WorldWideScience

Sample records for aneurysm hemodynamic analysis

  1. Morphological and hemodynamic analysis of mirror posterior communicating artery aneurysms.

    Directory of Open Access Journals (Sweden)

    Jinyu Xu

    Full Text Available BACKGROUND AND PURPOSE: Hemodynamic factors are commonly believed to play an important role in the pathogenesis, progression, and rupture of cerebral aneurysms. In this study, we aimed to identify significant hemodynamic and morphological parameters that discriminate intracranial aneurysm rupture status using 3-dimensional-angiography and computational fluid dynamics technology. MATERIALS AND METHODS: 3D-DSA was performed in 8 patients with mirror posterior communicating artery aneurysms (Pcom-MANs. Each pair was divided into ruptured and unruptured groups. Five morphological and three hemodynamic parameters were evaluated for significance with respect to rupture. RESULTS: The normalized mean wall shear stress (WSS of the aneurysm sac in the ruptured group was significantly lower than that in the unruptured group (0.52±0.20 versus 0.81±0.21, P = .012. The percentage of the low WSS area in the ruptured group was higher than that in the unruptured group (4.11±4.66% versus 0.02±0.06%, P = .018. The AR was 1.04±0.21 in the ruptured group, which was significantly higher than 0.70±0.17 in the unruptured group (P = .012. By contrast, parameters that had no significant differences between the two groups were OSI (P = .674, aneurysm size (P = .327, size ratio (P = .779, vessel angle (P = 1.000 and aneurysm inclination angle (P = 1.000. CONCLUSIONS: Pcom-MANs may be a useful disease model to investigate possible causes of aneurysm rupture. The ruptured aneurysms manifested lower WSS, higher percentage of low WSS area, and higher AR, compared with the unruptured one. And hemodynamics is as important as morphology in discriminating aneurysm rupture status.

  2. Cluster Analysis of Vortical Flow in Simulations of Cerebral Aneurysm Hemodynamics.

    Science.gov (United States)

    Oeltze-Jafra, Steffen; Cebral, Juan R; Janiga, Gábor; Preim, Bernhard

    2016-01-01

    Computational fluid dynamic (CFD) simulations of blood flow provide new insights into the hemodynamics of vascular pathologies such as cerebral aneurysms. Understanding the relations between hemodynamics and aneurysm initiation, progression, and risk of rupture is crucial in diagnosis and treatment. Recent studies link the existence of vortices in the blood flow pattern to aneurysm rupture and report observations of embedded vortices -a larger vortex encloses a smaller one flowing in the opposite direction -whose implications are unclear. We present a clustering-based approach for the visual analysis of vortical flow in simulated cerebral aneurysm hemodynamics. We show how embedded vortices develop at saddle-node bifurcations on vortex core lines and convey the participating flow at full manifestation of the vortex by a fast and smart grouping of streamlines and the visualization of group representatives. The grouping result may be refined based on spectral clustering generating a more detailed visualization of the flow pattern, especially further off the core lines. We aim at supporting CFD engineers researching the biological implications of embedded vortices. PMID:26390475

  3. Time evolution and hemodynamics of cerebral aneurysms

    Science.gov (United States)

    Sforza, Daniel M.; Putman, Christopher; Tateshima, Satoshi; Viñuela, Fernando; Cebral, Juan

    2011-03-01

    Cerebral aneurysm rupture is a leading cause of hemorrhagic strokes. Because they are being more frequently diagnosed before rupture and the prognosis of subarachnoid hemorrhage is poor, clinicians are often required to judge which aneurysms are prone to progression and rupture. Unfortunately, the processes of aneurysm initiation, growth and rupture are not well understood. Multiple factors associated to these processes have been identified. Our goal is to investigate two of them, arterial hemodynamics (using computational fluid dynamics) and the peri-aneurysmal environment, by studying a group of growing cerebral aneurysms that are followed longitudinally in time. Six patients with unruptured untreated brain aneurysms which exhibited growth during the observation period were selected for the study. Vascular models of each aneurysm at each observation time were constructed from the corresponding computed tomography angiography (CTA) images. Subsequently, models were aligned, and geometrical differences quantified. Blood flow was modeled with the 3D unsteady incompressible Navier-Stokes equation for a Newtonian fluid, and wall shear stress distribution and flow patterns were calculated and visualized. Analysis of the simulations and changes in geometry revealed asymmetric growth patterns and suggests that areas subject to vigorous flows, i.e. relative high wall shear stress and concentrated streamlines patterns; correspond to regions of aneurysm growth. Furthermore, in some cases the geometrical evolution of aneurysms is clearly affected by contacts with bone structures and calcifications in the wall, and as a consequence the hemodynamics is greatly modified. Thus, in these cases the peri-aneurysmal environment must be considered when analyzing aneurysm evolution.

  4. In vivo visualization and analysis of 3-D hemodynamics in cerebral aneurysms with flow-sensitized 4-D MR imaging at 3 T

    International Nuclear Information System (INIS)

    Blood-flow patterns and wall shear stress (WSS) are considered to play a major role in the development and rupture of cerebral aneurysms. These hemodynamic aspects have been extensively studied in vitro using geometric realistic aneurysm models. The purpose of this study was to evaluate the feasibility of in vivo flow-sensitized 4-D MR imaging for analysis of intraaneurysmal hemodynamics. Five cerebral aneurysms were examined using ECG-gated, flow-sensitized 4-D MR imaging at 3 T in three patients. Postprocessing included quantification of flow velocities, visualization of time-resolved 2-D vector graphs and 3-D particle traces, vortical flow analysis, and estimation of WSS. Flow patterns were analyzed in relation to aneurysm geometry and aspect ratio. Magnitude, spatial and temporal evolution of vortical flow differed markedly among the aneurysms. Particularly unstable vortical flow was demonstrated in a wide-necked parophthalmic ICA aneurysm (high aspect ratio). Relatively stable vortical flow was observed in aneurysms with a lower aspect ratio. Except for a wide-necked cavernous ICA aneurysm (low aspect ratio), WSS was reduced in all aneurysms and showed a high spatial variation. In vivo flow-sensitized 4-D MR imaging can be applied to analyze complex patterns of intraaneurysmal flow. Flow patterns, distribution of flow velocities, and WSS seem to be determined by the vascular geometry of the aneurysm. Temporal and spatial averaging effects are drawbacks of the MR-based analysis of flow patterns as well as the estimation of WSS, particularly in small aneurysms. Further studies are needed to establish a direct link between definitive flow patterns and different aneurysm geometries. (orig.)

  5. Post-Treatment Hemodynamics of a Basilar Aneurysm and Bifurcation

    Energy Technology Data Exchange (ETDEWEB)

    Ortega, J; Hartman, J; Rodriguez, J; Maitland, D

    2008-01-16

    Aneurysm re-growth and rupture can sometimes unexpectedly occur following treatment procedures that were initially considered to be successful at the time of treatment and post-operative angiography. In some cases, this can be attributed to surgical clip slippage or endovascular coil compaction. However, there are other cases in which the treatment devices function properly. In these instances, the subsequent complications are due to other factors, perhaps one of which is the post-treatment hemodynamic stress. To investigate whether or not a treatment procedure can subject the parent artery to harmful hemodynamic stresses, computational fluid dynamics simulations are performed on a patient-specific basilar aneurysm and bifurcation before and after a virtual endovascular treatment. The simulations demonstrate that the treatment procedure produces a substantial increase in the wall shear stress. Analysis of the post-treatment flow field indicates that the increase in wall shear stress is due to the impingement of the basilar artery flow upon the aneurysm filling material and to the close proximity of a vortex tube to the artery wall. Calculation of the time-averaged wall shear stress shows that there is a region of the artery exposed to a level of wall shear stress that can cause severe damage to endothelial cells. The results of this study demonstrate that it is possible for a treatment procedure, which successfully excludes the aneurysm from the vascular system and leaves no aneurysm neck remnant, to elevate the hemodynamic stresses to levels that are injurious to the immediately adjacent vessel wall.

  6. Correlation between Hemodynamics and Treatment Outcome of Intracranial Aneurysms after Intervention with Flow Diverters

    Science.gov (United States)

    Paliwal, Nikhil; Damiano, Robert; Davies, Jason; Siddiqui, Adnan; Meng, Hui

    2015-11-01

    Endovascular intervention by Flow Diverter (FD) - a densely woven stent - occludes an aneurysm by inducing thrombosis in the aneurysm sac and reconstructing the vessel. Hemodynamics plays a vital role in the thrombotic occlusion of aneurysms and eventual treatment outcome. CFD analysis of pre- and post-treatment aneurysms not only provides insight of flow modifications by FD, but also allows investigation of interventional strategies and prediction of their outcome. In this study 80 patient-specific aneurysms treated with FDs were retrospectively studied to evaluate the effect of intervention. Out of these cases, 16 required retreatment and thus are considered as having unfavorable outcome. Clinical FD deployment in these cases was simulated using an efficient virtual stenting workflow. CFD analysis was carried out on both pre- and post-treatment cases, and changes in hemodynamic parameters were calculated. Support vector machine algorithm was used to correlate the hemodynamic changes with outcome. Results show that cases having higher flow reduction into the aneurysmal sac have a better likelihood of occlusion. This suggests that changes in hemodynamics can be potentially used to predict the outcome of different clinical intervention strategies in aneurysms. This work was supported by the National Institutes of Health (R01 NS091075).

  7. A study of the hemodynamics of anterior communicating artery aneurysms

    Science.gov (United States)

    Cebral, Juan R.; Castro, Marcelo A.; Putman, Christopher M.

    2006-03-01

    In this study, the effects of unequal physiologic flow conditions in the internal carotid arteries on the intra-aneurysmal hemodynamics of anterior communicating artery aneurysms were investigated. Patient-specific vascular computational fluid dynamics models of five cerebral aneurysms were constructed from bilateral 3D rotational angiography images. The aneurysmal hemodynamics was analyzed under a range of physiologic flow conditions including the effects of unequal mean flows and phase shifts between the flow waveforms of the left and right internal carotid arteries. A total of five simulations were performed for each patient, and unsteady wall shear stress (WSS) maps were created for each flow condition. Time dependent curves of average WSS magnitude over selected regions on the aneurysms were constructed and used to analyze the influence of the inflow conditions. It was found that mean flow imbalances in the feeding vessels tend to shift the regions of elevated WSS (flow impingement region) towards the dominating inflow jet and to change the magnitude of the WSS peaks. However, the overall qualitative appearance of the WSS distribution and velocity simulations is not substantially affected. In contrast, phase differences tend to increase the temporal complexity of the hemodynamic patterns and to destabilize the intra-aneurysmal flow pattern. However, these effects are less important when the A1 confluence is less symmetric, i.e. dominated by one of the A1 segments. Conditions affecting the flow characteristics in the parent arteries of cerebral aneurysms with more than one avenue of inflow should be incorporated into flow models.

  8. The Effect of Hemodynamics on Cerebral Aneurysm Morphology

    Science.gov (United States)

    Metcalfe, Ralph; Mantha, Aishwarya; Karmonik, Christof; Strother, Charles

    2004-11-01

    One of the difficulties in applying principles of hemodynamics to the study of blood flow in aneurysms are the drastic variations in possible shape of both the aneurysms and the parent arteries in the region of interest. We have taken data from three para-opthalmic internal carotid artery aneurysms using 3D-digital subtraction angiography (3D-DSA) and performed CFD simulations of steady and unsteady flows through the three different cases using the same pressure gradients and pulsatile flow waveforms (based on the Ku model for flow through the Carotid bifurcation). We have found that the total pressure differential within the aneurysms is consistent with the direction of flow, and that the dynamic pressure gradient within the aneurysm is very small compared with the static pressure variations. Wall shear stresses were highest near regions of sharp arterial curvature, but always remained low inside the aneurysm. These results suggest a more complex role for hemodynamics in aneurysm generation, growth and rupture.

  9. Image-based investigation of hemodynamics and rupture of cerebral aneurysms of a single morphological type: terminal aneurysms

    Science.gov (United States)

    Castro, Marcelo; Putman, Christopher; Radaelli, Alessandro; Frangi, Alejandro; Cebral, Juan

    2008-03-01

    In this study, the relationship between hemodynamics patterns and aneurysmal rupture was investigated in cerebral aneurysms of a single morphological type (terminal aneurysms) regardless of their location. Hemodynamics information (intra-aneurysmal velocity and pressure fields and wall shear stress distributions) was derived from image-based computational fluid dynamics models with realistic patient specific anatomies. A total of 41 patient-specific models constructed from 3D rotational angiography images were analyzed. The results suggest that high wall shear stress may be associated with aneurysm rupture and that in turn different flow splitting patterns from the parent artery to the daughter branches and the aneurysm produce different levels of wall shear stress.

  10. Comparison of two stents in modifying cerebral aneurysm hemodynamics.

    Science.gov (United States)

    Kim, Minsuok; Taulbee, Dale B; Tremmel, Markus; Meng, Hui

    2008-05-01

    There is a general lack of quantitative understanding about how specific design features of endovascular stents (struts and mesh design, porosity) affect the hemodynamics in intracranial aneurysms. To shed light on this issue, we studied two commercial high-porosity stents (Tristar stent and Wallstent) in aneurysm models of varying vessel curvature as well as in a patient-specific model using Computational Fluid Dynamics. We investigated how these stents modify hemodynamic parameters such as aneurysmal inflow rate, stasis, and wall shear stress, and how such changes are related to the specific designs. We found that the flow damping effect of stents and resulting aneurysmal stasis and wall shear stress are strongly influenced by stent porosity, strut design, and mesh hole shape. We also confirmed that the damping effect is significantly reduced at higher vessel curvatures, which indicates limited usefulness of high-porosity stents as a stand-alone treatment. Finally, we showed that the stasis-inducing performance of stents in 3D geometries can be predicted from the hydraulic resistance of their flat mesh screens. From this, we propose a methodology to cost-effectively compare different stent designs before running a full 3D simulation. PMID:18264766

  11. Hemodynamic simulations in coronary aneurysms of children with Kawasaki disease

    Science.gov (United States)

    Sengupta, Dibyendu; Burns, Jane; Marsden, Alison

    2009-11-01

    Kawasaki disease (KD) is a serious pediatric illness affecting the cardiovascular system. One of the most serious complications of KD, occurring in about 25% of untreated cases, is the formation of large aneurysms in the coronary arteries, which put patients at risk for myocardial infarction. In this project we performed patient specific computational simulations of blood flow in aneurysmal left and right coronary arteries of a KD patient to gain an understanding about their hemodynamics. Models were constructed from CT data using custom software. Typical pulsatile flow waveforms were applied at the model inlets, while resistance and RCR lumped models were applied and compared at the outlets. Simulated pressure waveforms compared well with typical physiologic data. High wall shear stress values are found in the narrow region at the base of the aneurysm and low shear values occur in regions of recirculation. A Lagrangian approach has been adopted to perform particle tracking and compute particle residence time in the recirculation. Our long-term goal will be to develop links between hemodynamics and the risk for thrombus formation in order to assist in clinical decision-making.

  12. Intra-aneurysmal thrombosis induced by stenting in the parent artery in rabbit. Hemodynamic consideration

    International Nuclear Information System (INIS)

    The indication of coil embolization for unruptured aneurysms is recently increasing. However, a safer procedure is required, since the patients are asymptomatic. We presumed that the manipulation in aneurysm can be avoided to prevent rupture if intra-aneurysmal thrombosis is induced with only stenting in the parent artery of aneurysm, and considered whether stenting is effective from a hemodynamic point of view. Neuroform2 is a self-expandable stent used in these experiments. The aneurysm is induced at the origin on the right common carotid artery in rabbits, and the stent introduced into the parent artery of an aneurysm. Aneurysm was also induced in another rabbit without stenting. Intra-aneurysmal partial thrombosis was induced and the volume increased in the term of observation with 3DCT-angiography every month in the stented rabbit. There was no intra-aneurysmal thrombosis in the rabbit without stenting. We also confirmed the decreased intra-aneurysmal velocity in the hemodynamic study using realistic silicon models. These results indicate that intra-aneurysmal partial thrombosis is induced by alteration of the hemodynamics with stenting. This procedure has the possibility for preventing rupture of the aneurysm. We also consider that improvement of the mesh design of the stent and double stenting would lead to complete thrombosis in the aneurysm. (author)

  13. Numerical predictions of hemodynamics following surgeries in cerebral aneurysms

    Science.gov (United States)

    Rayz, Vitaliy; Lawton, Michael; Boussel, Loic; Leach, Joseph; Acevedo, Gabriel; Halbach, Van; Saloner, David

    2014-11-01

    Large cerebral aneurysms present a danger of rupture or brain compression. In some cases, clinicians may attempt to change the pathological hemodynamics in order to inhibit disease progression. This can be achieved by changing the vascular geometry with an open surgery or by deploying a stent-like flow diverter device. Patient-specific CFD models can help evaluate treatment options by predicting flow regions that are likely to become occupied by thrombus (clot) following the procedure. In this study, alternative flow scenarios were modeled for several patients who underwent surgical treatment. Patient-specific geometries and flow boundary conditions were obtained from magnetic resonance angiography and velocimetry data. The Navier-Stokes equations were solved with a finite volume solver Fluent. A porous media approach was used to model flow-diverter devices. The advection-diffusion equation was solved in order to simulate contrast agent transport and the results were used to evaluate flow residence time changes. Thrombus layering was predicted in regions characterized by reduced velocities and shear stresses as well as increased flow residence time. The simulations indicated surgical options that could result in occlusion of vital arteries with thrombus. Numerical results were compared to experimental and clinical MRI data. The results demonstrate that image-based CFD models may help improve the outcome of surgeries in cerebral aneurysms. acknowledge R01HL115267.

  14. The Effect of Inlet Waveforms on Computational Hemodynamics of Patient-Specific Intracranial Aneurysms

    OpenAIRE

    J. Xiang; Siddiqui, A.H.; Meng, H.

    2014-01-01

    Due to the lack of patient-specific inlet flow waveform measurements, most computational fluid dynamics (CFD) simulations of intracranial aneurysms usually employ waveforms that are not patient-specific as inlet boundary conditions for the computational model. The current study examined how this assumption affects the predicted hemodynamics in patient-specific aneurysm geometries. We examined wall shear stress (WSS) and oscillatory shear index (OSI), the two most widely studied hemodynamic qu...

  15. A critical role for proinflammatory behavior of smooth muscle cells in hemodynamic initiation of intracranial aneurysm.

    Directory of Open Access Journals (Sweden)

    Max Mandelbaum

    Full Text Available BACKGROUND: Intracranial aneurysm initiation is poorly understood, although hemodynamic insult is believed to play an important role in triggering the pathology. It has recently been found in a rabbit model that while macrophages are absent during hemodynamic aneurysm initiation, matrix metalloproteinases (MMPs are elevated and co-localize with smooth muscle cells (SMCs. This study investigates whether SMCs play a mechanistic role in aneurysm initiation triggered by hemodynamics. METHODS: Aneurysmal damage was induced at the basilar terminus via bilateral common carotid artery ligation in rabbits (n = 45, plus 7 sham controls. 16 ligated rabbits were treated with doxycycline to inhibit MMPs, 7 received clodronate liposomes to deplete circulating monocytes, and the rest received no drug. Effects of the treatments on aneurysm development were assessed histologically 5 days and 6 months after ligation. MMP production and expression of inflammatory markers by SMCs was monitored by immunohistochemistry and in situ hybridization. RESULTS: Treatment with doxycycline attenuated aneurysmal development examined at 5 days and 6 months, suggesting that MMPs contribute to aneurysm initiation. However, systemic depletion of macrophages did not decrease MMPs or suppress aneurysmal development. Immunofluorescence showed that during aneurysm initiation MMP-2 and MMP-9 were distributed in SMCs, and in situ hybridization indicated that they were transcribed by SMCs. In regions of early aneurysmal lesion, SMCs exhibited decreased expression of smooth muscle actin and increased NF-κB and MCP-1 expressions. CONCLUSIONS: During aneurysm initiation triggered by hemodynamics, SMCs rather than macrophages are responsible for MMP production that is critical for aneurysmal lesion development. These SMCs exhibit proinflammatory behavior.

  16. The effect of inlet waveforms on computational hemodynamics of patient-specific intracranial aneurysms.

    Science.gov (United States)

    Xiang, J; Siddiqui, A H; Meng, H

    2014-12-18

    Due to the lack of patient-specific inlet flow waveform measurements, most computational fluid dynamics (CFD) simulations of intracranial aneurysms usually employ waveforms that are not patient-specific as inlet boundary conditions for the computational model. The current study examined how this assumption affects the predicted hemodynamics in patient-specific aneurysm geometries. We examined wall shear stress (WSS) and oscillatory shear index (OSI), the two most widely studied hemodynamic quantities that have been shown to predict aneurysm rupture, as well as maximal WSS (MWSS), energy loss (EL) and pressure loss coefficient (PLc). Sixteen pulsatile CFD simulations were carried out on four typical saccular aneurysms using 4 different waveforms and an identical inflow rate as inlet boundary conditions. Our results demonstrated that under the same mean inflow rate, different waveforms produced almost identical WSS distributions and WSS magnitudes, similar OSI distributions but drastically different OSI magnitudes. The OSI magnitude is correlated with the pulsatility index of the waveform. Furthermore, there is a linear relationship between aneurysm-averaged OSI values calculated from one waveform and those calculated from another waveform. In addition, different waveforms produced similar MWSS, EL and PLc in each aneurysm. In conclusion, inlet waveform has minimal effects on WSS, OSI distribution, MWSS, EL and PLc and a strong effect on OSI magnitude, but aneurysm-averaged OSI from different waveforms has a strong linear correlation with each other across different aneurysms, indicating that for the same aneurysm cohort, different waveforms can consistently stratify (rank) OSI of aneurysms. PMID:25446264

  17. Impact of stents and flow diverters on hemodynamics in idealized aneurysm models.

    Science.gov (United States)

    Seshadhri, Santhosh; Janiga, Gábor; Beuing, Oliver; Skalej, Martin; Thévenin, Dominique

    2011-07-01

    Cerebral aneurysms constitute a major medical challenge as treatment options are limited and often associated with high risks. Statistically, up to 3% of patients with a brain aneurysm may suffer from bleeding for each year of life. Eight percent of all strokes are caused by ruptured aneurysms. In order to prevent this rupture, endovascular stenting using so called flow diverters is increasingly being regarded as an alternative to the established coil occlusion method in minimally invasive treatment. Covering the neck of an aneurysm with a flow diverter has the potential to alter the hemodynamics in such a way as to induce thrombosis within the aneurysm sac, stopping its further growth, preventing its rupture and possibly leading to complete resorption. In the present study the influence of different flow diverters is quantified considering idealized patient configurations, with a spherical sidewall aneurysm placed on either a straight or a curved parent vessel. All important hemodynamic parameters (exchange flow rate, velocity, and wall shear stress) are determined in a quantitative and accurate manner using computational fluid dynamics when varying the key geometrical properties of the aneurysm. All simulations are carried out using an incompressible, Newtonian fluid with steady conditions. As a whole, 72 different cases have been considered in this systematic study. In this manner, it becomes possible to compare the efficiency of different stents and flow diverters as a function of wire density and thickness. The results show that the intra-aneurysmal flow velocity, wall shear stress, mean velocity, and vortex topology can be considerably modified thanks to insertion of a suitable implant. Intra-aneurysmal residence time is found to increase rapidly with decreasing stent porosity. Of the three different implants considered in this study, the one with the highest wire density shows the highest increase of intra-aneurysmal residence time for both the straight and

  18. Hemodynamic Alterations after Stent Implantation in 15 Cases of Intracranial Aneurysms

    Science.gov (United States)

    Wang, Chao; Tian, Zhongbin; Liu, Jian; Jing, Linkai; Paliwal, Nikhil; Wang, Shengzhang; Zhang, Ying; Xiang, Jianping; Siddiqui, Adnan H; Meng, Hui; Yang, Xinjian

    2016-01-01

    Background Stent-assisted coiling technology has been widely used in the treatment of intracranial aneurysms. In current study, we investigated the intra-aneurysmal hemodynamic alterations after stent implantation and its association with aneurysm location. Methods We first retrospectively studied 15 aneurysm cases (8 internal carotid artery-ophthalmic artery (ICA-OphA) aneurysms and 7 posterior communicating artery (PcoA) aneurysms) treated with Enterprise stents and coils. Then based on patient-specific geometries before and after stenting, we built virtual stenting computational fluid dynamics (CFD) simulation models. Results Before and after stent deployment, the average Wall Shear Stress (WSS) on the aneurysmal sac at systolic peak changed from 7.04 Pa (4.14 Pa, 15.77 Pa) to 6.04 Pa (3.86 Pa, 11.13 Pa), P = 0.001; and the spatially averaged value of flow velocity in the perpendicular plane of aneurysm dropped from 0.5 m/s (0.28 m/s, 0.7 m/s) to 0.33 m/s (0.25 m/s, 0.49 m/s), P = 0.001, respectively. Post-stent implantation, WSS in ICA-OphA aneurysms and PcoA aneurysms decreased by 14.4% (P = 0.012) and 16.6% (P = 0.018) respectively, and flow velocity also reduced by 10.3% (P = 0.029) and 10.5% (P = 0.013), respectively. Changes in WSS, flow velocity, and pressure were not significantly different between ICA-OphA aneurysms and PcoA aneurysms (P > 0.05). Stent implantation did not significantly change the peak systolic pressure in both aneurysm types. Conclusion After stent implantation, intra-aneurysmal flow velocity and WSS decreased independent of aneurysm type (ICA-OphA and PcoA). Little change was observed on peak systolic pressure. PMID:26746828

  19. Quantitative comparison of hemodynamics in simulated and 3D angiography models of cerebral aneurysms by use of computational fluid dynamics.

    Science.gov (United States)

    Saho, Tatsunori; Onishi, Hideo

    2015-07-01

    In this study, we evaluated hemodynamics using simulated models and determined how cerebral aneurysms develop in simulated and patient-specific models based on medical images. Computational fluid dynamics (CFD) was analyzed by use of OpenFOAM software. Flow velocity, stream line, and wall shear stress (WSS) were evaluated in a simulated model aneurysm with known geometry and in a three-dimensional angiographic model. The ratio of WSS at the aneurysm compared with that at the basilar artery was 1:10 in simulated model aneurysms with a diameter of 10 mm and 1:18 in the angiographic model, indicating similar tendencies. Vortex flow occurred in both model aneurysms, and the WSS decreased in larger model aneurysms. The angiographic model provided accurate CFD information, and the tendencies of simulated and angiographic models were similar. These findings indicate that hemodynamic effects are involved in the development of aneurysms. PMID:25911446

  20. The hemodynamics in intracranial aneurysm ruptured region with active contrast leakage during computed tomography angiography

    Science.gov (United States)

    Li, Ming-Lung; Wang, Yi-Chou; Liou, Tong-Miin; Lin, Chao-An

    2014-10-01

    Precise locations of rupture region under contrast agent leakage of five ruptured cerebral artery aneurysms during computed tomography angiography, which is to our knowledge for the first time, were successfully identified among 101 patients. These, together with numerical simulations based on the reconstructed aneurysmal models, were used to analyze hemodynamic parameters of aneurysms under different cardiac cyclic flow rates. For side wall type aneurysms, different inlet flow rates have mild influences on the shear stresses distributions. On the other hand, for branch type aneurysms, the predicted wall shear stress (WSS) correlates strongly with the increase of inlet vessel velocity. The mean and time averaged WSSes at rupture regions are found to be lower than those over the surface of the aneurysms. Also, the levels of the oscillatory shear index (OSI) are higher than the reported threshold value, supporting the assertion that high OSI correlates with rupture of the aneurysm. However, the present results also indicate that OSI level at the rupture region is relatively lower.

  1. Image based hemodynamic modeling of cerebral aneurysms and the determination of the risk of rupture

    Science.gov (United States)

    Kroon, D. J.; Slump, C. H.; Sluzewski, M.; van Rooij, W. J. J.

    2006-03-01

    This paper is about the quantitative prediction of the long term outcome of the endovascular coiling treatment of a patient's cerebral aneurysm. It is generally believed that the local hemodynamic properties of the patient's cerebral arteries are strongly influencing the origin and growth of aneurysms. We describe our approach: modelling the flow in a 3D Rotational Angiography (3DRA) reconstruction of the aneurysms including supplying and draining blood vessels, in combination with simulations and experiments of artificial blood vessel phantom constructs and measurements. The goal is to obtain insight in the observed phenomena to support the diagnostic decision process in order to predict the outcome of the intervention with possible simulation of the flow alternation due to the pertinent intervention.

  2. Hemodynamic simulations in coronary aneurysms of a patient with Kawasaki Disease

    Science.gov (United States)

    Sengupta, Dibyendu; Marsden, Alison; Burns, Jane

    2010-11-01

    Kawasaki Disease is the leading cause of acquired pediatric heart disease, and can cause large coronary artery aneurysms in untreated cases. A simulation case study has been performed for a 10-year-old male patient with coronary aneurysms. Specialized coronary boundary conditions along with a lumped parameter heart model mimic the interactions between the ventricles and the coronary arteries, achieving physiologic pressure and flow waveforms. Results show persistent low shear stress in the aneurismal regions, and abnormally high shear at the aneurysm neck. Correlation functions have been derived to compare wall shear stress and wall shear stress gradients with recirculation time with the idea of localizing zones of calcification and thrombosis. Results are compared with those of an artificially created normal coronary geometry for the same patient. The long-term goal of this work is to develop links between hemodynamics and thrombotic risk to assist in clinical decision-making.

  3. Hemodynamics, inflammation, vascular remodeling, and the development and rupture of intracranial aneurysms: a review

    Directory of Open Access Journals (Sweden)

    Francesco Signorelli

    2015-06-01

    Full Text Available The central nervous system is an immunologically active environment where several components of the immune and inflammatory response interact among them and with the constituents of nervous tissue and vasculature in a critically orchestrated manner, influencing physiologic and pathologic processes. In particular, inflammation takes a central role in the pathogenesis of intracranial aneurysms (IAs. The common pathway for aneurysm formation involves endothelial dysfunction and injury, a mounting inflammatory response, vascular smooth muscle cells (VSMCs phenotypic modulation, extracellular matrix remodeling, and subsequent cell death and vessel wall degeneration. We conducted a literature review (1980-2014 by Medline and EMBASE databases using the searching terms "IA" and "cerebral aneurysm" and further search was performed to link the search terms with the following key words: inflammation, hemodynamic(s, remodeling, macrophages, neutrophils, lymphocytes, complement, VSMCs, mast cells, cytokines, and inflammatory biomarkers. The aim of this review was to summarize the most recent and pertinent evidences regarding the articulated processes of aneurysms formation, growth, and rupture. Knowledge of these processes may guide the diagnosis and treatment of these vascular malformations, the most common cause of subarachnoid hemorrhage, which prognosis remains dismal.

  4. CFD Modelling of Abdominal Aortic Aneurysm on Hemodynamic Loads Using a Realistic Geometry with CT

    Directory of Open Access Journals (Sweden)

    Eduardo Soudah

    2013-01-01

    Full Text Available The objective of this study is to find a correlation between the abdominal aortic aneurysm (AAA geometric parameters, wall stress shear (WSS, abdominal flow patterns, intraluminal thrombus (ILT, and AAA arterial wall rupture using computational fluid dynamics (CFD. Real AAA 3D models were created by three-dimensional (3D reconstruction of in vivo acquired computed tomography (CT images from 5 patients. Based on 3D AAA models, high quality volume meshes were created using an optimal tetrahedral aspect ratio for the whole domain. In order to quantify the WSS and the recirculation inside the AAA, a 3D CFD using finite elements analysis was used. The CFD computation was performed assuming that the arterial wall is rigid and the blood is considered a homogeneous Newtonian fluid with a density of 1050 kg/m3 and a kinematic viscosity of 4×10-3 Pa·s. Parallelization procedures were used in order to increase the performance of the CFD calculations. A relation between AAA geometric parameters (asymmetry index (β, saccular index (γ, deformation diameter ratio (χ, and tortuosity index (ε and hemodynamic loads was observed, and it could be used as a potential predictor of AAA arterial wall rupture and potential ILT formation.

  5. CFD Modelling of Abdominal Aortic Aneurysm on Hemodynamic Loads Using a Realistic Geometry with CT

    Science.gov (United States)

    Ng, E. Y. K.; Loong, T. H.; Bordone, Maurizio; Pua, Uei; Narayanan, Sriram

    2013-01-01

    The objective of this study is to find a correlation between the abdominal aortic aneurysm (AAA) geometric parameters, wall stress shear (WSS), abdominal flow patterns, intraluminal thrombus (ILT), and AAA arterial wall rupture using computational fluid dynamics (CFD). Real AAA 3D models were created by three-dimensional (3D) reconstruction of in vivo acquired computed tomography (CT) images from 5 patients. Based on 3D AAA models, high quality volume meshes were created using an optimal tetrahedral aspect ratio for the whole domain. In order to quantify the WSS and the recirculation inside the AAA, a 3D CFD using finite elements analysis was used. The CFD computation was performed assuming that the arterial wall is rigid and the blood is considered a homogeneous Newtonian fluid with a density of 1050 kg/m3 and a kinematic viscosity of 4 × 10−3 Pa·s. Parallelization procedures were used in order to increase the performance of the CFD calculations. A relation between AAA geometric parameters (asymmetry index (β), saccular index (γ), deformation diameter ratio (χ), and tortuosity index (ε)) and hemodynamic loads was observed, and it could be used as a potential predictor of AAA arterial wall rupture and potential ILT formation. PMID:23864906

  6. 破裂前期后交通动脉动脉瘤的形态学及血流动力学分析%Analysis of morphologic and hemodynamic parameters for "pre-ruptured" intracranial aneurysm

    Institute of Scientific and Technical Information of China (English)

    于瀛; 徐瑾瑜; 黄清海; 刘建民

    2014-01-01

    Objective To identify the significant morphologic and hemodynamic parameters in per -ruptured period and assess the risk factors of intracranial aneurysms.Methods The CFD model was constructed from patient-specific 3D rotation angiographic images.Three-cardiac-cycle simulation was performed and the morphologic and hemodynamic parameters in the second cardiac cycle were calculated and analyzed in the pre-ruptured and ruptured group.Results There was no significant statistical difference between two groups in the morphologic parameters.The Hemodynamic parameter significantly different between the two groups was the WSS of aneurysm wall (P =0.024).For pre-ruptured group,there was a statistically significant correlation between AR and LSA (rs =0.833,P =0.005),AR and OSI (rs =0.817,P =0.007),SR and WSS of aneurysm wall (rs =-0.683,P =0.042) ; for ruptured group,there was no significant correlation established.Conclusions The "pre-ruptured" aneurysms had similar morphologic and hemodynamic characteristics compared with the ruptured ones.Low WSS and bleb formation might play an important role in aneurysm rupture.%目的 明确破裂前期颅内动脉瘤的形态学及血流动力学特征,评估颅内动脉瘤的破裂风险因素.方法 构建特异性破裂前期动脉瘤计算流体力学模型,并将其与破裂组后交通动脉动脉瘤进行了形态和血流动力学的数值模拟结果进行比较研究.结果 破裂前期组与破裂组在形态学指标及瘤体低壁面切应力面积比(LSA)、瘤体剪切震荡指数(OSI)等血流动力学指标上差异无统计学意义,而破裂前期组平均瘤体壁面切应力(WSS)较破裂组显著降低(P=0.024);其中颈体比(AR)与LSA和OSI存在正相关关系,体径比(SR)与平均瘤体WSS存在负相关关系.结论 处于破裂前期的颅内动脉瘤与破裂颅内动脉瘤有着相似形态学及血流动力学特征,较低的WSS和子囊的形成可能是促进动脉瘤破裂的重要因素.

  7. Comparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics

    International Nuclear Information System (INIS)

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to compare hemodynamics of intracranial aneurysms of MR fluid dynamics (MRFD) using 3D cine PC MR imaging (4D-Flow) at 1.5 T and MR-based computational fluid dynamics (CFD). 4D-Flow was performed for five intracranial aneurysms by a 1.5 T MR scanner. 3D TOF MR angiography was performed for geometric information. The blood flow in the aneurysms was modeled using CFD simulation based on the finite element method. We used MR angiographic data as the vascular models and MR flow information as boundary conditions in CFD. 3D velocity vector fields, 3D streamlines, shearing velocity maps, wall shear stress (WSS) distribution maps and oscillatory shear index (OSI) distribution maps were obtained by MRFD and CFD and were compared. There was a moderate to high degree of correlation in 3D velocity vector fields and a low to moderate degree of correlation in WSS of aneurysms between MRFD and CFD using regression analysis. The patterns of 3D streamlines were similar between MRFD and CFD. The small and rotating shearing velocities and higher OSI were observed at the top of the spiral flow in the aneurysms. The pattern and location of shearing velocity in MRFD and CFD were similar. The location of high oscillatory shear index obtained by MRFD was near to that obtained by CFD. MRFD and CFD of intracranial aneurysms correlated fairly well. (orig.)

  8. Hemodynamic performance of coil embolization and stentassisted coil embolization treatments: a numerical comparative study based on subject-specific models of cerebral aneurysms

    Science.gov (United States)

    Wang, Shengzhang; Zhang, Yisen; Lu, Gang; Yang, Xinjian; Zhang, Xiaolong; Ding, Guanghong

    2011-11-01

    Hemodynamic characteristics such as blood velocity, blood pressure, flow impingement, wall shear stress and oscillatory shear index are considered to play important roles in the initiation, growth, rupture and recurrence of the cerebral aneurysms. Endovascular therapy is widely implemented to treat the cerebral aneurysms by releasing coils into the aneurysm sac for limiting the blood flow to the sac and stent-assisted coil embolization is adopted to occlude the wide-necked or complex aneurysms. Some researchers believe that stents are not only a mechanical device but may act as a biological system and contribute to vessel wall healing. Hemodynamics simulation helps people understand the effect of hemodynamic characteristics on the recurrence of the coiled aneurysm and it also benefits the interventional planning of neurosurgeons. This study constructed the numerical model for a subject-specific ICA aneurysm treated with stent-assisted coil embolization, which combined the coiled model of the aneurysm with a porous stent placement, and simulated the pulsatile blood flow in these aneurysm models. When a stent was placed across the aneurysm orifice in the coiled aneurysm, the high wall shear stress around the distal aneurysm root was reduced more than that of the coiled aneurysm without a stent. The simulated results point to the conclusion that the stent not only protects the parent artery from occlusion due to extension of coils or thrombosis, but may also reduce the recurrence risk of the stent-assisted coiled aneurysm.

  9. The analysis of cerebral hemodynamics in patients with aneurysmal subarachnoid hemorrhage%动脉瘤性蛛网膜下腔出血患者的脑血流动力学分析

    Institute of Scientific and Technical Information of China (English)

    颜燕红; 惠品晶; 王中; 张世明; 郭亮

    2012-01-01

    Objective To study the clinical value of hemodynamic changes in cerebral circulation detected by transcranial Doppler (TCD) in the patients with aneurysm subarachnoid hemorrhage(SAH). Methods SAH in 35 patients was confirmed by CTA and/or DSA, who were operated for aneurysm clipping and underwent periodic TCD monitoring. The changes of mean flow velocities in the middle cerebral artery (MCA Vm) were record and Lindegaard index (LI) was calculated The hemodynamic changes of cerebral circulation were analyzed and the onset of cerebral vasospasm(CVS) detected by TCD with CTA during 7-10 days after aneurysm SAH was compared. Results MCA Vm and LI usually increased during 3-6 days,peaked in 7-9 days and lasted until 13-16 days after aneurysm SAH. Taking MCA Vm> 120 cm/s and Ll>3 as the criteria for CVS. the incidence rate of CVS was 51.4%. The results of TCD were well accordant to those of CTA (Kappa= 0. 727). Conclusion TCD is a noninvasive method for detecting CVS after aneurysm SAH with an advantage of simple and repeated examination.%目的 探讨经颅多普勒(TCD)检测动脉瘤性蛛网膜下腔出血(SAH)患者脑血流动力学改变的临床意义.方法 35例CT检查为SAH患者,均行CTA和(或)DSA检查证实为动脉瘤并行动脉瘤夹闭术.于SAH后备时间段行TCD检测,动态检测大脑中动脉平均血流速度(MCA Vm)、阻力指数(RI)等血流动力学参数,计算同侧大脑中动脉与颅外段颈内动脉之比(LI)指数,分析血流频谱形态等脑血流动力学改变,并且与SAH后7-10 d CTA检测结果进行对比分析.结果 TCD检测显示,MCA Vm、LI指数于动脉瘤性SAH后3-6 d开始升高,7-9d达高峰,持续至13-16 d;以MCA Vm高于120 cm/s及LI指数>3作为判断脑血管痉挛(CVS)的标准,CVS发生率51.4% (18/35),且TCD与CTA检测结果有良好的一致性(Kappa=0.727).结论 TCD是判断动脉瘤性SAH后CVS的一项无创的检查手段,具有操作简便、可重复检测等优势.

  10. Hemodynamic alterations measured with phase-contrast MRI in a giant cerebral aneurysm treated with a flow-diverting stent

    Directory of Open Access Journals (Sweden)

    Matthew Ethan MacDonald, PhD

    2015-01-01

    Full Text Available Many risk factors have been proposed in the development of the cerebral aneurysms. Hemodynamics including blood velocity, volume flow rate (VFR, and intravascular pressure are thought to be prognostic indicators of aneurysm development. We hypothesize that treatment of cerebral aneurysm using a flow-diverting stent will bring these hemodynamic parameters closer to those observed on the contralateral side. In the current study, a patient with a giant cerebral aneurysm was studied pre- and postoperatively using phase contrast MRI (PC-MRI to measure the hemodynamic changes resulting from the deployment of a flow-diverting stent. PC-MRI was used to calculate intravascular pressure, which was compared to more invasive endovascular catheter-derived measurements. After stent placement, the measured VFRs in vessels of the treated hemisphere approached those measured on the contralateral side, and flow symmetry changed from a laterality index of -0.153 to 0.116 in the middle cerebral artery. Pressure estimates derived from the PC-MRI velocity data had an average difference of 6.1% as compared to invasive catheter transducer measurements. PC-MRI can measure the hemodynamic parameters with the same accuracy as invasive methods pre- and postoperatively.

  11. Influence of endoleaks on aneurysm volume and hemodynamics after endovascular aneurysm repair; Einfluss von Typ-II-Endoleaks auf die Groessenaenderung und Haemodynamik experimenteller Aortenaneurysmen nach endovaskulaerer Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Welter, B.; Schmenger, P.; Thelen, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Dueber, C. [Universitaetsklinikum Mannheim gGmbH (Germany). Inst. fuer Diagnostische Radiologie; Neufang, A. [Mainz Univ. (Germany). Klinik fuer Herz-, Thorax- und Gefaesschirurgie

    2003-12-01

    Purpose: To evaluate the aneurysm volume and the intra-aneurysmatic pressure and maximal pressure pulse (dp/dtmax) in completely excluded aneurysms and cases with endoleaks. Materials and Methods: In 36 mongrel dogs, experimental autologous aneurysms were treated with stent-grafts. All aortic side branches were ligated in 18 cases (group I) but were preserved in group II (n=18). Aneurysm volumes were calculated from CT scans before and after intervention, and from follow-up CT scans at 1 week, 6 weeks and 6 months. Finally, for hemodynamic measurements, manometer-tipped catheters were introduced into the excluded aneurysm sac (group I and II), selectively in endoleaks (group II), and intraluminally for aortic reference measurement. Systemic hypertension was induced by volume load and pharmacologic stress. Pressure curves and dp/dt were simultaneously recorded and the ratios of aneurysm pressure to systemic reference pressure calculated. Results: At follow-up, type-II, endoleaks were excluded in all cases of group I by selective angiography. In contrast, endoleaks were evident in all cases of group II. Volumetric analysis of the aneurysms showed a benefit for group I with an improved aneurysm shrinkage: {delta}Volume +0.08%, -1.62% and -9.76% at 1 week, 6 weeks and 6 months follow-up (median, group I), compared to +1.43%, +0.67%, and -4.04% (group II), p<0.05. In case of complete aneurysm exclusion the ratio of systolic aneurysm pressure to systemic reference pressure was 0.662, 0.575 and 0.385 (median) at 1 week, 6 weeks and 6 months. The corresponding dp/dtmax ratios were 0.12, 0.07 and 0.04, respectively. However, within endoleaks selective measurements showed significantly increased pressure load: the ratios of systolic endoleak pressure to systemic reference pressure and the corresponding ratios for dp/dtmax were 0.882 and 0.913 (median), respectively. These hemodynamic findings were linear from hypotension, physiologic blood pressure to hypertension. (orig

  12. The Numerical Study of the Hemodynamic Characteristics in the Patient-Specific Intracranial Aneurysms before and after Surgery

    Science.gov (United States)

    Byun, Jun Soo; Choi, Sun-Young

    2016-01-01

    The patient-specific pre- and postsurgery cerebral arterial geometries in the study were reconstructed from computed tomography angiography (CTA). Three-dimensional computational fluid dynamics models were used to investigate the hemodynamic phenomena in the cerebral arteries before and after surgery of the aneurysm under realistic conditions. CFD simulations for laminar flow of incompressible Newtonian fluid were conducted by using commercial software, ANSYS v15, with the rigid vascular wall assumption. The study found that the flow patterns with the complex vortical structures inside the aneurysm were similar. We also found that the inflow jet streams were coming strongly in aneurysm sac in the presurgery models, while the flow patterns in postsurgery models were quite different from those in presurgery models. The average wall shear stress after surgery for model 1 was approximately three times greater than that before surgery, while it was about twenty times greater for model 2. The area of low WSS in the daughter saccular aneurysm region in model 2 is associated with aneurysm rupture. Thus the distribution of WSS in aneurysm region provides useful prediction for the risk of aneurysm rupture. PMID:27274764

  13. Fluid-Structure Interaction Modeling of Intracranial Aneurysm Hemodynamics: Effects of Different Assumptions

    Science.gov (United States)

    Rajabzadeh Oghaz, Hamidreza; Damiano, Robert; Meng, Hui

    2015-11-01

    Intracranial aneurysms (IAs) are pathological outpouchings of cerebral vessels, the progression of which are mediated by complex interactions between the blood flow and vasculature. Image-based computational fluid dynamics (CFD) has been used for decades to investigate IA hemodynamics. However, the commonly adopted simplifying assumptions in CFD (e.g. rigid wall) compromise the simulation accuracy and mask the complex physics involved in IA progression and eventual rupture. Several groups have considered the wall compliance by using fluid-structure interaction (FSI) modeling. However, FSI simulation is highly sensitive to numerical assumptions (e.g. linear-elastic wall material, Newtonian fluid, initial vessel configuration, and constant pressure outlet), the effects of which are poorly understood. In this study, a comprehensive investigation of the sensitivity of FSI simulations in patient-specific IAs is investigated using a multi-stage approach with a varying level of complexity. We start with simulations incorporating several common simplifications: rigid wall, Newtonian fluid, and constant pressure at the outlets, and then we stepwise remove these simplifications until the most comprehensive FSI simulations. Hemodynamic parameters such as wall shear stress and oscillatory shear index are assessed and compared at each stage to better understand the sensitivity of in FSI simulations for IA to model assumptions. Supported by the National Institutes of Health (1R01 NS 091075-01).

