagnosis, with illustration by two observations collected within our Radiopediatrics department of the CHU Mohammed VI of Marrakech, having benefited from a cerebral angio-scanner. Case Report: 1st case:is an 18-month-old infant with no particular history presenting macrocrania with generalized seizures.2nd case:is also a 2-year-old infant, with the appearance of a vein in the suborbital groove for 6 months, with no other associated signs.3rd patientis a 1-year-old infant with macrocrania with signs of HTIC. 4th case6-month-old boy, presents with HTIC syndrome. Objective cerebral CT in the first three patients: a rounded median mass, in the pineal region behind the 3rd ventricle, slightly hyperdense in spontaneous contrast; CT angiography proves the vascular nature of the lesion by showing intense and homogeneous enhancement after injection of PDC, associated with dilation of the venous sinuses, and moderate passive triventricular hydrocephalus by compression of the aqueduct of Sylvius. The fourth patient benefited from a transfontanellar ultrasound which objectified an anechoic interhemispheric fusiform structure presenting a vascular flow to the color Doppler. Conclusion: The aneurysmal malformation of the Vein of Galen (AVGM) is a rare vascular malformation, specific to children, discovered ante or post natally, in fact only corresponds to a venous dilation draining an arterio-venous malformation, whose system afferent arterial comes from the carotid system or the vertebro-basilar axis; it results from the absence of differentiation in the mature arterio-venous system, between 7 and 12 SA, of a primitive, median embryonic vein which ......

A fatal case of spleen rupture secondary to thrombosed aneurysm of the splenic vein

ABSTRACT Vascular abnormalities of the spleen are infrequently encountered in medical practice and, among these, an aneurysm of the splenic vein is a rare event, being only a few dozen cases reported to date in the literature. The rarity of this clinical condition hinders the understanding of its clinical history, related medical management and potential complications, which are currently unclear. In this article, we report an autopsy case observed in the practice of forensic medicine concerning a 45-year-old woman, anaemic, who died at home a few hours after a previous hospital evaluation for abdominal pain and vaginal spotting. The autopsy revealed a massive secondary hemoperitoneum caused by a laceration of the spleen. On examination of the organ, an aneurysm of the proximal branch of the splenic vein was detected, affected by complete thrombotic occlusion. This case offers a new perspective regarding the clinical evolution of splenic vein aneurysm to death, unprecedented in the current literature.

Subfascial aneurysm of the incompetent popliteal perforator vein: case series overview and novel minimally invasive approach presentation

Subfascial aneurysm of the incompetent popliteal perforator vein: case series overview and novel minimally invasive approach presentation

Point-of-care Ultrasound for the Evaluation of Acute Arterial Pathology in the Emergency Department: A Case Series.

IntroductionThe use of point-of care ultrasound (POCUS) in the evaluation of vascular emergencies including abdominal aortic aneurysm and deep vein thrombosis is well established. However, no current guidelines exist to outline the use of POCUS in the management of acute peripheral arterial pathology.Case SeriesHere, we present a case series that illustrates the utility of POCUS in the assessment of both traumatic and nontraumatic peripheral arterial disease. Direct visualization of the vasculature via B-mode, color Doppler, and pulsed-wave Doppler assisted in the diagnosis of the following: 1) an acute, post-catheterization thrombus of the proximal radial artery; 2) a complete, traumatic radial artery transection; 3) a forearm hematoma with active arterial extravasation; 4) a traumatic arteriovenous fistula; 5) an acute thrombosis of an artery bypass graft; and 6) an infected pseudoaneurysm.ConclusionThe incorporation of POCUS into patient care allowed for rapid identification of significant peripheral arterial pathology and led to changes in clinical management, expedited patient care, and circumvented potentially harmful complications.