  14. The influence of hemodynamic forces on biomarkers in the walls of elastase-induced aneurysms in rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Kadirvel, Ramanathan; Ding, Yong-Hong; Dai, Daying; Danielson, Mark A.; Lewis, Debra A.; Cloft, Harry J.; Kallmes, David F. [Mayo Clinic College of Medicine, Department of Radiology, Rochester, MN (United States); Zakaria, Hasballah; Robertson, Anne M. [University of Pittsburgh, Department of Mechanical Engineering, Pittsburgh, PA (United States)

    2007-12-15

    Biological and biophysical factors have been shown to play an important role in the initiation, progression, and rupture of intracranial aneurysms. The purpose of this study was to evaluate the association between hemodynamic forces and markers of vascular remodeling in elastase-induced saccular aneurysms in rabbits. Elastase-induced aneurysms were created at the origin of the right common carotid artery in rabbits. Hemodynamic parameters were estimated using computational fluid dynamic simulations based on 3-D-reconstructed models of the vasculature. Expression of matrix metalloproteinases (MMPs), their inhibitors (TIMPs) and markers of vascular remodeling were measured in different spatial regions within the aneurysms. Altered expression of biological markers relative to controls was correlated with the locations of subnormal time-averaged wall shear stress (WSS) but not with the magnitude of pressure. In the aneurysms, WSS was low and expression of biological markers was significantly altered in a time-dependent fashion. At 2 weeks, an upregulation of active-MMP-2, downregulation of TIMP-1 and TIMP-2, and intact endothelium were found in aneurysm cavities. However, by 12 weeks, endothelial cells were absent or scattered, and levels of pro- and active-MMP-2 were not different from those in control arteries, but pro-MMP-9 and both TIMPs were upregulated. These results reveal a strong, spatially localized correlation between diminished WSS and differential expression of biological markers of vascular remodeling in elastase-induced saccular aneurysms. The ability of the wall to function and maintain a healthy endothelium in a low shear environment appears to be significantly impaired by chronic exposure to low WSS. (orig.)

  15. The influence of hemodynamic forces on biomarkers in the walls of elastase-induced aneurysms in rabbits

    International Nuclear Information System (INIS)

    Biological and biophysical factors have been shown to play an important role in the initiation, progression, and rupture of intracranial aneurysms. The purpose of this study was to evaluate the association between hemodynamic forces and markers of vascular remodeling in elastase-induced saccular aneurysms in rabbits. Elastase-induced aneurysms were created at the origin of the right common carotid artery in rabbits. Hemodynamic parameters were estimated using computational fluid dynamic simulations based on 3-D-reconstructed models of the vasculature. Expression of matrix metalloproteinases (MMPs), their inhibitors (TIMPs) and markers of vascular remodeling were measured in different spatial regions within the aneurysms. Altered expression of biological markers relative to controls was correlated with the locations of subnormal time-averaged wall shear stress (WSS) but not with the magnitude of pressure. In the aneurysms, WSS was low and expression of biological markers was significantly altered in a time-dependent fashion. At 2 weeks, an upregulation of active-MMP-2, downregulation of TIMP-1 and TIMP-2, and intact endothelium were found in aneurysm cavities. However, by 12 weeks, endothelial cells were absent or scattered, and levels of pro- and active-MMP-2 were not different from those in control arteries, but pro-MMP-9 and both TIMPs were upregulated. These results reveal a strong, spatially localized correlation between diminished WSS and differential expression of biological markers of vascular remodeling in elastase-induced saccular aneurysms. The ability of the wall to function and maintain a healthy endothelium in a low shear environment appears to be significantly impaired by chronic exposure to low WSS. (orig.)

  16. Computational Analysis of Cardiovascular Hemodynamics

    OpenAIRE

    Eun Bo Shim; Thomas Heldt; Akira Amano; Kyehan Rhee

    2012-01-01

    The human body requires a complex circulatory system to supply nutrients to, and to remove metabolic waste products from, its tissues. Given this primary purpose, circulatory function is closely related to the hemodynamic characteristics of blood vessels. This includes not only macroscale fluid dynamics, but also mass transfer in the microvasculature. Many experimental and clinical studies have examined these characteristics of vascular function. Over the past 50 years, mathematical modeling ...

  17. Flow diversion and coil embolization may perform best in conjunction for treatment of intracranial aneurysms: a hemodynamic investigation

    Science.gov (United States)

    Damiano, Robert; Ma, Ding; Siddiqui, Adnan; Meng, Hui

    2015-11-01

    Coiling and flow diversion is the current standard for treatment of intracranial aneurysms (IAs). Coils deployed into the IA sac trigger its thrombotic occlusion, while flow diverters (FDs) deployed across the IA ostium redirect blood flow and reconstruct the parent vessel. Despite the wide adoption of these interventions, poor treatment outcomes have been reported. Recent clinical reports indicate that IA patients treated with both coils and FDs had better outcomes, compared to individual strategies alone. To better understand the hemodynamic mechanisms underlying coiling and flow diversion, we applied our advanced FEM-based device modeling toolset in conjunction with CFD to investigate 3 clinical strategies: coiling, FD, and FD with adjunctive coiling. Using 3 patient-specific IAs as test beds, we assessed the hemodynamic modifications induced by each strategy. Hemodynamic modifications in inflow rate, velocity, and wall shear stress revealed that coils were most effective at reducing intra-aneurysmal flow, while FD worked best at reducing flow into the IA sac. When coils were combined with FD, these effects appeared to be synergistically enhanced. Our modeling results support clinical observations that flow diversion and coiling may work best in conjunction for treating IAs. Funded by the National Institutes of Health (1R01 NS 091075-01).

  18. Computational analysis of anterior communicating artery aneurysm shear stress before and after aneurysm formation

    Science.gov (United States)

    Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

    2011-12-01

    It is widely accepted that complexity in the flow pattern at the anterior communicating artery (AComA) is associated with the high rate of aneurysm formation at that location observed in large studies. The purpose of this work is to study associations between hemodynamic patterns, and AComA aneurysm initiation by comparing hemodynamics in the aneurysm and the normal model where the aneurysm was computationally removed. Vascular models of both right and left circulation were independently reconstructed from three-dimensional rotational angiography images using deformable models after image registration of both images, and fused using a surface merging algorithm. The geometric models were then used to generate high-quality volumetric finite element grids of tetrahedra with an advancing front technique. For each patient, the second anatomical model was created by digitally removing the aneurysm. It was iteratively achieved by applying a Laplacian smoothing filter and remeshing the surface. Finite element blood flow numerical simulations were performed for both the pathological and normal models under the same personalized pulsatile flow conditions imposed at the inlets of both models. The Navier-Stokes equations were numerically integrated by using a finite-element formulation. It was observed that aneurysms initiated in regions of high and moderate WSS in the counterpart normal models. Adjacent or close to those regions, low WSS portions of the arterial wall were not affected by the disease. These results are in line with previous observations at other vascular locations.

  19. Effect of Turbulence on the Temporal Variation of Hemodynamic Stresses in Aneurysm Model under Resting and Exercise Conditions

    Science.gov (United States)

    Khanafer, Khalil

    2005-11-01

    A numerical model is developed to analyze pulsatile turbulent flow in axisymmetric abdominal aortic aneurysm models (AAM) using realistic physiological resting and exercise waveforms. The transport equations are solved using the finite element formulation based on the Galerkin method of weighted residuals. The κ-ɛ model is used in this work to simulate turbulence characteristics of the convective flow by incorporating Boussinesq eddy-viscosity model. A number of interesting features of the flow field resulting from using realistic physiological waveforms are obtained for various pertinent parameters. Such parameters include Reynolds number, size of aneurysm, flexibility of aneurysm's wall, and the propagation of pressure and flow waves through AAM. The effect of non-Newtonian behavior of blood on hemodynamic stresses and compared with Newtonian behavior through AAM is investigated in the present study. The results of the present work illustrate that maximum turbulent shear stress occurs at the distal end of the AAA model. Furthermore, turbulence is found to have a significant effect on the pressure distribution along AAA wall for both physiological waveforms. This work paves the road for researchers in the area of AAA risk rupture to improve their understanding on the mechanics of aneurysm rupture enhanced by increased flow turbulence.

  20. Hemodynamic patterns of anterior communicating artery aneurysms: a possible association with rupture

    Science.gov (United States)

    Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

    2007-03-01

    The aim of this study is to characterize the different flows present at anterior communicating artery (AcoA) aneurysms and investigate possible associations with rupture. For that purpose, patient-specific computational models of 26 AcoA aneurysms were constructed from 3D rotational angiography images. Bilateral images were acquired in 15 patients who had both A1 segments of the anterior cerebral arteries and models were created by fusing the reconstructed left and right arterial trees. Computational fluid dynamics simulations were performed under pulsatile flow conditions. Visualizations of the flow velocity pattern were created to classify the aneurysms into the following flow types: A) inflow from both A1 segments, B) flow jet in the parent artery splits into three secondary jets, one enters the aneurysm and the other two are directed to the A2 segments, C) the parent artery jet splits into two secondary jets, one is directed to one of the A2 segments and the other enters the aneurysm before being directed to the other A2 segment, and D) the parent artery jet enters the aneurysm before being directed towards the A2 segments. The maximum wall shear stress in the aneurysm at the systolic peak (MWSS) was calculated. Most aneurysms in group A were unruptured and had the lowest MWSS. Group B had the same number of unruptured and ruptured aneurysms, and a low MWSS. Groups C and D had high rupture ratios, being the average MWSS significantly higher in group C. Finally, it was found that the MWSS was higher for ruptured aneurysms of all flow types.

  1. True pancreaticoduodenal artery aneurysms: A decision analysis

    International Nuclear Information System (INIS)

    Purpose: True pancreaticoduodenal artery aneurysms are rare. No definitive study evaluating the natural history of these lesions or their preferred method of treatment has been published. The purpose of this study was to evaluate the outcome of preventive treatment of unruptured pancreaticoduodenal artery aneurysms using a Markov model. Materials and methods: With the use of a Markov model, we performed a decision analysis to evaluate the outcome of preventive treatment of unruptured pancreaticoduodenal artery aneurysms. The risk of rupture and the mortality of preventive treatment are unknown. Therefore, we performed sensitivity analysis using these parameters. Effectiveness was measured in life expectancy. Results: For 80-year-old patients, preventive treatment was dominated by no treatment if mortality rates of preventive treatment were greater than 1.4%, greater than 2.6%, greater than 3.8%, and greater than 4.8% at annual rupture rates of 1%, 2%, 3%, and 4%, respectively. For 50-year-old patients, preventive treatment was dominated by no treatment if mortality rates of preventive treatment were greater than 3.3%, greater than 5.9%, greater than 8.0%, and greater than 9.7% at annual rupture rates of 1%, 2%, 3%, and 4%, respectively. Conclusion: The effectiveness of preventive treatment of unruptured pancreaticoduodenal artery aneurysms depends on the aneurysm rupture rate, mortality rate of preventive treatment, and patient age. Taking into account the effects of these parameters is important in making treatment decisions.

  2. Multidirectional flow analysis by cardiovascular magnetic resonance in aneurysm development following repair of aortic coarctation

    Directory of Open Access Journals (Sweden)

    Stalder Aurelien F

    2008-06-01

    Full Text Available Abstract Aneurysm formation is a life-threatening complication after operative therapy in coarctation. The identification of patients at risk for the development of such secondary pathologies is of high interest and requires a detailed understanding of the link between vascular malformation and altered hemodynamics. The routine morphometric follow-up by magnetic resonance angiography is a well-established technique. However, the intrinsic sensitivity of magnetic resonance (MR towards motion offers the possibility to additionally investigate hemodynamic consequences of morphological changes of the aorta. We demonstrate two cases of aneurysm formation 13 and 35 years after coarctation surgery based on a Waldhausen repair with a subclavian patch and a Vosschulte repair with a Dacron patch, respectively. Comprehensive flow visualization by cardiovascular MR (CMR was performed using a flow-sensitive, 3-dimensional, and 3-directional time-resolved gradient echo sequence at 3T. Subsequent analysis included the calculation of a phase contrast MR angiography and color-coded streamline and particle trace 3D visualization. Additional quantitative evaluation provided regional physiological information on blood flow and derived vessel wall parameters such as wall shear stress and oscillatory shear index. The results highlight the individual 3D blood-flow patterns associated with the different vascular pathologies following repair of aortic coarctation. In addition to known factors predisposing for aneurysm formation after surgical repair of coarctation these findings indicate the importance of flow sensitive CMR to follow up hemodynamic changes with respect to the development of vascular disease.

  3. Three-band decomposition analysis in multiscale FSI models of abdominal aortic aneurysms

    Science.gov (United States)

    Nestola, Maria G. C.; Gizzi, Alessio; Cherubini, Christian; Filippi, Simonetta

    2016-07-01

    Computational modeling plays an important role in biology and medicine to assess the effects of hemodynamic alterations in the onset and development of vascular pathologies. Synthetic analytic indices are of primary importance for a reliable and effective a priori identification of the risk. In this scenario, we propose a multiscale fluid-structure interaction (FSI) modeling approach of hemodynamic flows, extending the recently introduced three-band decomposition (TBD) analysis for moving domains. A quantitative comparison is performed with respect to the most common hemodynamic risk indicators in a systematic manner. We demonstrate the reliability of the TBD methodology also for deformable domains by assuming a hyperelastic formulation of the arterial wall and a Newtonian approximation of the blood flow. Numerical simulations are performed for physiologic and pathologic axially symmetric geometry models with particular attention to abdominal aortic aneurysms (AAAs). Risk assessment, limitations and perspectives are finally discussed.

  4. The Computational Fluid Dynamics Rupture Challenge 2013--Phase II: Variability of Hemodynamic Simulations in Two Intracranial Aneurysms.

    Science.gov (United States)

    Berg, Philipp; Roloff, Christoph; Beuing, Oliver; Voss, Samuel; Sugiyama, Shin-Ichiro; Aristokleous, Nicolas; Anayiotos, Andreas S; Ashton, Neil; Revell, Alistair; Bressloff, Neil W; Brown, Alistair G; Chung, Bong Jae; Cebral, Juan R; Copelli, Gabriele; Fu, Wenyu; Qiao, Aike; Geers, Arjan J; Hodis, Simona; Dragomir-Daescu, Dan; Nordahl, Emily; Bora Suzen, Yildirim; Owais Khan, Muhammad; Valen-Sendstad, Kristian; Kono, Kenichi; Menon, Prahlad G; Albal, Priti G; Mierka, Otto; Münster, Raphael; Morales, Hernán G; Bonnefous, Odile; Osman, Jan; Goubergrits, Leonid; Pallares, Jordi; Cito, Salvatore; Passalacqua, Alberto; Piskin, Senol; Pekkan, Kerem; Ramalho, Susana; Marques, Nelson; Sanchi, Stéphane; Schumacher, Kristopher R; Sturgeon, Jess; Švihlová, Helena; Hron, Jaroslav; Usera, Gabriel; Mendina, Mariana; Xiang, Jianping; Meng, Hui; Steinman, David A; Janiga, Gábor

    2015-12-01

    With the increased availability of computational resources, the past decade has seen a rise in the use of computational fluid dynamics (CFD) for medical applications. There has been an increase in the application of CFD to attempt to predict the rupture of intracranial aneurysms, however, while many hemodynamic parameters can be obtained from these computations, to date, no consistent methodology for the prediction of the rupture has been identified. One particular challenge to CFD is that many factors contribute to its accuracy; the mesh resolution and spatial/temporal discretization can alone contribute to a variation in accuracy. This failure to identify the importance of these factors and identify a methodology for the prediction of ruptures has limited the acceptance of CFD among physicians for rupture prediction. The International CFD Rupture Challenge 2013 seeks to comment on the sensitivity of these various CFD assumptions to predict the rupture by undertaking a comparison of the rupture and blood-flow predictions from a wide range of independent participants utilizing a range of CFD approaches. Twenty-six groups from 15 countries took part in the challenge. Participants were provided with surface models of two intracranial aneurysms and asked to carry out the corresponding hemodynamics simulations, free to choose their own mesh, solver, and temporal discretization. They were requested to submit velocity and pressure predictions along the centerline and on specified planes. The first phase of the challenge, described in a separate paper, was aimed at predicting which of the two aneurysms had previously ruptured and where the rupture site was located. The second phase, described in this paper, aims to assess the variability of the solutions and the sensitivity to the modeling assumptions. Participants were free to choose boundary conditions in the first phase, whereas they were prescribed in the second phase but all other CFD modeling parameters were not

  5. Image-based analysis of blood flow modification in stented aneurysms

    Science.gov (United States)

    Cebral, Juan; Mut, Fernando; Appanaboyina, Sunil; Löhner, Rainald; Miranda, Carlos; Escrivano, Esteban; Lylyk, Pedro; Putman, Christopher

    2009-02-01

    Currently there is increased interest in the use of stents as flow diverters for the treatment of intracranial aneurysms, especially wide necked aneurysms that are difficult to treat by coil embolization or surgical clipping. This paper presents image-based patient-specific computational models of the hemodynamics in cerebral aneurysms before and after treatment with a stent alone, with the goal of better understanding the hemodynamic effects of these devices and their relation to the outcome of the procedures. Stenting of cerebral aneurysms is a feasible endovascular treatment option for aneurysms with wide necks that are difficult to treat with coils or by surgical clipping. However, this requires stents that are capable of substantially modifying the intra-aneurysmal flow pattern in order to cause thrombosis of the aneurysm. The results presented in this paper show that the studied stent was able to change significantly the hemodynamic characteristics of the aneurysm. In addition, it was shown that patient-specific computational models constructed from medical images are capable of realistically representing the in vivo hemodynamic characteristics observed during conventional angiography examinations before and after stenting. This indicates that these models can be used to better understand the effects of different stent designs and to predict the alteration in the hemodynamic pattern of a given aneurysm produced by a given flow diverter. This is important for improving current design of flow diverting devices and patient treatment plans.

  6. CFD Modelling of Abdominal Aortic Aneurysm on Hemodynamic Loads Using a Realistic Geometry with CT

    OpenAIRE

    Loong, T. H.; Maurizio Bordone; Uei Pua; Sriram Narayanan; Eduardo Soudah; E. Y. K. Ng

    2013-01-01

    The objective of this study is to find a correlation between the abdominal aortic aneurysm (AAA) geometric parameters, wall stress shear (WSS), abdominal flow patterns, intraluminal thrombus (ILT), and AAA arterial wall rupture using computational fluid dynamics (CFD). Real AAA 3D models were created by three-dimensional (3D) reconstruction of in vivo acquired computed tomography (CT) images from 5 patients. Based on 3D AAA models, high quality volume meshes were created using an optimal tetr...

  7. Continuous Hemodynamic Monitoring in Acute Stroke: An Exploratory Analysis

    OpenAIRE

    Sen, Ayan; Miller, Joseph; Wilkie, Heidi; Moyer, Michele; Lewandowski, Christopher; Nowak, Richard

    2014-01-01

    Introduction Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED) stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements. Methods This study was a secondary analysis of 7 stroke patients from a prospectively collected data set ...

  8. Continuous Hemodynamic Monitoring in Acute Stroke: An Exploratory Analysis

    OpenAIRE

    Sen, Ayan; Miller, Joseph; Wilkie, Heidi; Moyer, Michele; Lewandowski, Christopher; Nowak, Richard

    2014-01-01

    Introduction: Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED) stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements. Methods: This study was a secondary analysis of 7 stroke patients from a prospectively collecte...

  9. Natural course of unruptured cerebral aneurysms without surgery. Analysis of the various radiological findings

    International Nuclear Information System (INIS)

    The rate of incidental discovery of asymptomatic unruptured aneurysms has increased because of Magnetic Resonance Angiography (MRA). However, the natural history of unruptured aneurysms has not been well examined. In order to investigate this issue, we followed 41 patients with 50 unruptured aneurysms without surgical intervention from 1 to 164 months (Mean=19.8 months). Thirty patients, with 35 unruptured aneurysms and without surgery were studied radiologically using 3D-CT Angiography (3D-CTA), MRA and Magnetic Resonance Imaging (MRI). These studies revealed no change in the size and the shape of the aneurysms. Among patients who were lost to follow-up, one patient died of an aneurysmal rupture in the 4th month after detection; a 67 year-old man who bled from an 8 mm diameter middle cerebral artery aneurysm. In this patient, hemodynamic factors were considered to be the most influential causes of the rupture of the middle cerebral artery aneurysm, because the angle between the parent artery and the axis of the aneurysm was relatively large. Four patients died without any symptom of an aneurysm rupture. Malignant tumor and pneumonia precipitated the death of these patients. (author)

  10. Diabetes may affect intracranial aneurysm stabilization in older patients: Analysis based on intraoperative findings

    Science.gov (United States)

    Song, Jihye; Shin, Yong Sam

    2016-01-01

    Background: Only a small proportion of aneurysms progress to rupture. Previous studies have focused on predicting the rupture risk of intracranial aneurysms. Atherosclerotic aneurysm wall appears resistant to rupture. The purpose of this study was to evaluate clinical and morphological factors affecting atherosclerosis of an aneurysm and identify the parameters that predict aneurysm stabilization. Methods: We conducted a retrospective analysis of 253 consecutive patients with 291 unruptured aneurysms who underwent clipping surgery in a single institution between January 2012 and October 2013. Aneurysms were categorized based on intraoperative video findings and assessed morphologic and demographic data. Aneurysms which had the atherosclerotic wall without any super thin and transparent portion were defined as stabilized group and the others as a not-stabilized group. Results: Of the 207 aneurysms, 176 (85.0%) were assigned to the not-stabilized group and 31 (15.0%) to the stabilized group. The relative proportion of stabilized aneurysms increased significantly as the age increased (P logistic analysis showed that age ≥65 years (P logistic analysis showed that age ≥65 years (P = 0.009) and hypertension (P = 0.041) were strongly correlated with stable aneurysms. In older patients (≥65 years of age), multivariate logistic regression revealed that only diabetes was associated with stabilized aneurysms (P = 0.027). Conclusions: In patients ≥65 years of age, diabetes mellitus may highly predict the stabilized aneurysms. These results provide useful information in determining treatment and follow-up strategies, especially in older patients.

  11. Computational fluid dynamics study of bifurcation aneurysms treated with pipeline embolization device: side branch diameter study

    OpenAIRE

    Tang, Abraham Yik-Sau; Chung, Wai-Choi; Liu, Eric Tian-Yang; Qu, Jie-Qiong; Tsang, Anderson Chun-On; Leung, Gilberto Ka-Kit; Leung, Kar-Ming; Yu, Alfred Cheuk-Hang; Chow, Kwok-Wing

    2015-01-01

    An intracranial aneurysm, abnormal swelling of the cerebral artery, may lead to undesirable rates of mortality and morbidity upon rupture. Endovascular treatment involves the deployment of a flow-diverting stent that covers the aneurysm orifice, thereby reducing the blood flow into the aneurysm and mitigating the risk of rupture. In this study, computational fluid dynamics analysis is performed on a bifurcation model to investigate the change in hemodynamics with various side branch diameters...

  12. Continuous Hemodynamic Monitoring in Acute Stroke: An Exploratory Analysis

    Directory of Open Access Journals (Sweden)

    Ayan Sen

    2014-07-01

    Full Text Available Introduction: Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements. Methods: This study was a secondary analysis of 7 stroke patients from a prospectively collected data set of patients that received 2 hours of hemodynamic monitoring in the ED. Stroke patients were included if hemorrhagic or ischemic stroke was confirmed by neuroimaging, and symptom onset was within 24 hours. They were excluded for the presence of a stroke mimic or transient ischemic attack. Monitoring was performed using the Nexfin device (Edwards Lifesciences, Irvine CA. Results: The mean age of the cohort was 71 ± 17 years, 43% were male, and the mean National Institute of Health Stroke Scale (NIHSS was 6.9 ± 5.5. Two patients had hemorrhagic stroke. We obtained 42,456 hemodynamic data points, including beat-to-beat blood pressure measurements with variability of 18 mmHg and cardiac indices ranging from 1.8 to 3.6 l/min/m2. The correlation coefficient between continuous blood pressure measurements with the Nexfin device and standard ED readings was 0.83. Conclusion: This exploratory investigation revealed that continuous, noninvasive monitoring in the ED is feasible in acute stroke. Further research is currently underway to determine how such monitoring may impact outcomes in stroke or replace the need for invasive monitoring. [West J Emerg Med. 2014;15(4:–0.

  13. Computer simulation of blood flow and colour doppler studies of experimental aneurysms: A correlative study

    International Nuclear Information System (INIS)

    The recent interest in the use endovascular techniques to treat cerebral aneurysm has stimulated the investigation of the role played by hemodynamic factors such as blood velocity and wall shear stress before and after aneurysmal creation. The purpose of this research is to create an animal model with a view to assay the feasibility of using a new angiographic-data-based computer simulation in evaluating the hemodynamics of aneurysms. Colour Doppler flow direction analysis measurements are used to validate the computer simulation. The analysis of the obtained data demonstrates that both colour Doppler and computer simulation are complementary. Both procedures show a rapid reversal of flow direction within the aneurysmal cavity during one cardiac cycle, and a shear stress increase in the proximal and distal neck of the aneurysm. 15 refs., 10 figs. (author)

  14. Analysis of slipstream flow in two ruptured intracranial cerebral aneurysms.

    Science.gov (United States)

    Imbesi, S G; Kerber, C W

    1999-10-01

    Replicas of ruptured posterior communicating and basilar artery aneurysms were created from cadaveric specimens and then were placed in a circuit of pulsating non-Newtonian fluid. Individual fluid slipstreams were opacified with isobaric dyes, and images were recorded on film. The slipstreams entered the distal aneurysm neck with impact against the distal lateral wall of the aneurysm. They then swirled slowly in a reverse vortical pattern within the aneurysm sac. Fluid exited the aneurysm at the proximal neck. The flow pattern clearly shows the impact zone of entering slipstreams (the point of aneurysm rupture) and provides information pertaining to aneurysm growth and formation. PMID:10543644

  15. Risk–benefit analysis of the treatment of unruptured intracranial aneurysms

    Science.gov (United States)

    Vindlacheruvu, R; Mendelow, A; Mitchell, P

    2005-01-01

    Objectives: To determine under what circumstances repair of unruptured intracranial aneurysms may be beneficial. Methods: A life expectancy analysis of patients with unruptured aneurysms with and without repair based on prospective data from the International Study of Unruptured Intracranial Aneurysms (ISUIA). Results: Life years are lost at all ages by repairing anterior circulation aneurysms under 7 mm in diameter in patients with no history of a subarachnoid haemorrhage from another aneurysm (incidental). For all other aneurysms the number of life years saved by repair is dependent on the patient's age at the time when repair is undertaken. Between 2 and 40 years are saved by repairing aneurysms in patients aged 20 years. These benefits fall to 0 when remaining life expectancy falls below 15–35 years, corresponding to the age range of 45–70 years. Conclusions: Repair of unruptured aneurysms benefits patients harbouring them by improving life expectancy except in certain circumstances. The exceptions are patients with remaining life expectancy less than 15–35 years or aged 45–70 (depending on aneurysm size and location) and patients with aneurysms of the anterior circulation under 7 mm in diameter with no history of a previous subarachnoid haemorrhage. These results are based on the findings of the ISUIA and are dependent on their accuracy. PMID:15654039

  16. Intracranial infective aneurysms presenting with haemorrhage: An analysis of angiographic findings, management and outcome

    International Nuclear Information System (INIS)

    AIM: This study is an analysis of angiographic findings in 17 patients with infective aneurysms who presented with intracranial haemorrhage and reviews the management and outcome in the context of the existing literature. MATERIALS AND METHODS: A retrospective study of infective aneurysms in 17 patients was carried out. Cranial angiography was performed in all patients. The location, size and outline of aneurysms were analysed. Ten patients were managed conservatively and six patients underwent surgery for the ruptured infective aneurysms and were followed up for a period of 35.8 months and 23 months, respectively. RESULTS: Twenty-two aneurysms were identified (five unruptured) in 17 patients. Twenty aneurysms (90.9%) were distal in location and two (9.1%) proximal. Sixty percent were in the posterior circulation with 55% in the posterior cerebral artery (PCA) territory, 27.3% in the middle cerebral artery (MCA) territory and 9.1% in the anterior cerebral artery (ACA) territory. Fourteen aneurysms were small (3-5 mm) and eight were medium sized (6-9 mm). 72.7% of aneurysms had irregular outline and 27.3% regular outline. Out of the 10 ruptured aneurysms managed conservatively, eight resolved. One patient died, presumably due to rebleed, and one had infarction due to parent vessel thrombosis. Six aneurysms were surgically managed with good results. Of the five unruptured aneurysms one was surgically managed and the remaining four conservatively managed patients did not bleed during follow-up. CONCLUSION: Patients with ruptured infective aneurysms fared well with medical management and the outcome in this series is better than that reported in literature. Patients on conservative management, however, need closer monitoring with angiographic follow-up. Active management is required with enlarging or persisting aneurysms. Venkatesh, S.K. (2000)

  17. Aneurysm Complications

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  18. 犬动脉瘤动物模型的血流动力学分析%Haemodynamic analysis in canine aneurysm model

    Institute of Scientific and Technical Information of China (English)

    李浩; 马勃; 李志强; 王启弘

    2015-01-01

    Objective To explore a way to establish a stable, ideal and handy intracranial aneurysm model for related studies. Methods Modified microsurgery technology was applied to establish sidewall, bifurcation, terminal and merged types of aneurysm (n=7 in each type). Two weeks after operation, color Doppler ultrasound, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (IADSA) were performed and computational fluid dynamics (CFD) was used for simulation analysis of aneurysm models. Biomechanical properties of aneurysm wall tissues was analyzed by cell culture, then the above examinations were performed again after the aneurysm was embolized by micro coil (MC). Results All models were successfully established, and the MC embolization of aneurysm cavity achieved good efficacy. Vascular endothelial cells (VECs) proliferate well in vitro, and the VECs adhered to the sur⁃face of biodegradable polymeric materials successfully and grow into VEC layer structure. Hemodynamics analysis was per⁃formed in aneurysms model before and after embolization and relevant hemodynamic parameters was obtained. , Blood flow velocity are 2-7 cm/s in aneurysm and 8-26 cm/s in its parental artery. Conclusion A stable, ideal and handy intracranial aneurysm model was established and are essential in aneurysm related research.%目的:探讨建立稳定、理想、快捷的颅内动脉瘤模型的方法,为动脉瘤的相关研究提供可靠的动脉瘤模型。方法在改良的外科显微技术条件下制作侧壁型、分叉部、末端型和真性合并假性囊状动脉瘤,每种类型各7只。术后2周行彩色多普勒超声仪、磁共振成像(MRI)、磁共振血管成像(MRA)、数字减影动脉血管造影(IADSA)检查,进行动脉瘤模型的计算机流体力学(CFD)模拟分析。采用体外细胞培养的方法,对动脉瘤壁的组织生物力学特性进行分析,以微弹簧

  19. Analysis of coronary hemodynamics in exercise by 201Tl scintigraphy

    International Nuclear Information System (INIS)

    From our observation that initial distribution of 201Tl in tissue is mainly dependent on blood flow distribution, we designed the method to obtain the rates of change of coronary blood flow and coronary vascular resistance and applied it to the analysis of coronary hemodynamics in patients with ischemic heart disease during submaximal exercise. We measured the rates of change of cardiac output (Δ CO) and myocardial blood flow distribution (Δ Fract) in two occasions by the sequential two injections of Tl, and obtained the rate of change of coronary blood flow (Δ Flow) from Δ CO and Δ Fract. Using the rate of change of mean blood pressure, we calculated also the rate of change of coronary vascular resistance (Δ CVR). The initial components of histograms of the right ventricle by the first and second injections of Tl were fitted into gamma function curve. S1 and S2 were the areas bounded by the curve and baseline of the first and second injections, and then the cardiac output ratio was estimated by R x S1/S2, where R was the dose ratio measured by another camera system. The five min count rates on the myocardium by the first (H1) and second (H2) injections of Tl were calculated five min after the injection. H2 was approximately H1 x R in the same condition of Tl injection but H2 was not equal to H1 x R, when the Tl injection was done in the different loading condition. Therefore the rate of change of myocardial blood flow distribution was calculated as Δ Fract = (H1 x R - H2)/H2. With submaximal exercise the increases in Δ CO, Δ Fract and Δ Flow were smaller in patients with ischemic heart disease (IHD) than those in control subjects. In the patients with IHD, there was response of lesser degree in Δ Flow under increased myocardial oxygen demand, suggesting low coronary reserve in this condition. (author)

  20. Flow dynamics in anatomical models of abdominal aortic aneurysms: computational analysis of pulsatile flow.

    Science.gov (United States)

    Finol, Ender A; Amon, Cristina H

    2003-01-01

    Blood flow in human arteries is dominated by time-dependent transport phenomena. In particular, in the abdominal segment of the aorta under a patient's average resting conditions, blood exhibits laminar flow patterns that are influenced by secondary flows induced by adjacent branches and in irregular vessel geometries. The flow dynamics becomes more complex when there is a pathological condition that causes changes in the normal structural composition of the vessel wall, for example, in the presence of an aneurysm. An aneurysm is an irreversible dilation of a blood vessel accompanied by weakening of the vessel wall. This work examines the importance of hemodynamics in the characterization of pulsatile blood flow patterns in individual Abdominal Aortic Aneurysm (AAA) models. These patient-specific computational models have been developed for the numerical simulation of the momentum transport equations utilizing the Finite Element Method (FEM) for the spatial and temporal discretization. We characterize pulsatile flow dynamics in AAAs for average resting conditions by means of identifying regions of disturbed flow and quantifying the disturbance by evaluating wall pressure and wall shear stresses at the aneurysm wall. PMID:14515766

  1. Numerical analysis of hemodynamics in spastic middle cerebral arteries.

    Science.gov (United States)

    Wen, Jun; Wang, Qingfeng; Wang, Qingyuan; Khoshmanesh, Khashayar; Zheng, Tinghui

    2016-11-01

    Cerebral vasospasm (CVS) is the most common serious complication of subarachnoid hemorrhage. Among the many factors that are associated with the pathogenesis of CVS, hemodynamics plays an important role in the initiation and development of CVS. Numerical simulation was carried out to obtain the flow patterns and wall shear stress (WSS) distribution in spastic middle cerebral arteries. The blood was assumed to be incompressible, laminar, homogenous, Newtonian, and steady. Our simulations reveal that flow velocity and WSS level increase at the stenosis segment of the spastic vessels, but further downstream of stenosis, the WSS significantly decreases along the inner wall, and flow circulation and stagnation are observed. The hydrodynamic resistance increases with the increase of vessel spasm. Moreover, the change of flow field and hydrodynamic forces are not linearly proportional to the spasm level, and the rapid change of hemodynamic parameters is observed as the spasm is more than 50%. Accordingly, in the view of hemodynamic physiology, vessels with less than 30% stenosis are capable of self-restoration towards normal conditions. However, vessels with more than 50% stenosis may eventually lose their capacity to adapt to differing physiologic conditions due to the extreme non-physilogic hemodynamic environment, and the immediate expansion of the vessel lumen might be needed to minimize serious and non-reversible effects. PMID:26942314

  2. COMPLICATION ANALYSIS OF INTRACRANIAL ANEURYSM EMBOLIZATION WITH CONTROLLABLE COILS

    Institute of Scientific and Technical Information of China (English)

    王大明; 凌锋; 王安顺

    2004-01-01

    Objective To explore the causes, prevention, and management of the complications during intracranial aneurysm embolization with controllable coils (mechanical detachable spiral, MDS; and Guglielmi detachable coil, GDC). Methods Retrospective review of 120 cases with 125 intracranial aneurysms embolized with controllable coils from March 1995 to July 1999 was conducted. The 20 accidents (in 18 cases) including aneurysm rupture, over-embolization, protrusion of coil end into the parent artery, and thrombosis of the parent artery were analyzed. Results Among the 20 accidents, there were 6 aneurysm ruptures, 6 over-embolizations (in 5cases), 6 coil protrusions, and 2 thromboses (one was secondary to coil protrusion). The embolizationrelated mortality was 3.33% (4/120), the permanent neurological deficit was 1.67% (2/120), and the transitory neurological deficit was 3.33% (4/120). The occurrence and outcome of the complications were related to the embolizing technique, the pattern of aneurysm and its parent artery, the imperfection of embolic materials, and the observation and management during embolization. Conclusion Skilled embolizing technique, better understanding of the angio-anatomy of an aneurysm and its parent artery, correct judgement and management during embolization, and improvement of embolic materials are beneficial to the reduction of complications and to the melioration of the outcome of complications.

  3. Advances in the imaging of cerebral aneurysm inflammation

    Directory of Open Access Journals (Sweden)

    Michael R Levitt

    2015-06-01

    Full Text Available Cerebral aneurysm formation, growth and rupture are thought to be the result of a complex interaction between cerebrovascular hemodynamics and pathobiology. Recently, new evidence has emerged regarding the role of inflammation in the walls of cerebral aneurysms. Noninvasive methods to characterize the degree of inflammation in aneurysms could enable clinicians to estimate the risk of future aneurysm growth and rupture, influencing treatment. This review examines emerging techniques of imaging inflammatory biomarkers in cerebral aneurysms.

  4. Efficient hemodynamic event detection utilizing relational databases and wavelet analysis

    Science.gov (United States)

    Saeed, M.; Mark, R. G.

    2001-01-01

    Development of a temporal query framework for time-oriented medical databases has hitherto been a challenging problem. We describe a novel method for the detection of hemodynamic events in multiparameter trends utilizing wavelet coefficients in a MySQL relational database. Storage of the wavelet coefficients allowed for a compact representation of the trends, and provided robust descriptors for the dynamics of the parameter time series. A data model was developed to allow for simplified queries along several dimensions and time scales. Of particular importance, the data model and wavelet framework allowed for queries to be processed with minimal table-join operations. A web-based search engine was developed to allow for user-defined queries. Typical queries required between 0.01 and 0.02 seconds, with at least two orders of magnitude improvement in speed over conventional queries. This powerful and innovative structure will facilitate research on large-scale time-oriented medical databases.

  5. EFFECTS OF PARENT ARTERY SEGMENTATION AND ANEURISMALWALL ELASTICITY ON PATIENT-SPECIFIC HEMODYNAMIC SIMULATIONS

    Institute of Scientific and Technical Information of China (English)

    CHEN Jia-liang; DING Guang-hong; YANG Xin-jian; LI Hai-yun

    2011-01-01

    It is well known that hemodynamics and wall tension play an important role in the formation,growth and rupture of aneurysms.In the present study,the authors investigated the influence of parent artery segmentation and aneurismal-wall elasticity on patient-specific hemodynamic simulations with two patient-specific eases of cerebral aneurysms.Realistic models of the aneurysms were constructed from 3-D angiography images and blood flow dynamics was studied under physiologically representative waveform of inflow.For each aneurysm three computational models were constructed:Model 1 with more extensive upstream parent artery with the rigid arterial and aneurismal wall,Model 2 with the partial upstream parent artery with the elastic arterial and aneurismal wall,Model 3 with more extensive upstream parent artery with the rigid wall for arterial wall far from the aneurysm and the elastic wall for arterial wall near the aneurysm.The results show that Model 1 could predict complex intra-aneurismal flow patterns and wall shear stress distribution in the aneurysm,but is unable to give aneurismal wall deformation and tension,Model 2 demonstrates aneurismal wall deformation and tension,but fails to properly model inflow pattern contributed by the upstream parent artery,resulting in local misunderstanding Wall Shear Stress (WSS) distribution,Model 3 can overcome limitations of the former two models,and give an overall and accurate analysis on intra-aneurismal flow patterns,wall shear stress distribution,aneurismal-wall deformation and tension.Therefore we suggest that the proper length of extensive upstream parent artery and aneuri-smal-wall elasticity should be considered carefully in establishing computational model to predict the intra-aneurismal hemodynamic and wall tension.

  6. Sensitivity Analysis of Simulated Blood Flow in Cerebral Aneurysms

    OpenAIRE

    2011-01-01

    Bakgrunn: En cerebral aneurysme er en dilatasjon av en blodåre, som kan utvide seg og briste, og derved forårsake blødninger i og rundt hjernen. En slik tilstand er alvorlig og medfører ofte alvorlig hjerneskade eller død. For å bedre forstå hvorfor enkelte aneurysmer utvikler seg og brister, gjør man datasimuleringer av blodstrømningen i disse aneurysmene for å få en økt forståelse, og på sikt bidra til diagnoser og behandlingsmetoder. Slike simuleringer fører med seg mange usikkerhetsmoment...

  7. A meta-analysis of aneurysm formation in laser assisted vascular anastomosis (LAVA)

    Science.gov (United States)

    Chen, Chen; Peng, Fei; Xu, Dahai; Cheng, Qinghua

    2009-08-01

    Laser assisted vascular anastomosis (LAVA) is looked as a particularly promising non-suture method in future. However, aneurysm formation is one of the main reasons delay the clinical application of LAVA. Some scientists investigated the incidence of aneurysms in animal model. To systematically analyze the literature on reported incidence of aneurysm formation in LAVA therapy, we performed a meta-analysis comparing LAVA with conventional suture anastomosis (CSA) in animal model. Data were systematically retrieved and selected from PUBMED. In total, 23 studies were retrieved. 18 studies were excluded, and 5 studies involving 647 animals were included. Analysis suggested no statistically significant difference between LAVA and CSA (OR 1.24, 95%CI 0.66-2.32, P=0.51). Result of meta analysis shows that the technology of LAVA is very close to clinical application.

  8. Biology and hemodynamics of aneurismal vasculopathies

    International Nuclear Information System (INIS)

    Aneurysm vasculopathies represents a group of vascular disorders that share a common morphological diagnosis: a vascular dilation, the aneurysm. They can have a same etiology and a different clinical presentation or morphology, or have different etiology and very similar anatomical geometry. The biology of the aneurysm formation is a complex process that will be a result of an endogenous predisposition and epigenetic factors later on including the intracranial hemodynamics. We describe the biology of saccular aneurysms, its growth and rupture, as well as, current concepts of hemodynamics derived from application of computational flow dynamics on patient specific vascular models. Furthermore, we describe different aneurysm phenotypes and its extremely variability on morphological and etiological presentation

  9. Biology and hemodynamics of aneurismal vasculopathies

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Vitor Mendes, E-mail: vitormpbr@hotmail.com [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Brina, Olivier, E-mail: olivier.brina@hcuge.ch [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Gonzalez, Ana Marcos, E-mail: ana.marcosgonzalez@hcuge.ch [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Narata, Ana Paula, E-mail: ana.p.narata@hcuge.ch [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Ouared, Rafik, E-mail: rafik.ouared@unige.ch [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Karl-Olof, Lovblad, E-mail: Karl-olof.lovblad@hcuge.ch [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland)

    2013-10-01

    Aneurysm vasculopathies represents a group of vascular disorders that share a common morphological diagnosis: a vascular dilation, the aneurysm. They can have a same etiology and a different clinical presentation or morphology, or have different etiology and very similar anatomical geometry. The biology of the aneurysm formation is a complex process that will be a result of an endogenous predisposition and epigenetic factors later on including the intracranial hemodynamics. We describe the biology of saccular aneurysms, its growth and rupture, as well as, current concepts of hemodynamics derived from application of computational flow dynamics on patient specific vascular models. Furthermore, we describe different aneurysm phenotypes and its extremely variability on morphological and etiological presentation.

  10. Finite element analysis of magnetohydrodynamic effects on blood flow in an aneurysmal geometry

    Science.gov (United States)

    Raptis, Anastasios; Xenos, Michalis; Tzirtzilakis, Efstratios; Matsagkas, Miltiadis

    2014-10-01

    Blood flow in an aneurysmal geometry, subjected to a static and uniform magnetic field, was studied. Blood was considered as a Newtonian, incompressible, and electrically conducting fluid. The nonlinear system of partial differential equations, describing the blood flow under the presence of a magnetic field, was discretized by the Galerkin weighted residual method. The transformation in generalized curvilinear coordinates facilitates the solution of the governing equations within arbitrary geometries. Pressure and velocity fields along with wall shear stress distributions were obtained for varying magnetic field intensities and directions. The visualization of the blood streamlines in the dilatation region highlights the effect of a magnetic field on the recirculation zones. The application of static magnetic fields can yield spatio-temporal description of blood flow patterns. The current study discusses implications of the hemodynamic properties estimated by respective screening techniques since the static magnetic field might cause alterations that possibly cannot be detected and thus eliminated.

  11. Aneurysmal subarachnoid hemorrhage prognostic decision-making algorithm using classification and regression tree analysis

    Science.gov (United States)

    Lo, Benjamin W. Y.; Fukuda, Hitoshi; Angle, Mark; Teitelbaum, Jeanne; Macdonald, R. Loch; Farrokhyar, Forough; Thabane, Lehana; Levine, Mitchell A. H.

    2016-01-01

    Background: Classification and regression tree analysis involves the creation of a decision tree by recursive partitioning of a dataset into more homogeneous subgroups. Thus far, there is scarce literature on using this technique to create clinical prediction tools for aneurysmal subarachnoid hemorrhage (SAH). Methods: The classification and regression tree analysis technique was applied to the multicenter Tirilazad database (3551 patients) in order to create the decision-making algorithm. In order to elucidate prognostic subgroups in aneurysmal SAH, neurologic, systemic, and demographic factors were taken into account. The dependent variable used for analysis was the dichotomized Glasgow Outcome Score at 3 months. Results: Classification and regression tree analysis revealed seven prognostic subgroups. Neurological grade, occurrence of post-admission stroke, occurrence of post-admission fever, and age represented the explanatory nodes of this decision tree. Split sample validation revealed classification accuracy of 79% for the training dataset and 77% for the testing dataset. In addition, the occurrence of fever at 1-week post-aneurysmal SAH is associated with increased odds of post-admission stroke (odds ratio: 1.83, 95% confidence interval: 1.56–2.45, P decision making. This prognostic decision-making algorithm also shed light on the complex interactions between a number of risk factors in determining outcome after aneurysmal SAH. PMID:27512607

  12. A two-system, single-analysis, fluid-structure interaction technique for modelling abdominal aortic aneurysms.

    Science.gov (United States)

    Kelly, S C; O'Rourke, M J

    2010-01-01

    This work reports on the implementation and validation of a two-system, single-analysis, fluid-structure interaction (FSI) technique that uses the finite volume (FV) method for performing simulations on abdominal aortic aneurysm (AAA) geometries. This FSI technique, which was implemented in OpenFOAM, included fluid and solid mesh motion and incorporated a non-linear material model to represent AAA tissue. Fully implicit coupling was implemented, ensuring that both the fluid and solid domains reached convergence within each time step. The fluid and solid parts of the FSI code were validated independently through comparison with experimental data, before performing a complete FSI simulation on an idealized AAA geometry. Results from the FSI simulation showed that a vortex formed at the proximal end of the aneurysm during systolic acceleration, and moved towards the distal end of the aneurysm during diastole. Wall shear stress (WSS) values were found to peak at both the proximal and distal ends of the aneurysm and remain low along the centre of the aneurysm. The maximum von Mises stress in the aneurysm wall was found to be 408kPa, and this occurred at the proximal end of the aneurysm, while the maximum displacement of 2.31 mm occurred in the centre of the aneurysm. These results were found to be consistent with results from other FSI studies in the literature. PMID:20923114

  13. Multivariate analysis of correlation between electrophysiological and hemodynamic responses during cognitive processing.

    Science.gov (United States)

    Kujala, Jan; Sudre, Gustavo; Vartiainen, Johanna; Liljeström, Mia; Mitchell, Tom; Salmelin, Riitta

    2014-05-15

    Animal and human studies have frequently shown that in primary sensory and motor regions the BOLD signal correlates positively with high-frequency and negatively with low-frequency neuronal activity. However, recent evidence suggests that this relationship may also vary across cortical areas. Detailed knowledge of the possible spectral diversity between electrophysiological and hemodynamic responses across the human cortex would be essential for neural-level interpretation of fMRI data and for informative multimodal combination of electromagnetic and hemodynamic imaging data, especially in cognitive tasks. We applied multivariate partial least squares correlation analysis to MEG-fMRI data recorded in a reading paradigm to determine the correlation patterns between the data types, at once, across the cortex. Our results revealed heterogeneous patterns of high-frequency correlation between MEG and fMRI responses, with marked dissociation between lower and higher order cortical regions. The low-frequency range showed substantial variance, with negative and positive correlations manifesting at different frequencies across cortical regions. These findings demonstrate the complexity of the neurophysiological counterparts of hemodynamic fluctuations in cognitive processing. PMID:24518260

  14. PATIENT-SPECIFIC BLOOD DYNAMIC SIMULATIONS IN ASSESSING ENDOVASCULAR OCCLUSION OF INTRACRANIAL ANEURYSMS

    Institute of Scientific and Technical Information of China (English)

    CHEN Jia-liang; WANG Sheng-zhang; DING Guang-hong; YANG Xin-jian; LI Hai-yun

    2009-01-01

    According to recent studies, there are various potential predictors for surgical outcome for cerebral aneurysms. An accurate surgical outcome assessment would help make better-informed decisions and avoid the risk of rebleeding. It is well known that hemodynamic factors play an important role in the pathogenesis and treatment of intracranial aneurysms. In this article, a computational fluid dynamic analysis is applied to one patient-specific model of the cerebral aneurysm located at the tip of basilar artery, by which the differences of hemodynamic parameters before and after endovascular treatment may be evaluated. Based on the model, we show that the flow behavior near the neck of the aneurysm sees great differences after endovascular treatment as compared with that before treatment, which also affects the wall shear stress and the displacement distribution. In addition, our whole simulation process is based on a series of CFD commercial software packages, which are easily available for doctors to implement such a method in their daily practice. These results would be used to assess the outcome of endovascular treatment for the aneurysm occlusion.

  15. Wall shear stress in intracranial aneurysms and adjacent arteries

    Institute of Scientific and Technical Information of China (English)

    Fuyu Wang; Bainan Xu; Zhenghui Sun; Chen Wu; Xiaojun Zhang

    2013-01-01

    Hemodynamic parameters play an important role in aneurysm formation and growth. However, it is difficult to directly observe a rapidly growing de novo aneurysm in a patient. To investigate possible associations between hemodynamic parameters and the formation and growth of intracranial aneurysms, the present study constructed a computational model of a case with an internal carotid artery aneurysm and an anterior communicating artery aneurysm, based on the CT angiography findings of a patient. To simulate the formation of the anterior communicating artery aneurysm and the growth of the internal carotid artery aneurysm, we then constructed a model that virtually removed the anterior communicating artery aneurysm, and a further two models that also progressively decreased the size of the internal carotid artery aneurysm. Computational simulations of the fluid dynamics of the four models were performed under pulsatile flow conditions, and wall shear stress was compared among the different models. In the three aneurysm growth models, increasing size of the aneurysm was associated with an increased area of low wall shear stress, a significant decrease in wall shear stress at the dome of the aneurysm, and a significant change in the wall shear stress of the parent artery. The wall shear stress of the anterior communicating artery remained low, and was significantly lower than the wall shear stress at the bifurcation of the internal carotid artery or the bifurcation of the middle cerebral artery. After formation of the anterior communicating artery aneurysm, the wall shear stress at the dome of the internal carotid artery aneurysm increased significantly, and the wall shear stress in the upstream arteries also changed significantly. These findings indicate that low wall shear stress may be associated with the initiation and growth of aneurysms, and that aneurysm formation and growth may influence hemodynamic parameters in the local and adjacent arteries.

  16. Biomarkers of Hemodynamic Stress and Aortic Stiffness after STEMI: A Cross-Sectional Analysis

    Directory of Open Access Journals (Sweden)

    Sebastian Johannes Reinstadler

    2015-01-01

    Full Text Available Aim. Increased aortic stiffness might adversely affect cardiac structure, function, and perfusion. Release of biomarkers of hemodynamic stress is thought to be enhanced by these alterations. We aimed to evaluate the association between biomarkers of hemodynamic stress and aortic stiffness assessed at a chronic stage after ST-segment elevation myocardial infarction (STEMI. Methods. Fifty-four patients four months after STEMI were enrolled in this cross-sectional, single-center study. N-terminal pro–B-type natriuretic peptide (NT-proBNP, mid-regional pro–A-type natriuretic peptide (MR-proANP, and mid-regional proadrenomedullin (MR-proADM levels were measured by established assays. Aortic stiffness was assessed by the measurement of pulse wave velocity using phase-contrast cardiovascular magnetic resonance. Results. NT-proBNP, MR-proANP, and MR-proADM concentrations were all correlated with aortic stiffness in univariate analysis (r=0.378, r=0.425, and r=0.532; all P<0.005, resp.. In multiple linear regression analysis, NT-proBNP (β=0.316, P=0.005 and MR-proADM (β=0.284, P<0.020 levels were associated with increased aortic stiffness independently of age, blood pressure, and renal function. NT-proBNP was the strongest predictor for high aortic stiffness (area under the curve: 0.82, 95% CI 0.67–0.96. Conclusion. At a chronic stage after STEMI, concentrations of biomarkers for hemodynamic stress, especially NT-proBNP, are positively correlated with aortic stiffness. These biomarkers might also be useful as predictors of high aortic stiffness after STEMI.

  17. Unruptured Brain Aneurysms

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  18. Brain Aneurysm: Treatment Options

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  19. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    Science.gov (United States)

    Trylesinski, Gabriel

    Intracranial aneurysms (IAs) are a potentially devastating pathological dilation of brain arteries that affect 1.5-5 % of the population. Causing around 500 000 deaths per year worldwide, their detection and treatment to prevent rupture is critical. Multiple recent studies have tried to find a hemodynamics predictor of aneurysm rupture, but concluded with distinct opposite trends using Wall Shear Stress (WSS) based parameters in different clinical datasets. Nevertheless, several research groups tend to converge for now on the fact that the flow patterns and flow dynamics of the ruptured aneurysms are complex and unstable. Following this idea, we investigated the vortex properties of both unruptured and ruptured cerebral aneurysms. A brief comparison of two Eulerian vortex visualization methods (Q-criterion and lambda 2 method) showed that these approaches gave similar results in our complex aneurysm geometries. We were then able to apply either one of them to a large dataset of 74 patient specific cases of intracranial aneurysms. Those real cases were obtained by 3D angiography, numerical reconstruction of the geometry, and then pulsatile CFD simulation before post-processing with the mentioned vortex visualization tools. First we tested the two Eulerian methods on a few cases to verify their implementation we made as well as compare them with each other. After that, the Q-criterion was selected as method of choice for its more obvious physical meaning (it shows the balance between two characteristics of the flow, its swirling and deformation). Using iso-surfaces of Q, we started by categorizing the patient-specific aneurysms based on the gross topology of the aneurysmal vortices. This approach being unfruitful, we found a new vortex-based characteristic property of ruptured aneurysms to stratify the rupture risk of IAs that we called the Wall-Kissing Vortices, or WKV. We observed that most ruptured aneurysms had a large amount of WKV, which appears to agree with

  20. Morphometric and hemodynamic analysis of atherosclerotic progression in human carotid artery bifurcations.

    Science.gov (United States)

    Huang, Xu; Yin, Xiaoping; Xu, Yingjin; Jia, Xinwei; Li, Jianhui; Niu, Pei; Shen, Wenzeng; Kassab, Ghassan S; Tan, Wenchang; Huo, Yunlong

    2016-03-01

    Although atherosclerosis has been widely investigated at carotid artery bifurcation, there is a lack of morphometric and hemodynamic data at different stages of the disease. The purpose of this study was to determine the lesion difference in patients with carotid artery disease compared with healthy control subjects. The three-dimensional (3D) geometry of carotid artery bifurcation was reconstructed from computed tomography angiography (CTA) images of Chinese control subjects (n = 30) and patients with carotid artery disease (n = 30). We defined two novel vector angles (i.e., angles 1 and 2) that were tangential to the reconstructed contour of the 3D vessel. The best-fit diameter was computed along the internal carotid artery (ICA) center line. Hemodynamic analysis was performed at various bifurcations. Patients with stenotic vessels have larger angles 1 and 2 (151 ± 11° and 42 ± 20°) and smaller diameters of the external carotid artery (ECA) (4.6 ± 0.85 mm) compared with control subjects (144 ± 13° and 36 ± 16°, 5.2 ± 0.57 mm) although there is no significant difference in the common carotid artery (CCA) (7.1 ± 1.2 vs. 7.5 ± 1.0 mm, P = 0.18). In particular, all patients with carotid artery disease have a stenosis at the proximal ICA (including both sinus and carina regions), while 20% of patients have stenosis at the middle ICA and 20% have stenosis expansion to the entire cervical ICA. Morphometric and hemodynamic analyses suggest that atherosclerotic plaques initiate at both sinus and carina regions of ICA and progress downstream. PMID:26747497

  1. Multivariate Analysis of Risk Factors of Cerebral Infarction in 439 Patients Undergoing Thoracic Endovascular Aneurysm Repair

    Science.gov (United States)

    Kanaoka, Yuji; Ohki, Takao; Maeda, Koji; Baba, Takeshi; Fujita, Tetsuji

    2016-01-01

    Abstract The aim of the study is to identify the potential risk factors of cerebral infarction associated with thoracic endovascular aneurysm repair (TEVAR). TEVAR was developed as a less invasive surgical alternative to conventional open repair for thoracic aortic aneurysm treatment. However, outcomes following TEVAR of aortic and distal arch aneurysms remain suboptimal. Cerebral infarction is a major concern during the perioperative period. We included 439 patients who underwent TEVAR of aortic aneurysms at a high-volume teaching hospital between July 2006 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify perioperative cerebral infarction risk factors. Four patients (0.9%) died within 30 days of TEVAR; 17 (3.9%) developed cerebral infarction. In univariate analysis, history of ischemic heart disease and cerebral infarction and concomitant cerebrovascular disease were significantly associated with cerebral infarction. “Shaggy aorta” presence, left subclavian artery coverage, carotid artery debranching, and pull-through wire use were identified as independent risk factors of cerebral infarction. In multivariate analysis, history of ischemic heart disease (odds ratio [OR] 6.49, P = 0.046) and cerebral infarction (OR 43.74, P = 0.031), “shaggy aorta” (OR 30.32, P < 0.001), pull-through wire use during surgery (OR 7.196, P = 0.014), and intraoperative blood loss ≥800 mL (OR 24.31, P = 0.017) were found to be independent risk factors of cerebral infarction. This study identified patient- and procedure-related risk factors of cerebral infarction following TEVAR. These results indicate that patient outcomes could be improved through the identification and management of procedure-related risk factors. PMID:27082585

  2. Flow-sensitive in-vivo 4D MR imaging at 3T for the analysis of aortic hemodynamics and derived vessel wall parameters; Die Analyse aortaler Haemodynamik und Gefaesswandparameter mittels fluss-sensitiver in-vivo 4D-MRT bei 3 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Frydrychowicz, A.; Markl, M.; Stalder, A.F.; Bock, J.; Bley, T.A.; Berger, A.; Russe, M.F.; Hennig, J.; Langer, M. [Freiburg Univ. (Germany). Abt. Roentgendiagnostik; Harloff, A. [Freiburg Univ. (Germany). Abt. Klinische Neurologie und Neurophysiologie; Schlensak, C. [Freiburg Univ. (Germany). Abt. Herz- und Gefaesschirurgie

    2007-05-15

    Modern phase contrast MR imaging at 3 Tesla allows the depiction of 3D morphology as well as the acquisition of time-resolved blood flow velocities in 3 directions. In combination with state-of-the-art visualization and data processing software, the qualitative and quantitative analysis of hemodynamic changes associated with vascular pathologies is possible. The 4D nature of the acquired data permits free orientation within the vascular system of interest and offers the opportunity to quantify blood flow and derived vessel wall parameters at any desired location within the data volume without being dependent on predefined 2D slices. The technique has the potential of overcoming the limitations of current diagnostic strategies and of implementing new diagnostic parameters. In light of the recent discussions regarding the influence of the wall shear stress and the oscillatory shear index on the genesis of arteriosclerosis and dilatative vascular processes, flow-sensitive 4D MRI may provide the missing diagnostic link. Instead of relying on experience-based parameters such as aneurysm size, new hemodynamic considerations can deepen our understanding of vascular pathologies. This overview reviews the underlying methodology at 3T, the literature on time-resolved 3D MR velocity mapping, and presents case examples. By presenting the pre- and postoperative assessment of hemodynamics in a thoracic aortic aneurysm and the detailed analysis of blood flow in a patient with coarctation we underline the potential of time-resolved 3D phase contrast MR at 3T for hemodynamic assessment of vascular pathologies, especially in the thoracic aorta. (orig.)

  3. LDV measurements in lateral model aneurysms of various sizes

    Science.gov (United States)

    Liou, T.-M.; Chang, W.-C.; Liao, C.-C.

    Laser Doppler velocimetry (LDV) measurements are presented of three-dimensional flow fields in lateral model aneurysms arising from a straight parent vessel at a 90° angle. The flow considered was pulsatile and the aneurysm wall was rigid. The mean, peak, and minimal Reynolds numbers based on the bulk average velocity and diameter of the parent vessel were 550, 790, and 375, respectively. Comparisons among present in vitro studies, previous in vitro studies, computational simulations, and in vivo studies were made. It was found that the inflow angle into the lateral aneurysm, the maximum wall shear stress acting on the distal lip of the lateral aneurysm, and the intra-aneurysmal vortical motion increased with decreasing aneurysm size. This fact together with the impingement bifurcation of the inflow at the aneurysm dome provide possible hemodynamic factors for the rupture of the lateral aneurysm at small critical size.

  4. Retrospective analysis of the prevalence of asymptomatic cerebral aneurysm in 4518 patients undergoing magnetic resonance angiography. When does cerebral aneurysm develop?

    International Nuclear Information System (INIS)

    The natural history of cerebral aneurysms was investigated by measuring the prevalence of incidentally found unruptured aneurysms in the general population and evaluating the characteristics including risk factors. 'De novo' formation of aneurysm was also demographically estimated. The prevalence of incidental aneurysm was evaluated among 4518 patients who underwent magnetic resonance (MR) angiography for various reasons in a neurosurgical institute. Double the number of patients were randomly selected from the remaining patients without aneurysm as the Control group so that sex and age group were matched to the Aneurysm group. One hundred twenty seven patients (2.8%) had diagnoses of aneurysm. The prevalence of asymptomatic aneurysm among middle-aged and elderly patients were predominant in women and increased with age in both sexes. Patients with aneurysms had significantly more hypertension and family history of subarachnoid hemorrhage compared to the controls. The prevalence was markedly increased in the 8th decade in men and the 7th decade in women, and new aneurysms seemed to develop predominantly around these decades. Cerebral aneurysms become detectable on MR angiography in the middle or later decades, and women tend to develop aneurysm earlier than men. Hypertension and family history of subarachnoid hemorrhage are probably risk factors for the development of aneurysm. (author)

  5. Brain Aneurysm

    Science.gov (United States)

    A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they ... often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, ...

  6. Risk-adjusted outcome analysis of endovascular abdominal aortic aneurysm repair in a large population: how do stent-grafts compare?

    NARCIS (Netherlands)

    Marrewijk, C.J. van; Leurs, L.J.; Vallabhaneni, S.R.; Harris, P.L.; Buth, J.; Laheij, R.J.F.

    2005-01-01

    PURPOSE: To compare differences in the applicability and incidence of postoperative adverse events among stent-grafts used for repair of infrarenal aortic aneurysms. METHODS: An analysis of 6787 patients from the EUROSTAR Registry database was conducted to compare aneurysm morphological features, pa

  7. Flow Diverters for Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Yazan J. Alderazi

    2014-01-01

    Full Text Available Flow diverters (pipeline embolization device, Silk flow diverter, and Surpass flow diverter have been developed to treat intracranial aneurysms. These endovascular devices are placed within the parent artery rather than the aneurysm sac. They take advantage of altering hemodynamics at the aneurysm/parent vessel interface, resulting in gradual thrombosis of the aneurysm occurring over time. Subsequent inflammatory response, healing, and endothelial growth shrink the aneurysm and reconstruct the parent artery lumen while preserving perforators and side branches in most cases. Flow diverters have already allowed treatment of previously untreatable wide neck and giant aneurysms. There are risks with flow diverters including in-stent thrombosis, perianeurysmal edema, distant and delayed hemorrhages, and perforator occlusions. Comparative efficacy and safety against other therapies are being studied in ongoing trials. Antiplatelet therapy is mandatory with flow diverters, which has highlighted the need for better evidence for monitoring and tailoring antiplatelet therapy. In this paper we review the devices, their uses, associated complications, evidence base, and ongoing studies.

  8. Endovascular treatment of an adolescent patient with ruptured intracranial aneurysm

    International Nuclear Information System (INIS)

    The occurrence of intracranial aneurysms in pediatric patients under 18 years of age is between 0,5-2% of all diagnosed aneurysms. We describe our experience with a patient of 10 years old with subarachnoid hemorrhage due to ruptured trilobular aneurysm on the top of the basilar artery, evidenced by CT angiography and DSA. Powered been consistently excluded from the bloodstream of two lobules of the aneurysm through coiling. Changed conditions of hemodynamics in aneurysmal sac fed to subsequent selftrombosing the third lobe of the aneurysm. Made control angiography after 10 months confirmed the good result of endovascular treatment and no neurological deficit. In conclusion it can be noted that in present conditions with a multidisciplinary approach endovascular treatment can be applied in this group of patients. (authors) Key words: SUBARACHNOID HEMORRHAGIA. CEREBRAL VESSEL ANEURYSM. BASILAR CEREBRAL ARTERY. COIL EMBOLIZATION

  9. Biomarkers of Hemodynamic Stress and Aortic Stiffness after STEMI: A Cross-Sectional Analysis

    OpenAIRE

    Sebastian Johannes Reinstadler; Hans-Josef Feistritzer; Gert Klug; Agnes Mayr; Luc Huybrechts; Angelika Hammerer-Lercher; Johannes Mair; Wolfgang-Michael Franz; Bernhard Metzler

    2015-01-01

    Aim. Increased aortic stiffness might adversely affect cardiac structure, function, and perfusion. Release of biomarkers of hemodynamic stress is thought to be enhanced by these alterations. We aimed to evaluate the association between biomarkers of hemodynamic stress and aortic stiffness assessed at a chronic stage after ST-segment elevation myocardial infarction (STEMI). Methods. Fifty-four patients four months after STEMI were enrolled in this cross-sectional, single-center study. N-termin...

  10. ABDOMINAL AORTIC ANEURYSM (AAA

    Directory of Open Access Journals (Sweden)

    Rajesh G

    2011-11-01

    Full Text Available AAA is defined as a distension of the infrarenal aorta by more than 50% (or 1.5 times compared with a corresponding healthy, aged and gender matched population. AAA afflicts 1 to 6 % of the general population aged more than 60 years and the incidence rises by approximately 0.15% annually. When the definition of a maximum external diameter ≥3 cm is used, the prevalence of AAA is upto 6 times greater in men than in women. AAAs are much more common than thoracic aortic aneurysms. Most common cause of AAA is atherosclerosis (95%. Less common causes include infectious or inflammatory origin or those associated with connective tissue disorders. Process of AAA formation is multifactorial. Other than the general risk factors for atherosclerosis, genetic predispo s iti on, aut o immunity and hemodynamic factors all play roles in its formation. AAA is 1.5 times more frequent in hypert ensive patients. Smokers have 8 times risk for developing AAA. The existence of familial aggre gation of AAA implicates genetic factors in the etiology of AAA. Women with AAA are more likely to have a positive family history of this disorder. Those with a family history of AAA have an increased risk of 30%, and their aneurysms tend to occur at a younger age and carry a greater risk of rupture than do sporadic aneurysms.

  11. The role of inflammation in cerebral aneurysms

    Directory of Open Access Journals (Sweden)

    Ali H Turkmani

    2015-06-01

    Full Text Available The natural history of unruptured intracranial aneurysms (IAs is poorly understood. At present, risk factors for aneurysm rupture are limited to demographics and rudimentary anatomic features of the aneurysm. The first sign of aneurysm destabilization and rupture may be subarachnoid hemorrhage, a potentially devastating brain injury with high morbidity and mortality. An emerging body of literature suggests a complex inflammatory cascade likely promotes aneurysm wall remodeling and progressive ballooning of the arterial wall, ultimately terminating in aneurysm rupture. These events likely begin with hemodynamic, flow-related endothelial injury; the injured endothelium stimulates inflammation, including the recruitment and transmigration of inflammatory cells, particularly macrophages. Various proteases are secreted by the inflammatory infiltrate, resulting in degradation of the extracellular matrix and the structural changes unique to IAs. Detailed understanding of these inflammatory processes may result in (1 early identification of patients at high risk for aneurysm rupture, perhaps via arterial wall imaging, and (2 targeted, noninvasive therapies to treat or even prevent cerebral aneurysms.

  12. Patient-specific analysis of post-operative aortic hemodynamics: a focus on thoracic endovascular repair (TEVAR)

    Science.gov (United States)

    Auricchio, F.; Conti, M.; Lefieux, A.; Morganti, S.; Reali, A.; Sardanelli, F.; Secchi, F.; Trimarchi, S.; Veneziani, A.

    2014-10-01

    The purpose of this study is to quantitatively evaluate the impact of endovascular repair on aortic hemodynamics. The study addresses the assessment of post-operative hemodynamic conditions of a real clinical case through patient-specific analysis, combining accurate medical image analysis and advanced computational fluid-dynamics (CFD). Although the main clinical concern was firstly directed to the endoluminal protrusion of the prosthesis, the CFD simulations have demonstrated that there are two other important areas where the local hemodynamics is impaired and a disturbed blood flow is present: the first one is the ostium of the subclavian artery, which is partially closed by the graft; the second one is the stenosis of the distal thoracic aorta. Besides the clinical relevance of these specific findings, this study highlights how CFD analyses allow to observe important flow effects resulting from the specific features of patient vessel geometries. Consequently, our results demonstrate the potential impact of computational biomechanics not only on the basic knowledge of physiopathology, but also on the clinical practice, thanks to a quantitative extraction of knowledge made possible by merging medical data and mathematical models.

  13. Turnover in intracranial aneurysm phantoms: its relation to neck size

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Tae Sub; Lee, Young Jun [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of); Rhim, Yoon Chul [School of Electrical and Mechanical Engineerig, Yonsei Univ., Seoul (Korea, Republic of)

    2003-11-01

    To evaluate the physiologic background of aneurysms poorly visualized during 3D-TOF MRA, contrast-enhanced MRA (CEMRA) and DSA due to hemodynamic isolation. Using handmade elastic silicon phantoms to represent terminal basilar tip aneurysms, 3D-TOF MRA, CEMRA and DSA were used to determine blood turnover. Aneurysmal neck size was 2 mm and 10 mm, and the use of a pulsatile pump also helped recreate human physiologic parameters. We compared the results with those of computational fluid dynamics. DSA images of the narrow-necked aneurysm showed that a small volume of contrast medium washed into it during the systolic phase. As the width of its neck increased, the turnover volume of fragments of contrast bolus also increased. At CEMRA, the broad-necked aneurysm was visualized as the main bolus of Gd-DTPA passed through it, and at delayed CEMRA, the narrow-necked aneurysm was visualized faintly after the passage of bolus Gd-DTPA. The results correlated closely with those of 3D-TOF MRA and computational fluid dynamics. The visualization of intracranial aneurysms at 3D-TOF MRA, CEMRA and DSA was greatly dependent upon blood turnover, which varied according to aneurysmal neck size. A narrow-necked aneurysm might be missed at 3D-TOF MRA, CEMRA and DSA due to hemodynamic isolation.

  14. Brain aneurysm repair

    Science.gov (United States)

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  15. Brain Aneurysm Statistics and Facts

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  16. Vein of Galen aneurysm: MRI with a fast gradient refocusing pulse sequence

    International Nuclear Information System (INIS)

    A case of vein of Galen aneurysm, studied with a fast gradient refocusing pulse MRI sequence, is presented. Fast MRI sequences allowed the acquisition of additional hemodynamic information that was not available with either routine MRI or angiography. (orig.)

  17. 未破裂颈内动脉侧方动脉瘤的血流动力学特点对比分析%Comparison of hemodynamics in small, medium and large unruptured lateral intracranial saccular aneurysms at the internal carotid artery

    Institute of Scientific and Technical Information of China (English)

    李良; 张莹; 陈家亮; 王盛章; 李海云; 于红玉; 汪阳; 李传辉; 杨新健

    2012-01-01

    目的 探讨直径大小对未破裂颈内动脉侧方动脉瘤的血流动力学影响.方法 对小中大三型未破裂颈内动脉侧方动脉瘤进行三维建模及计算流体力学模拟分析,分析其瘤内的血流动力学参数并进行比较.结果 小中大三型动脉瘤的血流均符合侧方动脉瘤的流动模式.小中大三型进行对比时发现动脉瘤越大,其内部涡流就越复杂.且小中大三型动脉瘤的壁面切应力( WSS)值顺序减小而切应力震荡因子( OSI)的值顺序增大.结论 未破裂动脉瘤随直径增大所具有的紊乱的涡流和低WSS高OSI可能跟其破裂风险增大有关.%Objective To explore and compare the hemodynamic factors in small,medium and large unruptured lateral intracranial saccular aneurysms at the Internal Carotid Artery.Method 27 patient -specific unruptured lateral intracranial saccular aneurysms at the Internal Carotid Artery were divided into small,medium and large groups based on their diameters.Results models were retrospectively constructed and analyzed by computational fluid dynamic(CFD) method.Results All these three groups displayed typical lateral aneurismal flow patterns.Larger - sized group displayed more unstable flow patterns,significantly lower wall shear stress(WSS) and higher oscillatory shear index( OSI ).Conclusions These observations indicated that more unstable flow patterns,lower WSS and higher OSI in the aneurysms might be involved in increasing the risk of rupture for larger - sized unruptured lateral intracranial saccular aneurysms.

  18. Aneurysms: thoracic aortic aneurysms.

    Science.gov (United States)

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  19. Cholinergic stimulation with pyridostigmine, hemodynamic and echocardiographic analysis in healthy subjects

    Directory of Open Access Journals (Sweden)

    Paulo Vasconcellos de Pontes

    1999-03-01

    Full Text Available OBJECTIVE: Growing evidence suggests that sudden death after an acute myocardial infarction (AMI correlates with autonomic nervous system imbalance. Parasympathomimetic drugs have been tested to reverse these changes. However, their effects on ventricular function need specific evaluation. Our objective was to analyze pyridostigmine's (PYR effect on hemodynamic and echocardiographic variables of ventricular function. METHODS: Twenty healthy volunteers underwent Doppler echocardiographic evaluations, blood pressure (BP, and heart rate (HR assessment at rest, before and 120 min after ingestion of 30 mg PYR or placebo, according to a double-blind, placebo-controlled, crossed and randomized protocol, on different days. RESULTS: PYR was well tolerated and did not cause alterations in BP or in ventricular systolic function. A reduction in HR of 10.9±1.3% occurred (p0.05. CONCLUSION: PYR reduces HR and increases E/A ratio, without hemodynamic impairment or ventricular function change.

  20. Using non-linear analogue of Nyquist diagrams for analysis of the equation describing the hemodynamics in blood vessels near pathologies

    Science.gov (United States)

    Cherevko, A. A.; Bord, E. E.; Khe, A. K.; Panarin, V. A.; Orlov, K. J.; Chupakhin, A. P.

    2016-06-01

    This article considers method of describing the behaviour of hemodynamic parameters near vascular pathologies. We study the influence of arterial aneurysms and arteriovenous malformations on the vascular system. The proposed method involves using generalized model of Van der Pol-Duffing to find out the characteristic behaviour of blood flow parameters. These parameters are blood velocity and pressure in the vessel. The velocity and pressure are obtained during the neurosurgery measurements. It is noted that substituting velocity on the right side of the equation gives good pressure approximation. Thus, the model reproduces clinical data well enough. In regard to the right side of the equation, it means external impact on the system. The harmonic functions with various frequencies and amplitudes are substituted on the right side of the equation to investigate its properties. Besides, variation of the right side parameters provides additional information about pressure. Non-linear analogue of Nyquist diagrams is used to find out how the properties of solution depend on the parameter values. We have analysed 60 cases with aneurysms and 14 cases with arteriovenous malformations. It is shown that the diagrams are divided into classes. Also, the classes are replaced by another one in the definite order with increasing of the right side amplitude.

  1. A comprehensive analysis of differentially expressed genes and pathways in abdominal aortic aneurysm.

    Science.gov (United States)

    Yuan, Kai; Liang, Wei; Zhang, Jiwei

    2015-08-01

    The current study aimed to investigate the molecular mechanism underlying abdominal aortic aneurysm (AAA) via various bioinformatics techniques. Gene expression profiling analysis of differentially expressed genes (DEGs) between AAA samples and normal controls was conducted. The Database for Annotation, Visualization and Integrated Discovery tool was utilized to perform Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes analyses for DEGs and clusters from the protein-protein interaction (PPI) network, which was constructed using the Search Tool for the Retrieval of Interacting Genes. In addition, important transcription factors (TFs) that regulated DEGs were investigated. A total of 346 DEGs were identified between AAA samples and healthy controls. Additionally, four clusters were identified from the PPI network. Cluster 1 was associated with sensory perception of smell and the olfactory transduction subpathway. The most significant GO function terms for cluster 2 and 3 were response to virus and defense response, respectively. Cluster 4 was associated with mitochondria-associated functions and the oxidative phosphorylation subpathway. Early growth response-1 (EGR-1), Myc, activating transcription factor 5 (ATF5) and specificity protein (SP) 1:SP3 were identified to be critical TFs in this disease. The present study suggested that the olfactory transduction subpathway, mitochondria and oxidative phosphorylation pathways were involved in AAA, and TFs, such as EGR-1, Myc, ATF5 and SP1:SP3, may be potential candidate molecular targets for this disease. PMID:25936411

  2. Identification of crucial genes in intracranial aneurysm based on weighted gene coexpression network analysis.

    Science.gov (United States)

    Zheng, X; Xue, C; Luo, G; Hu, Y; Luo, W; Sun, X

    2015-05-01

    The rupture of intracranial aneurysm (IA) is the leading cause for devastating subarachnoid hemorrhage. This study aimed to investigate genes related to IA and potential diagnosis targets. Two data sets (GSE15629 and GSE54083) were downloaded from Gene Expression Omnibus database. GSE15629 contained eight RI (ruptured IA), six UI (unruptured IA) and five control IA samples. GSE54083 included 8 RI, 5 UI and 10 superficial temporal artery samples. In total, 452 differentially expressed genes (DEGs) between RI and control, and 570 DEGs between UI and control, were identified. Protein-protein interaction networks for two kinds of DEGs related to RI and UI were constructed, respectively. Module networks were searched for DEGs related to RI or UI based on WGCNA (weighted gene coexpression network analysis). In the significant modules, FOS, CCL2, COL4A2 and CXCL5 were screened as crucial nodes with high degrees. Among them, FOS and CCL2 were enriched in immune response and COL4A2 was involved in the ECM (extracellular matrix) pathway, whereas CXCL5 was related to cytokine-cytokine receptor pathway. Taken together, FOS, CCL2, COL4A2 and CXCL5 might participate in the pathogenesis of RI or UI, and could serve as potential diagnosis targets. PMID:25721208

  3. Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Chao Tang

    Full Text Available BACKGROUND: Rebleeding is a serious complication of aneurysmal subarachnoid hemorrhaging. To date, there are conflicting data regarding the factors contributing to rebleeding and their significance. METHODS: A systematic review of PubMed and Embase databases was conducted for studies pertaining to aneurysmal subarachnoid hemorrhage (aSAH and rebleeding in order to assess the associated risk factors. Odds ratios (ORs and corresponding 95% confidence intervals (CIs were estimated from fourteen studies comprised of a total of 5693 patients that met the inclusion criteria. RESULTS: Higher rebleeding rates were observed 10 mm in size (OR  = 1.70, 95% CI  = 1.35-2.14. CONCLUSIONS: Aneurysmal rebleeding occurs more frequently within the first 6 hours after the initial aSAH. Risk factors associated with rebleeding include high systolic pressure, the presence of an intracerebral or intraventricular hematoma, poor Hunt-Hess grade (III-IV, aneurysms in the posterior circulation, and an aneurysm >10 mm in size.

  4. Giant intracranial aneurysms: development, clinical presentation and treatment

    International Nuclear Information System (INIS)

    The natural history of giant intracranial aneurysms are grave. More than 50% of patients suffer from rupture of these aneurysms and mortality is >60% in 2 years. Modern technology and advancement of knowledge in neurosurgery and interventional neuroradiology have altered its natural course for the better. As many reports have shown, the majority of these aneurysms can be treated either by surgery or by endovascular approach, even though morbidity is higher than when treating smaller aneurysms. Certain aneurysms are more suitable to direct surgical clipping and others may have better chances of good clinical outcome by endovascular treatment. It is imperative to analyse the location, morphology, hemodynamics and circulation of normal brain of each aneurysm before the mode of treatment is decided. Needless to say, the individual patient's age, neurological and medical condition should be considered. For endovascular treatment, application of each technique, endosaccular occlusion or parent artery occlusion depends on the aneurysm location and geometry as well as its pathology. Several reports indicated that clinical outcome is better in patients treated by parent artery occlusion since it eliminates any blood flow to the aneurysm and it provides a more effective reduction of the mass effect. However, not all parent arteries can be sacrificed. In addition, endosaccular treatment is effective in preventing haemorrhage if the aneurysm is not re-canalised. It is also demonstrated that symptoms of mass effect can be reversed by endosaccular coiling. The patients who are treated this way should be closely monitored for re-canalisation

  5. Predictor′s analysis of anterior circulation cerebral infarction after the endovascular treatment of anterior communicating artery aneurysms

    Directory of Open Access Journals (Sweden)

    Liqian Sun

    2014-01-01

    Full Text Available Background: Despite increasing acceptance of endovascular coiling for treating anterior communicating artery (ACoA aneurysms, anterior circulation cerebral infarction (ACI after embolization remains a limitation. With higher incidence, higher morbidity and higher mortality, it is one of the main factors influencing the ACoA aneurysms prognosis. Determining the risk factors leading to ACI after embolization will have clinical significance. Through retrospective case analysis, this study investigated the risk factors related to ACI after embolization in order to provide information to serve the clinical practice. Materials and Methods: A retrospective review was performed of patients who had undergone coiling of ACoA aneurysms from 2008 to 2012. All patients had ruptured prior to the completion of embolization. Cases with acute stroke symptoms without alternative diagnoses after embolization were diagnosed as ACI. A total of 32 risk factors such as age, sex, hypertension, diabetes mellitus, modified Fisher grade, Hunt-Hess grade, ventricular hemorrhage, etc. were analyzed using univariate and logistic regression analysis. Results: Univariate analysis showed that negative fluid volume balance (P = 0.041 <0.05 and modified Fisher grade (P = 0.049 <0.05 reached statistical significance, suggesting that they might be risk factors for ACI after embolization. Multiple logistic regression analysis showed that modified Fisher grade was significantly associated with ACI after embolization, suggesting that it was an independent risk factor (odds ratios (OR: 4.968, 95% confidence intervals (CI: 1.013-24.360, P = 0.048. Conclusion: Modified Fisher grade is an independent risk factor for ACI after embolization.

  6. An Attempt to evaluate cerebral hemodynamics before and after neurosurgical treatment of Moyamoya disease by factor analysis

    International Nuclear Information System (INIS)

    We made factor analysis on the data obtained by the radionuclide angiography to evaluate cerebral hemodynamics before and after neurosurgical treatment in a patient with Moyamoya disease (bilateral occlusion of internal carotid arteries). Tracer used was 99mTc-RBC or 99mTcHSA. Before the neurosurgical treatment, the cerebral factor image obtained by the factor analysis showed defects in the right and the left frontal cerebral regions, and the venous factor image showed abnormal accumulations in the right and the left frontal cerebral regions. After Encephalo-Myo-Synangiosis and burr hole operations, defects in the right and the left frontal cerebral regions on the cerebral factor image were improved and abnormal accumulations in the right and the left frontal cerebral regions on the venous factor image disappeared. (author)

  7. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Koike, Yuya, E-mail: r06118@hotmail.co.jp; Nishimura, Jun-ichi, E-mail: jun-ichi-n@nifty.com; Hase, Soichiro, E-mail: haseman@hotmail.co.jp; Yamasaki, Motoshige, E-mail: genyamasaki@gmail.com [Kawasaki Saiwai Hospital, Department of Interventional Radiology (Japan)

    2015-04-15

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

  8. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    International Nuclear Information System (INIS)

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients

  9. COMPUTER SIMULATION OF BLOOD FLOW IN ARTERIES AFFECTED BY MULTIPLE ANEURYSM

    Directory of Open Access Journals (Sweden)

    H. GIRIJA BAI

    2012-12-01

    Full Text Available The aim of this study is a numerical simulation of hemodynamics in blood vessels with multiple fusiform aneurysms. Dilation of 0.25 is considered. Using computational fluid dynamics, hemodynamic factors such as velocity and pressure are investigated. The problem is solved by finite volume method. Numerical simulation is prescribed using the CFD softwares Fluent and Gambit. High pressure and low velocity is observed in the region of aneurysm. This is an indication to the interruption of blood flow. These techniques based on computer flow study are important for understanding the relationship between hemodynamic parameters and risk of rupture.

  10. Visceral artery aneurysms: Incidence, management, and outcome analysis in a tertiary care center over one decade

    International Nuclear Information System (INIS)

    To evaluate the incidence, management, and outcome of visceral artery aneurysms (VAA) over one decade. 233 patients with 253 VAA were analyzed according to location, diameter, aneurysm type, aetiology, rupture, management, and outcome. VAA were localized at the splenic artery, coeliac trunk, renal artery, hepatic artery, superior mesenteric artery, and other locations. The aetiology was degenerative, iatrogenic after medical procedures, connective tissue disease, and others. The rate of rupture was much higher in pseudoaneurysms than true aneurysms (76.3 % vs.3.1 %). Fifty-nine VAA were treated by intervention (n = 45) or surgery (n = 14). Interventions included embolization with coils or glue, covered stents, or combinations of these. Thirty-five cases with ruptured VAA were treated on an emergency basis. There was no difference in size between ruptured and non-ruptured VAA. After interventional treatment, the 30-day mortality was 6.7 % in ruptured VAA compared to no mortality in non-ruptured cases. Follow-up included CT and/or MRI after a mean period of 18.0 ± 26.8 months. The current status of the patient was obtained by a structured telephone survey. Pseudoaneurysms of visceral arteries have a high risk for rupture. Aneurysm size seems to be no reliable predictor for rupture. Interventional treatment is safe and effective for management of VAA. (orig.)

  11. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  12. The mechanism of cerebral aneurysmal formation

    International Nuclear Information System (INIS)

    Cerebral aneurysm is a disease of poor prognosis and MR- and CT-angiographies are used for its diagnosis and in the preventive therapy of its rupture. Here discussed are formation and growth leading to rupture of the lesion for its advanced diagnosis and prevention of rupturing. Beginning from findings in animal experimentation in mice, rats and monkeys, discussed are pathology of the aneurysm, genes related with its formation, molecular biological approaches concerning apoptosis and NF-kB/TNF-α related inflammatory reactions, participation of sex hormone, clinical hemodynamic analyses based on 3D data from CT and MRI findings, and clinical studies. Authors consider that local hemodynamic stress loading is possibly related to cerebral aneurysm formation as it is yielded at the loading part of the vessel in human and in animal models. The aneurysm is possibly a result of remodeling disturbance by the load and subsequent excessive involution of the artery. In the process, probably included are the inflammation, apoptosis, degradation of extracellular matrix and functional impairment of endotherial cells. Future elucidation of molecular mechanisms underlying the aneurismal growth and rupture will bring about the improved treatment to prevent the disease by stabilizing the aneurismal wall. (T.T.)

  13. Cost-Effectiveness Analysis of Endovascular Coiling versus Neurosurgical Clipping for Intracranial Aneurysms in Republic of Korea

    Science.gov (United States)

    Shin, Shang Hun; Suh, Sang Hyun; Kim, Bum-soo; Rho, Myung Ho

    2016-01-01

    Purpose The International Subarachnoid Aneurysm Trial (ISAT) revealed that in ruptured intracranial aneurysms (RA), endovascular coiling (EC) yields better clinical outcomes than neurosurgical clipping (NC) at 1 year. In unruptured aneurysms (UIA), EC is being increasingly used as an alternative to NC due to patients' preference. There is a lot of difference in treatment cost (EC vs. NC) between countries. There is one recently published study dealing with the comparative cost analysis only in UIAs in South Korea. But it is a hospital-based study. So, the authors performed a nation-wide cost effective comparison in our country. Materials and Methods This study was a retrospective analysis of healthcare big data open systems in Health Insurance Review & Assessment Service (HIRA). Hospital cost data of the recent 5 years (from January 2010 to December 2014) were analyzed according to patients' age and sex and the presence of subarachnoid hemorrhage. Results When comparing the total hospital costs for NC of a UIA (n=13,756) and EC of a UIA (n=17,666), NC [mean±standard deviation (SD): ₩7,987,179±3,855,029] resulted in significantly lower total hospital costs than EC [₩10,201,645±5,001,626, pcosts for NC of a RA (n=7,293) and EC of a RA (n=6,954), NC [₩13,914,993±6,247,914] resulted in significantly lower total hospital costs than EC [₩16,702,446±7,841,141, pcosts for the NC of both UIAs and RAs were found to be lower than those for EC in South Korea.

  14. Analysis of positional candidate genes in the AAA1 susceptibility locus for abdominal aortic aneurysms on chromosome 19

    Directory of Open Access Journals (Sweden)

    Ferrell Robert E

    2011-01-01

    Full Text Available Abstract Background Abdominal aortic aneurysm (AAA is a complex disorder with multiple genetic risk factors. Using affected relative pair linkage analysis, we previously identified an AAA susceptibility locus on chromosome 19q13. This locus has been designated as the AAA1 susceptibility locus in the Online Mendelian Inheritance in Man (OMIM database. Methods Nine candidate genes were selected from the AAA1 locus based on their function, as well as mRNA expression levels in the aorta. A sample of 394 cases and 419 controls was genotyped for 41 SNPs located in or around the selected nine candidate genes using the Illumina GoldenGate platform. Single marker and haplotype analyses were performed. Three genes (CEBPG, PEPD and CD22 were selected for DNA sequencing based on the association study results, and exonic regions were analyzed. Immunohistochemical staining of aortic tissue sections from AAA and control individuals was carried out for the CD22 and PEPD proteins with specific antibodies. Results Several SNPs were nominally associated with AAA (p CEBPG, peptidase D (PEPD, and CD22. Haplotype analysis found a nominally associated 5-SNP haplotype in the CEBPG/PEPD locus, as well as a nominally associated 2-SNP haplotype in the CD22 locus. DNA sequencing of the coding regions revealed no variation in CEBPG. Seven sequence variants were identified in PEPD, including three not present in the NCBI SNP (dbSNP database. Sequencing of all 14 exons of CD22 identified 20 sequence variants, five of which were in the coding region and six were in the 3'-untranslated region. Five variants were not present in dbSNP. Immunohistochemical staining for CD22 revealed protein expression in lymphocytes present in the aneurysmal aortic wall only and no detectable expression in control aorta. PEPD protein was expressed in fibroblasts and myofibroblasts in the media-adventitia border in both aneurysmal and non-aneurysmal tissue samples. Conclusions Association testing

  15. Influence of high-porosity mesh stent on hemodynamics of intracranial aneu- rysm:A computational study

    Institute of Scientific and Technical Information of China (English)

    邱晓宁; 费智敏; 张珏; 曹兆敏

    2013-01-01

    This paper studies the influence of a High-Porosity Mesh (HPM) stent on the hemodynamic characteristics in the intracra- nial aneurysm based on the Computational Fluid Dynamics (CFD). An idealized basilar tip aneurysm model and a HPM stent model are built. The pulsating blood flow in a cardiac cycle is computationally simulated for non-stented and stented models, to provide a wealth of information of the spatio-temporally varying blood flow field. The influence of the stent placement on the hemodynamic characteristics is analyzed in terms of distributions of velocity, pressure, Wall Shear Stress (WSS) and Energy Loss (EL), which are believed to play an important role in the development and rupture of the aneurysm. The numerical results clearly show that the velo- city, pressure, WSS and EL of the blood flow in the aneurysm are reduced by 30%-40% when the HPM stent is implanted. These computational results may provide valuable hemodynamic information for clinical neurosurgeon.

  16. The intracranial aneurysm: cost-effective of the aneurysm intra-artery GDC embolization and the aneurysm incarcerated operation

    International Nuclear Information System (INIS)

    Objective: To evaluate the cost-effectiveness of the aneurysm intra-artery GDC embolization and the aneurysm clapping of intracranial aneurysm, and to give the instruction for the clinical practice. Methods: A case control study (1 vs. 1) was developed to evaluate the cost in hospital, the cost for return visit and the Quality-adusted Life-Year (QALY) and lifetime costs of the intra-artery GDC embolization and the aneurysm clapping of intraeranial aneurysm, under the matching of the age, sex, living place, the size and place of the aneurysm, and the Hunt and Hess score. Clinically effectiveness dates were derived from the medical records. Cost dates were derived from follow-up by telephones or letters. The correlation analysis was done with the SPSS 13.0. Results: The cost in hospital in AC group was (54 945±16 946)RMBs, which was higher than the ones in AE group (63 768±12 665) RMBs, (t=1.71, P0.05). Conclusion: The results suggest that the two therapies have no difference in cost effective rate. Considering the physical and mental loss, the aneurysm intra-arteu GDC embolization was better than the aneurysm clapping for the patients with aneurysm that diameter less than 25 mm. (authors)

  17. Elastase-induced intracranial aneurysm by means of endovascular balloon occlusion: preparation of animal model and progress in its applications

    International Nuclear Information System (INIS)

    It is of capital importance to establish a reliable experimental animal model of intracranial aneurysm which should be extremely similar to human intracranial aneurysm in histological and hemodynamic aspects. For recent years, the elastase-induced aneurysm model by means of endovascular balloon occlusion has been widely used abroad. This paper aims to review the preparation of animal mode, the advantages and disadvantages of such a model as well as the recent progress in its applications. (authors)

  18. Predictive risk factors for multiple intracranial aneurysms rupture

    International Nuclear Information System (INIS)

    Objective: To analyze the risk factors inducing the rupture of multiple intracranial aneurysms. Methods: Between July 2007 and July 2011, a total of 134 patients with 294 aneurysms were admitted to the hospital. Of the 294 aneurysms, 50 were ruptured and 244 were unruptured. Every patient had two or more aneurysms. Univariate and multivariate logistic regression analysis methods were used to analyze the risk factors, including age, gender, site and size, for multiple intracranial aneurysms. Results: The 134 patients were divided into three groups according to patient's age, including <4.5 group, (45-6.5) group and > 65 group. The rupture incidence of aneurysm in the (4.5-65) group was highest in the three groups. The difference was significant (P=0.001). Of 35 patients with anterior communicating arterial aneurysms, 13 (37.1%) were ruptured, accounting for 26% of all ruptured aneurysms, and the rupture rate of anterior communicating arterial aneurysms was significantly higher than that of the aneurysms located at other sites (P= 0.001). Of all 294 aneurysms, 88.1% were <5 mm, 58.2% were <3 mm. Of the ruptured aneurysms, 680-/o were <5 mm. Conclusion: This study indicates that the rupture of multiple intracranial aneurysm is closely related to the patient's age, the size and location of aneurysm. Therefore, patient's age, the size and location of aneurysm should be taken into consideration when to make the therapeutic plan. In multiple intracranial aneurysms, the anterior communicating arterial aneurysm is most prone to bleeding. (authors)

  19. Nonlinear Dynamics and Analysis of Intracranial Saccular Aneurysms with Growth and Remodeling

    Directory of Open Access Journals (Sweden)

    Manal Badgaish

    2016-01-01

    Full Text Available A new mathematical model for the interaction of blood flow with the arterial wall surrounded by cerebral spinal fluid is developed with applications to intracranial saccular aneurysms. The blood pressure acting on the inner arterial wall is modeled via a Fourier series, the arterial wall is modeled as a spring-mass system incorporating growth and remodeling, and the surrounding cerebral spinal fluid is modeled via a simplified one-dimensional compressible Euler equation with inviscid flow and negligible nonlinear effects. The resulting nonlinear coupled fluid-structure interaction problem is analyzed and a perturbation technique is employed to derive the first-order approximation solution to the system. An analytical solution is also derived for the linearized version of the problem using Laplace transforms. The solutions are validated against related work from the literature and the results suggest the biological significance of the inclusion of the growth and remodeling effects on the rupture of intracranial aneurysms.