A Rare case of Azygos vein arch Aneurysm: A case report

Background: The aneurysm of the azygos vein (AVA) is a dilatation of the azygos vein (AV) over 1,5cm; it is very rare, mostly fusiform and affecting people between 19 and 70 years old. Aetiology can be traumatic, inflammatory/infectious, cardiogenic, neoplastic or idiopathic. The weak points for the development of an AVA are essentially two: the confluence of the AV in the superior vena cava (SVC) and the convergence among its embryologic constituents. AVA is often asymptomatic, therefore it can be an incidentaloma. Symptoms, usually due to compression of neighbouring structures (such as trachea, bronchi, SVC, inferior vena cava (IVC), oesophagus or nerves), can simulate a mediastinal mass. The main complication of AVA is thrombosis, which can extend to pulmonary vessels. Other complications include rupture, fistulae and dissection. Most of the authors consider the occurrence of complications the only indications to treat it. Case report: We present the case of an 87-year-old woman with chronic atrial fibrillation, which came to our emergency department for wheezing and dyspnoea. Though the chest radiograph only found a pleural effusion, the subsequent CT scan showed a voluminous mediastinal mass compressing the oesophagus, which proved to be an AVA during the dynamic phase of the study. Conclusion: The AVA represents a possible hypothesis in the differential diagnosis of mediastinal masses, that in most cases can be probed radiologically.

The value of ultrasound in the multivariate assessment complications of permanent vascular access for hemodialysis

Background. The maximum duration of vascular access for hemodialysis functioning rarely exceeds 4 years. The main tool for diagnosing access dysfunction is duplex ultrasound. Dynamic ultrasound examination of vascular access is not included in the standard examination of patient undergoing hemodialysis in Russia.Objective. To study the structure of complications and changes in hemodynamics in the vascular access for hemodialysis and to determine the risk factors contributing to its development.Design and methods. Ultrasound, clinical and laboratory examination was performed in 550 patients undergoing program hemodialysis, 517 (94.0 %) of them had arteriovenous fistula, 33 (6.0 %) patients had arteriovenous graft.Results. Vascular access complications occurred in 26.7 % (147 patients), there was no significant difference in the detection rate of thrombosis (26.5 %), stenosis (23.8 %), and aneurysm (21.1 %). A combination of two complications was observed in 20.4 %, the steal syndrome — in 8.2 %. A correlation was established between the presence of significant stenosis, aneurysm of the outflow vein and the development of thrombosis, between the presence of concomitant diseases of the peripheral arteries and the development of steal syndrome and stenosis of the inflow artery and the anastomosis zone.Conclusion. Duplex ultrasound allows to diagnose complications of vascular access for hemodialysis and determine its causes.

Duplex ultrasound of vascular access for hemodialysis thrombosis

Introduction. The most common complication of the vascular access for hemodialysis, that can lead to its loss, is thrombosis. The method of choice in diagnosing fistula thrombosis is duplex ultrasound. Purpose: to study the ultrasound signs and changes in hemodynamics data in thrombosed fistulas and to determine the risk factors contributing to its development. Materials and methods. Duplex ultrasound was performed in 550 patients with vascular access for hemodialysis. Access thrombosis was detected in 12,0%, non-occlusive thrombosis was observed in 60,6%, occlusive thrombosis — in 39,4%. Thrombosis was significantly more common in women than in men (p=0,025). In patients with graft, thrombosis was more common (24,2%) than in those with arteriovenous fistula (11,2%), p=0,026. A correlation was found between the presence of significant vascular access stenosis, aneurysm of the outflow vein or graft, and the development of thrombosis (p<0,02). Duplex ultrasound allows to diagnose vascular access thrombosis and to determine the causes of its development.