  20. Individualized management for intracranial vertebral artery dissecting aneurysms

    Directory of Open Access Journals (Sweden)

    SHANG Yan-guo

    2012-02-01

    Full Text Available Objective To discuss the individualized management strategy for intracranial vertebral artery dissecting aneurysms. Methods Eighteen patients with intracranial vertebral artery dissecting aneurysms were treated with different surgical methods. Results Eighteen patients underwent different surgical treatment. Five patients underwent complete occlusion of the aneurysm and parent artery by coiling, 5 were treated by stent -assisted coiling (3 densely packed coiling and 2 non-densely packed coiling, 4 underwent stent-only therapy and 3 of them presented hemodynamic improvement after surgery, 3 were treated by direct surgical clipping, and 1 underwent occipital artery-posterior inferior cerebellar artery bypass. Two aneurysms ruptured immaturely, in which one patient died on the third day after operation and one patient occurred moderate disablity. Only 1 patient who underwent complete occlusion of aneurysm and parent artery presented temporarily ischemic symptoms. No adverse effects were seen in other patients. Seventeen patients were followed up for 1 month to 3 years, and all the aneurysms were stable. Conclusion There are many kinds of therapeutic methods for intracranial vertebral artery dissecting aneurysms. The patients should be treated according to several factors such as the clinical manifestations, aneurysm configuration, and relationship with the posterior inferior cerebellar artery. The treatment should be individualized.

  1. Analysis and computer program for rupture-risk prediction of abdominal aortic aneurysms

    OpenAIRE

    Li Zhonghua; Kleinstreuer Clement

    2006-01-01

    Abstract Background Ruptured abdominal aortic aneurysms (AAAs) are the 13th leading cause of death in the United States. While AAA rupture may occur without significant warning, its risk assessment is generally based on critical values of the maximum AAA diameter (>5 cm) and AAA-growth rate (>0.5 cm/year). These criteria may be insufficient for reliable AAA-rupture risk assessment especially when predicting possible rupture of smaller AAAs. Methods Based on clinical evidence, eight biomechani...

  2. Growth of Screen-Detected Abdominal Aortic Aneurysms in Men: A Bayesian Analysis

    OpenAIRE

    Sherer, E A; Bies, R R; Clancy, P; Norman, P. E.; Golledge, J

    2012-01-01

    There is considerable interindividual variability in the growth of abdominal aortic aneurysms (AAAs), but an individual's growth observations, risk factors, and biomarkers could potentially be used to tailor surveillance. To assess the potential for tailoring surveillance, this study determined the accuracy of individualized predictions of AAA size at the next surveillance observation. A hierarchical Bayesian model was fitted to a total of 1,732 serial ultrasound measurements from 299 men in ...

  3. Angiographic Findings In Patients With Cerebral Aneurysm

    Directory of Open Access Journals (Sweden)

    Miri S M

    2004-09-01

    Full Text Available Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm. Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation. Results: The data analysis revealed the following results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms. Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

  4. Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment.

    Science.gov (United States)

    Chen, Jia-Xiang; Lai, Ling-Feng; Zheng, Kuang; Li, Guo-Xiong; He, Xu-Ying; Li, Liang-Ping; Duan, Chuan-Zhi

    2015-09-01

    The purpose of this study was to analyze influencing factors associated with immediate angiographic results in intracranial aneurysms patients after endovascular treatment (EVT), providing theoretical evidence and guidance for clinical treatment of intracranial aneurysms. Totally 529 patients met the inclusive criteria, consisting of 338 males and 191 females. Gender; age; history of hypertension, diabetes, and smoking; intracranial atherosclerosis; rupture status, size and location, features of aneurysmal neck, shapes; vasospasm; treatment modality; and degree of aneurysm occlusion were all carefully and completely recorded. All data were investigated in univariate and multivariate logistic regression model to determine whether they were correlated with the degree of aneurysm occlusion. According to aneurysm size, aneurysms were classified as micro-miniature, miniature, and large aneurysms. There were 451 narrow-neck aneurysms and 78 wide-neck aneurysms. Totally 417 were regular and 112 were irregular. And 125 were un-ruptured aneurysms; 404 were ruptured aneurysms. The modalities of treatment were as follows: embolization with coil (n = 415), stent-assisted coil embolization (n = 89), and balloon-assisted coil embolization (n = 25). Univariate analysis showed that aneurysm size, feature of aneurysm neck, shape, and rupture status might affect the immediate occlusion after EVT. Multivariate logistic regression analysis indicated that ruptured aneurysm, tiny aneurysm, and wide-neck aneurysm were independent influencing factors of complete occlusion of intracranial aneurysm. Aneurysm rupture status, size, feature of aneurysmal neck, and shape might be the independent influencing factors of immediate angiographic results in intracranial aneurysm patients after EVT. Un-ruptured, micro-miniature, narrow-neck, and regular-shaped aneurysms were more probable to be occluded completely. PMID:26100332

  5. A prospective clinical, economic, and quality-of-life analysis comparing endovascular aneurysm repair (EVAR), open repair, and best medical treatment in high-risk patients with abdominal aortic aneurysms suitable for EVAR: the Irish patient trial.

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2007-12-01

    To report the results of a trial comparing endovascular aneurysm repair (EVAR) to open repair (OR) and best medical therapy (BMT) involving high-risk patients with abdominal aortic aneurysms (AAA) suitable for EVAR.

  6. Trends in aortic aneurysm- and dissection-related mortality in the state of São Paulo, Brazil, 1985–2009: multiple-cause-of-death analysis

    Directory of Open Access Journals (Sweden)

    Santo Augusto

    2012-10-01

    Full Text Available Abstract Background Aortic aneurysm and dissection are important causes of death in older people. Ruptured aneurysms show catastrophic fatality rates reaching near 80%. Few population-based mortality studies have been published in the world and none in Brazil. The objective of the present study was to use multiple-cause-of-death methodology in the analysis of mortality trends related to aortic aneurysm and dissection in the state of Sao Paulo, between 1985 and 2009. Methods We analyzed mortality data from the Sao Paulo State Data Analysis System, selecting all death certificates on which aortic aneurysm and dissection were listed as a cause-of-death. The variables sex, age, season of the year, and underlying, associated or total mentions of causes of death were studied using standardized mortality rates, proportions and historical trends. Statistical analyses were performed by chi-square goodness-of-fit and H Kruskal-Wallis tests, and variance analysis. The joinpoint regression model was used to evaluate changes in age-standardized rates trends. A p value less than 0.05 was regarded as significant. Results Over a 25-year period, there were 42,615 deaths related to aortic aneurysm and dissection, of which 36,088 (84.7% were identified as underlying cause and 6,527 (15.3% as an associated cause-of-death. Dissection and ruptured aneurysms were considered as an underlying cause of death in 93% of the deaths. For the entire period, a significant increased trend of age-standardized death rates was observed in men and women, while certain non-significant decreases occurred from 1996/2004 until 2009. Abdominal aortic aneurysms and aortic dissections prevailed among men and aortic dissections and aortic aneurysms of unspecified site among women. In 1985 and 2009 death rates ratios of men to women were respectively 2.86 and 2.19, corresponding to a difference decrease between rates of 23.4%. For aortic dissection, ruptured and non-ruptured aneurysms, the

  7. Brain Aneurysm: Early Detection and Screening

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  8. Brain Aneurysm Warning Signs/Symptoms

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  9. Traditional Chinese medicine wrist pulse-taking is associated with pulse waveform analysis and hemodynamics in hypertension

    Institute of Scientific and Technical Information of China (English)

    Ivan Cordovil; Arthur de S Ferreira

    2016-01-01

    BACKGROUND: Pulse wave analysis (PWA) quantiifes the phenomenon of pulse waveform propagation in patients with cardiovascular diseases, whereas pulse image analysis (PIA) is a subjective examination in traditional Chinese medicine. OBJECTIVE:This study evaluated the association of PIA with PWA and hemodynamics in patients with hypertension. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This observational, cross-sectional study enroled 45 patients (26 men, (55.2± 10.3) years, systolic blood pressure (155± 28) mmHg, diastolic blood pressure (93± 17) mmHg) for assessment of clinical and laboratorial data. MAIN OUTCOME MEASURES:Primary outcomes comprised: pattern differentiation based on an automated method; PIA at the radial artery using the ‘simultaneous pressing’ method for identiifcation of factors such as strength (strong/weak), depth (superifcial/deep), and speed (fast/moderate/slow); and PWA at the same artery using a noninvasive system. RESULTS: Signiifcant multivariate main effects were observed for depth (l=0.648,F5,29=3.149,P=0.022, h2=0.352), strength (l=0.608,F5,29=3.736,P=0.010,h2=0.392), and speed (l=0.535,F5,29=5.302, P=0.002,h2=0.465). General effects comprised high values of PWA and blood pressure for superifcial, strong, and fast pulse images. A strong pulse was found for pulse pressure ≥ 62.5 mmHg and systolic blood pressure ≥ 149.5 mmHg, whereas a superifcial pulse was found for heart rate ≥ 58.25 beats/min; a fast pulse was found for heart rate ≥ 69.6 beats/min and pulse wave velocity ≥ 9.185 m/s. CONCLUSION: Associations were explained by LaPlace’s law, arterial remodeling in hypertension, alongside the traditional criterion for classifying speed in pulse images. PIA is associated with PWA and hemodynamics in patients with hypertension. Systolic and pulse pressures, heart rate, and pulse wave velocity are quantitative variables that have information to describe the qualitative pulse images such as strength, depth and speed.

  10. Spectral analysis of respiratory-related hemodynamic variables in simulated hypovolemia: a study in healthy volunteers with spontaneous breathing using a paced breathing activity

    OpenAIRE

    Shin, Won Jung; Choi, Jae Moon; Kong, Yu Gyeong; Song, Jun Gol; Kim, Young Kug; Hwang, Gyu Sam

    2010-01-01

    Background A dynamic preload index such as stroke volume variation (SVV) is not as reliable in spontaneous breathing (SB) patients as in mechanically ventilated patients. This study examined the hypothesis that spectral analysis of hemodynamic variables during paced breathing (PB) activity may be a feasible index of volume changes and fluid responsiveness, despite insufficient respiratory changes in the preload index during SB activity. Methods Blood pressure and stroke volume (SV) were measu...

  11. Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial

    DEFF Research Database (Denmark)

    Lindholt, Jes S.; Sørensen, J; Søgaard, R; Henneberg, E W

    2010-01-01

    The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years.......The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years....

  12. Occupational exposure in hemodynamic

    International Nuclear Information System (INIS)

    This paper has an objective to perform a radiometric survey at a hemodynamic service. Besides, it was intended to evaluate the effective dose of health professionals and to provide data which can contribute with minimization of exposures during the realization of hemodynamic procedure. The radiometric survey was realized in the real environment of work simulating the conditions of a hemodynamic study with a ionization chamber

  13. Study on the related factors influencing the formation of intra-aneurysmal thrombosis in the established side-wall aneurysmal model in canine

    International Nuclear Information System (INIS)

    Objective: To analyze the related factors influencing the formation of intra-aneurysmal thrombosis (IAT) in the established side-wall aneurysmal model in canine, and to discuss the measures to prevent the occurrence of IAT. Methods: Twenty canines were randomly divided into 4 groups for building side-wall aneurysmal model: group A, vertical aneurysm without use of postoperative anticoagulation medication; group B, vertical aneurysm with use of postoperative anticoagulation medication; group C, oblique aneurysm without use of postoperative anticoagulation medication; and group D, oblique aneurysm with use of postoperative anticoagulation medication. Angiography was performed to evaluate the IAT. The potential related factors influencing the formation of IAT, including sex, age, operative time, aneurysmal morphology, postoperative anticoagulation medication and cervical hematoma, were statistically analysed with emphasis on aneurysmal morphology and the use of postoperative anticoagulation medication. The statistical software SPSS 12.0 was employed. Results: A total of 40 aneurysms were successfully established in 20 canines. Cervical hematoma occurred in 7 canines and IAT developed in 8 aneurysms. The univariate analysis showed that the formation of IAT was significantly influenced by the aneurysmal morphology and cervical hematoma. Surprisingly, the formation of IAT bore no relation to the postoperative anticoagulation, whether the medication was employed or not, which was further confirmed by stratified analysis. Conclusion: To establish oblique aneurysm and to reduce the occurrence of cervical hematoma can effectively decrease the incidence of IAT in established side-wall aneurysmal model in canine. The postoperative anticoagulation medication can not decrease the incidence of IAT. (authors)

  14. Carotid-cavernous fistula caused by rupture of persistent primitive trigeminal artery trunk aneurysm--case report.

    Science.gov (United States)

    Yoshida, Masahiro; Ezura, Masayuki; Mino, Masaki

    2011-01-01

    A 60-year-old female presented with a carotid-cavernous fistula (CCF) manifesting as left abducens nerve palsy. Left internal carotid digital subtraction angiography showed a persistent primitive trigeminal artery (PPTA) near the CCF. Super-selective angiography showed direct shunt flow between the PPTA trunk aneurysm and the left cavernous sinus. The aneurysm was successfully occluded with detachable coils. The CCF disappeared and the PPTA was preserved. The abducens nerve paralysis had disappeared 6 months later. CCF caused by a PPTA trunk aneurysm is extremely rare. We speculate that the PPTA trunk aneurysm formed and then ruptured due to hemodynamic stress caused by hypoplasia of the basilar artery. PMID:21785245

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to become you to our live webcast. Today we’re going to repair an abdominal aortic aneurysm ... and together as a team of multidisciplinary physicians, we’re going to repair an abdominal aortic aneurysm ...

  16. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... for the past three years, and his aneurysm has now grown to 5.4 centimeters. And this ... that in this particular patient that the aneurysm has reached the size where risk of rupture when ...

  17. Cerebral Aneurysms Fact Sheet

    Science.gov (United States)

    ... cerebral aneurysm from forming. People with a diagnosed brain aneurysm should carefully control high blood pressure, stop smoking, and avoid cocaine use or other stimulant drugs. They should also ...

  18. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... is actually an important factor. Most aneurysms we treat conservatively and we’ll just watch them. But ... has to be, and we generally don’t treat aneurysms until they get to be 5 to ...

  19. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is a ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  20. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... as atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is ... be screened. In fact, patients who have a family history of aneurysm, men who are smoking over ...

  1. Aortic Aneurysm Statistics

    Science.gov (United States)

    ... connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms. Signs and symptoms of thoracic aortic aneurysm can include Sharp, sudden pain in the chest or upper back. Shortness of ...

  2. Correlation between wall shear stress and the rupture of saccular intracranial aneurysms: the initial experimental results with patient-specific 3-D computational model

    International Nuclear Information System (INIS)

    Objective: To find out the hemodynamic factors relating to the rupture of intracranial aneurysm by comparing the hemodynamic parameters of the asymptomatic intracranial aneurysms with that of symptomatic ones. Methods: Eight intracranial aneurysms in five patients were discovered on DSA. By using rotational DSA, 3-D models of the intracranial aneurysms were established, and the numerical simulation of the hemodynamics parameters was performed with finite volume method. The hemodynamics parameters between the aneurysms and the parent arteries were statistically analyzed and compared. Results The average shear stress of the neck and the close parent artery in asymptomatic group was (5.54 ± 2.89) Pa and (6.6 ± 3.47) Pa respectively, while it was (4.78 ± 3.84) Pa and (7.30 ± 3.80) Pa respectively in symptomatic group. No significant difference in the average shear stress of both the aneurysmal neck and its close parent artery existed between two groups (P < 0.05). The low shear stress region of asymptomatic group and symptomatic group was (0.33 ± 0.57)% and (4.72 ± 5.31)% respectively, with a significant difference between the two (P < 0.05). Conclusion: The size of low shear stress region of aneurysmal wall may be one of the main factors causing the rupture of the saccular intracranial aneurysms. (authors)

  3. Cerebral aneurysms and inflammation

    Directory of Open Access Journals (Sweden)

    Toshihiro Yokoi

    2015-06-01

    Full Text Available Multiple inflammatory factors, playing a crucial role in cerebral aneurysm formation, have been identified. tumor necrosis factor-alpha (TNF-α has been revealed to have a close connection with several risk factors that affect aneurysm formation. Remarkable expression in aneurysm walls of mRNA for TNF-α has been observed in humans. Possible therapeutic interventions to reduce the formation of cerebral aneurysms may include the inhibition of mediators of inflammation.

  4. Pulsatile blood flow in Abdominal Aortic Aneurysms

    Science.gov (United States)

    Salsac, Anne-Virginie; Lasheras, Juan C.; Singel, Soeren; Varga, Chris

    2001-11-01

    We discuss the results of combined in-vitro laboratory measurements and clinical observations aimed at determining the effect that the unsteady wall shear stresses and the pressure may have on the growth and eventual rupturing of an Abdominal Aortic Aneurysm (AAA), a permanent bulging-like dilatation occurring near the aortic bifurcation. In recent years, new non-invasive techniques, such as stenting, have been used to treat these AAAs. However, the development of these implants, aimed at stopping the growth of the aneurysm, has been hampered by the lack of understanding of the effect that the hemodynamic forces have on the growth mechanism. Since current in-vivo measuring techniques lack the precision and the necessary resolution, we have performed measurements of the pressure and shear stresses in laboratory models. The models of the AAA were obtained from high resolution three-dimensional CAT/SCANS performed in patients at early stages of the disease. Preliminary DPIV measurements show that the pulsatile blood flow discharging into the cavity of the aneurysm leads to large spikes of pressure and wall shear stresses near and around its distal end, indicating a possible correlation between the regions of high wall shear stresses and the observed location of the growth of the aneurysm.

  5. Diagnosis of ventricular aneurysm on Tl-201 myocardial scintigraphy

    International Nuclear Information System (INIS)

    Author has proposed ''open beak sign'' (outward extension of left ventricular wall at the edge of scintigraphic hypoperfusion) and ''double chamber sign'' (division of left ventricular cavity) as new observations on planar images of Tl-201 myocardial scintigraphy for diagnosis of ventricular aneurysm. Open beak sign and/or double chamber sign could be detectable in 55 of the 60 myocardial infarctions with ventricular aneurysm, while, 4 of the 162 myocardial infarctions without ventricular aneurysm showed these signs. Thus both open beak sign and double chamber sign for the detection of ventricular aneurysm had a sensitivity of 91.7 %, a specificity of 97.5 %, and an accuracy of 95.9 %. Open beak sign was well demonstrated in middle-sized ventricular aneurysm (17 of the 18 aneurysms, 94.4 %). Detectability of double chamber sign was poor in small ventricular aneurysm (4 of the 10 aneurysms, 40.0 %), and good in large ventricular aneurysm (11 of the 13 aneurysms, 84.6 %). In comparison of rest scan with exercise scan, rest scan was more sensitive for open beak sign and detectability of open beak sign correlated with ischemia at the edge of scintigraphic hypoperfusion based on analysis of coronary arteriography. This report has revealed diagnostic efficacy of Tl-201 myocardial scintigraphy for the detection of ventricular aneurysm. (author)

  6. Histochemical and immunohistochemical analysis of ruptured atherosclerotic abdominal aortic aneurysm wall

    Directory of Open Access Journals (Sweden)

    Tanasković Irena

    2010-01-01

    Full Text Available Background/Aim. The main complication of the atherosclerotic abdominal aortic aneurism (AAA is her rupture that begins with lesion in intima and rupture. The purpose of this work was to determine immunocytochemical and morphofunctional characteristics of the cells in aortic wall in ruptured atherosclerotic abdominal aortic aneurysm. Method. During the course of this study, 20 samples of atherosclerotic AAA were analyzed, all of them obtained during authopsy. The samples were fixed in 4% formalin and embedded in paraffin. Sections of 5 μm thickness were stained histochemically (of Heidenhain azan stain and Periodic acid Schiff - PAS stain and immunocytochemically using a DAKO LSAB+/HRP technique to identify α-smooth muscle actin (α-SMA, vimentin, myosin heavy chains (MHC, desmin, S-100 protein, CD45 and CD68 (DAKO specification. Results. The results of our study showed that ruptured atherosclerotic AAA is characterized by a complete absence of endothelial cells, the disruption of basal membrane and internal elastic lamina, as well as a presence of the remains of hypocellular complicated atherosclerotic lesion in intima. On the plaque margins, as well as in the media, smooth muscle cells (SMCs are present, which express a α-SMA and vimentin (but without MHC or desmin expression, as well as leukocyte infiltration, and a large number of foam cells. Some of the foam cells show a CD68-immunoreactivity, while the others show vimentin- and S-100 protein-immunoreactivity. Media is thinned out with a disorganized elastic lamellas, while adventitia is characterized by inflammatory inflitrate (infection. Conclusion. Rupture of aneurysm occurs from the primary intimal disruption, which spreads into thinned out media and adventitia. Rupture is caused by unstable atherom, hypocellularity, loss of contractile characteristics of smooth muscle cells in intima and media, neovascularization of the media, as well as by the activity of the macrophages in the

  7. Predictors of Outcome after Open Repair of Ruptured Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Hao-Jui Li

    2011-10-01

    Full Text Available Background: To determine predictors associated with early hospital death, 30-day mortality, and long-term survival after open surgical treatment of ruptured abdominal aortic aneurysms (RAAAs.Methods: A retrospective chart review of 127 consecutive patients who received opensurgical treatment of a RAAA at Chang Gung Memorial Hospital, Taiwan,from February 1994 to May 2007. Data recorded included patient characteristics, medical history, perioperative variables, and outcomes.Results: There were 104 men and 23 women with a mean age of 70Ų12 years in theanalysis. Patients with RAAAs were classified into two groups; 100 (78.7%patients were classified as group I (hemodynamically stable, and 27 (21.3%patients were classified as group II (hemodynamically unstable at arrival.T h e 3 0 - d a y mo r t a l i t y wa s 2 2% f o r g r o u p I a n d 7 4 . 1% f o r g r o u p I I .Multivariate analysis identified age > 75 years old (odds ratio [OR], 0.083;95% confidence interval [CI] 0.02-0.36, hemodynamically unstable state(OR, 0.081; 95% CI 0.016-0.4, blood transfusion > 5 L (OR, 0.14; 95% CI0.038-0.54, intraperitoneal rupture (OR, 7.2; 95% CI 1.4-36, urine output 75 years old, intraperitoneal rupture, lowintraoperative urine output, and suprarenal cross-clamping.

  8. The Role of Computational Fluid Dynamics in the Management of Unruptured Intracranial Aneurysms: A Clinicians' View

    Directory of Open Access Journals (Sweden)

    Pankaj K. Singh

    2009-01-01

    Full Text Available Objective. The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs is widely accepted. Computational fluid dynamics (CFD is being used increasingly for hemodynamic predictions. However, alogn with the continuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. Methods. A workshop on CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT Teaching Course, Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse software developed within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performance was assessed on a scale of 1 to 4 and, compared with experts' performance. Results. Current dilemmas in the management of unruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showed interest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0–4 which was 63% (range 0–100% of an expert user. Conclusions. Although participants showed a manifest interest in CFD, there was a clear lack of awareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More efforts therefore are required to enhance understanding of the clinicians in the subject.

  9. Paediatric intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    A A Wani

    2006-01-01

    Full Text Available Intracranial aneurysms in childhood account for 1-2% of intracranial aneurysms.[1],[2] These aneurysms have unique characteristics that make them different from those in adults. These differences are evident in their epidemiology, location, clinical spectrum, association with trauma and infection, complications and outcome.

  10. A dimensionless parameter for classifying hemodynamics in intracranial

    Science.gov (United States)

    Asgharzadeh, Hafez; Borazjani, Iman

    2015-11-01

    Rupture of an intracranial aneurysm (IA) is a disease with high rates of mortality. Given the risk associated with the aneurysm surgery, quantifying the likelihood of aneurysm rupture is essential. There are many risk factors that could be implicated in the rupture of an aneurysm. However, the most important factors correlated to the IA rupture are hemodynamic factors such as wall shear stress (WSS) and oscillatory shear index (OSI) which are affected by the IA flows. Here, we carry out three-dimensional high resolution simulations on representative IA models with simple geometries to test a dimensionless number (first proposed by Le et al., ASME J Biomech Eng, 2010), denoted as An number, to classify the flow mode. An number is defined as the ratio of the time takes the parent artery flow transports across the IA neck to the time required for vortex ring formation. Based on the definition, the flow mode is vortex if An>1 and it is cavity if AnOSI on the human subject IA. This work was supported partly by the NIH grant R03EB014860, and the computational resources were partly provided by CCR at UB. We thank Prof. Hui Meng and Dr. Jianping Xiang for providing us the database of aneurysms and helpful discussions.

  11. Comparison of ejection fraction and Goldman risk factor analysis to dipyridamole-thallium 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery

    International Nuclear Information System (INIS)

    Associated coronary artery disease is the critical factor that influences early and late mortality after abdominal aortic aneurysm surgery. Dipyridamole-thallium 201 scintigraphy, left ventricular ejection fraction, and Goldman risk factor analysis have been suggested as preoperative noninvasive screening methods to detect significant coronary artery disease. In this series of 95 elective abdominal aortic aneurysm repairs dipyridamole-thallium 201 scintigraphy was highly predictive of the absence of perioperative cardiac morbidity (96% specificity, 44/46 normal scans, no cardiac morbidity), whereas ejection fraction (73% specificity, 31/42 normal ejection fraction, no cardiac morbidity) and Goldman risk factor analysis (84% specificity, 44/51 class I, no cardiac morbidity) were less. Furthermore, thallium redistribution on dipyridamole-thallium 201 scintigraphy leading to coronary angiography identified a significant number of patients with occult coronary artery disease who required preoperative coronary revascularization (8%, 8/95) and might have remained undetected on the basis of left ventricular ejection fraction or Goldman risk factor analysis. Finally, fixed thallium deficit, which some investigators have interpreted as a low probability finding for cardiac morbidity, was associated with a higher than expected incidence of cardiac complications. Forty-six percent (7/15) of all postoperative cardiac complications (three myocardial infarctions, three ischemic events, one death) occurred in patients with abdominal aortic aneurysms with fixed deficits. This suggests that patients with fixed deficits on dipyridamole-thallium 201 scintigraphy should be considered for later delayed (4 hours) thallium images or coronary angiography or both

  12. Insights on a Giant Aneurysm Treated Endovascularly.

    Science.gov (United States)

    Graziano, Francesca; Iacopino, Domenico Gerardo; Ulm, Arthur John

    2016-07-01

    Background Endovascular treatment with stent-assisted Guglielmi detachable coils is an accepted method for treating intracranial giant aneurysms that otherwise would require more invasive or destructive treatment or could not be treated at all. Nevertheless, there is a paucity of information concerning inner postcoiling aneurysmal changes in human subjects over the long term. We report a postmortem analysis of a patient with a giant aneurysm at the vertebrobasilar junction (VBJ) who was treated endovascularly and studied pathologically 24 months after treatment. Materials and Method The head was removed at autopsy and prefixed in a 10% neutral buffered formalin solution. The brain was gently removed from the skull base after cutting the intracranial nerves and vascular structures. The giant VBJ aneurysm and its relationship with the brainstem, cranial nerves, and vessels were captured photographically and analyzed. Afterward, under operating microscope guidance, the vertebrobasilar system with the aneurysm was gently and carefully detached from the brainstem and carefully analyzed. Results No complete fibrous obliteration of the aneurysm lumen could be detected in our case, and no endothelialization had taken place 24 months after treatment. Conclusions Our findings agree with those of previous similar reports. Coiling, in particular in large or giant aneurysms, may be burdened by the risk of coil compaction and recanalization, but it has the advantage of not affecting the flow in the perforating arteries. PMID:26296255

  13. Inflammation and intracranial aneurysms: mechanisms of initiation, growth, and rupture

    Directory of Open Access Journals (Sweden)

    Peter S Amenta

    2015-06-01

    Full Text Available Outcomes following aneurysmal subarachnoid hemorrhage remain poor in many patients, despite advances in microsurgical and endovascular management. Consequently, considerable effort has been placed in determining the mechanisms of aneurysm formation, growth, and rupture. Various environmental and genetic factors are implicated as key components in the aneurysm pathogenesis. Currently, sufficient evidence exists to incriminate the inflammatory response as the common pathway leading to aneurysm generation and rupture. Central to this model is the interaction between the vessel wall and inflammatory cells. Dysfunction of the endothelium and vascular smooth muscle cells (VSMCs promotes a chronic pathological inflammatory response that progressively weakens the vessel wall. We review the literature pertaining to the cellular and chemical mechanisms of inflammation that contribute to aneurysm development. Hemodynamic stress and alterations in blood flow are discussed regarding their role in promoting chronic inflammation. Endothelial cell and VSMC dysfunction are examined concerning vascular remodeling. The contribution of inflammatory cytokines, especially tumor necrosis factor-α is illustrated. Inflammatory cell infiltration, particularly macrophage-mediated deterioration of vascular integrity, is reviewed. We discuss the inflammation as a means to determine aneurysms at greatest risk of rupture. Finally, future therapeutic implications of pharmacologic modulation of the inflammation are discussed.

  14. The improvement and evaluation of the establishment of side-wall aneurysm model in canine

    International Nuclear Information System (INIS)

    Objective: To improve and evaluate the establishing method of carotid side-wall aneurysm model in canine. Methods: Bilateral multiple side-wall aneurysm models were surgically established on the carotid arteries in 15 dogs. The dogs were randomly divided into 3 groups: group A, being heparinized during procedure;group B, being heparinized after procedure;and group C, not receiving any heparin. Angiography was performed 2 weeks and 1 month after the procedure in order to evaluate the hemodynamic characteristics. Every one dog and two dogs from each group each time at 2 weeks and one month after the procedure respectively were sacrificed and the specimens were sent for histopathologic study. Results: Thirty-seven experimental wide-neck, side-wall aneurysms were established. Angiography showed whirl-like, vortex flow of blood within the dome of the aneurysms. One and 6 aneurysms in group A and C respectively were obliterated due to thrombus. No significant difference in the occurrence of thrombosis existed between group A and B (Nemenyi, P>0.5). Histopathologic study showed that the aneurysms remained stable with reduced inflammation one month after the procedure. Conclusion: For the establishment of side-wall aneurysm model in canine,the use of being heparinized during or after the procedure can obtain the same anti-coagulation effects. The method of surgical suture can be well controlled in establishing multiple aneurysms. This model is very useful for the study of the therapeutic technique of aneurysm. (authors)

  15. Interventional therapy of huge aneurysm

    International Nuclear Information System (INIS)

    Objective: To evaluate the methods and the efficacy of interventional therapy for huge aneurysm. Methods: Seven patients with huge aneurysm including 2 with pulmonary aneurysm, 2 with renal aneurysm, 1 with humeral artery aneurysm, 1 with right common iliac artery aneurysm, 1 with right internal iliac artery aneurysm. Among these, 5 were true aneurysm, and 2 were pseudoaneurysms caused by congenital, trauma, arteriosclerosis. Three patients were treated with endovascular covered stent graft and 2 patients with embolization containing metallic coils. Two patients were treated with partial aneurysm and feeding artery trunk embolization with metallic coils. Results: All 7 patients were successful carried out the interventional therapy with successful rate of 100%. Six aneurysms were completely obstructed with disappearance of symptoms and signs. One died of aneurysm rupture. No other complication occurred. Conclusion: Interventional therapy for huge aneurysm is an effective method. (authors)

  16. Brain Aneurysm Statistics and Facts

    Science.gov (United States)

    ... Statistics and Facts A- A A+ Brain Aneurysm Statistics and Facts An estimated 6 million people in ... Understanding the Brain Warning Signs/ Symptoms Brain Aneurysm Statistics and Facts Seeking Medical Attention Risk Factors Aneurysm ...

  17. Prevalence and trends of the abdominal aortic aneurysms epidemic in general population--a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Xi Li

    Full Text Available OBJECTIVE: To conduct a meta-analysis assessing the prevalence and trends of the abdominal aortic aneurysms (AAA epidemic in general population. METHOD: Studies that reported prevalence rates of AAA from the general population were identified through MEDLINE, EMBASE, Web of Science, and reference lists for the period between 1988 and 2013. Studies were included if they reported prevalence rates of AAA in general population from the community. In stratified analyses possible sources of bias, including areas difference, age, gender and diameter of aneurysms were examined. Publication bias was assessed with Egger's test method. RESULTS: 56 studies were identified. The overall pooled prevalence of AAA was 4.8% (4.3%, 5.3%. Stratified analyses showed the following results, areas difference: America 2.2% (2.2%, 2.2%, Europe 2.5% (2.4%, 2.5%, Australia 6.7% (6.5%, 7.0%, Asia 0.5% (0.3%, 0.7%; gender difference: male 6.0% (5.3%, 6.7%, female 1.6% (1.2%, 1.9%; age difference: 55-64years 1.3% (1.2%, 1.5%, 65-74 years 2.8% (2.7%, 2.9%, 75-84 years1.2%(1.1%, 1.3%, ≥85years0.6% (0.4%, 0.7%; aortic diameters difference: 30-39 mm, 3.3% (2.8%, 3.9%, 40-49 mm,0.7% (0.4%,1.0%, ≥50 mm, 0.4% (0.3%, 0.5%. The prevalence of AAA has decreased in Europe from 1988 to 2013. Hypertension, smoking, coronary artery disease, dyslipidemia, respiratory disease, cerebrovascular disease, claudication and renal insufficiency were risk factors for AAA in Europe. CONCLUSION: AAA is common in general population. The prevalence of AAA is higher in Australia than America and Europe. The pooled prevalence in western countries is higher than the Asia. Future research requires a larger database on the epidemiology of AAA in general population.

  18. Non-Invasive Pulse Wave Analysis in a Thrombus-Free Abdominal Aortic Aneurysm after Implantation of a Nitinol Aortic Endograft

    Science.gov (United States)

    Georgakarakos, Efstratios; Argyriou, Christos; Georgiadis, George S.; Lazarides, Miltos K.

    2016-01-01

    Endovascular aneurysm repair has been associated with changes in arterial stiffness, as estimated by pulse wave velocity (PWV). This marker is influenced by the medical status of the patient, the elastic characteristics of the aneurysm wall, and the presence of intraluminal thrombus. Therefore, in order to delineate the influence of the endograft implantation in the early post-operative period, we conducted non-invasively pulse wave analysis in a male patient with an abdominal aortic aneurysm containing no intraluminal thrombus, unremarkable past medical history, and absence of peripheral arterial disease. The estimated parameters were the systolic and diastolic pressure calculated at the aortic level (central pressures), PWV, augmentation pressure (AP) and augmentation index (AI), pressure wave reflection magnitude (RM), and peripheral resistance. Central systolic and diastolic pressure decreased post-operatively. PWV showed subtle changes from 11.6 to 10.6 and 10.9 m/s at 1-week and 1-month, respectively. Accordingly, the AI decreased from 28 to 14% and continued to drop to 25%. The AP decreased gradually from 15 to 6 and 4 mmHg. The wave RM dropped from 68 to 52% at 1-month. Finally, the peripheral resistance dropped from 1.41 to 0.99 and 0.85 dyn × s × cm−5. Our example shows that the implantation of an aortic endograft can modify the pressure wave reflection over the aortic bifurcation without causing significant alterations in PWV. PMID:26793712

  19. Comparative study of novel endovascular treatment techniques for intracranial aneurysms

    Science.gov (United States)

    Cantón, Gádor; Lasheras, Juan C.; Levy, David I.; Sparks, Steven R.

    2002-11-01

    Intracranial aneurysms are life-threatening vascular lesions, which are potentially treatable to avoid the consequences of their rupture. Current treatments, either surgical or endovascular, are all guided to reduce the hemodynamic forces acting on the aneurysm wall in an effort to minimize the risk of rupture. Surgical clipping is still the most used technique to treat this type of aneurysm but there is a continued demand for less invasive approaches. This has led to the development of several endovascular techniques. We report here a comparative study of the reduction in the hemodynamic stresses and the modification of the flow in the parent vessel resulting from the use of three different techniques. The first one consists of endosaccular packing with platinum coils (GDC, Target Therapeutics), which is already widely used but its long-term efficacy has not yet been determined. The second one consists of the embolization of the aneurismal sac with Onyx, a polymer which hardens when in contact with the blood (being developed by Micro Therapeutics, Inc.). The third one involves the packing of the sac with hydrocoils, platinum wires coated with a gel which quickly hydrates when in contact with blood (developed by MicroVention). A Digital Particle Image Velocimetry (DPIV) system is used to measure in vitro the velocity field inside a model of an ACOM aneurysm (an aneurysm forming in the anterior communicating artery). Physiological accurate pulsatile flow conditions are input to the arterial model through a programmable pump. The measurements show that although all treatment techniques lead to a reduction in both normal and tangential shear stresses on the aneurismal sac, each one of them also leads to different modifications of the flow in the parent vessel which may have consequences related to potential for clotting. Comparison of the untreated aneurysm with the above three treated cases also showed that the characteristics of the wall shear stresses on the parent

  20. The @neurIST ontology of intracranial aneurysms: providing terminological services for an integrated IT infrastructure.

    Science.gov (United States)

    Boeker, Martin; Stenzhorn, Holger; Kumpf, Kai; Bijlenga, Philippe; Schulz, Stefan; Hanser, Susanne

    2007-01-01

    The @neurIST ontology is currently under development within the scope of the European project @neurIST intended to serve as a module in a complex architecture aiming at providing a better understanding and management of intracranial aneurysms and subarachnoid hemorrhages. Due to the integrative structure of the project the ontology needs to represent entities from various disciplines on a large spatial and temporal scale. Initial term acquisition was performed by exploiting a database scaffold, literature analysis and communications with domain experts. The ontology design is based on the DOLCE upper ontology and other existing domain ontologies were linked or partly included whenever appropriate (e.g., the FMA for anatomical entities and the UMLS for definitions and lexical information). About 2300 predominantly medical entities were represented but also a multitude of biomolecular, epidemiological, and hemodynamic entities. The usage of the ontology in the project comprises terminological control, text mining, annotation, and data mediation. PMID:18693797

  1. Pediatric cerebral artery aneurysms

    OpenAIRE

    Koroknay-Pál, PÀivi

    2012-01-01

    Objectives. Intracranial aneurysms in children are rare and population-based long-term follow-up studies are limited. In this study, a large clinical and angiographic long-term follow-up was carried out. The special characteristics of the patients and their aneurysms were assessed together with factors affecting early and long-term morbidity and mortality. Materials and Methods. All pediatric (≀18 years) aneurysm patients treated at the Department of Neurosurgery in Helsinki during 193...

  2. Open Versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim; Alpert, Martin A; Faries, Peter; Dangas, George; Gluud, Christian

    2014-01-01

    We performed an analysis to assess the need for conducting additional randomized controlled trials (RCTs) comparing open and endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Trial sequential analysis (TSA) is a statistical methodology that can calculate the required inform...

  3. A dimensionless parameter for classifying hemodynamics in intracranial

    Science.gov (United States)

    Asgharzadeh, Hafez; Borazjani, Iman

    2015-11-01

    Rupture of an intracranial aneurysm (IA) is a disease with high rates of mortality. Given the risk associated with the aneurysm surgery, quantifying the likelihood of aneurysm rupture is essential. There are many risk factors that could be implicated in the rupture of an aneurysm. However, the most important factors correlated to the IA rupture are hemodynamic factors such as wall shear stress (WSS) and oscillatory shear index (OSI) which are affected by the IA flows. Here, we carry out three-dimensional high resolution simulations on representative IA models with simple geometries to test a dimensionless number (first proposed by Le et al., ASME J Biomech Eng, 2010), denoted as An number, to classify the flow mode. An number is defined as the ratio of the time takes the parent artery flow transports across the IA neck to the time required for vortex ring formation. Based on the definition, the flow mode is vortex if An>1 and it is cavity if An<1. We show that the specific definition of Le et al. works for sidewall but needs to be modified for bifurcation aneurysms. In addition, we show that this classification works on three-dimensional geometries reconstructed from three-dimensional rotational angiography of human subjects. Furthermore, we verify the correlation of IA flow mode and WSS/OSI on the human subject IA. This work was supported partly by the NIH grant R03EB014860, and the computational resources were partly provided by CCR at UB. We thank Prof. Hui Meng and Dr. Jianping Xiang for providing us the database of aneurysms and helpful discussions.

  4. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Dehdashti, A.R.; Tribolet, N. de [Department of Neurosurgery, HUG, Geneva (Switzerland); Safran, A.B. [Department of Ophthalmology, HUG, Geneva (Switzerland); Martin, J.B.; Ruefenacht, D.A. [Division of Neuroradiology, HUG, Geneva (Switzerland)

    2002-07-01

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  5. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

    International Nuclear Information System (INIS)

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  6. Hemodynamic Support in Sepsis

    Directory of Open Access Journals (Sweden)

    Fatih Yildiz

    2014-04-01

    Full Text Available Sepsis is called systemic inflammatory response syndrome due to infection. When added to organs failure and perfusion abnormality is defined in severe sepsis, Hypotension that do not respond to fluid therapy is as defined septic shock. Fluid resuscitation is a most important parts of the treatment in patients with septic shock. Ongoing hypotension that despite of the adequate fluid therapy, vasopressor support initiation is required. Sepsis and septic shock, hemodynamic support is often understood as the hemodynamic support. The different approaches to the development of methods to track and objective comes up. Patients with severe sepsis and septic shock should be follow in the intensive care unit and rapid fluid replacement and effectual hemodynamic support should be provided.

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the age of 55 should be screened for aneurysms. And the way to screen is with a simple ultrasound. But sometimes a ...

  8. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available Aortic Aneurysm Repair May 7, 2009 Good afternoon. Welcome to the Baptist Cardiac and Vascular Institute here in Miami. My name ... our live webcast. Today we’re going to repair an abdominal aortic aneurysm using a technology called ...

  9. Biosimulation and visualization: effect of cerebrovascular geometry on hemodynamics.

    Science.gov (United States)

    Oshima, Marie; Kobayashi, Toshio; Takagi, Kiyoshi

    2002-10-01

    Hemodynamics plays an important role in cardiovascular disorders, and the authors are applying numerical and experimental studies of cerebrovascular blood flow to the creation and rupture of cerebral aneurysms. In particular, this study aims to investigate the effects of cerebrovascular geometry on hemodynamics, such as flow pattern, wall shear stress distribution, and pressure. This report consists mainly of two parts: numerical study of blood flow in the artery extracted from computer tomography data, and numerical and experimental studies of a curved pipe model. The simulation was conducted by using a finite element method; the experiment was conducted by particle imaging velocimetry. Numerical and experimental results are compared and both show similar secondary flow behavior. PMID:12496038

  10. Hemodynamic analysis in an idealized artery tree: differences in wall shear stress between Newtonian and non-Newtonian blood models.

    Directory of Open Access Journals (Sweden)

    Jared C Weddell

    Full Text Available Development of many conditions and disorders, such as atherosclerosis and stroke, are dependent upon hemodynamic forces. To accurately predict and prevent these conditions and disorders hemodynamic forces must be properly mapped. Here we compare a shear-rate dependent fluid (SDF constitutive model, based on the works by Yasuda et al in 1981, against a Newtonian model of blood. We verify our stabilized finite element numerical method with the benchmark lid-driven cavity flow problem. Numerical simulations show that the Newtonian model gives similar velocity profiles in the 2-dimensional cavity given different height and width dimensions, given the same Reynolds number. Conversely, the SDF model gave dissimilar velocity profiles, differing from the Newtonian velocity profiles by up to 25% in velocity magnitudes. This difference can affect estimation in platelet distribution within blood vessels or magnetic nanoparticle delivery. Wall shear stress (WSS is an important quantity involved in vascular remodeling through integrin and adhesion molecule mechanotransduction. The SDF model gave a 7.3-fold greater WSS than the Newtonian model at the top of the 3-dimensional cavity. The SDF model gave a 37.7-fold greater WSS than the Newtonian model at artery walls located immediately after bifurcations in the idealized femoral artery tree. The pressure drop across arteries reveals arterial sections highly resistive to flow which correlates with stenosis formation. Numerical simulations give the pressure drop across the idealized femoral artery tree with the SDF model which is approximately 2.3-fold higher than with the Newtonian model. In atherosclerotic lesion models, the SDF model gives over 1 Pa higher WSS than the Newtonian model, a difference correlated with over twice as many adherent monocytes to endothelial cells from the Newtonian model compared to the SDF model.

  11. Hemodynamic analysis in an idealized artery tree: differences in wall shear stress between Newtonian and non-Newtonian blood models.

    Science.gov (United States)

    Weddell, Jared C; Kwack, JaeHyuk; Imoukhuede, P I; Masud, Arif

    2015-01-01

    Development of many conditions and disorders, such as atherosclerosis and stroke, are dependent upon hemodynamic forces. To accurately predict and prevent these conditions and disorders hemodynamic forces must be properly mapped. Here we compare a shear-rate dependent fluid (SDF) constitutive model, based on the works by Yasuda et al in 1981, against a Newtonian model of blood. We verify our stabilized finite element numerical method with the benchmark lid-driven cavity flow problem. Numerical simulations show that the Newtonian model gives similar velocity profiles in the 2-dimensional cavity given different height and width dimensions, given the same Reynolds number. Conversely, the SDF model gave dissimilar velocity profiles, differing from the Newtonian velocity profiles by up to 25% in velocity magnitudes. This difference can affect estimation in platelet distribution within blood vessels or magnetic nanoparticle delivery. Wall shear stress (WSS) is an important quantity involved in vascular remodeling through integrin and adhesion molecule mechanotransduction. The SDF model gave a 7.3-fold greater WSS than the Newtonian model at the top of the 3-dimensional cavity. The SDF model gave a 37.7-fold greater WSS than the Newtonian model at artery walls located immediately after bifurcations in the idealized femoral artery tree. The pressure drop across arteries reveals arterial sections highly resistive to flow which correlates with stenosis formation. Numerical simulations give the pressure drop across the idealized femoral artery tree with the SDF model which is approximately 2.3-fold higher than with the Newtonian model. In atherosclerotic lesion models, the SDF model gives over 1 Pa higher WSS than the Newtonian model, a difference correlated with over twice as many adherent monocytes to endothelial cells from the Newtonian model compared to the SDF model. PMID:25897758

  12. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.

    2006-01-01

    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile inde

  13. Cognition and Hemodynamics

    OpenAIRE

    Novak, Vera

    2012-01-01

    The relationship between cerebral hemodynamics and cognitive performance has increasingly become recognized as a major challenge in clinical practice for older adults. Both diabetes and hypertension worsen brain perfusion and are major risk factors for cerebrovascular disease, stroke and dementia. Cerebrovascular reserve has emerged as a potential biomarker for monitoring pressure–perfusion–cognition relationships. Endothelial dysfunction and inflammation, microvascular disease, and mascrovas...

  14. Simultaneous EEG-fMRI in patients with Unverricht-Lundborg disease: event-related desynchronization/synchronization and hemodynamic response analysis.

    Science.gov (United States)

    Visani, Elisa; Minati, Ludovico; Canafoglia, Laura; Gilioli, Isabella; Salvatoni, Lucia; Varotto, Giulia; Fazio, Patrik; Aquino, Domenico; Bruzzone, Maria Grazia; Franceschetti, Silvana; Panzica, Ferruccio

    2010-01-01

    We performed simultaneous acquisition of EEG-fMRI in seven patients with Unverricht-Lundborg disease (ULD) and in six healthy controls using self-paced finger extension as a motor task. The event-related desynchronization/synchronization (ERD/ERS) analysis showed a greater and more diffuse alpha desynchronization in central regions and a strongly reduced post-movement beta-ERS in patients compared with controls, suggesting a significant dysfunction of the mechanisms regulating active movement and movement end. The event-related hemodynamic response obtained from fMRI showed delayed BOLD peak latency in the contralateral primary motor area suggesting a less efficient activity of the neuronal populations driving fine movements, which are specifically impaired in ULD. PMID:20111730

  15. A large un-ruptured abdominal aortic aneurysm causing pulmonary embolism.

    Science.gov (United States)

    Sajjad, Jahangir; Ahmed, Abubakr; Coveney, Andrew; Fulton, Gregory

    2015-01-01

    A 79 years old woman presented in a peripheral hospital with dyspnea, right-sided pleuritic chest pain and cough for 3 days. On examination, she was tachycardiac and tachypneic. She had reduced air entry bilaterally on auscultation. Computed tomography-pulmonary angiogram, performed in peripheral Hospital, confirmed the diagnosis of pulmonary embolism, and she was commenced on warfarin. Ultrasonography showed no evidence of deep venous thrombosis in legs; however, ultrasound of the abdomen revealed an aortic aneurysm. She was hemodynamically stable on transfer to vascular surgery department, and her complete clinical examination revealed a pulsatile mass in the central abdomen. Computed tomography angiogram of aorta showed 8.7-cm abdominal aortic aneurysm. Venogram performed during inferior vena cava (IVC) filter insertion showed that IVC was displaced and compressed due to this large aortic aneurysm, causing thromboembolism. An open repair of the aneurysm was performed with uneventful recovery. PMID:26205717

  16. Assessment of Coronary Artery Aneurysms Cased By Kawasaki Diesease Using Transluminal Attenuation Gradient Analysis of CT Angiograms

    OpenAIRE

    Gutierrez, Noelia Grande

    2015-01-01

    Patients with coronary artery aneurysms (CAA) resulting from Kawasaki Disease (KD) are at risk for thrombosis and myocardial infarction. Current guidelines recommend using CAA diameter >8 mm as the criterion for initiating systemic anticoagulation, but there is little outcome data to support this choice. Transluminal Attenuation Gradient (TAG) has been proposed as a non-invasive method for evaluating the functional significance of coronary stenoses using CT Angiography (CTA). However TAG has ...

  17. Cerebral Blood Flow Changes after Shunt in Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage: Analysis by statistical Parametric Mapping

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the changes of regional cerebral blood flow (rCBF) after shunt operation in patients with hydrocephalus after aneurysmal subarachnoid hemorrhage ba statistical parametric mapping (SPM). Seven patients (4 male, mean age 54 years) with hydrocephalus after aneurysmal subarachnoid hemorrhage underwent a shunt operation. Tc-99m HMPAO SPECT was performed within I week before, and 2 weeks after the shunt operation. All of the SPECT images were spatially transformed to standard space, smoothed, and globally normalized. After spatial and count normalization, rCBF of pre- and post- shunting Tc- 99m HMPAO SPECT was estimated at every voxel using t statistics. The voxels with a P value of less than 0.001 were considered to be significantly different. The shunt operation was effective in all patients. Pre-shunting Tc-99m HMPAO SPECT showed hypoperfusion, predominantly in the periventricular area. After shunt operation, periventricular low perfusion was disappeared. The results of this study show that periventricular CBF is impaired in hydrocephalus after aneurysmal subarachnoid hemorrhage. Significant increase of periventricular CBF after shunt operation suggests the evaluation of periventricular CBF by SPM might be of value for the prediction of shunt effectiveness in hydrocephalus

  18. Polymorphisms of apolipoprotein E and aneurysmal subarachnoid haemorrhage: A meta-analysis.

    Science.gov (United States)

    Arati, S; Sibin, M K; Bhat, Dhananjaya I; Narasingarao, K V L; Chetan, G K

    2016-09-01

    Subarachnoid haemorrhage (SAH) is characterised by bleeding in the subarachnoid space in the brain. There are various polymorphisms in genes which are associated with this disease. We performed a systematic meta- analysis to investigate the relationship of APOE polymorphism on aSAH. A comprehensive literature search was done in the Pubmed database, Science Direct, Cochrane library and Google Scholar. The OR and 95% CI were evaluated for the gene and aSAH association using fixed and random effect models. Publication bias was assessed using Begg's funnel plot and Egger's regression test. All statistical evaluations were done using the software Review Manager 5.0 and Comprehensive Meta Analysis v2.2.023. A total of 9 studies were assessed on APOE polymorphism (1100 Cases, 2732 Control). Meta analysis results showed significant association in ε2/ ε2 versus ε3/ε3, ε2 versus ε3 genetic models and ε2 allele frequency. In subgroup analysis statistically significant association was observed in Asians in the genetic models ε2/ ε2 versus ε3/ε3, ε2/ε3 versus ε3/ε3, ε2 versus ε3 and also in ε2 allele frequency. However, in Caucasian population only ε2/ε2 versus ε3/ε3 genetic model showed significant association between APOE and risk of aSAH. In this meta-analysis study, the ε2/ε2 genotype is associated with increased risk of aSAH. PMID:27408823

  19. Transluminal Attenuation Gradient for Thrombotic Risk Assessment in Kawasaki Disease Patients with Coronary Artery Aneurysms

    Science.gov (United States)

    Grande Gutierrez, Noelia; Kahn, Andrew; Burns, Jane; Marsden, Alison

    2014-11-01

    Kawasaki Disease (KD) can result in coronary aneurysms in up to 25% of patients if not treated early putting patients at risk of thrombus formation, myocardial infarction and sudden death. Clinical guidelines for administering anti-coagulation therapy currently rely on anatomy alone. Previous studies including patient specific modeling and computer simulations in KD patients have suggested that hemodynamic data can predict regions susceptible to thrombus formation. In particular, high Particle Residence Time gradient (PRTg) regions have shown to correlate with regions of thrombus formation. Transluminal Attenuation Gradient (TAG) is determined from the change in radiological attenuation per vessel length. TAG has been used for characterizing coronary artery stenoses, however this approach has not yet been used in aneurysmal vessels. The aim of this study is to analyze the correlation between TAG and PRTg in KD patients with aneurysms and evaluate the use of TAG as an index to quantify thrombotic risk. Patient specific anatomic models for fluids simulations were constructed from CT angiographic image data from 3 KD aneurysm patients and one normal control. TAG values for the aneurysm patients were markedly lower than for the non-aneurysmal patient (mean -18.38 vs. -2). In addition, TAG values were compared to PRTg obtained for each patient. Thrombotic risk stratification for KD aneurysms may be improved by incorporating TAG and should be evaluated in future prospective studies.

  20. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... And one of the things that I’m learning from this movie as we looking at these ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  1. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... with such holes in the groin, this really offers the patient a tremendous advantage over having his ... a thousand aneurysms with this. So we can offer patients a very, very good integrated care with ...

  2. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... moving inside in the aneurysm sack with the spine projected in the background. So how long have ... have a much more rapid recovery than open surgery. What do you think about that, Ignacio, compared ...

  3. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... years, and his aneurysm has now grown to 5.4 centimeters. And this is actually an important ... balloon is trying to iron out the attachment. 5 So right now we have the first half ...

  4. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... been following in the institute for the past three years, and his aneurysm has now grown to ... may get for other reasons, but we use three-dimensional reconstruction and we can reconstruct all the ...

  5. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... the age of 65. It’s most common in males. There is an increasing number, due to the ... The risk factors for abdominal aortic aneurysms are males over 60, hardening of the arteries, which is ...

  6. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... wall will actually thin out. And the big risk here is that if this gets too big ... to the aging baby boomers. Next slide. The risk factors for abdominal aortic aneurysms are males over ...

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... They carry oxygen and blood to various organs. These arteries have muscular walls, and when they get ... continue to expand, and they can rupture. And these aneurysms can occur in a lot of different ...

  8. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... this procedure. So let’s go back now and learn a little bit about abdominal aortic aneurysms. Great. ... And one of the things that I’m learning from this movie as we looking at these ...

  9. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... dye and also to do measurements using our computer techniques that are going on here. So what ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  10. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to do now is begin to do the process of putting an endograft in, and I’m ... that we saw, actually thrombosis. So in the process of thrombosing or clotting off the aneurysm sack, ...

  11. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to the aging baby boomers. Next slide. The risk factors for abdominal aortic aneurysms are males over 60, ... doing a good examination and also accessing for risk factors. So we have a very integrated team here, ...

  12. Popliteal vein aneurysm.

    Science.gov (United States)

    Falkowski, A; Poncyljusz, W; Zawierucha, D; Kuczmik, W

    2006-06-01

    The incidence of a popliteal vein aneurysm is extremely low. Two cases of this rare venous anomaly are described. The epidemiology, morphology, and diagnostic methods are discussed and the potentially dangerous complications and treatment methods are presented. PMID:16796307

  13. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... information is critical for us in terms of planning and guiding the procedure we’re going to ... be screened. In fact, patients who have a family history of aneurysm, men who are smoking over ...

  14. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... this is to prevent rupture and to prevent death from rupture. This area just underneath the renal ... Okay. Abdominal aortic aneurysms cause approximately 15,000 deaths in the United States each year. It affects ...

  15. Heart function and hemodynamics

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930469 The effects of different ventricular pac-ing rates on cardiac hemodynamics and theirclinical significance.WEI Meng(魏盟),et al.Zhongshan Hosp,Shanghai Med Univ,Shanghai,200032.Shanghai Med J 1993;16(3):125—126.Changes of hemodynamics were investigated in26 patients at ventricular pacing rate of 60 to120,and 160 bpm.Effects of increasing ventricu-lar pacing rate on EF which were determined bygated blood pool scintigraphy were also studiedin another 11 patients.It is concluded that:1)inpatients with normal cardiac function as well asmost patients with cardiac insufficiency,the rela-tion of CO with increasing pacing rate can be il-

  16. Hemodynamics in fetal arrhythmia.

    Science.gov (United States)

    Sonesson, Sven-Erik; Acharya, Ganesh

    2016-06-01

    Fetal arrhythmias are among the few conditions that can be managed in utero. However, accurate diagnosis is essential for appropriate management. Ultrasound-based imaging methods can be used to study fetal heart structure and function noninvasively and help to understand fetal cardiovascular pathophysiology, and they remain the mainstay of evaluating fetuses with arrhythmias in clinical settings. Hemodynamic evaluation using Doppler echocardiography allows the elucidation of the electrophysiological mechanism and helps to make an accurate diagnosis. It can also be used as a tool to understand fetal cardiac pathophysiology, for assessing fetal condition and monitoring the effect of antiarrhythmic treatment. This narrative review describes Doppler techniques that are useful for evaluating fetal cardiac rhythms to refine diagnosis and provides an overview of hemodynamic changes observed in different types of fetal arrhythmia. PMID:26660845

  17. Hemodynamic Support in Sepsis

    OpenAIRE

    Fatih Yildiz; Emre Karakoc

    2014-01-01

    Sepsis is called systemic inflammatory response syndrome due to infection. When added to organs failure and perfusion abnormality is defined in severe sepsis, Hypotension that do not respond to fluid therapy is as defined septic shock. Fluid resuscitation is a most important parts of the treatment in patients with septic shock. Ongoing hypotension that despite of the adequate fluid therapy, vasopressor support initiation is required. Sepsis and septic shock, hemodynamic support is often under...

  18. Posterior cerebral artery angle and the rupture of basilar tip aneurysms.

    Directory of Open Access Journals (Sweden)

    Allen L Ho

    Full Text Available Since the initial publication of the International Study of Unruptured Intracranial Aneurysms (ISUIA, management of unruptured intracranial aneurysms has been mainly based on the size of the aneurysm. The contribution of morphological characteristics to treatment decisions of unruptured aneurysms has not been well studied in a systematic and location specific manner. We present a large sample of basilar artery tip aneurysms (BTA that were assessed using a diverse array of morphological variables to determine the parameters associated with ruptured aneurysms. Demographic and clinical risk factors of aneurysm rupture were obtained from chart review. CT angiograms (CTA were evaluated with Slicer, an open source visualization and image analysis software, to generate 3-D models of the aneurysms and surrounding vascular architecture. Morphological parameters examined in each model included aneurysm volume, aspect ratio, size ratio, aneurysm angle, basilar vessel angle, basilar flow angle, and vessel to vessel angles. Univariate and multivariate analyses were performed to determine statistical significance. From 2008-2013, 54 patients with BTA aneurysms were evaluated in a single institution, and CTAs from 33 patients (15 ruptured, 18 unruptured were available and analyzed. Aneurysms that underwent reoperation, that were associated with arteriovenous malformations, or that lacked preoperative CTA were excluded. Multivariate logistic regression revealed that a larger angle between the posterior cerebral arteries (P1-P1 angle, p = 0.037 was most strongly associated with aneurysm rupture after adjusting for other morphological variables. In this location specific study of BTA aneurysms, the larger the angle formed between posterior cerebral arteries was found to be a new morphological parameter significantly associated with ruptured BTA aneurysms. This is a physically intuitive parameter that can be measured easily and readily applied in the clinical

  19. Comprehensive validation of computational fluid dynamics simulationsof in-vivo blood flow in patient-specific cerebral aneurysms

    NARCIS (Netherlands)

    Sun, Q.; Groth, A.; Aach, T.

    2012-01-01

    Purpose: Recently, image-based computational fluid dynamic (CFD) simulations have been proposed to investigate the local hemodynamics inside human cerebral aneurysms. It is suggested that the knowledge ofthe computed three-dimensional flow fields can be used to assist clinical risk assessment and tr

  20. Hemichorea-hemiballismus caused by postoperative hyperperfusion after clipping of a giant unruptured middle cerebral artery aneurysm

    Directory of Open Access Journals (Sweden)

    Soichi Oya

    2015-01-01

    Conclusion: This case appears consistent with the theory that the connecting fibers responsible for the development of HC-HB are also located in the frontal lobe. The treatment of giant aneurysms involving the M1 portion can cause abrupt hemodynamic changes in both frontal cortex and the basal ganglia, which can potentially induce postoperative movement disorders.

  1. Three-dimensional digital subtraction angiography vs two-dimensional digital subtraction angiography for detection of ruptured intracranial aneurysms: A study of 86 aneurysms

    Directory of Open Access Journals (Sweden)

    Kawashima Masatou

    2005-01-01

    Full Text Available Aims : Three-dimensional reconstruction of intracranial vessels is of interest for evaluation of aneurysms. This study determined diagnostic difference of three-dimensional digital subtraction angiography (3D-DSA, volume-rendering image versus 2D-DSA for evaluating ruptured intracranial aneurysms, particularly focusing on the size of aneurysms as depicted in both images. Settings and Design : Sixty-nine patients underwent 3D-DSA and 2D-DSA. The relative size of an aneurysm, which is the ratio of the maximal diameter of an aneurysm to the diameter of a major vessel, was compared between imaging techniques. In addition, relative sizes of smaller aneurysms (10 mm. Statistical analysis used : For comparison of aneurysm size and location of aneurysm, statistical analysis was performed with the Yates chi square test; statistical significance was set with a P value of less than 0.05. Results: Sixty-three (73.3% of the 86 total aneurysms were bigger when measured with 3D-DSA versus 2D-DSA. When measured with 3D-DSA, 28 (84.8% of the 33 smaller aneurysms were bigger, and 50% of the larger aneurysms were bigger versus measurements of 2D-DSA images ( P P Conclusions : 3D-DSA, especially volume-rendering images, tends to depict ruptured intracranial aneurysms bigger than 2D-DSA. This is particularly true with cerebral aneurysms that are <5 mm in size and are located in the anterior circulation, especially ICA and ACA territories.

  2. Simulation of Cerebral Aneurysm Growth and Prediction of Evolving Rupture Risk

    Directory of Open Access Journals (Sweden)

    Martin Kroon

    2011-01-01

    Full Text Available Cerebral aneurysms are local expansions of blood vessel walls in the brain blood system. The rupture of an aneurysm is a very severe event associated with a high rate of mortality. When cerebral aneurysms are detected, clinicians need to decide if operation is required. The risk of aneurysm rupture is then compared to the risks associated with the medical intervention. In the present paper, a probabilistic framework for a mechanically based rupture risk assessment of cerebral aneurysms is proposed. The method is based on the assumption that the strength of aneurysmal tissues can be described by a statistical distribution. A structural analysis of the aneurysm in question is performed, and the maximum stress experienced by the aneurysm is compared to the strength distribution. The proposed model was compared with clinical results for ruptured aneurysms in terms of rupture density and accumulated rupture risk as a function of aneurysm size. The model was able to reproduce the clinical results well. The proposed framework may potentially be used under in vivo conditions to predict the risk of rupture for diagnosed aneurysms.

  3. Natriuretic peptides and cerebral hemodynamics

    DEFF Research Database (Denmark)

    Guo, Song; Barringer, Filippa; Zois, Nora Elisabeth;

    2014-01-01

    decompensated disease. In contrast, their biological effects on the cerebral hemodynamics are poorly understood. In this mini-review, we summarize the hemodynamic effects of the natriuretic peptides with a focus on the cerebral hemodynamics. In addition, we will discuss its potential implications in diseases...... where alteration of the cerebral hemodynamics plays a role such as migraine and acute brain injury including stroke. We conclude that a possible role of the peptides is feasible as evaluated from animal and in vitro studies, but more research is needed in humans to determine the precise response on...... cerebral vessels....

  4. Risk of Familial Intracranial Aneurysm

    OpenAIRE

    J Gordon Millichap; Millichap, John J.

    2014-01-01

    Investigators at University Medical Center Utrecht, Netherlands, studied the yield of long-term (up to 20 years) screening for intracranial aneurysms in individuals with a positive family history (2 or more first-degree relatives) of aneurysmal subarachnoid hemorrhage (aSAH) or unruptured intracranial aneurysm (1993-2013).

  5. Timing of Surgery for Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Enayatollah Abbas Nejad

    2012-05-01

    Full Text Available Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH, the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4% in early period after SAH (first 4 days and in 20 cases (28.6% in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54±13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2% of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%. The most common site of aneurysms was anterior communicating artery (41.4%, followed by middle cerebral artery (35.7%. The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46±9.36 vs. 22.5±7.97 days; P=0.01. The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.

  6. Hemodynamics in an Aorta with Bicuspid and Trileaflet Valves

    Science.gov (United States)

    Gilmanov, Anvar; Sotiropoulos, Fotis

    2015-11-01

    Bicuspid aortic valve (BAV) is a congenital heart defect that has been associated with serious aortopathies, such as ascending aortic aneurysm, aortic stenosis, aortic regurgitation, infective endocarditis, aortic dissection, calcific aortic valve and dilatation of ascending aorta. Two main hypotheses - the genetic and the hemodynamic are discussed in literature to explain the development and progression of aortopathies in patients with BAV. In this study we seek to investigate the possible role of hemodynamic factors as causes of BAV-associated aortopathy. We employ the Curvilinear Immersed Boundary (CURVIB) method coupled with an efficient thin-shell finite element (TS-FE) formulation for tissues to carry out fluid-structure interaction simulations of a healthy tri-leaflet aortic valve (TAV) and a BAV placed in the same anatomic aorta. The computed results reveal major differences between the TAV and BAV flow patterns. These include: the dynamics of the aortic valve vortex ring formation and break up; the large scale flow patterns in the ascending aorta; and the shear stress magnitude on the aortic wall. The computed results are in qualitative agreement with in vivo Magnetic Resonance Imaging (MRI) data and suggest that the linkages between BAV aortopathy and hemodynamics deserve further investigation. This work is supported by the Lillehei Heart Institute at the University of Minnesota and the Minnesota Supercomputing Institute.

  7. Blood flow dynamic improvement with aneurysm repair detected by a patient-specific model of multiple aortic aneurysms.

    Science.gov (United States)

    Sughimoto, Koichi; Takahara, Yoshiharu; Mogi, Kenji; Yamazaki, Kenji; Tsubota, Ken'ichi; Liang, Fuyou; Liu, Hao

    2014-05-01

    Aortic aneurysms may cause the turbulence of blood flow and result in the energy loss of the blood flow, while grafting of the dilated aorta may ameliorate these hemodynamic disturbances, contributing to the alleviation of the energy efficiency of blood flow delivery. However, evaluating of the energy efficiency of blood flow in an aortic aneurysm has been technically difficult to estimate and not comprehensively understood yet. We devised a multiscale computational biomechanical model, introducing novel flow indices, to investigate a single male patient with multiple aortic aneurysms. Preoperative levels of wall shear stress and oscillatory shear index (OSI) were elevated but declined after staged grafting procedures: OSI decreased from 0.280 to 0.257 (first operation) and 0.221 (second operation). Graftings may strategically counter the loss of efficient blood delivery to improve hemodynamics of the aorta. The energy efficiency of blood flow also improved postoperatively. Novel indices of pulsatile pressure index (PPI) and pulsatile energy loss index (PELI) were evaluated to characterize and quantify energy loss of pulsatile blood flow. Mean PPI decreased from 0.445 to 0.423 (first operation) and 0.359 (second operation), respectively; while the preoperative PELI of 0.986 dropped to 0.820 and 0.831. Graftings contributed not only to ameliorate wall shear stress or oscillatory shear index but also to improve efficient blood flow. This patient-specific modeling will help in analyzing the mechanism of aortic aneurysm formation and may play an important role in quantifying the energy efficiency or loss in blood delivery. PMID:23852404

  8. Verminous aneurysm caused by filaria.

    Science.gov (United States)

    Toledo, F V; de Araújo, A P; da Cunha, A M; Sidow, J R; Pavão, S G; de Araújo, E D

    1983-06-01

    Aneurysms caused by atherosclerosis are relatively frequent, as a consequence of the high incidence of this degenerative disease of the arteries. Other types of aneurysm, for example, those of infectious etiology, are more uncommon. Bacterias and fungi are able to cause aneurysms in several parts of the arterial tree. Stengel et al (1943), in a review of world literature described 217 cases of mycotic aneurysms. The Stedman's Medical Dictionary refers to a special type of aneurysm observed in horses, caused by intra-vascular migration of a worm, the Strongylus vulgaris. It has been named verminous aneurysm and generally involves the mesenteric arteries. We haven't found in medical literature any similar observations refering to human cases. The purpose of this paper is to describe a case of aneurysm the etiology of which we have imputed to the filaria (Wuchereria bancrofti). This case was observed in Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil. PMID:6346961

  9. Transcriptional (ChIP-Chip) Analysis of ELF1, ETS2, RUNX1 and STAT5 in Human Abdominal Aortic Aneurysm.

    Science.gov (United States)

    Pahl, Matthew C; Erdman, Robert; Kuivaniemi, Helena; Lillvis, John H; Elmore, James R; Tromp, Gerard

    2015-01-01

    We investigated transcriptional control of gene expression in human abdominal aortic aneurysm (AAA). We previously identified 3274 differentially expressed genes in human AAA tissue compared to non-aneurysmal controls. Four expressed transcription factors (ELF1, ETS2, STAT5 and RUNX1) were selected for genome-wide chromatin immunoprecipitation. Transcription factor binding was enriched in 4760 distinct genes (FDR < 0.05), of which 713 were differentially expressed in AAA. Functional classification using Gene Ontology (GO), KEGG, and Network Analysis revealed enrichment in several biological processes including "leukocyte migration" (FDR = 3.09 × 10-05) and "intracellular protein kinase cascade" (FDR = 6.48 × 10-05). In the control aorta, the most significant GO categories differed from those in the AAA samples and included "cytoskeleton organization" (FDR = 1.24 × 10-06) and "small GTPase mediated signal transduction" (FDR = 1.24 × 10-06). Genes up-regulated in AAA tissue showed a highly significant enrichment for GO categories "leukocyte migration" (FDR = 1.62 × 10-11), "activation of immune response" (FDR = 8.44 × 10-11), "T cell activation" (FDR = 4.14 × 10-10) and "regulation of lymphocyte activation" (FDR = 2.45 × 10-09), whereas the down-regulated genes were enriched in GO categories "cytoskeleton organization" (FDR = 7.84 × 10-05), "muscle cell development" (FDR = 1.00 × 10-04), and "organ morphogenesis" (FDR = 3.00 × 10-04). Quantitative PCR assays confirmed a sub-set of the transcription factor binding sites including those in MTMR11, DUSP10, ITGAM, MARCH1, HDAC8, MMP14, MAGI1, THBD and SPOCK1. PMID:25993293

  10. Transcriptional (ChIP-Chip Analysis of ELF1, ETS2, RUNX1 and STAT5 in Human Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Matthew C. Pahl

    2015-05-01

    Full Text Available We investigated transcriptional control of gene expression in human abdominal aortic aneurysm (AAA. We previously identified 3274 differentially expressed genes in human AAA tissue compared to non-aneurysmal controls. Four expressed transcription factors (ELF1, ETS2, STAT5 and RUNX1 were selected for genome-wide chromatin immunoprecipitation. Transcription factor binding was enriched in 4760 distinct genes (FDR < 0.05, of which 713 were differentially expressed in AAA. Functional classification using Gene Ontology (GO, KEGG, and Network Analysis revealed enrichment in several biological processes including “leukocyte migration” (FDR = 3.09 × 10−05 and “intracellular protein kinase cascade” (FDR = 6.48 × 10−05. In the control aorta, the most significant GO categories differed from those in the AAA samples and included “cytoskeleton organization” (FDR = 1.24 × 10−06 and “small GTPase mediated signal transduction” (FDR = 1.24 × 10−06. Genes up-regulated in AAA tissue showed a highly significant enrichment for GO categories “leukocyte migration” (FDR = 1.62 × 10−11, “activation of immune response” (FDR = 8.44 × 10−11, “T cell activation” (FDR = 4.14 × 10−10 and “regulation of lymphocyte activation” (FDR = 2.45 × 10−09, whereas the down-regulated genes were enriched in GO categories “cytoskeleton organization” (FDR = 7.84 × 10−05, “muscle cell development” (FDR = 1.00 × 10−04, and “organ morphogenesis” (FDR = 3.00 × 10−04. Quantitative PCR assays confirmed a sub-set of the transcription factor binding sites including those in MTMR11, DUSP10, ITGAM, MARCH1, HDAC8, MMP14, MAGI1, THBD and SPOCK1.

  11. 颅内动脉瘤介入术前血小板功能分析%Analysis of platelet function in patients with aneurysm when inventional operation

    Institute of Scientific and Technical Information of China (English)

    王鹏; 王实; 焦德让; 张赛

    2011-01-01

    目的 探讨颅内动脉瘤患者血小板功能的各项指标并分析破裂急性期与未破裂期的差别,以及决策是否在急诊介入手术中应用抗血小板或抗凝药物.方法 采用Sonoclot血小板功能检测仪对50例颅内动脉瘤患者进行检测,分为急性自发性蛛网膜下腔出血患者即破裂组25例,未破裂组25例,测量计算凝血曲线的各项指标并进行对比.结果 破裂组急性期均出现不同程度的血小板功能降低,与未破裂组相比差别有统计学意义(P<0.05).破裂组动脉瘤急性期血小板功能低于未破裂组(P<0.05),主要体现在R2和R3这2个曲线段,即纤维蛋白与血小板之间交联后产生的凝血收缩能力,以及进一步凝血收缩到完成的能力,前者低于后者.结论 颅内动脉瘤破裂急性期血小板功能低于未破裂者,其介入手术给予肝素化及术后应用抗血小板药时需慎重.%Objective To explore each index of platelet function in patients with intracranial aneurysms and analysis the differences between ruptured when acute case and unruptured, and decide whether using the anti-platelet or anti-coagulation drugs when the emergency interventional operation. Methods Sonoclot platelet function detector was used to detect the platelet function of 50 cases patients catching intracranial aneurysms, included acute spontaneous subarachnoid hemorrhage (SAH) in 25 cases (rupture group) and 25 patients with unruptured aneurysms (unruptured group) ,then measured and calculated each indicators of the coagulation curve and compared that. Results The study demonstrated that there was different degree of reduced in platelet function while acute period in rupture group,and had statistical differences compared with unruptured group ( P < 0.05 ). In other words, the platelet function in rupture group was inferior to which in unruptured group( P < 0.05), mainly reflecting in coagulation curve R2 and R3 segment,that was to say,the blood

  12. Matched Cohort Analysis of the Effects of Limb Remote Ischemic Conditioning in Patients with Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Laiwalla, Azim N; Ooi, Yinn Cher; Liou, Raymond; Gonzalez, Nestor R

    2016-02-01

    Remote ischemic conditioning (RIC) is a powerful innate response to transient subcritical ischemia that protects against severe ischemic insults at distant sites. We have previously shown the safety and feasibility of limb RIC in aneurysmal subarachnoid hemorrhage (aSAH) patients, along with changes in neurovascular and cerebral metabolism. In this study, we aim to detect the potential effect of an established lower-limb conditioning protocol on clinical outcomes of aSAH patients. Neurologic outcome (modified Rankin Scale (mRS)) of patients enrolled in a prospective trial (RIPC-SAH) was measured. A matching algorithm was applied to identify control patients with aSAH from an institutional departmental database. RIC patients underwent four lower-limb conditioning sessions, consisting of four 5-min cycles per session over nonconsecutive days. Good functional outcome was defined as mRS of 0 to 2. The study population consisted of 21 RIC patients and 61 matched controls. There was no significant intergroup difference in age, gender, aneurysm location, clipping vs coiling, Fisher grades, Hunt and Hess grades, or vasospasm. RIC was independently associated with good outcome (OR 5.17; 95% confidence interval (CI) 1.21-25.02). RIC also showed a trend toward lower incidence of stroke (28.6 vs. 47.5%) and death (4.8 vs. 19.7%). Lower-limb RIC following aSAH appears to have a positive effect in the functional outcomes of patients with aSAH. While this effect is consistent with prior preclinical studies, future trials are necessary to conclusively evaluate the effects of RIC for aSAH. PMID:26630942

  13. What You Should Know about Cerebral Aneurysms

    Science.gov (United States)

    ... T. Quiz 5 Things to Know About Stroke What You Should Know About Cerebral Aneurysms Updated:Jun ... Damage Treatments Click image to view an animation What is a cerebral aneurysm? An aneurysm is a ...

  14. Endovascular management of vein of galen aneurysm malformation: A series of two case reports

    Directory of Open Access Journals (Sweden)

    Lakshmi Sudha Prasanna Karanam

    2011-01-01

    Full Text Available Vein of Galen Aneurysm malformation is one of the most difficult intracranial vascular lesions to manage. The difficulty in management of its shunts is aggravated by the hemodynamic effect and shunting reflected in the growing brain of infants and children. At present, the therapeutic options are widened by the opening of a new horizon in Intervention Neuroradiology. We present a series of two case reports of these malformations treated using the endovascular method, at our institution.

  15. Cerebral hemodynamics in migraine

    DEFF Research Database (Denmark)

    Hachinski, V C; Olesen, Jes; Norris, J W;

    1977-01-01

    Clinical and angiographic findings in migraine are briefly reviewed in relation to cerebral hemodynamic changes shown by regional cerebral blood flow (rCBF) studies. Three cases of migraine studied by the intracarotid xenon 133 method during attacks are reported. In classic migraine, with typical...... prodromal symptoms, a decrease in cerebral blood flow has been demonstrated during the aura. Occasionally, this flow decrease persists during the headache phase. In common migraine, where such prodromata are not seen, a flow decrease has not been demonstrated. During the headache phase of both types of...... migraine, rCBF has usually been found to be normal or in the high range of normal values. The high values may represent postischemic hyperemia, but are probably more frequently secondary to arousal caused by pain. Thus, during the headache phase rCBF may be subnormal, normal or high. These findings do not...

  16. Invasive hemodynamic assessment of pulmonary hypertension

    OpenAIRE

    Pagnamenta, Alberto

    2015-01-01

    The diagnosis of pulmonary hypertension requires an invasive confirmation of an elevated mean pulmonary artery pressure during a right heart catheterization. The present thesis reviews the invasive hemodynamic approaches to assess the functional state of the pulmonary circulation and its impact on right ventricular function in pulmonary vascular diseases. Pulmonary vascular resistance is better characterized by multi-point pressure/flow measurements. The occlusion analysis of the pulmonary ar...

  17. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... past three years, and his aneurysm has now grown to 5.4 centimeters. And this is actually ... that looks like kind of railroad tracks going up and down, that’s the catheter that we’re ...

  18. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... for all of you listening, you can ask online. Just click the “Ask a question” button, and ... aneurysm. Please feel free to ask any questions online. Just click “Ask a question,” and they’ll ...

  19. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... racquet-like device whether or not there is flow in this sack after we replace in aneurysm. ... space age. That’s fine. Don’t go too high. Pull it down a little bit. Pull that ...

  20. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an interventional radiologist. That’s a specialty many people haven’t heard of, but that’s a specialty that ... in that patient’s abdominal sack. Now remember we haven’t treated his aneurysm. We’re sort of ...

  1. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to repair an abdominal aortic aneurysm using a technology called an “endograft,” which is sometimes called the “ ... separate area, and it’s because of this small technology that allows you to do this. Exactly. So ...

  2. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an aneurysm, it’s important that you ask your doctor about your options. As I said, about 80 percent of the patients we treat end up -- 80 or 90 percent these days, end up being good candidates for this type of therapy. We would encourage you to seek the least ...

  3. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an abdominal aortic aneurysm. Normally this procedure takes us about 45 minutes to an hour of doctor work time, which is, I think, a fairly quick procedure to replace a major life-threatening problem in the patient’s abdomen. So you can see ...

  4. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... microchip that acts a little bit like a cell phone technology. We’ll show you how that works. But this is the device that we’re going to put in that space between the endograft and the patient to the wall of the aneurysm. So in that space where ...

  5. Epidemiological study of 183 patients with spontaneous rupture of cerebral aneurysm

    International Nuclear Information System (INIS)

    Cerebral vessels aneurysms represent a significant part of the cerebral vessels pathology. There is no extensive study on that in Bulgaria. We present a study of 183 patients with spontaneous rupture of cerebral aneurysm, diagnosed and treated in UMHATEM ‘Pirogov’, Sofia. We used clinical methods - data from subject history, analysis of the accompanying documentation, subject medical chart; imaging-diagnostics methods - CT, DSA and MRI; and statistical methods. A total of 183 patients with ruptured intracranial aneurysms were studied. 65% were females and 35% were men.The ration female/male is 1.86, The mean age of all patients is 53.1 ±10.1 years. The highest incidence of ruptured aneurysms is seen in the age group 50 to 59 years. Aneurysms of a. cerebri media and a. communicants anterior are the most frequent (63.4% in total); while the lest are those of a basilaris (4.9%). 88.5% of the aneurysms in the studied group are small, 9.8% are large and 1.6% are giant. Intracranial hematomas are seen in 13.1% of the patients with ruptured aneurysms. Most frequently hematomas are connected with a. cerebri media and a.communicants anterior (87.5% in total). Patients with multiple aneurysms are 11.5% in total, 85.7% of them with an aneurysm of a.cerebri media. The incidence of ruptured cerebral aneurysms is higher amongst female. Frequency in the fifth decade of life is the highest. Most often seen are the aneurysms of a. cerebri media and a. communicants anterior, and the least - those of a. basilaris. Intracranial hematomas most frequently are associated with ruptures of a. cerebri media and a. communicants anterior, in patients with multiple aneurysms the highest is the frequency of aneurysms of a. cerebri media. (authors)

  6. Abdominal aortic aneurysm: Treatment options, image visualizations and follow-up procedures

    Institute of Scientific and Technical Information of China (English)

    Zhong-Hua Sun

    2012-01-01

    Abdominal aortic aneurysm is a common vascular disease that affects elderly population.Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm,however,endovaseular aneurysm repair has rapidly expanded since its first introduction in 1990s.As a less invasive technique,endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair,especially in patients with co-morbid conditions.Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up.2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair.CT has the disadvantage of high cummulative radiation dose,of particular concern in younger patients,since patients require regular imaging follow-ups after endovascular repair,thus,exposing patients to repeated radiation exposure for life.There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair.Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts,but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta.This article reviews the treatment options of abdominal aortic aneurysm,various image visualization tools,and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods.Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.

  7. CT features of mycotic aneurysms

    International Nuclear Information System (INIS)

    To describe CT features of mycotic aneurysms. We have retrospectively checked 10 patients diagnosed with mycotic aneurysm. Three revealed previously treated arteriosclerotic aneurysms, one was diabetic and had undergone a reno pancreatic transplant,and another presented advanced HIV infection. They al presented fever syndrome and eight exhibited leucocytosis. Mycotic aneurysm diagnosis was made by means of CT findings, clinical examination and positive hemo culture in all cases. Anatomopathological findings were available as confirmation for all four surgically treated patients. The CT scan was performed during arterial phase with spiral acquisition, without contrast and with endo venous administration of a contrast medium. Saccular aneurysms were found in seven patients (double aneurysms in the case of two), with seven of these being abdominal aneurysms (one retrocrural aortic,three infra renal aortic, and three iliac arteries) and two thoracic (aortic arch). In all three remaining patients, there was a pre-existing arteriosclerotic aneurysm (fusiform) and only incipient changes were observed in the adjacent fat. Perianeurysmatic soft-tissue was was noted in eight cases. Only two patients presented signs of tear (peri aneurysm hematoma and/or with contrast extravasation). In three cases, the calcium ring was disrupted. In two patients, absences were observed in other locations. In none of the cases was there gas in the aneurysm wall. Mycotic aneurysm is a rate entity, but must be considered in the evaluation of septic patients since it demands early diagnosis and treatment. In such patients, a CT finding of saccular aneurysm with adjacent soft-tissue mass, and associated with a positive hemo culture, is highly suggestive of this pathology. (Author) 9 refs

  8. Interventional embolization with coils in the way of 'sandwich pattern' for the treatment of large splenic aneurysms: a therapeutic analysis of six cases

    International Nuclear Information System (INIS)

    Objective: To assess the feasibility and effectiveness of interventional embolization with coils in the way of 'sandwich pattern' for the treatment of large splenic aneurysms. Methods: From March 2000 to December 2008, the authors had treated six patients with large splenic aneurysms (4 females and 2 males; mean age 54 years) by means of interventional embolization with coils in the way of 'sandwich pattern'. There were 5 true splenic aneurysms, of which 2 were located at the origin of the splenic artery and 3 at the middle segment of the splenic artery. The remaining one lesion was a pseudo aneurysm that was located at the middle segment of the splenic artery. The diagnosis was confirmed by colour-Doppler ultrasonography and/or CT-angiography in all patients. Interventional embolization with coils in the way of 'sandwich pattern' was performed in all patients. Both the efferent and afferent arteries of the splenic aneurysms were embolized successively, the procedure was thus called 'sandwich pattern' way. The patients were followed up for 1 to 9 years. Based on CT angiographic manifestations, colour-Doppler ultrasound findings and clinical conditions the therapeutic results were evaluated. Results: All the six splenic aneurysms were successfully isolated by interventional embolization in 'sandwich pattern' way, with no occurrence of severe complications. One patient died from malignant bone tumor four months after the treatment. The followup CT imaging showed no signs of re-canalization of the lesions in other 5 cases, although small-sized, fan-shaped splenic infarction was seen in 2 cases. Conclusion: Interventional embolization with coils in the way of 'sandwich pattern' is a safe and effective technique for the treatment of splenic aneurysms, especially valuable when the aneurysm is a large one. (authors)

  9. A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed.

    OpenAIRE

    Hannan, E L; Kilburn, H; O'Donnell, J. F.; Bernard, H R; Shields, E P; Lindsey, M L; Yazici, A.

    1992-01-01

    This study uses New York State hospital discharge data to examine the relationship between in-hospital mortality for a patient receiving an abdominal aortic aneurysm resection and the volume of aneurysm operations performed in the previous year at the hospital where the operation took place and by the surgeon performing the operation. Previous research on this topic is extended in several respects: (1) A three-year data base is used to examine the manner in which hospital and surgeon volume j...

  10. Management of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Nasr, Deena M; Brown, Robert D

    2016-09-01

    Unruptured intracranial aneurysms (UIA) occur in approximately 2-3 % of the population. Most of these lesions are incidentally found, asymptomatic and typically carry a benign course. Although the risk of aneurysmal subarachnoid hemorrhage is low, this complication can result in significant morbidity and mortality, making assessment of this risk the cornerstone of UIA management. This article reviews important factors to consider when managing unruptured intracranial aneurysms including patient demographics, comorbidities, family history, symptom status, and aneurysm characteristics. It also addresses screening, monitoring, medical management and current surgical and endovascular therapies. PMID:27443382

  11. Differential Sex Response to Aspirin in Decreasing Aneurysm Rupture in Humans and Mice.

    Science.gov (United States)

    Chalouhi, Nohra; Starke, Robert M; Correa, Tatiana; Jabbour, Pascal M; Zanaty, Mario; Brown, Robert D; Torner, James C; Hasan, David M

    2016-08-01

    We previously found that aspirin decreases the risk of cerebral aneurysm rupture in humans. We aim to assess whether a sex differential exists in the response of human cerebral aneurysms to aspirin and confirm these observations in a mouse model of cerebral aneurysm. A nested case-control analysis from the International Study of Unruptured Intracranial Aneurysms was performed to assess whether a sex differential exists in the response of human cerebral aneurysms to aspirin. A series of experiments were subsequently performed in a mouse model of cerebral aneurysms. Aneurysms were induced with hypertension and elastase injection into mice basal cisterns. We found that aspirin decreased the risk of aneurysm rupture more significantly in men than in women in the International Study of Unruptured Intracranial Aneurysms. In mice, aspirin and cyclooxygenase-2 inhibitor did not affect cerebral aneurysm formation but significantly decreased the incidence of rupture. The incidence of rupture was significantly lower in male versus female mice on aspirin. Gene expression analysis from cerebral arteries showed higher 15-hydroxyprostaglandin dehydrogenase levels in male mice. The rate of cerebral aneurysm rupture was similar in male mice receiving aspirin and 15-hydroxyprostaglandin dehydrogenase inhibitor compared with females receiving aspirin and 15-hydroxyprostaglandin dehydrogenase agonist, signaling a reversal of the sex-differential response to aspirin. Aspirin decreases aneurysm rupture in human and mice, in part through cyclooxygenase-2 pathways. Evidence from animal and human studies suggests a consistent differential effect by sex. 15-Hydroxyprostaglandin dehydrogenase activation in females reduces the incidence of rupture and eliminates the sex-differential response to aspirin. PMID:27296993

  12. Assessment of Cerebral Hemodynamic Changes in Pediatric Patients with Moyamoya Disease Using Probabilistic Maps on Analysis of Basal/Acetazolamide Stress Brain Perfusion SPECT

    International Nuclear Information System (INIS)

    hemispheres with EDAS and frontal EGS, the post-operative CVRI, and ΔCVRI showed a significant difference between patients with a good and poor clinical outcome (p<0.05). In a multivariate logistic regression analysis, the ΔCVRI and the post-operative CVRI of medial frontal gyrus on the hemispheres where EDAS with frontal EGS was performed were the significant predictive factors for the clinical outcome (p=0.002, p=0.015). With probabilistic map, we could objectively evaluate pre/post-operative hemodynamic changes of pediatric patients with moyamoya disease. Specifically the post-operative CVRI and the post-operative CVRI of medial frontal gyrus where EDAS with frontal EGS was done were the significant predictive factors for further clinical outcomes

  13. Hemodynamic and genetic analysis in children with idiopathic, heritable, and congenital heart disease associated pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    Pfarr Nicole

    2013-01-01

    Full Text Available Abstract Background Aim of this prospective study was to compare clinical and genetic findings in children with idiopathic or heritable pulmonary arterial hypertension (I/HPAH with children affected with congenital heart defects associated PAH (CHD-APAH. Methods Prospectively included were 40 consecutive children with invasively diagnosed I/HPAH or CHD-APAH and 117 relatives. Assessment of family members, pedigree analysis and systematic screening for mutations in TGFß genes were performed. Results Five mutations in the bone morphogenetic protein type II receptor (BMPR2 gene, 2 Activin A receptor type II-like kinase-1 (ACVRL1 mutations and one Endoglin (ENG mutation were found in the 29 I/HPAH children. Two mutations in BMPR2 and one mutation in ACVRL1 and ENG, respectively, are described for the first time. In the 11 children with CHD-APAH one BMPR2 gene mutation and one Endoglin gene mutation were found. Clinical assessment of relatives revealed familial aggregation of the disease in 6 children with PAH (HPAH and one CHD-APAH patient. Patients with mutations had a significantly lower PVR. Conclusion Mutations in different TGFß genes occurred in 8/29 (27.6% I/HPAH patients and in 2/11 (18.2% CHD-APAH patients and may influence the clinical status of the disease. Therefore, genetic analysis in children with PAH, especially in those with I/HPAH, may be of clinical relevance and shows the complexity of the genetic background.

  14. Clinical value of three-dimensional digital subtraction angiography in the endovascular treatment of intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    Tianxiao Li; Dengwei Zong

    2006-01-01

    originated from the aneurysm; ③ Feasibility of endovascular occlusion: Whether the feasibility of endovascular occlusion could be judged based on the vascular anatomic form. The evaluative standards for the former two were cannot display, reluctantly display and clearly display, and those for the latter one were uncertain, possible but uncertain; certainly could not or certainly could be treated with endovascular occlusion. MAIN OUTCOME MEASURES: The images of 2D DSA and 3D DSA were observed and compared; The differences in the display of aneurysm neck, display of aneurysm form and feasibility of endovascular occlusion were compared between 2D DSA and 3D DSA. RESULTS: All the 44 patients with intracranial aneurysm (50 aneurysms) were involved in the analysis. ① Aneurysm necks displayed by 2D DSA and 3D DSA: Among the 50 ruptured aneurysms, the necks of 14 aneurysms could be clearly displayed by 2D DSA; 3D DSA could display the necks of all the aneurysm. ② Comparison of the the forms of aneurysm displayed by 2D DSA and 3D DSA: 2D DSA could clearly display the forms of 26 (36%) aneurysms; Whereas the 3D DSA with volume reconstruction clearly displayed the forms of all the aneurysms. ③ Feasibility of endovascular occlusion evaluated by 2D DSA and 3D DSA: 2D DSA believed that 6 cases were certainly unable to be treated with endovascular occlusion. 3D DSA showed that all the aneurysms were certainly able to be treated with endovascular occlusion, which was successfully performed. The reference images were obtained from the 3D DSA images in all the 49 aneurysms at the occlusion. The first spring ring was correctly selected for 48 aneurysms. CONCLUSION: 3D DSA can clearly display the form of the aneurysm, and the relationship between the aneurysm neck and the neighboring vessels, and it is helpful for obtaining the reference images in the endovascular occlusion of intracranial aneurysm; The diameter and length of the first spring ring can be correctly selected by the

  15. Transluminal color-coded three-dimensional magnetic resonance angiography for visualization of signal Intensity distribution pattern within an unruptured cerebral aneurysm: preliminarily assessment with anterior communicating artery aneurysms

    International Nuclear Information System (INIS)

    The natural history of unruptured cerebral aneurysm is not known; also unknown is the potential growth and rupture in any individual aneurysm. The authors have developed transluminal color-coded three-dimensional magnetic resonance angiography (MRA) obtained by a time-of-flight sequence to investigate the interaction between the intra-aneurysmal signal intensity distribution patterns and configuration of unruptured cerebral aneurysms. Transluminal color-coded images were reconstructed from volume data of source magnetic resonance angiography by using a parallel volume-rendering algorithm with transluminal imaging technique. By selecting a numerical threshold range from a signal intensity opacity chart of the three-dimensional volume-rendering dataset several areas of signal intensity were depicted, assigned different colors, and visualized transparently through the walls of parent arteries and an aneurysm. Patterns of signal intensity distribution were analyzed with three operated cases of an unruptured anterior communicating artery aneurysm and compared with the actual configurations observed at microneurosurgery. A little difference in marginal features of an aneurysm was observed; however, transluminal color-coded images visualized the complex signal intensity distribution within an aneurysm in conjunction with aneurysmal geometry. Transluminal color-coded three-dimensional magnetic resonance angiography can thus provide numerical analysis of the interaction between spatial signal intensity distribution patterns and aneurysmal configurations and may offer an alternative and practical method to investigate the patient-specific natural history of individual unruptured cerebral aneurysms. (orig.)