Left brachiocephalic vein aneurysm: a case report

BackgroundAneurysm of the left brachiocephalic vein is a very rare clinical disease and only 40 cases have been reported so far.Case presentationThe patient was a 61-year-old woman with no related medical history. She underwent CT to investigate the cause of a cough and a mass was noted in the anterior mediastinum. Dynamic computed tomography with contrast medium injected into the left basilic vein demonstrated the venous aneurysm with blood flow to the left brachiocephalic vein. The patient had no symptoms, but because of the risk of pulmonary infarction and aneurysm rupture, the aneurysm was surgically resected. A median sternotomy was a reasonable approach because of the fragility of the venous aneurysm wall with little working space in the anterior mediastinum.ConclusionsWe diagnosed an aneurysm of the left brachiocephalic vein on preoperative imaging and excised it through a median sternotomy. The venous wall was thin and fragile in some areas and so this approach was appropriate in view of the possibility of intraoperative injury.

Reconstructive operations for aneurysmatic transformation of veins in patients on programmed haemodialysis

Aneurysmatic transformation of a fistulous vein is one of the most frequently encountered complications in patients on programmed dialysis. This complication increases the risk of dysfunction of an arteriovenous fistula. However, there are no common approaches to correction of this complication. This study was aimed at assessing the results of aneurysmorrhaphy for treating aneurysms of fistulous veins in patients on programmed dialysis. For this purpose, we carried out a retrospective analysis of the results of operations in a total of 87 patients with aneurysmatic transformation of an arteriovenous fistula. All patients were subjected to aneurysmorrhaphy supplemented, if necessary, by plasty of stenosis with the use of the tissue of the wall of the resected aneurysm. The vein was placed into a new subcutaneous channel (transposition with transection of the vein) or a pocket formed by the separated subcutaneous tissue (transposition without transection). Secondary patency after 1 year amounted to 95.3%, after 2 years to 91.4%, and after 3 years to 87.6%. At 4.8 years, 69% (95% CI 44.9-84.2) of the arteriovenous fistulas proved patent. CONCLUSION: Aneurysmorrhaphy supplemented with correction of concomitant complications of aneurysms of fistulous veins is an effective and safe operation making it possible to maintain the function of an arteriovenous fistula for a long period of time.

Carotid Venous Interposition Graft Aneurysm Resection and Bypass Using Deep Femoral Vein

The video shows the surgery of 67-year-old woman with a history of left carotid body tumor resection with carotid replacement with greater saphenous vein. The vein replacement graft had become aneurysmal to 3 cm. The aneurysmal vein conduit was resected and replaced with a deep femoral vein using internal shunts.

Right internal jugular vein thrombosis due to venous aneurysm of right internal jugular vein

Right internal jugular vein thrombosis due to venous aneurysm of right internal jugular vein

Coil Embolization of an Iatrogenic Arteriovenous Fistula between the Superior Mesenteric Artery and Vein: A Case Report

Superior mesenteric arteriovenous fistulae are rare. A 32-year-old woman presented with abdominal pain. The angiography showed that the superior mesenteric vein was aneurysmal. The patient underwent coil embolization, during which a balloon catheter was inflated before the fistula for the protection of coil migration with a high blood flow. After the balloon inflation, one 8-mm and two 7-mm coils were deployed at the fistula site. The final angiography showed successful embolization with no visualization of the fistula and the aneurysmal vein.

An atypical case of pulmonary embolism from a jugular vein

SummaryNeck venous malformations and their potentially life-threatening complications are rarely reported in the available literature. Cases of aneurysmal or hypo-plastic jugular vein thrombosis associated with systemic embolization have not been frequently reported. We present the case of a 60-year-old male, without any known risk factors for thromboembolic disease, admitted for sudden onset dyspnea. The physical examination was remarkable for a right lateral cervical mass, expanding with Valsalva maneuver. Thoracic CT with contrast established the diagnosis of bilateral pulmonary embolism and raised the suspicion of superior vena cava and right atrial thrombosis. Bedside transthoracic echocardiography confirmed the presence of a large right atrial thrombus, with intermittent protrusion through the tricuspid valve. Systemic thrombolysis with Alteplase was initiated shortly after diagnosis, in parallel with unfractionated heparin, with complete resolution of the intracavitary thrombus documented by echocardiography. The patient showed significant improvement in symptoms and was later started on oral anticoagulation. Computed vascular tomography of the neck was performed before discharge, showing hypoplasia of the left internal jugular vein and aneurismal dilation of the contralateral internal jugular vein, without thrombosis. There were no identifiable systemic causes for thrombosis. Surgical resection of the aneurismal jugular vein was excluded, because of its potential to cause intracranial hypertension. The preferred therapeutic option in this case was long-term oral anticoagulation.

A rare case of a right common iliac venous aneurysm imitating a neoplastic tumour

BackgroundAneurysms of the deep lower limbs veins are extremely rare. Diagnosis of such conditions may be confusing and suggest the presence of a neoplastic lesion.Case presentationWe herein report a case of a 68-year-old woman who was admitted with a large vein tumour revealed by sonography and computed tomography. A direct phlebography revealed a large venous aneurysm of the right common iliac vein with an adhering thrombus and a large collateral circulation. Anticoagulant treatment and compression with an elastic stocking were initiated because the patient refused surgical treatment. A 2-year follow-up showed no aneurysm growth or thromboembolic complications.ConclusionsWe show herein that conservative management can be effective and safe in cases of this rare condition.

Arterial reconstructions for chronic lower extremity ischemia in preadolescent and adolescent children

ObjectiveChronic lower extremity ischemia in pediatric patients is uncommon. The intent of this study was to better define the arterial reconstructive options and their long-term durability in preadolescent and adolescent children having clinically relevant arterial occlusions affecting the lower extremity. MethodsThe medical records of 33 consecutive pediatric patients who underwent lower extremity revascularization for chronic ischemia at the University of Michigan from 1974 to 2016 were reviewed. Patients were categorized by age, clinical manifestation, surgical intervention undertaken, and outcomes. ResultsOperative treatments involved 26 preadolescent children (mean age, 6.1 years; range, 3-9 years) and 7 adolescent children (mean age, 13.9 years; range, 10-17 years). Occlusions were due to earlier injury related to catheter (14), cannula (2), or both catheter and cannula (14); penetrating trauma (2); and vasculitis (1). Preoperative manifestations included symptomatic extremity ischemia (25), growth retardation manifested by documented limb length discrepancies (21), and scoliosis (5). Primary arterial reconstructions were delayed after the precipitating vascular event an average of 5.3 and 11.2 years in the preadolescent and adolescent children, respectively. Primary procedures involved revascularizations of 36 extremities (in preadolescents and adolescents) including autologous vein (26/5), polyethylene terephthalate (Dacron; 1/0), and expanded polytetrafluoroethylene (0/3) bypasses and vein patch angioplasty (0/1). Vein grafts traversing the abdominal cavity (15) were wrapped with a synthetic mesh. Excluding one early graft occlusion, there were no major early postoperative complications after the primary procedures. Secondary operations followed 31% of the primary operations, being performed an average of 8.8 and 6.7 years later (in 8 preadolescent and 3 adolescent children, respectively) for late graft occlusions (6), graft stenoses (3), aneurysmal vein grafts (2), and anastomotic pseudoaneurysm (1). The unassisted primary graft patency rate was 69%, and the assisted secondary graft patency rate was 94%. Symptomatic ischemia resolved in all but two children. Mean postoperative ankle-brachial indices improved to 1.08 from 0.76 preoperatively. Among children having postoperative documentation of limb lengths, the limb length discrepancies became less (11), were unchanged (1), or progressed (3). Follow-up averaged 8.0 years. There was no operative mortality in this experience. ConclusionsPrimary lower extremity arterial reconstructions in children with chronic lower extremity ischemia can be successfully undertaken with excellent results. Nevertheless, the potential for late primary graft failures, evident in nearly a third of this experience, mandates careful long-term follow-up and may necessitate secondary interventions to maintain satisfactory outcomes.