  16. Assessment Of Coronary Artery Aneurysms Using Transluminal Attenuation Gradient And Computational Modeling In Kawasaki Disease Patients

    Science.gov (United States)

    Grande Gutierrez, Noelia; Kahn, Andrew; Shirinsky, Olga; Gagarina, Nina; Lyskina, Galina; Fukazawa, Ryuji; Owaga, Shunichi; Burns, Jane; Marsden, Alison

    2015-11-01

    Kawasaki Disease (KD) can result in coronary artery aneurysms (CAA) in up to 25% of patients, putting them at risk of thrombus formation, myocardial infarction and sudden death. Clinical guidelines recommend CAA diameter >8 mm as the arbitrary criterion for initiating systemic anticoagulation. KD patient specific modeling and flow simulations suggest that hemodynamic data can predict regions at increased risk of thrombosis. Transluminal Attenuation Gradient (TAG) is determined from the change in radiological attenuation per vessel length and has been proposed as a non-invasive method for characterizing coronary stenosis from CT Angiography. We hypothesized that CAA abnormal flow could be quantified using TAG. We computed hemodynamics for patient specific coronary models using a stabilized finite element method, coupled numerically to a lumped parameter network to model the heart and vascular boundary conditions. TAG was quantified in the major coronary arteries. We compared TAG for aneurysmal and normal arteries and we analyzed TAG correlation with hemodynamic and geometrical parameters. Our results suggest that TAG may provide hemodynamic data not available from anatomy alone. TAG represents a possible extension to standard CTA that could help to better evaluate the risk of thrombus formation in KD.

  17. An experimental and clinical study on the dissecting aortic aneurysm

    International Nuclear Information System (INIS)

    In the treatment of dissecting aortic aneurysm, it is important to understand the exact conditions of the disease. For this purpose Aortography (AOG) and X-ray computorized tomography (CT) have been used. Magnetic Resonance Imaging (MRI) and the ultrasonic pulsed Doppler duplex system are completely non-invasive and may be used instead of AOG and CT. Experimental aortic dissection was done surgically using modified Blanton's method in 8 mongrel dogs. MRI and the ultrasonic pulsed Doppler duplex system were used on these dogs before and after surgery which consisted of surgical closure of entry and insertion of Ivalon Sponge to false lumen. MRI patterns were classified into three: i.e, low, middle, and high intensity. The ultrasonic pulsed Doppler duplex system patterns were classified into four: i.e, normal flow, to and fro, turbulent flow and wall motion patterns respectively. These patterns of MRI and the ultrasonic pulsed Doppler duplex system were closely correlated to autopsy findings. These results indicated that MRI and the ultrasonic pulsed Doppler duplex system are useful to evaluate the changes of figures and hemodynamics of the false lumen. In the clinical study, MRI was performed on 26 patients of dissecting aortic aneurysm before and after surgery. These results were compared with those of AOG and CT. In the detection of the intimal flap, the main arterial branches, and the location of the entry and reentry, MRI was superior to CT and almost equal to AOG. key words: dissecting aortic aneurysm, hemodynamics of aortic dissection, the Ivalon Sponge Occlusion method, MRI, the ultrasonic pulsed Doppler duplex system. (author)

  18. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B; Olsen, P S; Perko, M J; Agerskov, Kim; Røder, O; Lorentzen, Jørgen Ewald

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 55......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems.......The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553...

  19. Intracranial aneurysm and sildenafil.

    Science.gov (United States)

    Adiga, Avinash; Edriss, Hawa; Nugent, Kenneth

    2016-04-01

    Sildenafil is one of the most commonly used drugs for the treatment of erectile dysfunction. To date, we found five reported cases of intracerebral bleeding and two reported cases of subarachnoid hemorrhage related to sildenafil use. We report a 49-year-old hypertensive and diabetic patient who presented with acute pulmonary edema and loss of consciousness following ingestion of 100 mg of sildenafil prior to sexual intercourse. He was not previously aware of the presence of an aneurysm and had no family history of it. Computed tomography of his head revealed a subarachnoid hemorrhage due to rupture of a saccular aneurysm with subsequent repeat hemorrhage within a few hours of presentation. A sudden increase in blood pressure led to pulmonary edema. Studies have shown that sildenafil acts on phosphodiesterase-1, -2 and -5 receptors and leads to a secondary increase in intracerebral circulation and vasodilatory effects, leading to sympathetic overactivity which increases the risk for intracranial bleeding. PMID:27034561

  20. Pediatric intracranial aneurysms

    OpenAIRE

    Tripathy L; Singh S

    2009-01-01

    The incidence of subarachnoid haemorrhage from intracranial aneurysms in the paediatric age group is extremely rare. Interestingly, occurrence of vasospasm has been reported to be less in comparison to the adults. Both coiling and clipping have been advocated in selected cases. Because of the thinness of the wall of the arteries, utmost care should be taken while handling these arteries during surgery. The overall results of surgery in children have been reported to be better than their adult...

  1. [Subarachnoid hemorrhage without aneurysm].

    Science.gov (United States)

    Müller-Forell, W; Welschehold, S; Köhler, J; Schicketanz, K H

    2002-11-01

    The rupture and bleeding of intracranial aneurysms is the most common cause of a spontaneous, non-traumatic subarachnoid hemorrhage (SAH). In up to 20% of these patients, no aneurysm is found, but the prognosis of these patients is known to be better than in those with aneurysms. The retrospective evaluation of the initial CT- and angiographic findings of 773 patients with spontaneous SAH, who underwent (up to three) 4-vessel DSA, brought a percentage of 12.4% with negative angiography. We found the favourable prognosis of these patients with negative angiography not only to be dependent from the distribution of the hemorrhage, with preference to perimesencephalic pattern, but the initial clinical state. 85% of our patients, who presented with perimesencephalic blood pattern and even 80% of those patients with additional intraventricular hemorrhage but the good clinical condition of Hunt-Hess I/II were discharged without neurological deficits. We recommend the obligatory 4-vessel catheter-angiography (DSA) in all patients with spontaneous SAH, independent of the blood pattern on initial CT, and one control in the presence of other than perimesencephalic subarachnoid hemorrhage, CTA might be reserved for additional controls. PMID:12458439

  2. Activation of Endocannabinoid System Is Associated with Persistent Inflammation in Human Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Christopher Gestrich

    2015-01-01

    Full Text Available Human aortic aneurysms have been associated with inflammation and vascular remodeling. Since the endocannabinoid system modulates inflammation and tissue remodeling, we investigated its components in human aortic aneurysms. We obtained anterior aortic wall samples from patients undergoing elective surgery for aortic aneurysm or coronary artery disease as controls. Histological and molecular analysis (RT-qPCR was performed, and endocannabinoid concentration was determined using LC-MRM. Patient characteristics were comparable between the groups except for a higher incidence of arterial hypertension and diabetes in the control group. mRNA level of cannabinoid receptors was significantly higher in aneurysms than in controls. Concentration of the endocannabinoid 2-arachidonoylglycerol was significantly higher, while the second endocannabinoid anandamide and its metabolite arachidonic acid and palmitoylethanolamide were significantly lower in aneurysms. Histology revealed persistent infiltration of newly recruited leukocytes and significantly higher mononuclear cell density in adventitia of the aneurysms. Proinflammatory environment in aneurysms was shown by significant upregulation of M-CSF and PPARγ but associated with downregulation of chemokines. We found comparable collagen-stained area between the groups, significantly decreased mRNA level of CTGF, osteopontin-1, and MMP-2, and increased TIMP-4 expression in aneurysms. Our data provides evidence for endocannabinoid system activation in human aortic aneurysms, associated with persistent low-level inflammation and vascular remodeling.

  3. Activation of Endocannabinoid System Is Associated with Persistent Inflammation in Human Aortic Aneurysm

    Science.gov (United States)

    Gestrich, Christopher; Duerr, Georg D.; Heinemann, Jan C.; Meertz, Anne; Probst, Chris; Roell, Wilhelm; Schiller, Wolfgang; Zimmer, Andreas; Bindila, Laura; Lutz, Beat; Welz, Armin; Dewald, Oliver

    2015-01-01

    Human aortic aneurysms have been associated with inflammation and vascular remodeling. Since the endocannabinoid system modulates inflammation and tissue remodeling, we investigated its components in human aortic aneurysms. We obtained anterior aortic wall samples from patients undergoing elective surgery for aortic aneurysm or coronary artery disease as controls. Histological and molecular analysis (RT-qPCR) was performed, and endocannabinoid concentration was determined using LC-MRM. Patient characteristics were comparable between the groups except for a higher incidence of arterial hypertension and diabetes in the control group. mRNA level of cannabinoid receptors was significantly higher in aneurysms than in controls. Concentration of the endocannabinoid 2-arachidonoylglycerol was significantly higher, while the second endocannabinoid anandamide and its metabolite arachidonic acid and palmitoylethanolamide were significantly lower in aneurysms. Histology revealed persistent infiltration of newly recruited leukocytes and significantly higher mononuclear cell density in adventitia of the aneurysms. Proinflammatory environment in aneurysms was shown by significant upregulation of M-CSF and PPARγ but associated with downregulation of chemokines. We found comparable collagen-stained area between the groups, significantly decreased mRNA level of CTGF, osteopontin-1, and MMP-2, and increased TIMP-4 expression in aneurysms. Our data provides evidence for endocannabinoid system activation in human aortic aneurysms, associated with persistent low-level inflammation and vascular remodeling. PMID:26539497

  4. The efficacy of pharmacotherapy for decreasing the expansion rate of abdominal aortic aneurysms: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Idris Guessous

    Full Text Available BACKGROUND: Pharmacotherapy may represent a potential means to limit the expansion rate of abdominal aortic aneurysms (AAAs. Studies evaluating the efficacy of different pharmacological agents to slow down human AAA-expansion rates have been performed, but they have never been systematically reviewed or summarized. METHODS AND FINDINGS: Two independent reviewers identified studies and selected randomized trials and prospective cohort studies comparing the growth rate of AAA in patients with pharmacotherapy vs. no pharmacotherapy. We extracted information on study interventions, baseline characteristics, methodological quality, and AAA growth rate differences (in mm/year. Fourteen prospective studies met eligibility criteria. Five cohort studies raised the possibility of benefit of beta-blockers [pooled growth rate difference: -0.62 mm/year, (95%CI, -1.00 to -0.24], but this was not confirmed in three beta-blocker RCTs [pooled RCT growth rate difference: -0.05 mm/year (-0.16 to 0.05]. Statins have been evaluated in two cohort studies that yield a pooled growth rate difference of -2.97 (-5.83 to -0.11. Doxycycline and roxithromycin have been evaluated in two RCTs that suggest possible benefit [pooled RCT growth rate difference: -1.32 mm/year (-2.89 to 0.25]. Studies assessing NSAIDs, diuretics, calcium channel blockers and ACE inhibitors, meanwhile, did not find statistically significant differences. CONCLUSIONS: Beta-blockers do not appear to significantly reduce the growth rate of AAAs. Statins and other anti-inflammatory agents appear to hold promise for decreasing the expansion rate of AAA, but need further evaluation before definitive recommendations can be made.

  5. [Large distal anterior cerebral artery aneurysm associated with azygos anterior cerebral artery: case report].

    Science.gov (United States)

    Suzuki, Y; Kawamata, T; Matsumoto, H; Kunii, N; Matsumoto, K

    1998-10-01

    A 51-year-old woman presented with a distal anterior cerebral artery aneurysm (DACAA) manifesting as severe headache and monoparesis of the left lower limb. Computed tomography revealed subarachnoid hemorrhage in the interhemispheric fissure, bilateral sylvian fissures, and basal cistern, and a hematoma in the supracallosal region. Angiography showed a large aneurysm (23 x 18 mm) located on the distal end of the azygos anterior cerebral artery (azygos ACA) at the supracallosal portion. T2-weighted magnetic resonance imaging demonstrated the hematoma as a mixed intensity mass, compressing the corpus callosum downward, and the aneurysm as a flow void anterior to the hematoma. Unilateral frontoparietal parasagittal craniotomy was performed with a horse-shoe shaped incision. The aneurysm was clipped via the interhemispheric approach, and the hematoma was aspirated. Postoperative angiography showed disappearance of the aneurysm and intact azygos ACA. The patient was discharged with mild monoparesis, paresthesia of the left lower limb and diagnostic dyspraxia. DACAA almost always arises at or near the genu of the corpus callosum and is often associated with vascular anomaly. In the literature, 22 of 26 cases of large and giant DACAA were located at or near the genu, but only 3 cases, including ours, in the supracallosal area. 11 cases were associated with azygos ACA. Therefore, hemodynamic stress caused by vascular anomaly may be involved in the formation of large or giant DACAA in contrast with cases of normal DACAA. PMID:9789300

  6. Giant superior mesenteric artery aneurysm

    OpenAIRE

    Temiz, Ahmet; Bostan, Mehmet; Şatıroğlu, Ömer; Çetin, Mustafa; Bozkurt, Engin

    2011-01-01

    Aneurysm of the superior mesenteric artery (SMA) is a rare condition and most of them are symptomatic. Gradu­ally increasing abdominal pain, intestinal ischemic symp­toms and rupture are the most common symptoms. We herein report a giant SMA aneurysm detected in a patient with complaint of abdominal discomfort.

  7. True aneurysm of brachial artery.

    Science.gov (United States)

    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms. PMID:20865459

  8. 18F-FDG PET-CT uptake is a feature of both normal diameter and aneurysmal aortic wall and is not related to aneurysm size

    International Nuclear Information System (INIS)

    Aortic metabolic activity is suggested to correlate with presence and progression of aneurysmal disease, but has been inadequately studied. This study investigates the 2-[18F] fluoro-2-deoxy-D-glucose (18F-FDG) uptake in a population of infra-renal abdominal aortic aneurysms (AAA), compared to a matched non-aneurysmal control group. The Positron Emission Tomography - Computed Tomography (PET/CT) database was searched for infra-renal AAA. Exclusion criteria were prior repair, vasculitis, and saccular/mycotic thoracic or thoraco-abdominal aneurysms. Matching of 159 non-aneurysmal (max) and target to background mediastinal blood pool ratio (TBR) were documented. Predictors of FDG uptake (age, sex, aortic diameter, hypertension, statin use, and diabetes) were assessed using univariate analysis. Follow-up questionnaires were sent to referring clinicians. Aneurysms (n = 151) and controls (n = 159) were matched (p > 0.05) for age, sex, diabetes, hypertension, smoking status, statin use, and indication for PET/CT. Median aneurysm diameter was 5.0 cm (range 3.2-10.4). On visual analysis there was no significant difference in the overall numbers with increased visual uptake 24 % (36/151) in the aneurysm group vs. 19 % (30/159) in the controls, p = ns. SUVmax was slightly lower in the aneurysm group vs. controls (mean (2 SD) 1.75(0.79) vs. 1.84(0.58), p = 0.02). However there was no difference in TBR between the AAA group and controls (mean (2 SD) 1.03 (0.46) vs. 1.05(0.31), p = 0.36). During a median 18 (interquartile range 8-35) months' follow-up 20 were repaired and four were confirmed ruptured. The level of metabolic activity as assessed by 18F-FDG PET/CT in infra-renal AAA does not correlate with aortic size and does not differ between aneurysms and matched controls. (orig.)

  9. Hemodynamic findings in patients with brain stroke

    OpenAIRE

    Siebert, Janusz; Gutknecht, Piotr; Molisz, Andrzej; Trzeciak, Bartosz; Nyka, Walenty

    2012-01-01

    Introduction Standard procedures carried out at a stroke department in patients after a cerebral event may prove insufficient for monitoring hemodynamic indices. Impedance cardiography enables hemodynamic changes to be monitored non-invasively. The aim of the work was to describe hemodynamic parameters in patients with acute phase of ischemic and hemorrhagic stroke and to analyse the correlation between the type of hemodynamic response and long-term prognosis. Material and methods The 45 cons...

  10. Effect of tilting on cerebral hemodynamics in preterm and term infants

    NARCIS (Netherlands)

    Pichler, G; van Boetzelar, MC; Muller, W; Urlesberger, B

    2001-01-01

    Tilting is known to cause changes in hemodynamics due to hydrostatic pressure. The present study is an analysis of changes in cerebral hemodynamics measured by near infrared spectroscopy (NIRS) following tilting up and down in preterm and term infants. A significantly different effect of tilting up

  11. Endovascular strategy for unruptured cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mangiafico, S., E-mail: mangiax@libero.it [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Guarnieri, G., E-mail: gianluigiguarnieri@hotmail.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Consoli, A., E-mail: onemed21@gmail.com [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Ambrosanio, G., E-mail: gambros@libero.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy)

    2013-10-01

    The treatment of unruptured intracranial aneurysms (UIAs) remains complex and not clearly defined. While for ruptured intracranial aneurysms the management and the treatment option (surgery or endovascular treatment) are well defined by several trials, for asymptomatic UIAs the best management is still currently uncertain. The rationale to treat an UIA is to prevent the rupture and its consequent SAH and all complications derived from hemorrhage or reduce/eliminate neurological palsy. Although this statement is correct, the indication to treat an UIA should be based on a correct balance between the natural history of UIA and treatment risk. Patient's clinical history, aneurysm characteristics, and strategy management influence the natural history of UIAs and treatment outcomes. In the last 10 years and more, two important large multicenter studies were performed in order to analysis of all these factors and to evaluate the best treatment option for UIAs. The aim of this paper is to try to synthesize the possible indications to the endovascular treatment (EVT), when and how to treat an UIA.

  12. Endovascular strategy for unruptured cerebral aneurysms

    International Nuclear Information System (INIS)

    The treatment of unruptured intracranial aneurysms (UIAs) remains complex and not clearly defined. While for ruptured intracranial aneurysms the management and the treatment option (surgery or endovascular treatment) are well defined by several trials, for asymptomatic UIAs the best management is still currently uncertain. The rationale to treat an UIA is to prevent the rupture and its consequent SAH and all complications derived from hemorrhage or reduce/eliminate neurological palsy. Although this statement is correct, the indication to treat an UIA should be based on a correct balance between the natural history of UIA and treatment risk. Patient's clinical history, aneurysm characteristics, and strategy management influence the natural history of UIAs and treatment outcomes. In the last 10 years and more, two important large multicenter studies were performed in order to analysis of all these factors and to evaluate the best treatment option for UIAs. The aim of this paper is to try to synthesize the possible indications to the endovascular treatment (EVT), when and how to treat an UIA

  13. ENDOVASCULAR TREATMENT OF SACCULAR CEREBRAL ANEURYSMS IN PATIENTS WITH PATHOLOGICAL KINKING AND LOOPING BRACHIOCEPHALIC ARTERIES IN ARTERIAL SPASM

    OpenAIRE

    Kuharuk, V.

    2013-01-01

    The objective — to analyses the results of endovascular treatment of cerebral aneurysm in patients with pathological kinking and looping in brachiocephalic arteries against the background of vasospasm. Materials and methods. The analysis of endovascular treatment of patients with saccular cerebral aneurysms was made in the neurosurgical department of Volyn Regional Hospital in 2008-2012. All patients that underwent various types of aneurysms and hemorrhage were operated by endovascular method...

  14. The role of vascular remodeling and inflammation in the pathogenesis of intracranial aneurysms.

    Science.gov (United States)

    Penn, David L; Witte, Samantha R; Komotar, Ricardo J; Sander Connolly, E

    2014-01-01

    While the mechanisms triggering pathogenesis of intracranial aneurysms have not been fully elucidated, different mechanisms have been proposed ranging from hemodynamic mechanisms to genetic predispositions. One mechanism that has been thoroughly explored is the physiological and pathological vascular remodeling that occurs in conjunction with inflammatory reactions resulting in the initiation and progression of these lesions. Both hemodynamic stimuli and vascular inflammation can trigger a series of biochemical reactions resulting in vascular smooth muscle cell apoptosis and migration causing thinned, dilated areas of the cerebral vasculature. In addition, an imbalance between extracellular matrix remodeling proteins, such as matrix metalloproteinases and their inhibitors, can result in accelerated degradation of the internal elastic lamina and the adventitial layers, further weakening the vessel. While these processes occur under normal physiological conditions, situations that alter their balance such as inflammation caused by cigarette smoking or cocaine usage or hypoxia induced under chronic hypertensive conditions can alter the delicate balance of these reactions potentiating pathological remodeling and aneurysm development. The present study represents a thorough literature review of the vascular remodeling and inflammatory components to aneurysmal pathogenesis. PMID:24120708

  15. Clinical and imaging features of intracranial arterial aneurysms in the pediatric population

    International Nuclear Information System (INIS)

    Intracranial arterial aneurysms (IAAs) are rare in children. Nevertheless, IAAs account for at least 10 % - 15 % of hemorrhagic strokes during the first two decades of life. Traditional vascular risk factors, which are common in the adult population, are generally absent in the pediatric population, engendering distinct modes of IAA pathogenesis. Classification of pediatric IAAs according to the pathogenetic mechanism shows eight distinct categories: idiopathic, traumatic, those due to excessive hemodynamic stress, vasculopathic, infectious, noninfectious inflammatory, oncotic, and familial. Pathogenetic mechanism is the best predictor of the clinical course of the disease, response to treatment, and long-term prognosis. The pathogenetic subtypes of pediatric IAA show characteristic and variably overlapping features. In most cases, IAAs manifesting during the first two decades of life are idiopathic. IAAs that are idiopathic, traumatic (second most common type), or due to excessive hemodynamic stresses (third most common type) account for more than 80 % of IAAs in the pediatric age group. Most of the remaining pediatric IAAs are the result of congenital cerebral aneurysmal arteriopathies or infection. Multiple IAAs are unusual in young children except in those with acquired (secondary to immune deficiency states) or congenital cerebral aneurysmal arteriopathies or infectious IAAs. (orig.)

  16. Enhanced recovery after elective open surgical repair of abdominal aortic aneurysm: a complementary overview through a pooled analysis of proportions from case series studies.

    Directory of Open Access Journals (Sweden)

    Sanderland J T Gurgel

    Full Text Available OBJECTIVES: To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS programs in elective open surgical repair (OSR of abdominal aortic aneurysm (AAA. BACKGROUND: Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes. METHODS: A review of PubMed, EMBASE and LILACS databases was conducted. As only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied. RESULTS: Thirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05]. CONCLUSION: This review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA.

  17. Direct clipping of a blister-like aneurysm in the supraclinoid segment of the internal carotid artery: a clinical analysis of nine cases.

    Science.gov (United States)

    Yu, Jinlu; Xu, Baofeng; Guo, Yunbao; Xu, Kan

    2015-01-01

    To investigate the method and outcome from direct clipping of a blister-like aneurysm (BBA) of the internal carotid artery supraclinoid segment. This study featured nine BBA patients, including eight females and one male. The patients presented subarachnoid hemorrhage (SAH) as the initial symptom and were diagnosed with BBA in the supraclinoid segment through a vascular exam and imaging. During the exam, the internal carotid artery was pressed to block the blood flow, and a transcranial Doppler (TCD) was performed to examine the blood flow in the (BBA) ipsilateral middle cerebral artery. The results showed that the blood flow was reduced by less than 40% in all nine patients. During surgery, a pterional craniotomy was used to fully expose the aneurysm for clipping. While clipping the aneurysm, the arterial wall at the root of the aneurysm was also clipped to improve stability. Intraoperative ultrasonography was performed before and after clipping to examine the blood flow in the parent artery, middle cerebral artery and anterior cerebral artery. Moreover, a TCD was performed within one week after surgery to monitor intracranial blood flow. During BBA clipping, four patients exhibited stenosis of the parent artery, but intraoperative ultrasonography showed adequate blood flow in the anterior cerebral artery and middle cerebral artery. TCD was performed within one week after surgery to examine the blood flow in the middle cerebral artery on the operative side; the TCD showed adequate blood flow. The patients recovered well after surgery and were discharged. Digital subtraction angiography (DSA) or computed tomography angiography (CTA) was performed six to 12 months after the surgery and showed no aneurysm relapse. Moreover, six patients exhibited no stenosis of the parent artery, 20% stenosis was observed in one patient, 30% stenosis was observed in one patient, and 50% stenosis was observed in one patient; none of the patients showed clinical symptoms, and all

  18. MCP-1, ICAM-1 and VCAM-1 are present in early aneurysmal dilatation in experimental rats

    International Nuclear Information System (INIS)

    Recent studies have suggested that inflammation actively participates in ascending aortic aneurysm formation. The aim of the present study was to evaluate the expression changes of adhesion molecules and MMPs in an experimental model of ascending aortic aneurysm induced by ascending aorta banding in Wistar rats. Twelve rats developed aortic dilation after ascending aorta banding treatment, while nine normal animals underwent surgery without banding were used as controls. Light microscope and scanning electron microscope showed that the wall of the ascending aorta became disorganized as well as infiltration by inflammatory cells in aneurysmal rats. By using immunohistochemical techniques, a significant increase in the immunostaining of MCP-1 was observed in the aneurysmal wall as compared to the normal aortic wall. Under similar experimental conditions, we also found that the immunostaining of ICAM-1 and VCAM-1 was markedly increased in the aneurysmal wall. In addition, gelatin zymo graphic analysis showed that the expression and activities of MMP-2 and MMP-9 were remarkably enhanced in the ascending aorta of ascending aortic aneurysmal rats as compared to normal rats. These results demonstrate that MCP-1, ICAM-1 and VCAM-1 are involved in the pathogenesis of ascending aortic aneurysm and an increase in the immunostaining and activity of MMP-2 and MMP-9 may promote the progression of ascending aortic aneurysm. (authors)

  19. Endovascular treatment of PICA aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mukonoweshuro, W.; Laitt, R.D.; Hughes, D.G. [Radiology Dept., Greater Manchester Neurosciences Unit, Hope Hospital, Salford, Manchester (United Kingdom)

    2003-03-01

    Endovascular treatment of aneurysms of the posterior inferior cerebellar artery (PICA) avoids manipulation of the brainstem or lower cranial nerves and should therefore carry a lower risk of neurological morbidity than surgical clipping. We reviewed our experience of 23 patients with PICA aneurysms treated by endovascular occlusion with Guglielmi detachable coils and documented their long-term outcome on follow-up. We observed a 28 day procedure-related neurological morbidity of 13% (3/23 patients). One patient suffered permanent neurological complications. There were no procedure-related deaths. None of our patients suffered a re-bleed from their treated aneurysms. Our series shows endovascular treatment of ruptured PICA aneurysms to be safe and effective. (orig.)

  20. Thoracic aortic aneurysm and dissection.

    Science.gov (United States)

    Goldfinger, Judith Z; Halperin, Jonathan L; Marin, Michael L; Stewart, Allan S; Eagle, Kim A; Fuster, Valentin

    2014-10-21

    Aortic dissection is the most devastating complication of thoracic aortic disease. In the more than 250 years since thoracic aortic dissection was first described, much has been learned about diseases of the thoracic aorta. In this review, we describe normal thoracic aortic size; risk factors for dissection, including genetic and inflammatory conditions; the underpinnings of genetic diseases associated with aneurysm and dissection, including Marfan syndrome and the role of transforming growth factor beta signaling; data on the role for medical therapies in aneurysmal disease, including beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors; prophylactic surgery for aneurysm; surgical techniques for the aortic root; and surgical and endovascular management of aneurysm and dissection for different aortic segments. PMID:25323262

  1. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Nordestgaard, Børge G; Grønbæk, Morten;

    2012-01-01

    from the Copenhagen City Heart Study followed for up to 34years and in 56,211 individuals from the Copenhagen General Population Study followed for up to 7years. RESULTS: During follow-up, 335 and 169 individuals developed aortic aneurysm outcomes in the Copenhagen City Heart Study and Copenhagen...... General Population Study, respectively. According to the magnitude of the hazard ratios, tobacco consumption was the most important risk factor for hospitalization and death from aortic aneurysm, followed by male sex and hypertension in both cohorts. The population attributable risk of aortic aneurysm...... outcomes due to tobacco consumption was 64% and 47% in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively, and ranked highest among population attributable risks of aortic aneurysm in both cohorts. The absolute 10-year risk for hospitalization or death from aortic...

  2. Evolving concepts of hemodynamic monitoring for critically ill patients

    Directory of Open Access Journals (Sweden)

    Olfa Hamzaoui

    2015-01-01

    Full Text Available The last decades have been characterized by a continuous evolution of hemodynamic monitoring techniques from intermittent toward continuous and real-time measurements and from an invasive towards a less invasive approach. The latter approach uses ultrasounds and pulse contour analysis techniques that have been developed over the last 15 years. During the same period, the concept of prediction of fluid responsiveness has also been developed and dynamic indices such as pulse pressure variation, stroke volume variation, and the real-time response of cardiac output to passive leg raising or to end-expiration occlusion, can be easily obtained and displayed with the minimally invasive techniques. In this article, we review the main hemodynamic monitoring devices currently available with their respective advantages and drawbacks. We also present the current viewpoint on how to choose a hemodynamic monitoring device in the most severely ill patients and especially in patients with circulatory shock.

  3. Cluster headache and intracranial aneurysm

    OpenAIRE

    Valença, Marcelo Moraes; Andrade-Valença, Luciana P. A.; Martins, Carolina; de Aragão, Maria Fátima Vasco; Batista, Laécio Leitão; Peres, Mario Fernando Prieto; da Silva, Wilson Farias

    2007-01-01

    In the present study we describe the cases of two patients with cluster-like headache related to intracranial carotid artery aneurysm. One of these patients responded to verapamil prescription with headache resolution. In both cases the surgical clipping of the aneurysm resolved the cluster pain. These findings strongly suggest a pathophysiological link between the two conditions. The authors discuss the potential pathophysiological mechanisms underlying cluster-like headache due to intracran...

  4. Regulation of a Hemodynamics Adaptation to Ageing

    Directory of Open Access Journals (Sweden)

    Astakhov A.A.

    2011-03-01

    Full Text Available The aim of the investigation is to study a scheme implementation of the vegetative supply of the hemodynamics adaptive reaction connected with ageing. It should be evaluated with hemodynamic parameter variability. Materials and Methods. 489 healthy people have been divided into 2 age groups: 329 at the age of 20—44 years and 160 at the age of 45—65 years. The variability values of an average arterial pressure have been recorded. R—R-interval, the highest volume of the heart and the peripheral vessels pulsation amplitudes have been observed as well. The researchers have carried out a spectral analysis on the plane of complex frequencies with a spectral density capacity assessment according to the four regulatory ranges. Results. The received data allows to assess the regulation mechanisms of such parameters as the highest volume and microvessels pulsation amplitude in different age groups. Moreover, it is possible to figure out the cardiac rhythm and arterial pressure regulation mechanisms considering a probability of the oscillation analysis of the most low-frequency range.

  5. Clinical presentation of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cianfoni, Alessandro [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Pravatà, Emanuele, E-mail: emanuele.pravata@gmail.com [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); De Blasi, Roberto [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Tschuor, Costa Silvia [Dipartimento di Radiologia, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Bonaldi, Giuseppe [U.O. Neuroradiologia, Ospedali Riuniti di Bergamo, Largo Barozzi, 1, 24128 Bergamo (Italy)

    2013-10-01

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls.

  6. Clinical presentation of cerebral aneurysms

    International Nuclear Information System (INIS)

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls

  7. Risk factors for intracranial aneurysm in a Chinese ethnic population

    Institute of Scientific and Technical Information of China (English)

    GU Yu-xiang; CHEN Xian-cheng; SONG Dong-lei; LENG Bing; ZHAO Fan

    2006-01-01

    Background Intracranial aneurysm (IAN) is a protruding bubble or a sac on a brain artery that balloons out over time, which may lead to spontaneous subarachnoid hemorrhage (SAH), ultimately disability and mortality.Current research indicates that the disease is due to multiple causes, including environmental factors and various congenital abnormalities of blood vessels. Apart from congenital predisposition, various high-risk factors such as sex, age, hypertension, and atherosclerosis are involved in the formation of intracranial aneurysms. The aim of this study was to investigate the risk factors associated with the formation of sporadic intracranial aneurysms in Chinese Han ethnic patients.Methods A total of 251 patients with intracranial aneurysm and 338 patients with other cerebral diseases (control group) were enrolled in this study. Single factor and logistic regression model were used to analyze the association of intracranial aneurysms with age; sex; cigarette smoking; alcohol or cocaine consumption; history of hypertension, coronary artery disease, diabetes mellitus and inherited connective tissue disease; and the levels of fasting blood glucose and blood fat. The data expressed as mean ± standard deviation were processed with the statistical software SPSS13. Quantitative and qualitative data were analyzed by the independent-sample t test,and the chi-square test respectively. Logistic regression method was used to analyze the multiple factors.Results In the 251 patients, 163 (64.94%) were at age of 40 to 60 years. Sex (OR, 1.41; 95% CI, 1.01-1.96), cigarette smoking (OR, 1.81; 95% CI, 1.06-3.10), hypertension (OR, 2.32; 95% CI, 1.30-4.16) and fasting blood glucose were significantly associated with intracranial aneurysm (P<0.05). Intracranial aneurysm was correlated with alcohol consumption, coronary artery disease, and the level of blood lipids (P>0.05). Using logistic regression analysis, we identified female sex and advanced age as significant risk

  8. Intracranial aneurysm associated with relapsing polychondritis

    Energy Technology Data Exchange (ETDEWEB)

    Coumbaras, M.; Boulin, A.; Pierot, L. [Dept. of Neuroradiology, Hopital Foch, Suresnes (France); Piette, A.M.; Bletry, O. [Dept. of Medicine, Hopital Foch, Suresnes (France); Graveleau, P. [Dept. of Neurology, Hopital Foch, Suresnes (France)

    2001-07-01

    We describe a 50-year-old man with relapsing polychondritis (RP) involving auricular cartilage, uveitis and hearing loss, who had an aneurysm of the anterior cerebral artery. Intracranial aneurysm is a rare manifestation of RP. (orig.)

  9. Brain Aneurysm: Early Detection and Screening

    Science.gov (United States)

    ... and Screening A- A A+ Early Detection and Screening Brain aneurysms can be similar to heart attacks. ... aneurysm is about to rupture. Fortunately, through imaging screening techniques, individuals at high risk of harboring a ...

  10. Surveillance intervals for small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Bown, Matthew J; Sweeting, Michael J; Brown, Louise C;

    2013-01-01

    Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture....

  11. Aneurysms - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Aneurysms URL of this page: https://medlineplus.gov/languages/aneurysms.html Other topics A-Z A B ...

  12. Aortic aneurysm secondary to umbilical artery catheterization

    International Nuclear Information System (INIS)

    A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected. (orig.)

  13. Renal failure after operation for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Olsen, P S; Schroeder, T; Perko, M;

    1990-01-01

    Among 656 patients undergoing surgery for abdominal aortic aneurysm, 81 patients (12%) developed postoperative renal failure. Before operation hypotension and shock occurred in 88% of the patients with ruptured aneurysm, whereas none of the patients operated electively were hypotensive. Dialysis......-up. In six cases the death was caused by renal failure only or in combination with failure of other organs. Analysis of the cumulative survival shows that, if the patients survive the postoperative period, their life expectancy is comparable to that of patients without renal complications....

  14. Hemodynamic Changes in Blood Donors

    Directory of Open Access Journals (Sweden)

    M Rafiei

    2004-07-01

    Full Text Available Introduction: Everyday, millions of people around the world go through phlebotomy, either to donate blood or for therapeutic intention. The most important worrisome adverse effects are hemodynamic alterations. In this study, hemodynamic changes following blood donation were assessed. Methods & Materials: Three hundred laborers who donated blood voluntarily were enrolled in this study. Blood pressure (BP and pulse rate were measured before the procedure, ten minutes afterwards, and one week following phlebotomy. Hemoglobin (Hgb and hematocrit (Hct were also determined prior to and one week after phlebotomy. Finally, results before and after donation were compared with each other. Results: 242 volunteers had normal BP and 58 were hypertensive. The mean systolic blood pressures (SBP before phlebotomy, ten minutes after the procedure, and one week later were 120, 117, and 122 mmHg, respectively. During the same periods of time, the mean of diastolic blood pressures (DBP were 77 , 78 and 78 mmHg , in order , while pulse rates on average were 80 , 82 and 76 beats/minute . None of the aforementioned changes were clinically significant. After one week, Hgb decreased by about 0.3 g/dl (P<0.001 and Hct declined on average of 1.7 (P<0.001. Forty six individuals had high DBP and one week after donation, their DBP was reduced by 7 mmHg. Age, body mass index and smoking did not have any significant effect on hemodynamic status. Conclusion: Hemodynamic changes in healthy blood donors were not clinically significant. It seems that DBP drops desirably in hypertensive individuals. This needs to be evaluated more carefully in future studies.

  15. Hemodynamic changes in depressive patients

    OpenAIRE

    Ma, Ying; Li, Hui-Chun; Zheng, Lei-lei; Yu, Hua-liang

    2006-01-01

    Objective: This study is aimed at exploring the relationship between hemodynamic changes and depressive and anxious symptom in depression patients. Methods: The cardiac function indices including the left stroke index (LSI), ejection fraction (EF), heart rate (HR), diastolic pressure mean (DPM), systolic pressure mean (SPM), left ventricle end-diastolic volume (LVDV), effective circulating volume (ECV), resistance total mean (RTM) and blood flow smooth degree (BFSD) were determined in 65 pati...

  16. Echocardiographic evidence of innate aortopathy in the human intracranial aneurysm.

    Directory of Open Access Journals (Sweden)

    Yong-Won Shin

    Full Text Available BACKGROUND: Intracranial aneurysm (IA is significantly more prevalent in patients with coarctation of the aorta or bicuspid aortic valve than in the general population, suggesting a common pathophysiology connecting IA and aortopathy. Here, we analyzed echocardiographic aortic root dimension (ARD in patients with IA to confirm this possibility. METHODS: From January 2008 to December 2010, 260 consecutive patients with IA who were admitted to our institution for coil embolization or for acute stroke management and who also underwent echocardiography were enrolled. We hypothesized that patients with large, ruptured, or multiple IAs are more likely to harbor co-prevalent aortopathy as measured by ARD compared to patients with small, isolated, unruptured IAs. Eccentric group was defined as patients aged <55 years with at least one ruptured aneurysm, an aneurysm ≥7 mm in size, or multiple aneurysms; the remainder was classified into a non-eccentric group. Clinical, angiographic, and echocardiographic findings of the two groups were compared. RESULTS: ARD was significantly larger in the eccentric group than in the non-eccentric group (P = 0.049, and the difference was confirmed by multivariable analysis (P = 0.02. Subgroup analysis of patients aged <55 years showed similar result for ARD (P = 0.03, whereas hypertension was more associated with the non-eccentric group (P = 0.01. In addition, height was inversely related to aneurysm size after adjustment for age, sex, weight, ARD, smoking status, and number of aneurysms (P = 0.004. CONCLUSIONS: A certain group of IA patients share a common intrinsic wall defect with aortopathy. Shared neural crest cell origin may give rise to this phenomenon.

  17. True Giant Posterior Tibial Artery Aneurysm

    OpenAIRE

    Patrizio Colotto; Gabriele Testi; Giacomo Di Iasio; Alessandro Robaldo

    2012-01-01

    We report an unusual case of true atherosclerotic posterior tibial artery (PTA) aneurysm without any apparent causative history. To our knowledge, in the English Literature only seven previously cases of true PTA aneurysms are reported. Due to its location, this lesion may require surgical intervention and removal. The presentation, the diagnostic evaluation, and the surgical management of the aneurysm are discussed.

  18. Microsurgical cerebral aneurysm training porcine model

    Directory of Open Access Journals (Sweden)

    Jon Olabe

    2011-01-01

    Full Text Available The authors developed a simple reproducible technique for aneurysm creation and adapted it to mimic intracranial dissection conditions using glue application as a pseudo-arachnoid type layer. Ten 1-2-month-old healthy domestic swine were employed under general anesthesia. A novel technique for bifurcation aneurysm creation was developed using two arteries and a vein. After aneurysm creation, diluted sulfuric acid was applied on the dome with a micropipette to increase aneurysm fragility in selected zones. The surgical field was then dried and contact glue was applied around the vascular complex in a circular manner so as to emulate arachnoidal connection fibers. Microsurgical dissection of the aneurysm and surrounding vessels was performed by delicately removing the adhesive substance. Diverse aneurysm clipping techniques, emergency rupture situations and vascular reconstruction procedures were trained. Twenty-two aneurysms were created at several vascular sites, one aneurysm dome ruptured during application of sulfuric acid, two aneurysm models were proved to be thrombosed, two aneurysms ruptured during the dissection and no intraoperative deaths occurred. All aneurysms were clipped in an acceptable manner. This bifurcation aneurysm model provides a novel training system to be used not only by neurosurgeons but also by neurovascular interventionists.

  19. Internal carotid artery bifurcation aneurysms. Surgical experience

    International Nuclear Information System (INIS)

    Internal carotid artery (ICA) bifurcation aneurysms are relatively uncommon and frequently rupture at a younger age compared to other intracranial aneurysms. We have treated a total of 999 patients for intracranial aneurysms, of whom 89 (8.9%) had ICA bifurcation aneurysms, and 42 of the 89 patients were 30 years of age or younger. The present study analyzed the clinical records of 70 patients with ICA bifurcation aneurysms treated from mid 1997 to mid 2003. Multiple aneurysms were present in 15 patients. Digital subtraction angiography films were studied in 55 patients to identify vasospasm and aneurysm projection. The aneurysm projected superiorly in most of these patients (37/55, 67.3%). We preferred to minimize frontal lobe retraction, so widely opened the sylvian fissure to approach the ICA bifurcation and aneurysm neck. Elective temporary clipping was employed before the final dissection and permanent clip application. Vasospasm was present in 24 (43.6%) of 55 patients. Forty-eight (68.6%) of the 70 patients had good outcome, 14 (20%) had poor outcome, and eight (11.4%) died. Patients with ICA bifurcation aneurysms tend to bleed at a much younger age compared to those with other intracranial aneurysms. Wide opening of the sylvian fissure and elective temporary clipping of the ICA reduces the risk of intraoperative rupture and perforator injury. Mortality was mainly due to poor clinical grade and intraoperative premature aneurysm rupture. (author)

  20. Virtual Treatment of Basilar Aneurysms Using Shape Memory Polymer Foam

    Science.gov (United States)

    Ortega, J. M.; Hartman, J.; Rodriguez, J. N.; Maitland, D. J.

    2012-11-01

    Numerical simulations are performed on patient-specific basilar aneurysms that are treated with shape memory polymer (SMP) foam. In order to assess the post-treatment hemodynamics, two modeling approaches are employed. In the first, the foam geometry is obtained from a micro-CT scan and the pulsatile blood flow within the foam is simulated for both Newtonian and non-Newtonian viscosity models. In the second, the foam is represented as a porous media continuum, which has permeability properties that are determined by computing the pressure gradient through the foam geometry over a range of flow speeds comparable to those of in vivo conditions. Virtual angiography and additional post-processing demonstrate that the SMP foam significantly reduces the blood flow speed within the treated aneurysms, while eliminating the high-frequency velocity fluctuations that are present prior to treatment. A prediction of the initial locations of thrombus formation throughout the SMP foam is obtained by means of a low fidelity thrombosis model that is based upon the residence time and shear rate of blood. The two modeling approaches capture similar qualitative trends for the initial locations of thrombus within the SMP foam.

  1. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management.

    Science.gov (United States)

    Scaife, Mark; Giannakopoulos, Triantafillos; Al-Khoury, Georges E; Chaer, Rabih A; Avgerinos, Efthymios D

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intraoperative execution, and postoperative surveillance all mandate accurate imaging. While computed tomographic angiography and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, US technology has significantly evolved over the past decade. In addition to standard color duplex US, 2D, 3D, or 4D contrast-enhanced US modalities are revolutionizing AAA management and postoperative surveillance. This technology can accurately measure AAA diameter and volume, and most importantly, it can detect endoleaks post-EVAR with high sensitivity and specificity. 4D contrast-enhanced US can even provide hemodynamic information about the branch vessels following fenestrated EVARs. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. This review article presents a comprehensive overview of the literature on the state-of-art US imaging in AAA management, including post-EVAR follow-up, techniques, and diagnostic accuracy. PMID:27303669

  2. Direct clipping of a blister-like aneurysm in the supraclinoid segment of the internal carotid artery: a clinical analysis of nine cases

    OpenAIRE

    Yu, Jinlu; Xu, Baofeng; Guo, Yunbao; Xu, Kan

    2015-01-01

    To investigate the method and outcome from direct clipping of a blister-like aneurysm (BBA) of the internal carotid artery supraclinoid segment. This study featured nine BBA patients, including eight females and one male. The patients presented subarachnoid hemorrhage (SAH) as the initial symptom and were diagnosed with BBA in the supraclinoid segment through a vascular exam and imaging. During the exam, the internal carotid artery was pressed to block the blood flow, and a transcranial Doppl...

  3. Enhanced Recovery after Elective Open Surgical Repair of Abdominal Aortic Aneurysm: A Complementary Overview through a Pooled Analysis of Proportions from Case Series Studies

    OpenAIRE

    Gurgel, Sanderland J. T.; Regina El Dib; Paulo do Nascimento

    2014-01-01

    OBJECTIVES: To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA). BACKGROUND: Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes. METHODS: A review of PubMed, EMBASE and LILACS databases was conducted. As on...

  4. [Subdural hemorrhage of aneurysmal origin].

    Science.gov (United States)

    Sánchez, R; Alfaro, A; Perla, C; Blasco, R; Cortés, F; Solís, P

    1994-02-01

    Although most subdural hematomas are considered to be venous in origin, they may also be of arterial origin. When subdural bleeding is due to the rupture of an intracranial aneurysm, most commonly at the middle cerebral or internal carotid arteries, the amount of subdural blood is usually small and of no clinical importance. We describe two patients with subdural hematomas secondary to rupture of an intracranial aneurysm, who needed prompt surgical treatment. The first patient had a left internal carotid artery aneurysm at the origin of the ophthalmic artery. In the second patient the aneurysm was at the anterior communicating artery and rebled into the subdural space directly through a right intraparenchymatous frontobasal hematoma. The most probable mechanism of subdural bleeding in our two patients was the existence of adhesions between the aneurysm and the arachnoid due to previous minor hemorrhages. The indication of cerebral angiography in a patient with subdural hematoma is based mainly upon the existence of meningeal signs, the presence of blood in more than one intracranial compartment or the rapid progression of bleeding. PMID:8204251

  5. Combined treatment for complex intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-06-01

    Full Text Available Complex aneurysms often cannot be completely excluded by a single approaches. Today successful treatment of these lesions requires a combination between microsurgical and endovascular techniques. Planning of combined treatment require a very good understanding of aneurysm anatomy and a close collaboration between neurosurgeon and neuroendovascular interventionist. Endovascular coiling can usually be used as early treatment for a partially aneurysm occlusion including the ruptured area and followed by definitive clipping. On the other hand microsurgical clipping also can be used as first treatment for complex aneurysm neck reconstruction, allowing successful secondary placement of coils inside the remnant aneurysm sac

  6. Management of symptomatic venous aneurysm.

    Science.gov (United States)

    Gabrielli, Roberto; Rosati, Maria Sofia; Siani, Andrea; Irace, Luigi

    2012-01-01

    Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients' series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism. PMID:22566766

  7. [Introduction of Hemodynamic Monitoring in Critical Care Units].