External Jugular Vein Aneurysm with Thrombus Presenting as Neck Mass: A Case Report (Rare Case)

External jugular vein aneurysm with thrombosis presenting as neck swelling is a rare clinical entity and rarely encountered in routine clinical practice in otorhinolaryngology. We present a case of a 52-year-old female with external jugular vein aneurysm presenting as a neck mass. Ultrasound of the neck and CT showed saccular dilation of the external jugular vein with thrombosis within the aneurysm. Saccular aneurysm of the external jugular vein is very uncommon and can lead to thrombotic complications with serious consequence.

Effect of treated length in endovenous laser ablation of great saphenous vein on early outcomes

The aim of this preliminary study was to document the effect of treated great saphenous vein (GSV) length on short-term outcomes using freedom from secondary intervention as a marker. Analysis was performed of a prospective database of endovascular laser therapy (EVLT) procedures performed by a single surgeon in an NHS hospital setting using a standardized technique in a series of consecutive ambulatory patients. During a 2-year period, 131 episodes with sufficient data were recorded. The effect of GSV vein length treated was assessed at 6 weeks. Hospital records were monitored for unplanned events for a minimum of 6 months. All patients with primary or recurrent varicose veins affecting the GSV were offered EVLT ablation. Aneurysmal vein segments, severely tortuous veins, ankle-brachial pressure index of<0.5, and presence of thrombus in the vein were excluded. Patients on anticoagulation were not excluded. Of 192 patients scheduled for EVLT for varicose veins, 61 were excluded from the analysis (40 small saphenous veins, 5 failures to complete procedure, 16 with incomplete data). There were 79 women (60.3%) and 52 men (39.7%), with a mean age of 54± 16 (standard deviation) years. CEAP clinical categories were C2, 30 (22.9%); C3, 33 (25.2%); C4, 52 (39.7%); C5, 1 (0.8%); and C6, 15 (11.5%). In addition to EVLT, ultrasound-guided foam sclerotherapy or surgical avulsions were used when required. The main outcome measure was freedom from ancillary treatment with foam sclerotherapy or multiple avulsions. The freedom from reintervention was 68.9% if the treated vein length was 0 to 20 cm (n= 17), 86.5% for a vein length of 21 to 39 cm (n= 74), and 100% for a vein length >40 cm (n= 41; P= .003). The total length of vein treated appears to have a significant effect on reintervention rates. This may be due to better occlusion of tributaries. Where possible, ≥30 cm should be treated; otherwise, sclerotherapy or avulsions may be incorporated simultaneously to allow for one-stop treatment.

Huge dilatation of the azygos vein (Aneurysms of the azygos vein).

Introduction: Huge dilatacion of the azygos vein (Aneurysms of the azygos vein) are rare and can sometimes mimic a paratracheal or posterior mediastinal mass. Objective: It is important to confirm the diagnosis with radiologic tools before performing invasive procedures, which carry the risk of hemorrhage. Discussion: The usual diagnosis of a mediastinal mass by mediastinoscopy or percutaneous fine-needle aspiration or biopsy is very hazardous if there is a venous varix. Noninvasive thoracic contrast CT scanning is a safe and better choice for diagnosis.

A combination of pulmonary artery aneurysm and deep vein thrombosis.

A combination of pulmonary artery aneurysm and deep vein thrombosis.

Approach to the Swollen Arm With Chronic Dialysis Access: It's Not Just Deep Vein Thrombosis.

The purposes of this pictorial essay are as follows: (1) Review a systematic approach to using sonography in the initial evaluation of patients with acute arm swelling and permanent dialysis access. (2) Identify normal grayscale and Doppler findings in arteriovenous fistulas and grafts. (3) Discuss a spectrum of vascular differential diagnoses for arm swelling in this setting, including stenosis of the access, draining vein complications, thrombosis, steal syndrome, and aneurysms, as well as several nonvascular causes. (4) Recognize findings that warrant further imaging evaluation or intervention.