    Science.gov (United States)

    Lin, Chen-Wei; Wang, Shiao-Pei

    2016-02-01

    Hemodynamic monitoring is a very important treatment in intensive care units. Measurements taken during monitoring include pulmonary artery catheter (PAC), pulse-induced contour output (PiCCO), and non-invasive hemodynamic monitoring. PAC measures cardiopulmonary parameters using the thermodilution principle. PiCCO uses transpulmonary thermodilution and pulse contour analysis to measure cardiopulmonary parameters and extra-vascular lung water, to predict lung edema, and to differentiate between cardiogenic and non-cardiogenic respiratory failure. Non-invasive hemodynamic monitoring uses the thoracic electrical bioimpedance principle to measure electrical conductivity and then calculates stroke volume and cardiopulmonary parameters using the arrangement of red blood cells. The author is a nurse in an intensive care unit who is familiar with the various methods used in hemodynamic monitoring, with preparing the related devices, with briefing patients and family members prior to procedures, with related aseptic skills, with preventing complications during the insertion procedure, and with analyzing and interpreting those parameters accurately. The issues addressed in this paper are provided as a reference for nurses and other medical personnel to choose appropriate treatments when caring for critical patients. PMID:26813070

  8. Nonruptured intracranial aneurysms: therapeutic recommendations

    International Nuclear Information System (INIS)

    With the development of new diagnostic noninvasive tools an increase in the diagnosis of asymptomatic nonruptured intracranial aneurysms has been shown. Physician and patient now have to decide wether to treat or to follow-up these aneurysms. This paper trys to review and to discuss the literature and to give guidelines for therapeutic decisions. The decision to treat an unruptured intracranial aeurysm must always comprise the individuell factors such as age, life prognosis, neurological status, and the advantages and disdavantages of the considered method. (orig.)

  9. [Treatment of aneurysmal subarachnoid hemorrhage].

    Science.gov (United States)

    Proust, François; Douvrin, Françoise; Gilles-Baray, Marie; Levêque, Sophie

    2007-01-01

    The incidence of subarachnoid hemorrhages is about 10.5/100,000 persons/year. Early obliteration of the aneurysmal sac is necessary to avoid rebleeding. The neurovascular staff meeting must decide the appropriate obliteration procedure for each patient. Intraoperative morbidity is 8% after endovascular coiling and 10% after microsurgical clipping. Endovascular coiling leads to complete obliteration of the aneurysm in 60% of patients and microsurgical clipping in 95%. Delayed ischemic deficits may be prevented by volemic expansion and calcium channel blockers. Hospitalization and general prophylaxis against deep venous thrombosis, pain and seizures are essential. Curative treatment is required against common complications such as intraparenchymatous hematoma, hydrocephalus, and delayed ischemic deficit. PMID:17296483

  10. Vortex Dynamics in Cerebral Aneurysms

    CERN Document Server

    Byrne, Greg

    2013-01-01

    We use an autonomous three-dimensional dynamical system to study embedded vortex structures that are observed to form in computational fluid dynamic simulations of patient-specific cerebral aneurysm geometries. These structures, described by a vortex which is enclosed within a larger vortex flowing in the opposite direction, are created and destroyed in phase space as fixed points undergo saddle-node bifurcations along vortex core lines. We illustrate how saddle-node bifurcations along vortex core lines also govern the formation and evolution of embedded vortices in cerebral aneurysms under variable inflow rates during the cardiac cycle.

  11. Septal aneurysm with associated anomalies

    International Nuclear Information System (INIS)

    A 15-year-old boy had a history of a functional systolic murmur with systolic and diastolic murmurs and radiological evidence of left ventricular hypertrophy. The angiorcardiogram demonstrated an aneurysm of the membranous septum, bicuspid aortic valve, dilatation of the left subclavian artery and left common carotid artery. Echocardiography showed a holosystolic prolapse of the mitral valve with mitral insufficiency and a bicuspid aortic valve with insignificant incompetence of the aortic valve. Classical TM mode echocardiography did not show an aneurysm of the membranous septum. (orig.)

  12. Flow Instability Detected by High-Resolution Computational Fluid Dynamics in Fifty-Six Middle Cerebral Artery Aneurysms.

    Science.gov (United States)

    Varble, Nicole; Xiang, Jianping; Lin, Ning; Levy, Elad; Meng, Hui

    2016-06-01

    Recent high-resolution computational fluid dynamics (CFD) studies have detected persistent flow instability in intracranial aneurysms (IAs) that was not observed in previous in silico studies. These flow fluctuations have shown incidental association with rupture in a small aneurysm dataset. The aims of this study are to explore the capabilities and limitations of a commercial cfd solver in capturing such velocity fluctuations, whether fluctuation kinetic energy (fKE) as a marker to quantify such instability could be a potential parameter to predict aneurysm rupture, and what geometric parameters might be associated with such fluctuations. First, we confirmed that the second-order discretization schemes and high spatial and temporal resolutions are required to capture these aneurysmal flow fluctuations. Next, we analyzed 56 patient-specific middle cerebral artery (MCA) aneurysms (12 ruptured) by transient, high-resolution CFD simulations with a cycle-averaged, constant inflow boundary condition. Finally, to explore the mechanism by which such flow instabilities might arise, we investigated correlations between fKE and several aneurysm geometrical parameters. Our results show that flow instabilities were present in 8 of 56 MCA aneurysms, all of which were unruptured bifurcation aneurysms. Statistical analysis revealed that fKE could not differentiate ruptured from unruptured aneurysms. Thus, our study does not lend support to these flow instabilities (based on a cycle-averaged constant inflow as opposed to peak velocity) being a marker for rupture. We found a positive correlation between fKE and aneurysm size as well as size ratio. This suggests that the intrinsic flow instability may be associated with the breakdown of an inflow jet penetrating the aneurysm space. PMID:27109451

  13. Endovascular Treatment of a Giant Aneurysm of the Maxillary Artery

    OpenAIRE

    J. A. Stephenson; Panteleimonitis, S; E. Choke; Dennis, M.; Glasby, M.

    2012-01-01

    Aneurysms of the maxillary artery are rare and the majority of the literature refers to false aneurysms. We report the first case of what we believe to be a spontaneous true maxillary artery aneurysm and its endovascular management.

  14. 18F-FDG PET-CT uptake is a feature of both normal diameter and aneurysmal aortic wall and is not related to aneurysm size

    Energy Technology Data Exchange (ETDEWEB)

    Barwick, Tara D. [Imperial College Healthcare NHS Trust, Charing Cross Hospital, Department of Radiology/Nuclear Medicine, London (United Kingdom); Hammersmith Hospital, Department of Surgery and Cancer, Imperial College London, London (United Kingdom); Lyons, O.T.A.; Waltham, M. [King' s College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at King' s Health Partners, Academic Department of Surgery, London (United Kingdom); Mikhaeel, N.G. [Guy' s and St Thomas' Foundation NHS Trust, Department of Oncology, London (United Kingdom); O' Doherty, M.J. [King' s Health Partners, Clinical PET Centre, St Thomas' Hospital, London (United Kingdom)

    2014-12-15

    Aortic metabolic activity is suggested to correlate with presence and progression of aneurysmal disease, but has been inadequately studied. This study investigates the 2-[{sup 18}F] fluoro-2-deoxy-D-glucose ({sup 18}F-FDG) uptake in a population of infra-renal abdominal aortic aneurysms (AAA), compared to a matched non-aneurysmal control group. The Positron Emission Tomography - Computed Tomography (PET/CT) database was searched for infra-renal AAA. Exclusion criteria were prior repair, vasculitis, and saccular/mycotic thoracic or thoraco-abdominal aneurysms. Matching of 159 non-aneurysmal (<3 cm diameter) controls from the same population was assessed. Infra-renal aortic wall FDG uptake was assessed using visual analysis; maximum standardized uptake value (SUV{sub max}) and target to background mediastinal blood pool ratio (TBR) were documented. Predictors of FDG uptake (age, sex, aortic diameter, hypertension, statin use, and diabetes) were assessed using univariate analysis. Follow-up questionnaires were sent to referring clinicians. Aneurysms (n = 151) and controls (n = 159) were matched (p > 0.05) for age, sex, diabetes, hypertension, smoking status, statin use, and indication for PET/CT. Median aneurysm diameter was 5.0 cm (range 3.2-10.4). On visual analysis there was no significant difference in the overall numbers with increased visual uptake 24 % (36/151) in the aneurysm group vs. 19 % (30/159) in the controls, p = ns. SUV{sub max} was slightly lower in the aneurysm group vs. controls (mean (2 SD) 1.75(0.79) vs. 1.84(0.58), p = 0.02). However there was no difference in TBR between the AAA group and controls (mean (2 SD) 1.03 (0.46) vs. 1.05(0.31), p = 0.36). During a median 18 (interquartile range 8-35) months' follow-up 20 were repaired and four were confirmed ruptured. The level of metabolic activity as assessed by {sup 18}F-FDG PET/CT in infra-renal AAA does not correlate with aortic size and does not differ between aneurysms and matched controls

  15. Infected aortic aneurysm and inflammatory aortic aneurysm. In search of an optimal differential diagnosis

    International Nuclear Information System (INIS)

    Infected aortic aneurysm and inflammatory aortic aneurysm each account for a minor fraction of the total incidence of aortic aneurysm and are associated with periaortic inflammation. Despite the similarity, infected aortic aneurysm generally shows a more rapid change in clinical condition, leading to a fatal outcome; in addition, delayed diagnosis and misuse of corticosteroid or immunosuppressing drugs may lead to uncontrolled growth of microorganisms. Therefore, it is mandatory that detection of aortic aneurysm is followed by accurate differential diagnosis. In general, infected aortic aneurysm appears usually as a saccular form aneurysm with nodularity, irregular configuration; however, the differential diagnosis may not be easy sometimes for the following reasons: symptoms, such as abdominal and/or back pain and fever, and blood test abnormalities, such as elevated C-reactive protein and enhanced erythrocyte sedimentation rate, are common in infected aortic aneurysm, but they are not found infrequently in inflammatory aortic aneurysm; some inflammatory aortic aneurysms are immunoglobulin (Ig) G4-related, but not all of them; the prevalence of IgG4 positivity in infected aortic aneurysm has not been well investigated; enhanced uptake of 18F-fluorodeoxyglucose (FDG) by 18F-FDG-positron emission tomography may not distinguish between inflammation mediated by autoimmunity and that mediated by microorganism infection. Here we discuss the characteristics of these two forms of aortic aneurysm and the points of which we have to be aware before reaching a final diagnosis. (author)

  16. Isolated iliac artery aneurysms with associated hydronephrosis.

    LENUS (Irish Health Repository)

    O'Driscoll, D

    2012-02-03

    An isolated iliac artery aneurysm is where there is aneurysmal dilatation of one or more branches of the iliac system, with no associated dilatation of the aorta. Such aneurysms are rare and comprise 1% of all intra-abdominal aneurysms. The signs and symptoms of such an aneurysm are influenced by its concealed location within the bony pelvis. Awareness of these special characteristics improves the chances of early diagnosis and proper treatment before possible rupture. We present the clinical and radiological features of three such aneurysms. Ultrasound was the first imaging modality to be performed. Ipsilateral hydronephrosis was demonstrated in each case, this lead to imaging the pelvis and the correct diagnosis. We review the clinical and radiological literature and conclude that the pelvis should be imaged in all cases of unexplained hydronephrosis.

  17. Anesthetic Implications of Emergent Cesarean Section in a Parturient with Marfan Syndrome Complicated by Ascending Aortic Aneurysm and Heart Failure

    Directory of Open Access Journals (Sweden)

    Young Sung Kim

    2014-07-01

    Full Text Available Cardiovascular comorbidities to the Marfan syndrome may induce hemodynamic instability especially in the parturients during labor or delivery. For anesthesiologists, it is challenging to maintain hemodynamic stability during Cesarean section in those patients with Marfan syndrome. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action which provides cardiovascular stability during surgery. Together with remifentanil, the use of a laryngeal mask airway can reduce the risk of hypertensive response followed by tracheal intubation. We describe the successful administration of remifentanil and application of laryngeal mask airway for emergent Cesarean section performed under general anesthesia in a patient with Marfan syndrome complicated by ascending aortic aneurysm and heart failure. The use of remifentanil (loading dose of 1 μg/kg for 1 min, 2 min before induction; thereafter continuous infusion dose of 0.1 μg/kg/min was useful to maintain hemodynamic stability of the parturient throughout the surgery without neonatal respiratory depression.Keywords: Ascending Aortic Aneurysm; Cesarean section; Laryngeal mask airway; Marfan syndrome; Remifentanil

  18. MR angiography after coiling of intracranial aneurysms

    OpenAIRE

    Schaafsma, J.D.

    2012-01-01

    Introduction Endovascular occlusion with detachable coils has become an alternative treatment to neurosurgical clipping of intracranial aneurysms over the last two decades. Its minimal invasiveness is the most important advantage of this treatment compared to clipping. The disadvantage of occlusion with coils is an approximately 20% risk of reopening of the aneurysm as a result of coil impaction, dissolution of thrombus, or growth of the aneurysm and 10% of coiled patients need additional tre...

  19. Gender differences in cerebral aneurysm location

    OpenAIRE

    Ali Jourabchi Ghods; Demetrius eLopes; Michael eChen

    2012-01-01

    Background and Purpose: A limited number of studies consisting predominantly of ruptured aneurysms have looked at differences in anatomical distribution of aneurysms between male and females. Unlike all other causes of stroke, subarachnoid-hemorrhages (SAH) occur more often in women and are thought to be a result of both hormonal influences and variation in wall shear stress (WSS). This paper retrospectively looks at a cohort of largely unruptured intracranial aneurysms to determine if there ...

  20. Portal Vein Aneurysm Presenting with Obstructive Jaundice

    OpenAIRE

    Chandana Lall; Sadhna Verma; Rajesh Gulati; Puneet Bhargava

    2012-01-01

    To the best of our knowledge, a portal vein aneurysm presenting with obstructive jaundice has not been reported in the literature. The preferred treatment for these aneurysms is surgical and a shunting procedure should be considered in cases with portal hypertension to preserve portal vein flow when portal hypertension is present or is secondary to the aneurysm itself. In our case, due to patient′s advanced age and co-morbidities, an endoscopic biliary stent was placed which led to successful...

  1. Experimental Model of Saccular Abdominal Aortic Aneurysm in Swines with Pericardium Sac

    Directory of Open Access Journals (Sweden)

    Maurício de Amorim Aquino

    2016-02-01

    Full Text Available Abstract Objective: To consider modifications in an experimental model of saccular aortic aneurysm, aiming at better reproducibility, to be used in the development of vascular prostheses. Methods: Experimental study in two phases, developed in the Center of Experimental Surgery and Bioterium (CCEB of the University of Health Sciences of Alagoas (UNCISAL, with 11 hybrid swine, female, mean weight of 20 ± 5 kg, according to modifications in the Perini technique was performed. In the first phase, the aneurysm was confectioned with bovine pericardial patch. In the second phase, fifteen days later, the patency of the aneurysms was confirmed by Doppler ultrasonography. The described variables were aortic and aneurysm sac patency, incidence of rupture, morbidity and mortality. The statistical analysis program used was STATA v.8. Results: All animals survived to the procedures. Surgical mean time was 73 minutes. Aneurysm rupture, proximal or distal aortic thrombosis, visceral or legs ischemia weren't observed. Parietal thrombus formation was observed in all of the aneurysms, two of which (18%; IC 95% = 3.98 - 48.84 were occluded and nine (82%; IC 95% = 51.15 - 96.01 were patent. Conclusion: In this series, the modifications carried out in the technique related to the surgical approach, race, anesthesia, and imaging exams reproduced the experimental model, reducing its costs, without hindering the analysis of the variables. The satisfactory patency ratio allows the method to be used in experimental models for the development of vascular prostheses.

  2. Aneurysm miRNA Signature Differs, Depending on Disease Localization and Morphology

    Directory of Open Access Journals (Sweden)

    Albert Busch

    2016-01-01

    Full Text Available Limited comprehension of aneurysm pathology has led to inconclusive results from clinical trials. miRNAs are key regulators of post-translational gene modification and are useful tools in elucidating key features of aneurysm pathogenesis in distinct entities of abdominal and popliteal aneurysms. Here, surgically harvested specimens from 19 abdominal aortic aneurysm (AAA and 8 popliteal artery aneurysm (PAA patients were analyzed for miRNA expression and histologically classified regarding extracellular matrix (ECM remodeling and inflammation. DIANA-based computational target prediction and pathway enrichment analysis verified our results, as well as previous ones. miRNA-362, -19b-1, -194, -769, -21 and -550 were significantly down-regulated in AAA samples depending on degree of inflammation. Similar or inverse regulation was found for miR-769, 19b-1 and miR-550, -21, whereas miR-194 and -362 were unaltered in PAA. In situ hybridization verified higher expression of miR-550 and -21 in PAA compared to AAA and computational analysis for target genes and pathway enrichment affirmed signal transduction, cell-cell-interaction and cell degradation pathways, in line with previous results. Despite the vague role of miRNAs for potential diagnostic and treatment purposes, the number of candidates from tissue signature studies is increasing. Tissue morphology influences subsequent research, yet comparison of distinct entities of aneurysm disease can unravel core pathways.

  3. Endovascular treatment for pediatric intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, Hebei (China)

    2009-11-15

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged {<=}17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  4. Natural history of giant intracranial aneurysms

    International Nuclear Information System (INIS)

    The outcome of a consecutive series of 28 patients with giant aneurysm who had been followed without surgery from one month to 12 years after the diagnosis was made, are presented with reviewing their radiological and clinical features. Symptoms and signs were directly or indirectly attributable to the intracranial mass effect and nine patients (32 %) presented subarachnoid hemorrhage. Subarachnoid hemorrhage was frequently associated with intraventricular or intracerebral hemorrhage, a poor clinical grading at admission and a high mortality. Subarachnoid hemorrhage was most often recorded from the giant aneurysm at the supraclinoid portion of the internal carotid artery and the vertebro-basilar artery, but the rupture from the intracavernous giant aneurysm, completely thrombosed giant aneurysm and the fusiform type of giant aneurysm was rare. The mortality rate in 28 cases for the above follow up period was 46 % (13 in 28 cases) and major morbidity occured in 11 % (3 in 28 cases). The above outcome of non operated giant aneurysm cases may justify the surgical management of the giant aneurysm, but as the intracavernous giant aneurysm and thrombosed giant aneurysm are relatively harmless, surgical indication should be carefully decided, especially in the older patients. (author)

  5. Microsurgical clipping of an unruptured lenticulostriate aneurysm.

    Science.gov (United States)

    Kalani, M Yashar S; Martirosyan, Nikolay L; Nakaji, Peter; Spetzler, Robert F

    2012-11-01

    Aneurysms of the lenticulostriate artery have been associated with hypertension, vasculopathy, tumors, and arteriovenous malformations. Although several cases of microsurgical treatment of ruptured lenticulostriate artery aneurysms have been reported, to our knowledge there is no published case of microsurgical treatment of an unruptured lenticulostriate artery aneurysm. We report a 66-year-old woman with a history of moyamoya disease, previously treated with a right-sided middle cerebral artery-to-superficial temporal artery bypass who presented with an unruptured aneurysm of a lenticulostriate artery. We report successful microsurgical treatment of this rare lesion and discuss the rationale for our treatment strategy. PMID:22925414

  6. Endovascular treatment for pediatric intracranial aneurysms

    International Nuclear Information System (INIS)

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged ≤17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  7. Hemodynamic evaluation of transluminal iliac artery balloon dilatation.

    Science.gov (United States)

    Breslau, P J; van Soest, M; Janevski, B; Jörning, P J

    1985-10-01

    In order to document the hemodynamic results of transluminal iliac artery balloon dilatation, 23 aortoiliac segments were evaluated before and after treatment. Hemodynamic parameters were: intra-arterial common femoral pressure measurements, indirect ankle pressure measurements and femoral velocity waveform analysis. The segments were divided into group (a) aortoiliac segments with an open superficial femoral artery (n = 8), and group (b) aortoiliac segments with an occluded superficial femoral artery (n = 15). In group (a) all patients were free of symptoms and ankle pressure improved significantly six months after dilatation. Velocity waveform analysis of the common femoral artery did not correlate with this improvement. In group (b) intra-arterial pressure measurements showed improvement in 60% (9/15) after six months. Ankle pressure measurements and velocity waveform analysis did not correlate with the intra-arterial pressure changes. Transluminal iliac artery balloon dilatation of iliac stenosis in patients with an open superficial femoral artery can be evaluated by indirect ankle pressure measurements. In patients with iliac stenosis in combination with occluded superficial femoral arteries intra-arterial pressure measurements are needed to demonstrate hemodynamic improvement. PMID:2932658

  8. Transitional flow in intracranial aneurysms - a space and time refinement study below the Kolmogorov scales using Lattice Boltzmann Method

    CERN Document Server

    Jain, Kartik; Mardal, Kent-Andre

    2015-01-01

    Most Computational Fluid Dynamics (CFD) studies of hemodynamics in intracranial aneurysms are based on the assumption of laminar flow due to a relatively low (below 500) parent artery Reynolds number. A few studies have recently demonstrated the occurrence of transitional flow in aneurysms, but these studies employed special finite element schemes tailored to capture transitional nature of flow. In this study we investigate the occurrence of transition using a standard Lattice Boltzmann method (LBM). The LBM is used because of its computational efficiency, which in the present study allowed us to perform simulations at a higher resolution than has been done in the context of aneurysms before. The high space-time resolutions of 8{\\mu}m and 0.11 {\\mu}s resulted in nearly one billion cells and 9 million time steps per second and allowed us to quantify the turbulent kinetic energy at resolutions below the Kolmogorov scales. We perform an in-depth space and time refinement study on 2 aneurysms; one was previously ...

  9. Arterial Stiffness, Central Pulsatile Hemodynamic Load, and Orthostatic Hypotension.

    Science.gov (United States)

    Liu, Kai; Wang, Si; Wan, Shixi; Zhou, Yufei; Pan, Pei; Wen, Bo; Zhang, Xin; Liao, Hang; Shi, Di; Shi, Rufeng; Chen, Xiaoping; Jangala, Tulasiram

    2016-07-01

    The association between central pulsatile hemodynamic load, arterial stiffness, and orthostatic hypotension (OH) is unclear. The authors recruited 1099 participants from the community. Questionnaire, physical examination, and laboratory tests were performed. To assess the correlation between central pulsatile hemodynamic load, arterial stiffness, and OH, multiple logistic regression analysis was performed, and the discriminatory power was assessed by the area under the receiver operating curve. The prevalence of OH in this population was 5.6%. After adjusting for potential confounders, brachial-ankle pulse wave velocity (BaPWV) was significantly and positively correlated with OH in both the hypertension and nonhypertension groups (all Ppower than CSBP in both subgroups. BaPWV appears to be a better indicator of OH than CSBP in routine clinical practice. PMID:26543017

  10. Cesarean section under epidural anesthesia in a documented case of ruptured aneurysm of the sinus of valsalva.

    Science.gov (United States)

    Divakar, S R; Singh, Chandrashekhar; Verma, Chandra Mohan; Kulkarni, Chaitanya D

    2015-01-01

    Ruptured aneurysm of sinus of Valsalva (RSOV) occurring in pregnancy is a rare cardiac anomaly and it may be either congenital or acquired. Congenital sinus of Valsalva aneurysms are commonly associated with other structural defects such as ventricular septal defect (50-55%), aortic regurgitation (AR) (25-35%), bicuspid aortic valve (10-15%) and Marfan's syndrome (10%). RSOV in pregnancy accentuates the hemodynamic stress on maternal cardiovascular system and pose a significant challenge from obstetric anesthesia point of view. We report a case of 35-year-old documented patient of RSOV with mild AR presenting completely asymptomatic at 37 weeks 4 days of gestation. A successful elective lower segment cesarean section was conducted under epidural anesthesia. PMID:25788785

  11. Aneurysmal subarachnoid hemorrhage: outcome of aneurysm clipping versus coiling in anterior circulation aneurysm

    International Nuclear Information System (INIS)

    To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm. Study Design: Comparative study. Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013. Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society (WFNS) grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale (mRS) as favourable (mRS =2 ) and unfavourable (mRS > 2). Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 ± 10 years and in group B was 51.00 ± years. Overall, 56 (40%) males, 28 (60%) males in each group; and 84 (60%) females, 42 (60%) in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 (38.6%) patients had no disability (grades 1 and 2), 25 (35.7%) were slightly disabled (grade 3) and 18 (25.7%) had moderate disability (grade 4); whereas in group B, i.e. clipping group 23 (32.9%) patients had no disability (grades 1 and 2), 23 (32.9%) were slightly disabled (grade 3) and 24 (34.3%) had moderate disability (grade 4). At one year follow-up, in group A, favourable outcome was achieved in 56 (80%) of patients compared to 48 (68.6%) in group B; whilst, 14 (20%) patients in group A and 22 (33.1%) in group B showed unfavourable outcome. Although mortality rate was higher in clipping (n=3, 4.3%) as compared to coiling (n=1, 1.4%), but was not statistically

  12. Coronary artery aneurysm: case report

    OpenAIRE

    Burkhart Harold M; Everett Jeffrey E

    2008-01-01

    Abstract Introduction Aneurysms of the left main coronary artery are rare with an incidence of 0.1% in large angiographic series. The majority are atherosclerotic in origin. Other causes include connective tissue disorders, trauma, vasculitis, congenital, mycotic and idiopathic. The primary complication is myocardial ischemia or infarction, with rupture being rare. Treatment options include anticoagulation, custom made covered stents, reconstruction, resection, and exclusion with bypass. Case...

  13. Traumatic intracranial aneurysms in children

    International Nuclear Information System (INIS)

    To describe the imaging findings of traumatic intracranial aneurysms (TICA) in children. Five boys aged 3-15 (mean, 7) years with surgically confirmed TICA were included in this study. All had a history of nonpenetrating head trauma, and they underwent precontrast CT imaging immediately after the injury and follow-up CR or MRI. In all cases, angiography revealed the presence of aneurysms, which at surgery were shown to be pseudoaneurysms with sever adhesions. Angiography demonstrated that all aneurysms were located in the anterior cerebral artery (ACA) or its branches. The precise locations were the A2 segment of the ACA, the site of origin of the callosomarginal artery or its first branch, or of the anterior internal frontal artery, or between the first and second branch of the pericallosal artery. In all patients, precontrast CT performed immediately after trauma depicted subarachnoid hemorrhage (SAH) in the anterior interhemispheric fissure (AIHF). Follow-up precontrast CT showed nodular high density around the anterior falx in three, recurrent SAH in the AIHF in two, and intracerebral hemorrhage (ICH) with intraventricular hemorrhage in two. In two patients with a nodular high-density lesion, nodular enhancement was demonstrated at postcontrast CT, and in one, follow-up MRI revealed a nodular signal void around the anterior falx; nodular enhancement was seen at postcontrast imaging, and MR angiogram depicted a saccular aneurysm. In one patient, MRI demonstrated infarction in the caudate nucleus and ACA territory. If, after head injury, an area of nodular high density is revealed by CT, or a signal void by MRI, or is SAH or ICH is present around the anterior falx, the possibility of TICA should be considered

  14. Idiopathic giant right atrial aneurysm

    International Nuclear Information System (INIS)

    A 2-year-old boy with an incidental finding of massive cardiomegaly on a chest X-ray was diagnosed with a giant right atrial aneurysm upon further investigation with echocardiography. The patient underwent successful surgical reduction of the right atrium and closure of the patent foramen ovale to prevent thromboembolic complications and to lower the risk of atrial arrhythmias. The resected atrium had paper-thin walls and pathological features of interstitial fibrosis with endocardial thickening

  15. Intracranial dissecting and saccular aneurysms in polycystic kidney disease.

    Science.gov (United States)

    Kulla, L; Deymeer, F; Smith, T W; Weiner, M; Mullins, T F

    1982-12-01

    A young man with polycystic kidney disease was seen initially with an brain-stem infarction. Postmortem examination disclosed a dissecting aneurysm of the basilar artery and a saccular aneurysm of the right vertebral artery. Dissecting intracranial aneurysms rarely are associated with saccular aneurysms and, to our knowledge, have not been reported in association with polycystic kidney disease. PMID:7138321

  16. Hemodynamic changes in depressive patients

    Institute of Scientific and Technical Information of China (English)

    MA Ying; LI Hui-chun; ZHENG Lei-lei; YU Hua-liang

    2006-01-01

    Objective: This study is aimed at exploring the relationship between hemodynamic changes and depressive and anxious symptom in depression patients. Methods: The cardiac function indices including the left stroke index (LSI), ejection fraction (EF), heart rate (HR), diastolic pressure mean (DPM), systolic pressure mean (SPM), left ventricle end-diastolic volume (LVDV), effective circulating volume (ECV), resistance total mean (RTM) and blood flow smooth degree (BFSD) were determined in 65 patients with major depressive disorders and 31 healthy normal controls. The clinical symptoms were assessed with Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA). Results: In patients with depression without anxiety,LSI, EF, LVDV, DPM, SPM, ECV, BFSD were significantly lower than those in controls, while RTM was higher than that in controls. Patients with comorbidity of depression and anxiety showed decreased LVDV, ECV, BFSD, and increased HR in comparison with the controls. The anxiety/somatization factor score positively correlated with LSI, EF, LVDV, but negatively correlated with RTM. There was negative correlation between retardation factor score and DPM, SPM, LVDV. Conclusion: The study indicated that there are noticeable changes in left ventricle preload and afterload, blood pressure, peripheral resistance, and microcirculation in depressive patients, and that the accompanying anxiety makes the changes more complicated.

  17. Hemodynamics driven cardiac valve morphogenesis.

    Science.gov (United States)

    Steed, Emily; Boselli, Francesco; Vermot, Julien

    2016-07-01

    Mechanical forces are instrumental to cardiovascular development and physiology. The heart beats approximately 2.6 billion times in a human lifetime and heart valves ensure that these contractions result in an efficient, unidirectional flow of the blood. Composed of endocardial cells (EdCs) and extracellular matrix (ECM), cardiac valves are among the most mechanically challenged structures of the body both during and after their development. Understanding how hemodynamic forces modulate cardiovascular function and morphogenesis is key to unraveling the relationship between normal and pathological cardiovascular development and physiology. Most valve diseases have their origins in embryogenesis, either as signs of abnormal developmental processes or the aberrant re-expression of fetal gene programs normally quiescent in adulthood. Here we review recent discoveries in the mechanobiology of cardiac valve development and introduce the latest technologies being developed in the zebrafish, including live cell imaging and optical technologies, as well as modeling approaches that are currently transforming this field. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel. PMID:26608609

  18. Update on diagnosis and treatment of cardiac pseudo aneurysm

    International Nuclear Information System (INIS)

    Echocardiography is an essential tool in the diagnosis of pseudo aneurysm. It has been the most studied in diagnosing this condition.The M, two-dimensional and Doppler apply to reach a correct diagnosis of ventricular pseudo aneurysm. The use of this imaging technique allows noninvasive detection of asymptomatic or postoperative pseudo aneurysms after M mode used to diagnose a pseudo aneurysm to recognize an echo-free space in the posterior wall of the left ventricle. In 1980, Catherwood et al used to compare the two-dimensional echo pseudo aneurysm and a true aneurysm cavity demonstrated pseudo aneurysm globular and discontinuity of the ventricular myocardium

  19. Migraine before rupture of intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Gurary, Natalia M; Sakovich, Vladimir P;

    2013-01-01

    Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA.......Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA....

  20. Two cases of giant serpentine aneurysm.

    Science.gov (United States)

    Kumabe, T; Kaneko, U; Ishibashi, T; Kaneko, K; Uchigasaki, S

    1990-06-01

    Giant serpentine aneurysm (GSA) is an entity defined on radiological and pathological grounds as a giant, partially thrombosed aneurysm containing tortuous vascular channels. We have had the opportunity to study two patients with GSAs, which has allowed for a complete comparative anatomical and radiological study. This report emphasizes the etiology of the GSAs. Twenty-two patients with GSAs have been reported in the literature, of which pathological studies were done in 10. In most of these, the aneurysm was found to be filled with an organized thrombus, but in our patients the aneurysm was filled with relatively new clot. The aneurysm enlarged and a change in the tortuous vascular channel was observed over a period of 1 year in the first patient, whereas a globoid aneurysm developed into a GSA in the brief period of just 2 weeks in the second patient. This rapid transformation of a globoid aneurysm into a GSA is of particular interest when the etiology of GSAs is considered. Our patients therefore shed some interesting light on the possible pathophysiology of GSAs. That is, the bloodstream may change dynamically in a giant aneurysm and may become a serpentine channel under conditions that lead to a "Coanda effect." PMID:2362659

  1. Cardiovascular syphilis with coronary stenosis and aneurysm.

    Science.gov (United States)

    Tewari, Satyendra; Moorthy, Nagaraja

    2014-01-01

    Cardiovascular manifestations of tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation, and coronary ostial stenosis. Coronary ostial lesions have been detected in as many as 26% of patients with syphilitic aortitis. However nonostial coronary stenosis and coronary aneurysms in same patient is rarely described in cardiovascular syphilis. PMID:25634420

  2. Radiation protection in hemodynamics work process: the look of the multidisciplinary team

    International Nuclear Information System (INIS)

    The study was conducted in a hemodynamics service of a public hospital in Florianopolis, SC, Brazil. Qualitative research with the participation of 13 professionals from a multidisciplinary team: doctors, technicians, technologists in radiology and nurses. The research material was extracted from the observations, semi-structured interviews and documentary analysis. The responses were grouped into three categories relating to: training of hemodynamic professionals and the perception of radiological protection in the work process; occupational exposure and safety of the professionals of Hemodynamics; and continuing education in hemodynamic service. Professionals are daily exposed to ionizing radiation, and for being long procedures, lead to high levels of exposure in workers. In hemodynamic services the risk of biological effects are cumulative, because radiodiagnostic procedures include issuing the higher doses of ionizing radiation in which the personnel exposure is critical. The workforce in the service researched mostly consists of technical professionals who reported little knowledge of radiation protection and ionizing radiation and that this issue was not addressed during their training. However, despite mention little knowledge about radiological protection, participants demonstrated understand the biological effects, especially with regard to pathologies caused by frequent exposure without protection to ionizing radiation. These professionals said they have no knowledge of the proper use of radiological protection equipment and the dosimeter, and that the institution does not provide all individual protective equipment required for the procedures performed in the hemodynamic service. Permanent education in hemodynamic service is very important part in the work process, though, cited by participants as little effectiveness in the institution, even when the professionals show interest in the area. Knowledge of the team providing hemodynamic service calls

  3. Left Ventricular Mass: Correlation with Fatness, Hemodynamics and Renal Morphology

    International Nuclear Information System (INIS)

    Left ventricular mass (LVM) is correlated with body composition and central hemodynamics as well as kidney function. Recently, fat-free mass has been considered to be more strongly correlated with LVM in comparison to other descriptors of fatness. We therefore address the question of whether comprehensive descriptors of fatness, central hemodynamics and renal characteristics demonstrate the association with left ventricular mass in healthy non-obese population. 119 healthy non-obese subjects (53 females, 66 males, mean age 50 yrs) were evaluated. Central hemodynamics was measured by Pulse Wave Analysis, left ventricular mass was assessed by echocardiography, fatness was evaluated by anthropometry, bioimpedance, and ultrasound. Left ventricular mass index (LVMI) correlated to the same extent with central and peripheral blood pressure but not with descriptors of wave reflection. Fat-free mass as well as intraabdominal fat correlated to a similar extent with LVMI. Kidney morphological characteristics indexed to body surface area were associated inversely and independently with LVMI. Comprehensive assessment of fatness reinforced the concept that intraabdominal fat compartment is strongly correlated with left ventricular mass. Descriptors of wave reflection are not associated with left ventricular mass. The interrelationsh between kidney morphology and LVMI indicates that such associations may be a biologically plausible phenomenon

  4. Hemodynamic Characterization of Rodent Models of Pulmonary Arterial Hypertension.

    Science.gov (United States)

    Ma, Zhiyuan; Mao, Lan; Rajagopal, Sudarshan

    2016-01-01

    Pulmonary arterial hypertension (PAH) is a rare disease of the pulmonary vasculature characterized by endothelial cell apoptosis, smooth muscle proliferation and obliteration of pulmonary arterioles. This in turn results in right ventricular (RV) failure, with significant morbidity and mortality. Rodent models of PAH, in the mouse and the rat, are important for understanding the pathophysiology underlying this rare disease. Notably, different models of PAH may be associated with different degrees of pulmonary hypertension, RV hypertrophy and RV failure. Therefore, a complete hemodynamic characterization of mice and rats with PAH is critical in determining the effects of drugs or genetic modifications on the disease. Here we demonstrate standard procedures for assessment of right ventricular function and hemodynamics in both rat and mouse PAH models. Echocardiography is useful in determining RV function in rats, although obtaining standard views of the right ventricle is challenging in the awake mouse. Access for right heart catheterization is obtained by the internal jugular vein in closed-chest mice and rats. Pressures can be measured using polyethylene tubing with a fluid pressure transducer or a miniature micromanometer pressure catheter. Pressure-volume loop analysis can be performed in the open chest. After obtaining hemodynamics, the rodent is euthanized. The heart can be dissected to separate the RV free wall from the left ventricle (LV) and septum, allowing an assessment of RV hypertrophy using the Fulton index (RV/(LV+S)). Then samples can be harvested from the heart, lungs and other tissues as needed. PMID:27167679

  5. Hemodynamic stroke: A rare pitfall in cranio cervical junction surgery

    Directory of Open Access Journals (Sweden)

    Jan Frederick Cornelius

    2014-01-01

    Full Text Available Surgical C1C2-stabilization may be complicated by arterial-arterial embolism or arterial injury. Another potential complication is hemodynamic stroke. The latter might be induced in patients with poor posterior fossa collateralization (risk factor 1 when the vertebral artery (VA is compressed during reduction (risk factor 2. We report a clinical case where this rare situation occurred: A 72-year old patient was undergoing C1C2-stabilization for subluxation due to rheumatoid arthritis. Preoperative computed tomography angiography (CTA had shown poor collaterals in the posterior fossa. Furthermore, intraoperative Doppler ultrasound (US detected unilateral VA occlusion during reduction. It appeared to be a high-risk situation for hemodynamic stroke. Surgical inspection of the VA found osteofibrous compressing elements. Arterial decompression was performed resulting in the normal flow as detected by US. Subsequently, C1C2-stabilization could be realized. The clinical and radiological outcome was very favorable. In C1C2-stabilization precise analysis of preoperative CTA and intraoperative US are important to detect risk factors of hemodynamic stroke. Using these data may prevent this rare, but potentially life-threatening complication.

  6. Disappearing Saccular Intracranial Aneurysms: Do They Really Disappear?

    OpenAIRE

    Jayakumar, P. N.; Ravishankar, S.; Balasubramaya, K.S.; Chavan, R.; Goyal, G

    2007-01-01

    Evolution and natural history of cerebral aneurysms is a dynamic process. Spontaneous regression in size or complete disappearance of an aneurysm is a known phenomenon, more commonly noted in giant intracranial aneurysms. However, reappearance or regrowth of such aneurysms is rare with few anecdotal reports. We report a series of four cases including one giant aneurysm, which either disappeared or regressed on sequential angiograms. Regrowth or reappearance of two of these previously disappea...

  7. Large and giant intracranial aneurysms: A radiologico-clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Lovrencic, M.; Jelicic, I.; Jakovac, I.; Kalousek, M.; Besenski, N.; Surdonja, P.

    1983-12-01

    The brain scans and cerebral angiograms of 13 patients with intracranial aneurysms larger than 15 mm. in diameter are analysed. The radiological findings obtained are compared with clinical symptoms and signs. Twelve patients had genuine aneurysms and one patient a posttraumatic false aneurysm. Post-contrast CT in transversal and coronal plane revealed the real size of the aneurysm in 7 cases of intraluminal thrombosis. Cerebral angiography demonstrated the presence of aneurysms, their anatomic relations and haemodynamic changes.

  8. Subarachnoid hemorrhage with blister aneurysms: Endovascular management

    Directory of Open Access Journals (Sweden)

    Swati Dayanand Chinchure

    2014-01-01

    Full Text Available Blister aneurysms of are rare lesions representing a real challenge for diagnosis and management. They typically show small size, hemispherical shape, fragile wall, broad neck, and are arising from non-branching sites of intracranial arteries. Materials and Methods: We retrospectively reviewed all aneurysms treated at our institution. Seventeen patients (6 male, 11 female with 17 blister aneurysms were identified (mean age 53.3, range 41-63 years. Clinical, procedural, angiographic data as well as follow up data were evaluated. Results: All patients presented with aneurysmal subarachnoid hemorrhage. Majority of the blister aneurysms were located in ICA while 1 was located at posterior cerebral artery, 1 at vertebral and 1 involving basilar artery. All patients were treated using single or overlapping stents and if possible additional coiling. There was no intra-operative rupture. Good outcome (mrs 0-2 was seen in 14 patients. Poor clinical outcome (mrs 3-5 was seen in 2 patients due to vasospasm induced ischemic deficits at discharge, both of them improved on follow up (mrs 1 on follow up. There were 3 mortalities, One patient died of rebleeding while other 2 died due to SAH induced complications. Follow-up angiography was available in 16 patients (one patient died before follow up angiogram and revealed complete or near complete aneurysm occlusion in 11, incomplete obliteration in 1 and no change in 2 cases. Two cases showed post-treatment angiographic aneurysm recurrence. Both cases were managed with repeat coiling and overlapping stent placement. Conclusion: Endovascular management using single/overlapping stent and if possible coil placement is technically safe and feasible in blister aneurysms. Overlapping stents lead to better aneurysm occlusion than a single stent. Blister aneurysm in dorso-medial ICA showed higher tendency of continued growth/recurrence, higher incidence of clinical vasospasm and in these cases early angiographic follow

  9. The effect of endoleak on intra-aneurysmal pressure after EVE for abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the intra-aneurysmal pressure curve in the presence of endoleak after endovascular exclusion (EVE) for abdominal aortic aneurysm (AAA). Methods: Infrarenal aortic aneurysms were created with bovine jugular vein segments or patches. Then they were underwent incomplete endovascular exclusion of the aneurysm and formation of endoleaks. The pressures of blood flow outside the graft into the sac were measured. Results: The intrasac pressure was higher than systemic pressure in the presence of endoleak. After sealing the endoleak, pressure decreased significantly, and the pressure cure showed approximately linear. Conclusion: The change of intra-aneurysmal pressure curve reflected the load on aneurysmal wall after EVE, and can also help to determine the endoleak existence

  10. Electronic database of arterial aneurysms

    Directory of Open Access Journals (Sweden)

    Fabiano Luiz Erzinger

    2014-12-01

    Full Text Available Background:The creation of an electronic database facilitates the storage of information, as well as streamlines the exchange of data, making easier the exchange of knowledge for future research.Objective:To construct an electronic database containing comprehensive and up-to-date clinical and surgical data on the most common arterial aneurysms, to help advance scientific research.Methods:The most important specialist textbooks and articles found in journals and on internet databases were reviewed in order to define the basic structure of the protocol. Data were computerized using the SINPE© system for integrated electronic protocols and tested in a pilot study.Results:The data entered onto the system was first used to create a Master protocol, organized into a structure of top-level directories covering a large proportion of the content on vascular diseases as follows: patient history; physical examination; supplementary tests and examinations; diagnosis; treatment; and clinical course. By selecting items from the Master protocol, Specific protocols were then created for the 22 arterial sites most often involved by aneurysms. The program provides a method for collection of data on patients including clinical characteristics (patient history and physical examination, supplementary tests and examinations, treatments received and follow-up care after treatment. Any information of interest on these patients that is contained in the protocol can then be used to query the database and select data for studies.Conclusions:It proved possible to construct a database of clinical and surgical data on the arterial aneurysms of greatest interest and, by adapting the data to specific software, the database was integrated into the SINPE© system, thereby providing a standardized method for collection of data on these patients and tools for retrieving this information in an organized manner for use in scientific studies.

  11. Complications of endovascular treatment of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Orrù, Emanuele, E-mail: surgeon.ema@gmail.com [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Roccatagliata, Luca, E-mail: lroccatagliata@neurologia.unige.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy); Department of Health Sciences (DISSAL), University of Genoa (Italy); Cester, Giacomo, E-mail: giacomo.cester@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Causin, Francesco, E-mail: francesco.causin@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Castellan, Lucio, E-mail: lucio.castellan@hsanmartino.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy)

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  12. Screening for Abdominal Aortic Aneurysm

    OpenAIRE

    Linné, Anneli

    2014-01-01

    Abdominal Aortic Aneurysm (AAA) is a common disease with a prevalence of 1.5-2.0% in 65-year old men in Sweden. The risk of having AAA is increased with smoking, high age, family history of AAA and cardiovascular disease. Women have a lower prevalence (0.5%) and develop AAA later in life. An AAA seldom gives any symptom prior to rupture. Untreated rupture is associated with 100% mortality, while surgically treated rupture is associated with 25-70% mortality. Prophylactic sur...

  13. Novel risk predictor for thrombus deposition in abdominal aortic aneurysms

    Science.gov (United States)

    Nestola, M. G. C.; Gizzi, A.; Cherubini, C.; Filippi, S.; Succi, S.

    2015-10-01

    The identification of the basic mechanisms responsible for cardiovascular diseases stands as one of the most challenging problems in modern medical research including various mechanisms which encompass a broad spectrum of space and time scales. Major implications for clinical practice and pre-emptive medicine rely on the onset and development of intraluminal thrombus in which effective clinical therapies require synthetic risk predictors/indicators capable of informing real-time decision-making protocols. In the present contribution, two novel hemodynamics synthetic indicators, based on a three-band decomposition (TBD) of the shear stress signal, are introduced. Extensive fluid-structure computer simulations of patient-specific scenarios confirm the enhanced risk-prediction capabilities of the TBD indicators. In particular, they permit a quantitative and accurate localization of the most likely thrombus deposition in realistic aortic geometries, where previous indicators would predict healthy operation. The proposed methodology is also shown to provide additional information and discrimination criteria on other factors of major clinical relevance, such as the size of the aneurysm.

  14. Characterizations and Correlations of Wall Shear Stress in Aneurysmal Flow.

    Science.gov (United States)

    Arzani, Amirhossein; Shadden, Shawn C

    2016-01-01

    Wall shear stress (WSS) is one of the most studied hemodynamic parameters, used in correlating blood flow to various diseases. The pulsatile nature of blood flow, along with the complex geometries of diseased arteries, produces complicated temporal and spatial WSS patterns. Moreover, WSS is a vector, which further complicates its quantification and interpretation. The goal of this study is to investigate WSS magnitude, angle, and vector changes in space and time in complex blood flow. Abdominal aortic aneurysm (AAA) was chosen as a setting to explore WSS quantification. Patient-specific computational fluid dynamics (CFD) simulations were performed in six AAAs. New WSS parameters are introduced, and the pointwise correlation among these, and more traditional WSS parameters, was explored. WSS magnitude had positive correlation with spatial/temporal gradients of WSS magnitude. This motivated the definition of relative WSS gradients. WSS vectorial gradients were highly correlated with magnitude gradients. A mix WSS spatial gradient and a mix WSS temporal gradient are proposed to equally account for variations in the WSS angle and magnitude in single measures. The important role that WSS plays in regulating near wall transport, and the high correlation among some of the WSS parameters motivates further attention in revisiting the traditional approaches used in WSS characterizations. PMID:26592536

  15. Therapeutic approaches to cerebral vasospasm complicating ruptured aneurysm

    Directory of Open Access Journals (Sweden)

    Mohamed Barbarawi

    2009-10-01

    Full Text Available Cerebral vasospasm is a serious complication of ruptured aneurysm. In order to avoid short- and long-term effects of cerebral vasospasm, and as there is no single or optimal treatment modality employed, we have instituted a protocol for the prevention and treatment of vasospasm in patients suffering aneurysmal sub-arachnoid hemorrhage (SAH. We then reviewed the effectiveness of this protocol in reducing the mortality and morbidity rate in our institution. In this study we present a retrospective analysis of 52 cases. Between March 2004 and December 2008 52 patients were admitted to our service with aneurysmal SAH. All patients commenced nimodipine, magnesium sulphate (MgSO4 and triple H therapy. Patients with significant reduction in conscious level were intubated, ventilated and sedated. Intracranial pressure (ICP monitoring was used for intubated patients. Sodium thiopental coma was induced for patients with refractory high ICP; angiography was performed for diagnosis and treatment. Balloon angioplasty was performed if considered necessary. Using this protocol, only 13 patients (25% developed clinical vaso-spasm. Ten of them were given barbiturates to induce coma. Three patients underwent transluminal balloon angioplasty. Four out of 52 patients (7.7% died from severe vasospasm, 3 patients (5.8% became severely disabled, and 39 patients (75% were discharged in a condition considered as either normal or near to their pre-hemorrhage status. Our results confirm that the aforementioned protocol for treatment of cerebral vasospasm is effective and can be used safely.

  16. Nuclear medical diagnostic with ventricular aneurysm

    International Nuclear Information System (INIS)

    In the diagnostic of ventricular aneurysms myocardial scintigraphy and above all radionuclide ventriculography (RNV) have special importance. Because of the non-invasive method and the as a result safe and easy use even with stress studies, RNV can provide a very valuable aid with aneurysm patients in early diagnosis, evaluation of the operability and as well as in the prognosis. It must be noted, however, that the differentiation of multivascular diseases and sometimes ventricular aneurysms can be difficult and the inclusion of an angiocardiograph as a radiological invasive examination procedure seems fitting. (orig./MG)

  17. Abdominal aortic aneurysm demonstrated on renal scintigraphy.

    Science.gov (United States)

    Phisitkul, Sorot; Brian, Susan; Rakvit, Ariwan; Jenkins, Leigh A; Bohannon, W Todd; Harris, Jennifer; Tsikouris, James; Silva, Michael B; Meyerrose, Gary E

    2003-08-01

    A 74-year-old hypertensive woman presented with abdominal discomfort and a pulsatile abdominal mass. Anterior abdominal angiography during cardiac blood pool, and renal scintigraphic imaging demonstrated a large abdominal aortic aneurysm. 1, 2 Before endovascular repair with an aortoiliac endograft, the abdominal aneurysm measured 7.5 x 7.0 cm on abdominal computed tomography. This study demonstrates that a suspected abdominal aortic aneurysm can be confirmed using the addition of anterior abdominal imaging with normal posterior imaging at the time of renal scintigraphy. PMID:12897671

  18. 基于LabVIEW的心血管动力学参数分析与研究%The Analysis and Research of Hemodynamic Parameters of Artery Based on LabVIEW

    Institute of Scientific and Technical Information of China (English)

    廖辰川; 全晓莉; 梁光越; 雷梅雨; 徐竞屹

    2011-01-01

    Objective: A set of analysis system about cardiovascular parameters based on pulse wave theory and virtual instrument is designed. Methods: This paper apply LabVIEW7.0 programming environment to generalize the measure methods of systolic blood pressure, mean arterial pressure, diastolic blood pressure, heart rate, stroke volume, cardiac output, etc. Based on the oscillometric method and the theories of Windkessel. Results: It can detect difference between cardiovascular patients and normal persons by the analysis of hemodynamic parameters of artery. It provides a convenient method for researching and preventing cardiovascular diseases. Large amounts of experimental results turned out that the system has a good accuracy and stability. Conclusions: This system of waveforms collection and analysis has these characteristics such as simple operation, flexibility and extendibility, and it can provide cardiovascular conditions of the patient visually, thus being able to take measures and do prevention, which provides a simple and effective way for analysis and research of cardiovascular parameters.%目的:根据脉搏波理论设计出一套基于虚拟仪器的心血管动力学参数分析系统.方法:本文以LabVIEW7.0作为软件开发平台,根据示波法原理和弹性腔理论总结提炼出收缩压、平均压、舒张压、心率、每搏心输出量、每分心输出量、外周阻力等参数.结果:通过心血管动力学参数的分析能判断心血管病患者与正常人的差异性,对心血管病的预防及疾病早期发现都能发挥很大的作用.大量的实测结果表明系统有较好的准确性和稳定性.结论:此采集分析系统有操作便捷.灵活性高,可扩展性好的特点,可以直观地观测病人的心血管状况以便及时的对心血管疾病采取措施和进行预防,为心血管动力学参数的分析研究提供了一种简便有效的途径.

  19. Hemodynamic significance of internal carotid artery disease

    DEFF Research Database (Denmark)

    Schroeder, T

    1988-01-01

    most indirect tests become positive at relatively small pressure gradients. Studies of cerebral blood flow at rest and during cerebral vasodilation makes it possible to identify patients with severe reduction of cerebral perfusion pressure. Such hemodynamic failure of one hemisphere may be identified...... can a significant improvement in baseline flow occur. Flow reserve determined by cerebral vasodilation, however, will improve in most patients with hemodynamic failure. In addition, some patients in the low-pressure group develop marked, but temporary, hyperperfusion after reconstruction of very high...

  20. Clinical and imaging features of intracranial arterial aneurysms in the pediatric population; Klinische und radiologische Merkmale des intrakraniellen arteriellen Aneurysmas bei Kindern und Jugendlichen

    Energy Technology Data Exchange (ETDEWEB)

    Abruzzo, Todd A. [Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States). Dept. of Radiology; Aeron, Gunjan; Jones, Blaise V.

    2013-07-15

    Intracranial arterial aneurysms (IAAs) are rare in children. Nevertheless, IAAs account for at least 10 % - 15 % of hemorrhagic strokes during the first two decades of life. Traditional vascular risk factors, which are common in the adult population, are generally absent in the pediatric population, engendering distinct modes of IAA pathogenesis. Classification of pediatric IAAs according to the pathogenetic mechanism shows eight distinct categories: idiopathic, traumatic, those due to excessive hemodynamic stress, vasculopathic, infectious, noninfectious inflammatory, oncotic, and familial. Pathogenetic mechanism is the best predictor of the clinical course of the disease, response to treatment, and long-term prognosis. The pathogenetic subtypes of pediatric IAA show characteristic and variably overlapping features. In most cases, IAAs manifesting during the first two decades of life are idiopathic. IAAs that are idiopathic, traumatic (second most common type), or due to excessive hemodynamic stresses (third most common type) account for more than 80 % of IAAs in the pediatric age group. Most of the remaining pediatric IAAs are the result of congenital cerebral aneurysmal arteriopathies or infection. Multiple IAAs are unusual in young children except in those with acquired (secondary to immune deficiency states) or congenital cerebral aneurysmal arteriopathies or infectious IAAs. (orig.)

  1. Hemodynamic aspects of biventricular pacing in heart failure

    OpenAIRE

    Ståhlberg, Marcus

    2010-01-01

    Background and aims Biventricular pacing or cardiac resynchronization therapy (CRT) is an established treatment option for selected heart failure (HF) patients. We aimed at evaluating acute and longer-term hemodynamic effects of different pacemaker programmings in CRT patients. For the latter purpose, 10 CRT patients also received an implantable hemodynamic monitor (IHM), allowing for long-term hemodynamic monitoring during ambulatory periods. Study I The hemodynamic ...

  2. Bilateral giant femoropopliteal artery aneurysms: a case report

    Directory of Open Access Journals (Sweden)

    Perdikides Theodossios P

    2008-04-01

    Full Text Available Abstract Introduction Popliteal artery aneurysms are the most common peripheral arterial aneurysms, and are frequently bilateral. Acute limb ischemia, rupture and compression phenomena can complicate these aneurysms when the diameter exceeds 2 cm. Case Presentation We report an 82-year-old male patient with two giant femoropopliteal aneurysms, 10.5 and 8.5 cm diameters, managed in our institution. Both aneurysms were resected and a polytetrafluoroethylene (PTFE femoropopliteal interposition graft was placed successfully. Management and literature review are discussed. Conclusion We believe this is the first report in the medical literature of bilateral giant femoropopliteal aneurysms.

  3. Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis

    Energy Technology Data Exchange (ETDEWEB)

    Stefanczyk, Ludomir; Elgalal, Marcin, E-mail: telgalal@yahoo.co.uk [Medical University of Lodz, Department of Radiology and Diagnostic Imaging (Poland); Papiewski, Andrzej [Medical University of Lodz, Department of Gastroenterological Surgery (Poland); Szubert, Wojciech [Medical University of Lodz, Department of Radiology and Diagnostic Imaging (Poland); Szopinski, Piotr [Institute of Hematology and Transfusion Medicine, Clinic of Vascular Surgery (Poland)

    2013-06-15

    Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.

  4. Cerebral hemodynamic difference between early- and late-onset Alzheimer's disease by circumferential profile analysis with 123I-IMP brain SPECT

    International Nuclear Information System (INIS)

    We conducted investigation to determine whether early- and late-onset Alzheimer's diseases differ pathophysiologically. Five patients with the early-onset (65 years and under) of the disease and 11 with the late-onset (65 years and over) of the disease were studied by single photon emission CT (SPECT) with N-isopropyl-p-[123I]iodoamphetamine (IMP). Circumferential profile analysis (CPA) was performed to examine differences in the predominant hypoperfusion in the temporoparietal lobe, which is considered to be functionally damaged the most in Alzheimer's disease. The Xm values, calculated from gradients between the motorsensory or occipital cortices and temporoparietal cortex in the circumferential profile curve, were compared in both groups. The Xm values for patients with early- and late-onset Alzheimer's disease were 6.81±2.10 (counts/degree) and 3.28±1.58, respectively, the difference being significant. Our results suggest that functional abnormalities in the temporoparietal area severer in early- than late-onset Alzheimer's disease and that the application of CPA to IMP SPECT is useful to elucidate the pathophysiological difference between each of the disease. (author)

  5. Microcatheter looping to facilitate aneurysm selection in coil embolization of paraclinoid aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Rhim, Jong Kook; Park, Jeong Jin; Jeon, Jin Sue; Yoo, Roh Eul; Kang, Hyun Seung; Kim, Jeong Eun; Cho, Won Sang; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2015-08-15

    Described herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy. This retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment. Through this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping. This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

  6. Venous Aneurysm Complicating Dialytic Arteriovenous Fistula

    OpenAIRE

    Arjun K.Nambiar; Anand, K. T.; Jayakrishnan, A. G.

    2012-01-01

    A case of venous aneurysm complicating arteriovenous fistula created for chronic haemodialysis is presented. The patient underwent successful ligation and excision of the fistula and creation of a fistula on the opposite limb.

  7. Asthma May Raise Risk for Abdominal Aneurysm

    Science.gov (United States)

    ... nlm.nih.gov/medlineplus/news/fullstory_157202.html Asthma May Raise Risk for Abdominal Aneurysm Airway disease ... People 50 and older who have had recent asthma activity appear to be at an increased risk ...

  8. Tubercular mycotic aortic aneurysm: A case report

    Directory of Open Access Journals (Sweden)

    Satish Kumar

    2016-01-01

    Full Text Available Tubercular aneurysms of larger vessels, particularly the aorta is very rare. The first case of tubercular involvement of the aorta in the form of aortitis was reported in 1882 by Weigert and the first case of tubercular mycotic aneurysm of the aorta was reported in 1895. The preoperative diagnosis of tubercular aortic aneurysm is difficult. Even at surgery, determining the tubercular nature of the lesion is problematic. The gross appearance may not be distinctive, and acid-fast stains are unlikely to be performed. We report the case of a young female patient who was started on antitubercular treatment for pleural effusion and was found to have aortic aneurysm, which later on proved to be tubercular in origin.

  9. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ounissi M

    2009-01-01

    Full Text Available The dissecting aortic aneurysm (DAA is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.

  10. Aneurysm of the vein of Galen

    International Nuclear Information System (INIS)

    We report a case of a vein of Galen aneurysm in a neonate in which MR imaging provided essentially all pertinent diagnostic information prior to surgery. MR findings correlated well with selective cerebral angiography. (orig./MG)

  11. Endovascular repair of aortic aneurysm: Preliminary results

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2009-01-01

    Full Text Available Introduction. Endovascular aneurysm repair (EVAR has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male, aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers, while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia. All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant® endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent® endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years, there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft

  12. Splenic artery aneurysm rupture in pregnancy

    International Nuclear Information System (INIS)

    Rupture of a splenic artery aneurysm, commonly associated with pregnancy is a rare and catastrophic event. We report here a case of a patient in her second pregnancy who presented with a short history of left hypochondriac and epigastric pain, followed by collapse at 32 weeks gestation. Sudden fetal distress lead to emergency caesarean delivery when splenic artery aneurysm rupture was diagnosed. With timely involvement of multidisciplinary personnel both mother and baby survived and had an uneventful recovery. (author)

  13. Multiple Intracranial Aneurysms in HIV Infection.

    Science.gov (United States)

    Dhawan, Sumeet R; Gupta, Anju; Gupta, Vivek; Singhi, Pratibha D

    2016-08-01

    Neurological findings in HIV are common and include cognitive impairment, microcephaly, nonspecific white matter lesions and seizures. Cerebral vasculopathy and stroke are uncommon and may be due to primary HIV vasculopathy or opportunistic infections such as tuberculosis and cryptococcal meningitis. The authors describe a 7-y-old boy who presented with severe headache and was detected to have aneurysmal bleed due to intracranial aneurysm. PMID:27072660

  14. A proposal for standardizing computed tomography reports on abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Objective: to propose a model to standardize computed tomography reports on abdominal aortic aneurysms. Materials and methods: interviews were carried out with members of the Vascular Surgery Division of our institution, in the period between April and October 2004, aiming at developing a standardized model of computed tomography reports on abdominal aortic aneurysms. Based on this model, a questionnaire was elaborated and sent to other nine surgeons, all of them experienced in the field of abdominal aortic surgery. The questionnaires response rate was 55.5% (5/9). Results: the most frequently mentioned parameters of interest for evaluation of abdominal aortic aneurysms were: maximum diameter of proximal aortic neck, proximal aortic neck length to lower renal arteries, shape of proximal aortic neck, maximum diameter of the aneurysm and diameter of the common iliac arteries. These data allowed the development of a proposal for a model to standardize computed tomography reports. Conclusion: a model for standardized tomographic analysis of abdominal aortic aneurysms has met vascular surgeons' needs for following-up patients and planning their treatment. (author)

  15. Basic Perforator Flap Hemodynamic Mathematical Model

    Science.gov (United States)

    Tao, Youlun; Ding, Maochao; Wang, Aiguo; Zhuang, Yuehong; Chang, Shi-Min; Mei, Jin; Hallock, Geoffrey G.

    2016-01-01

    Background: A mathematical model to help explain the hemodynamic characteristics of perforator flaps based on blood flow resistance systems within the flap will serve as a theoretical guide for the future study and clinical applications of these flaps. Methods: There are 3 major blood flow resistance network systems of a perforator flap. These were defined as the blood flow resistance of an anastomosis between artery and artery of adjacent perforasomes, between artery and vein within a perforasome, and then between vein and vein corresponding to the outflow of that perforasome. From this, a calculation could be made of the number of such blood flow resistance network systems that must be crossed for all perforasomes within a perforator flap to predict whether that arrangement would be viable. Results: The summation of blood flow resistance networks from each perforasome in a given perforator flap could predict which portions would likely survive. This mathematical model shows how this is directly dependent on the location of the vascular pedicle to the flap and whether supercharging or superdrainage maneuvers have been added. These configurations will give an estimate of the hemodynamic characteristics for the given flap design. Conclusions: This basic mathematical model can (1) conveniently determine the degree of difficulty for each perforasome within a perforator flap to survive; (2) semiquantitatively allow the calculation of basic hemodynamic parameters; and (3) allow the assessment of the pros and cons expected for each pattern of perforasomes encountered clinically based on predictable hemodynamic observations.

  16. Force plate monitoring of human hemodynamics

    Czech Academy of Sciences Publication Activity Database

    Kříž, J.; Šeba, Petr

    2008-01-01

    Roč. 2, č. 1 (2008), s. 1-9. ISSN 1753-4631 Grant ostatní: GA ČR(CZ) GP202/06/P130; GA MŠk(CZ) LC06002 Institutional research plan: CEZ:AV0Z10100521 Keywords : hemodynamics * balistocardiography * pulse wave velocity Subject RIV: BO - Biophysics www.nonlinearbiomedphys.com

  17. Endovascular therapeutic strategies in ruptured intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Machi, Paolo, E-mail: paolo.machi@gmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Lobotesis, Kyriakos, E-mail: kyriakos@lobotesis.co.uk [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Vendrell, Jean Francoise, E-mail: jfvendrell@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Riquelme, Carlos, E-mail: riquelme.carlos@neuf.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Eker, Omer, E-mail: eker_omer@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Costalat, Vincent, E-mail: vincentcost@hotmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Bonafe, Alain, E-mail: bonafeh@aol.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France)

    2013-10-01

    The aim of the present study was to evaluate endovascular techniques used currently which were not available at the time of ISAT inclusion period, such as balloon remodelling and flow-divertion, in order to assess whether these new technologies have improved the endovascular approach outcomes. We present a review of articles, published in major journals, with the aim to evaluate the efficacy and the safety of coiling with balloon remodelling for the treatment of ruptured aneurysms in comparison to coiling performed without such coadjutant techniques. Furthermore, we reviewed publications reporting on the treatment of ruptured aneurysms in the acute phase with the one of the most recent technologies available nowadays: the flow diverting stent. Looking at the recent literature the results regarding ruptured aneurysms treated with balloon assisted coiling (BAC) have shown an improvement in terms of anatomical results and morbi-mortality rates. Case series of ruptured middle cerebral artery (MCA) aneurysms treated by EVT report results similar to those obtained by surgical clipping. Several articles recently report encouraging results in treating ruptured dissecting and blister aneurysms with flow diverters. Questions regarding the best treatment available for ruptured aneurysms are yet to be answered. Hence there is a need for a subsequent trial aiming to answer these unresolved issues.

  18. Computed tomography of the aortic aneurysm

    International Nuclear Information System (INIS)

    The diagnostic usefulness of CT was studied in 31 cases in total of thoracic and abdominal aneurysm. CT was useful for not only visualizing the transverse plane and wall of an aneurysm but also ascertaining the status of destruction of vertebra due to aneurysm. CT was considered to be of value, particularly for diagnosis of dissecting aneurysm. Of 8 cases of dissecting aneurysm, it in fact brought about a correct diagnosis in 6 cases (75%). The tomographic findings in these cases were characterized by formation of images of the exfoliated intima and dissection cavity, abnormality in the site of intimal calcification, and delay in opacification of the dissection cavity. The use of a bolus injection of contrast medium is recommended in the CT of thoracic or abdominal aneurysm. Since CT can be performed non-invasively, it is suitable for follow-up of the clinical course of dissection cavity. The CT value of thrombi varies among individual cases, which raises a possibility that the CT value may reflect the time-course change in their properties after thrombogenesis. (author)

  19. Symptomatic calcified splenic artery aneurysm: Case report

    Directory of Open Access Journals (Sweden)

    Čolović Radoje

    2010-01-01

    Full Text Available Introduction. Although the third most common aneurysm within the abdomen, after aneurysms of the aorta and iliac arteries, splenic artery aneurysms are rare, but not exceptionally. Owing to new imaging techniques, they have been discovered with increasing frequency. Case Outline. Authors present a 47-year-old woman, multipara, who presented with left upper abdominal pain in whom X-ray showed a calcified ring in the area of distal pancreas. Selective angiography confirmed a splenic artery aneurysm of its proximal part. During an open surgery the aneurysm was excised (aneurismectomy without immediate, early or late complications. The patient became symptom-free. Conclusion. In patients, particularly women, the multiparas who present with epigastric or left upper abdominal pain of unknown aetiology, splenic artery aneurysm has to be taken into account. Further diagnostic procedures such as plain X-ray and selective angiography in suspected cases should be performed. Surgery or other treatment modalities are to be seriously considered in all patients, particularly in those with increased risk of rupture.

  20. Intracranial aneurysms in an African country

    Directory of Open Access Journals (Sweden)

    Ogeng'o Julius

    2009-12-01

    Full Text Available Background : Characteristics of intracranial aneurysms display ethnic variations. Data on this disease from the African continent is scarce and often conflicting. Aim : To describe site, age and gender distribution of intracranial aneurysms among Kenyans. Study Design and Setting : Retrospective study at Kenyatta National Hospital, Kenya. Materials and Methods: All records of black African patients with a diagnosis of intracranial aneurysms seen at Kenyatta National Hospital, the largest referral hospital in the Eastern and Central African region, over the period from January 1998 to December 2007 were examined for site, age and gender distribution. The data gathered were coded, analyzed with SPSS 11.50. Results : Fifty-six cases of intracranial aneurysms were analyzed. The posterior communicating artery was the most affected (35.7%, followed by the anterior communicating artery (26.8%, while the posterior cerebral artery was the least affected (2%. Multiple aneurysms were present in 2%. The mean age at presentation was 50.9 years (range 21-80 years and the gender distribution was equal. Conclusions : Intracranial aneurysms among Kenyans occur most commonly on the posterior communicating artery, in young individuals, and without gender bias. The distribution differs from that described in the literature and this requires search for risk factors.

  1. Bronchial Artery Aneurysm Embolization with NBCA

    International Nuclear Information System (INIS)

    We present a case of asymptomatic bronchial artery aneurysm that formed a fistula with part of the pulmonary artery (there was no definite fistula with the pulmonary vein). We were able to catheterize the feeding vessel but could not reach the aneurysm. We therefore injected a mixture of N-butyl-2-cyanoacrylate (NBCA; Histoacryl, B. Braun, Melsungen, Germany) and iodized oil (Lipiodol; Guerbet, Aulnay-sous-Bois, France) from the feeding vessel. The fistula, aneurysm, and feeding vessel were almost totally occluded. After embolization, the patient coughed a little; there were no other definite side effects or complications. One and 3 months later, on chest CT, the aneurysm was almost completely occupied with hyperattenuating NBCA-Lipiodol embolization. NBCA is a liquid embolization material whose time to coagulation after injection can be controlled by diluting it with Lipiodol. It is therefore possible to embolize an aneurysm, feeding vessels, and efferent vessels (in our case, it was a fistula) by using an NBCA-Lipiodol mixture of an appropriate concentration, regardless of whether the catheter can reach the aneurysm or not

  2. Clinical Manifestations of Aortocaval Fistulas in Ruptured Abdominal Aortic Aneurysm: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Emmanouil D. Psathas

    2012-01-01

    Full Text Available Aortocaval fistula (ACF is an unusual complication of ruptured abdominal aortic aneurysm (AAA, involving less than 3–6% of all ruptured cases. The clinical presentation is often obscure, depending on the coexistence of retroperitoneal rupture and hemodynamic instability. Prompt preoperative diagnosis is essential in order to plan the operative approach and improve patient’s outcome. We report the surgical treatment of two patients presented in the emergency department with ACF due to ruptured AAA, each with different clinical presentation, emphasizing the high index of suspicion needed by the clinician to early diagnose and treat this often lethal condition. Operative strategy and special considerations in the management of this subgroup of patients are also discussed.

  3. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms.

    LENUS (Irish Health Repository)

    Su, I-Chang

    2014-06-01

    Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development.

  4. Potential value of aneurysm sac volume measurements in addition to diameter measurements after endovascular aneurysm repair.

    NARCIS (Netherlands)

    Keulen, J.W. van; Prehn, J. van; Prokop, M.; Moll, F.L.; Herwaarden, J.A. van

    2009-01-01

    PURPOSE:To investigate the value of aneurysm sac volume measurement in addition to diameter measurements based on computed tomographic angiography (CTA) after endovascular aneurysm repair (EVAR). METHODS:Interrogation of a vascular database identified 56 patients (51 men; median age 77 years, range

  5. Patterns and predictors of in-hospital aneurysmal rebleed: An institutional experience and review of literature

    Directory of Open Access Journals (Sweden)

    Menon Girish

    2007-01-01

    Full Text Available Background: Rebleeding is an important cause for mortality following aneurysmal subarachnoid hemorrhage. Early intervention is believed to reduce the risk of rebleeding. However, in developing countries such as India, early intervention is often difficult due to various reasons. The knowledge about the risks and predictors for rebleeding is essential to prioritize the management policy. Aims: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, to study the clinical profile of patients with rebleed and to review the controversial aspects on aneurysmal rebleed. Materials and Methods: This observational study is based on the retrospective analysis of the case records of all patients admitted with aneurysmal subarachnoid hemorrhage (SAH since January 1999 in our institute. Twenty patients rebled after admission before surgical clipping, and these patients formed our study group. The findings were compared with all the major series on rebleeding published in literature. Results: Since January 1999, 952 patients underwent treatment for aneurysmal subarachnoid hemorrhage in our institute. Twenty patients rebled while awaiting surgery following the admission with an incidence of 2.14%. The study group included nine males and eleven females. The age of the patients ranged from 31 to 69 years, but the majority were in the sixth decade. Mean bleed to admission days was 7.9 days (range: 1-27 days, the mean admission to rebleed was 1.42 days (Range: 0-4 and the mean first bleed to rebleed was 9.26 days. The history of loss of consciousness at the time of bleeding was observed in 16 patients. Four patients bled before an angiogram could be performed. Two patients had giant aneurysms, while the rest had small aneurysms; two patients had multiple aneurysms. Angiographic spasm was observed in eight patients. In three patients, rebleeding was precipitated by angiogram. Twelve patients rebled while taking rest or in sleep, while

  6. Impact of Intra-Extracranial Hemodynamics on Cerebral Ischemia by Arterial Hypertension (Part 2

    Directory of Open Access Journals (Sweden)

    Alexander G. Kruglov, PhD, ScD

    2012-06-01

    Full Text Available The association between hemodynamic and biochemical parameters of cerebral blood flow have been studied in man, using mathematical methods of statistics. The values have been obtained through catheterization using a probe jammed at the level of the bulb of the superior jugular vein. Relationships with central hemodynamic parameters have been evaluated, including the right atrium, the right ventricle, and the left ventricle, as well as with pressure and biochemical values of the arterial bed. Data have been acquired in patients with stable arterial hypertension. Analysis of all relationship between hemodynamic and biochemical parameters has shown that the uniform hemodynamic zone: Sin.P. – SJV – SEV – the right atrium, normally participates in regulation of gaseous exchange in the human brain depending on the minimum pressure on the way of outflow from the brain. In stable arterial hypertension, this type of regulation is lost. On the basis of the results of this study, it has been concluded that blood viscosity is normally a primary controlled parameter of homeostasis. In stable arterial hypertension, homeostatic control of factors determining rheological and thrombogenic properties of blood, as well as participating in the development of brain ischemic conditions is lost. This increases risk of disturbances in central hemodynamics.

  7. Hemodynamics in stented vertebral artery ostial stenosis based on computational fluid dynamics simulations.

    Science.gov (United States)

    Qiao, Aike; Dai, Xuan; Niu, Jing; Jiao, Liqun

    2016-08-01

    Hemodynamic factors may affect the potential occurrence of in-stent restenosis (ISR) after intervention procedure of vertebral artery ostial stenosis (VAOS). The purpose of the present study is to investigate the influence of stent protrusion length in implantation strategy on the local hemodynamics of the VAOS. CTA images of a 58-year-old female patient with posterior circulation transient ischemic attack were used to perform a 3D reconstruction of the vertebral artery. Five models of the vertebral artery before and after the stent implantation were established. Model 1 was without stent implantation, Model 2-5 was with stent protruding into the subclavian artery for 0, 1, 2, 3 mm, respectively. Computational fluid dynamics simulations based on finite element analysis were employed to mimic the blood flow in arteries and to assess hemodynamic conditions, particularly the blood flow velocity and wall shear stress (WSS). The WSS and the blood flow velocity at the vertebral artery ostium were reduced by 85.33 and 35.36% respectively after stents implantation. The phenomenon of helical flow disappeared. Hemodynamics comparison showed that stent struts that protruded 1 mm into the subclavian artery induced the least decrease in blood speed and WSS. The results suggest that stent implantation can improve the hemodynamics of VAOS, while stent struts that had protruded 1 mm into the subclavian artery would result in less thrombogenesis and neointimal hyperplasia and most likely decrease the risk of ISR. PMID:26691981

  8. Long-term results after repair of ruptured and non-ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Kuzmanović Ilija B.

    2004-01-01

    peripheral arteries and other vascular reconstructive procedures were the factors that significantly reduced long-term survival of patients operated immediately due to rupture. DISCUSSION This comprehensive study has searched for more factors than others had done before. The applied discriminative analysis numerically evaluated the influence of any risk factor of mortality. These factors were divided in three groups as follows: preoperative, operative and postoperative ones. Preoperative factors were sex, age, diabetes mellitus, arterial hypertension, obesity, COPD, and naturally, the indication for operative treatment of ruptured or non-ruptured abdominal aneurysm. Among all these factors, only obesity significantly reduced long-term survival of electively operated patients. It may be said that immediately operated patients who survived the first 30 postoperative days had quite good long-term survival. Operative factors such as type of operative procedure and vascular graft had no influence on long-term survival of patients in both groups. Postoperative risk factors were early postoperative complications, graft infection, symptomatic cerebrovascular disease, carotid endarterectomy, myocardial revascularization, ventral hernias, "other" non vascular operations, malignancy, mental disorders, peripheral aneurysms and occlusive vascular disease, and other vascular operations either due to aneurysm or peripheral occlusive disease. Early postoperative complications (even graft infection had no significant effect on long-term survival. Ventral hernias and peripheral aneurysms were factors that significantly decreased long-term survival of patients operated for rupture of the abdominal aneurysm. CONCLUSION It is interesting that endarterectomy, myocardial revascularization or malignancy after repair of the abdominal aneurysm (ruptured or non-ruptured had no effect on long-term survival.

  9. [True aneurysm of the common hepatic artery: a case report].

    Science.gov (United States)

    Mighri, Mohamed Mongi; Boujelbene, Salah; Trabelsi, Khaled; Zouaoui, Taieb; Khemakhem, Abdelhamid; Abid, Skander; Gzara, Kaouther; Chebbi, Fethi; Touinsi, Hassen; Azzouz, Mohamed Moussadek; Sassi, Sadok

    2004-02-01

    We report a case of hepatic artery aneurysm suggested by the appearance of epigastric mass. The diagnosis was confirmed by doppler sonography and helical CT. Surgical excision of the aneurysm without vascular reconstruction was carried out. PMID:15185605

  10. Talk to Your Doctor about Abdominal Aortic Aneurysm

    Science.gov (United States)

    ... Print This Topic En español Talk to Your Doctor about Abdominal Aortic Aneurysm Browse Sections The Basics ... Why do I need to talk to the doctor? Aneurysms usually grow slowly without any symptoms. When ...

  11. Aneurysms of the posterior cerebral artery in children

    International Nuclear Information System (INIS)

    Two cases of aneurysms of the posterior cerebral artery, diagnosed by CT and confirmed angiographically, are reported. In the first case, the aneurysm was discovered fortuitously. The second began with intracerebral haemorrhage. A review of the literature is reported. (orig.)

  12. Diabetes and Abdominal Aortic Aneurysm Growth.

    Science.gov (United States)

    Takagi, Hisato; Umemoto, Takuya

    2016-07-01

    We performed a systematic literature search and a meta-analysis to assess the association between diabetes mellitus (DM) and abdominal aortic aneurysm (AAA) growth. Databases including MEDLINE and EMBASE were searched through June 2015 using PubMed and OVID. For each study, data regarding AAA growth rates in both the DM and the non-DM groups were used to generate standardized mean differences (SMDs) and 95% confidence intervals (CIs). Our search identified 19 relevant studies including data on 9777 patients with AAA. Pooled analyses demonstrated a statistically significant slower growth rates in DM patients than in non-DM patients (unadjusted SMD, -0.32; 95% CI, -0.40 to -0.24; P plot asymmetry, even adjustment of the asymmetry did not alter the beneficial effect of DM. In conclusion, on the basis of a meta-analysis of data on a total of 9777 patients (19 studies) identified through a systematic literature search, we confirmed the association of DM with slower growth rates of AAA. PMID:26311742

  13. [Evaluation of the blood coagulation system after surgeries on abdominal aortic aneurysms].

    Science.gov (United States)

    Nikul'nikov, P I; Liksunov, O V; Ratushniuk, A V; Lugovs'koĭ, E V; Kolesnikova, I M; Lytvynova, L M; Kostiuchenko, O P; Chernyshenko, T M; Hornyts'ka, O V; Platonova, T M

    2012-09-01

    Basing on data of analysis of the hemostasis system state in the patients, suffering abdominal aorta aneurysm, a tendency for raising of postoperative soluble fibrin and D-dimer content in the blood plasm and reduction of these indices on the third day was noted. The abovementioned markers content depends on the aneurysm size, the fibrin deposits presence, the terms from clinical signs beginning to the certain therapy administration and anticoagulants application. Information about correlation between content of D-dimer and soluble fibrin in the treatment dynamics is important for determination of activation degree in the patients blood coagulation system and the thrombotic complications prognosis. PMID:23285650

  14. [Hemodynamic analysis of a centrifugal blood pump].

    Science.gov (United States)

    Wang, Yang; Yang, Ming; Xu, Zihao; Zhuang, Xiaoqi; Li, Qilei; Xu, Liang

    2015-01-01

    This paper built the mathematical model of a centrifugal blood pump, which was designed by ourselves, combined it with that of the human cardiovascular system and simulated the coupling system using Matlab. Then we set up the experiment platform, linked the blood pump to mock human cardiovascular system in case of three-stage heart failure, and measured aortic pressure and flow under different speed. The comparison between experiment results and simulation results not only indicates the coupling model is correct and the blood pump works well, but also shows that with the increase of blood pump speed, the pulsation of aortic pressure and flow will be reduced, this situation will affect the structure and function of blood vessels. PMID:26027287

  15. Isolated common femoral artery aneurysm: a case report

    OpenAIRE

    Sharma, Saurabh; Nalachandran, Sanjay

    2009-01-01

    Introduction Isolated aneurysm of common femoral artery is a rare occurrence. They may mimic other common conditions like groin lymph nodes or groin hernia. Case presentation Here we present a case of 61-years-old Chinese gentleman who presented with a right groin lump, which was suspected to be groin hernia but turned out common femoral artery aneurysm. The aneurysm was surgically excised and a prosthetic vascular repair was done. Conclusion Isolated common femoral artery aneurysms are rare ...

  16. Rupture of popliteal arterial aneurysm due to salmonella infection

    International Nuclear Information System (INIS)

    We report here on a case of popliteal aneurysm and rupture that occurred over a 10-day period and this was all secondary to salmonella infection. Computed tomography (CT) angiography of the extremity that was performed before and after aneurysmal rupture showed the aneurysm's rapid evolution to rupture over a short period of time. We also review the pathogenesis, clinical presentation, diagnostic approach and management of salmonella aneurysms

  17. Endovascular management of giant middle cerebral artery aneurysms

    OpenAIRE

    Huang, Lei; Cao, Wenjie; Ge, Liang; Lu, Gang; Wan, Jun; Zhang, Lei; Gu, Weijin; Zhang, Xiaolong; Geng, Daoying

    2015-01-01

    Background: This article reported the experience of endovascular treatment in giant middle cerebral artery (MCA) aneurysms with parent artery occlusion or stent-assisted coiling. Material and methods: Eleven consecutive patients with giant MCA aneurysms were included. The aneurysms predominantly involved the M1 segment in two cases, bifurcation in four cases, and M2 in five cases. Four M2 fusiform aneurysms were treated with parent artery sacrifice after balloon occlusion test. The seven unru...

  18. Basilar artery aneurysm with autonomic features: an interesting pathophysiological problem

    OpenAIRE

    Giffin, N; Goadsby, P

    2001-01-01

    Unruptured cerebral aneurysms often present with neuro-ophthalmological symptoms but ocular autonomic involvement from an aneurysm of the posterior circulation has not previously been reported. A patient is described with a basilar artery aneurysm presenting with headache and unilateral autonomic symptoms. After angiographic coiling of the aneurysm there was a near complete resolution of these features. The relevant anatomy and proposed mechanism of autonomic involvement of what may be ...

  19. Distal posterior inferior cerebellar artery aneurysm in a child

    OpenAIRE

    J. FRANCISCO SALOMÃO; René D. Leibinger; Yara M. S. Lima Ciro de A. Cunha; Ilton G. Shinzato; Paulo de T. L. Dantas

    1992-01-01

    The case of a 7-year-old boy presenting with recurrent episodes of subarachnoid hemorrhage due to a distal posterior inferior cerebellar artery aneurysm (PICA), successfully operated, is reported.' The low incidence of intracranial aneurysms in the first decade of life and the rare occurrence of distal PICA aneurysms are unusual features of this case. The theories regarding the origin of intracranial berry aneurysms are discussed.

  20. Clinical Practice Guideline for the Management of Intracranial Aneurysms

    OpenAIRE

    Jeong, Hae Woong; Seo, Jung Hwa; Kim, Sung Tae; Jung, Cheol Kyu; Suh, Sang-il

    2014-01-01

    Purpose An intracranial aneurysm, with or without subarachnoid hemorrhage (SAH), is a relevant health problem. The rupture of an intracranial aneurysm is a critical concern for individual health; even an unruptured intracranial aneurysm is an anxious condition for the individual. The aim of this guideline is to present current and comprehensive recommendations for the management of intracranial aneurysms, with or without rupture. Materials and Methods We performed an extensive literature sear...

  1. Traumatic aneurysms of the intracranial and cervical vessels: A review

    Directory of Open Access Journals (Sweden)

    Kamlesh S Bhaisora

    2016-01-01

    Full Text Available Traumatic intracranial aneurysms (TICA are rare in occurrence, constituting less than 1% of the total cases of intracranial aneurysms. Cervical posttraumatic aneurysms arising from major blood vessels supplying the brain are also extremely rare. Their variable locations, morphological variations and the presence of concomitant head injury makes their diagnosis and treatment a challenge. In this review, we discuss the epidemiology, etiology, classification and management issues related to TICA as well as traumatic neck aneurysms and review the pertinent literature.

  2. Large Residual Volume, Not Low Packing Density, Is the Most Influential Risk Factor for Recanalization after Coil Embolization of Cerebral Aneurysms

    Science.gov (United States)

    Sadato, Akiyo; Hayakawa, Motoharu; Adachi, Kazuhide; Nakahara, Ichiro; Hirose, Yuichi

    2016-01-01

    Background Tight coil packing with density of at least 20%–25% is known to be important for preventing recanalization after embolization of cerebral aneurysms. However, large aneurysms sometimes recanalize regardless of the packing density, suggesting that the absolute residual volume which is determined by aneurysm volume and packing density may be more important risk factor for recanalization. To validate this hypothesis, we analyzed the factors affecting the outcomes of treated aneurysms at our institute. Methods and Findings We included 355 small and large aneurysms. The following six factors were obtained from every case: aneurysm volume (mL), neck size (mm), packing density (%), residual volume (mL), rupture status at presentation, and stent assistance (with or without stent). The data were then subjected to multivariate logistic regression analysis to identify significant risk factors for recanalization. Recanalization occurred in 61 aneurysms (17.2%). Significant predictors for recanalization were aneurysm volume (odds ratio, 15.3; P < 0.001) and residual volume (odds ratio, 30.9; P < 0.001), but not packing density (odds ratio, 0.98; P = 0.341). These results showed that for each 0.1-mL increase in aneurysm volume and residual volume, the risk of recanalization increased by 1.3 times and 1.4 times, respectively. Conclusions The most influential risk factor for recanalization after coil embolization was residual volume, not packing density. The larger the aneurysm volume, the greater the packing density has to be to minimize the residual volume and risk of recanalization. Since tight coil packing has already been aimed, further innovation of coil property or embolization technique may be needed. Otherwise, different treatment modality such as flow diverter or parent artery occlusion may have to be considered. PMID:27153192

  3. A microfabricated microfluidic bioMEMS device to model human brain aneurisms: the aneurysm-on-a-chip

    Science.gov (United States)

    Reece, Lisa M.; Khor, Jian Wei; Thakur, Raviraj; Amin, Ahmed; Wereley, Steven T.; Leary, James F.

    2015-03-01

    Aneurysms are pockets of blood that collect outside blood vessel walls forming dilatations and leaving arterial walls very prone to rupture. There is little information concerning the causes of intracranial aneurysm formation, growth, and rupture. Current treatments include: (1) clipping, and (2) coil embolization, including stent-assisted coiling. Further, the evolution of any aneurysm is assumed to be caused by the remodeling of the affected blood vessel's material constituents (tunica intima, tunica media, or tunica adventitia). Velocity, pressure, and wall shear stresses aid in the disease development of aneurysmal growth, while the shear force mechanisms effecting wound closure are elusive. To study aneurysm pathogenesis, a lab-on-a-chip device is the key to discovering the underlying mechanisms of these lesions. A two-dimensional microfluidic model, the Aneurysm-on-a-Chip™ (AOC), was the logical answer to study particle flow within an aneurysm "sac". The AOC apparatus can track particles/cells when it is coupled to particle image velocimetry software (PIV) package. The AOC fluid flow was visualized using standard microscopy techniques with commercial microparticles and human aortic smooth muscle cells (HASMC). Images were taken during fluid flow experiments and PIV was utilized to monitor the flow of particles within the "sac" region, as well as particles entering and exiting the device. Quiver plots were generated from fluid flow experiments using standard 7 μm latex particles and fixed HASMC in PBS. PIV analysis shows that the particles flowed nicely from input to output. Wall shear stress provided evidence that there was some back flow at the edges of the "sac" - an indicator of aneurysm development in human patients.

  4. Epidemiology and genetics of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Caranci, F., E-mail: ferdinandocaranci@libero.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Briganti, F., E-mail: frabriga@unina.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Cirillo, L.; Leonardi, M. [Neuroradiology service, Bellaria Hospital, Bologna (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service Cardarelli Hospital Naples (Italy)

    2013-10-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  5. Epidemiology and genetics of intracranial aneurysms

    International Nuclear Information System (INIS)

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  6. Emergency Abdominal Aortic Aneurysm Repair in a Patient with Failing Heart: Axillofemoral Bypass Using a Centrifugal Pump Combined with Levosimendan for Inotropic Support

    Directory of Open Access Journals (Sweden)

    Pavel Michalek

    2011-01-01

    Full Text Available We describe the case of an 83-year-old patient requiring repair of a large symptomatic abdominal aortic aneurysm (AAA. The patient was known to have coronary artery disease (CAD with symptoms and signs of significant myocardial dysfunction, left-heart failure, and severe aortic insufficiency. The procedure was performed with the help of both mechanical and pharmacological circulatory support. Distal perfusion was provided by an axillofemoral bypass with a centrifugal pump, with dobutamine and levosimendan administered as pharmacological inotropic support. The patient's hemodynamic status was monitored with continuous cardiac output monitoring and transesophageal echocardiography. No serious circulatory complications were recorded during the perioperative and postoperative periods. This paper suggests a potential novel approach to combined circulatory support in patients with heart failure, scheduled for open abdominal aortic aneurysm repair.

  7. Lipolysis of emulsion models of triglyceride-rich lipoproteins is altered in male patients with abdominal aorta aneurysm

    Directory of Open Access Journals (Sweden)

    J.J. Hosni

    2007-03-01

    Full Text Available Disorders of the lipid metabolism may play a role in the genesis of abdominal aorta aneurysm. The present study examined the intravascular catabolism of chylomicrons, the lipoproteins that carry the dietary lipids absorbed by the intestine in the circulation in patients with abdominal aorta aneurysm. Thirteen male patients (72 ± 5 years with abdominal aorta aneurysm with normal plasma lipid profile and 13 healthy male control subjects (73 ± 5 years participated in the study. The method of chylomicron-like emulsions was used to evaluate this metabolism. The emulsion labeled with 14C-cholesteryl oleate and ³H-triolein was injected intravenously in both groups. Blood samples were taken at regular intervals over 60 min to determine the decay curves. The fractional clearance rate (FCR of the radioactive labels was calculated by compartmental analysis. The FCR of the emulsion with ³H-triolein was smaller in the aortic aneurysm patients than in controls (0.025 ± 0.017 vs 0.039 ± 0.019 min-1; P < 0.05, but the FCR of14C-cholesteryl oleate of both groups did not differ. In conclusion, as indicated by the triglyceride FCR, chylomicron lipolysis is diminished in male patients with aortic aneurysm, whereas the remnant removal which is traced by the cholesteryl oleate FCR is not altered. The results suggest that defects in the chylomicron metabolism may represent a risk factor for development of abdominal aortic aneurysm.

  8. Endovascular reconstruction of aneurysms with a complex geometry.

    Science.gov (United States)

    Gupta, Vipul; Parthasarathy, Rajsrinivas; Jha, Ajaya Nand

    2016-01-01

    Conventional endovascular coiling remains the mainstay of treatment for most aneurysms; however, it may not be suitable for aneurysms with a complex geometry and there remains the risk of recanalization. Aneurysms with an unfavorable morphology are difficult to treat through both endovascular and surgical means. Progress in endovascular technology has allowed for the emergence of newer strategies to treat aneurysms with a complex geometry. Better packing density in wide-necked and large aneurysms can be achieved through the balloon remodeling technique. Similarly, a self-expanding stent cannot only act as a scaffold that helps to retain coils but also aids in diverting the blood flow away from the aneurysm sac. Lately, focus has shifted from endosaccular occlusion to endoluminal reconstruction; flow diverters are being increasingly used to treat aneurysms with an unfavorable geometry. However, there is no clear consensus on the best endovascular management strategy in certain subset of aneurysms - large and giant internal carotid aneurysms, blister aneurysms, and fusiform/dissecting aneurysms of the vertebrobasilar artery. We present a review of literature and discuss the current evidence for the various endovascular strategies to treat complex aneurysms. PMID:26954964

  9. Marfan's syndrome and isolated aneurysm of the abdominal aorta.

    OpenAIRE

    Van Ooijen, B.

    1988-01-01

    A 43 year old woman presented with an aneurysm of the abdominal aorta. Marfan's syndrome was diagnosed as the underlying cause of the aneurysm. An isolated aneurysm as presenting sign of Marfan's syndrome is rare. In a review of published reports about 30 cases were found.

  10. Advances in endovascular aneurysm treatment: are we making a difference?

    International Nuclear Information System (INIS)

    Recent advancements in endovascular aneurysm repair, including bioactive and expansile coils and intracranial stents, hold promise for improved aneurysm occlusion rates. We report the immediate and midterm clinical and angiographic outcomes of a consecutive series of patients treated since the advent of these technologies. Clinical and radiological records of 134 patients with 142 aneurysms treated between 2001 and 2004 were retrospectively evaluated by an independent neurologist. Endovascular procedures were analyzed by an independent neuroradiologist blinded to all clinical information. Seventy-two ruptured and 60 un-ruptured saccular aneurysms, nine fusiform and one post-traumatic aneurysm were treated. Matrix coils were used in 53% of saccular aneurysms and HydroCoils in 13% of all aneurysms. Neuroform stents were deployed in 19% of aneurysms. Angiographic total or subtotal occlusion was achieved in 76% of cases and in 96% at last follow-up. Aneurysm recanalization was observed in 14% over a mean follow-up of 12 months, and 18% of aneurysms were retreated. Clinically relevant complications occurred in 6.0%, resulting in procedure-related morbidity of 0.6% and 0.6% mortality at 6 months. No aneurysm bled over a cumulative 1,347 months of observation. Newer embolization technologies can be exploited successfully even in more complex aneurysms with very low morbidity and mortality. (orig.)

  11. A Fatal Case of Klebsiella pneumoniae Mycotic Aneurysm

    OpenAIRE

    Chien-Ming Chao; Kun-Kuang Lee; Chia-Sheng Wang; Ping-Jen Chen; Tsung-Chih Yeh

    2011-01-01

    Mycotic aneurysm is a serious clinical condition with significant morbidity and mortality. Staphylococcus aureus and Salmonella species are the most common causative pathogens. Klebsiella pneumoniae was rarely reported as a possible pathogen causing mycotic aneurysm; therefore, we describe a K. pneumoniae-related fatal bacteremia mycotic aneurysm in a patient in spite of appropriate antimicrobial agents and surgical management.

  12. Unruptured sinus of Valsalva aneurysm involving all three sinuses.

    Science.gov (United States)

    Altarabsheh, Salah Eldien I; Araoz, Philip A; Deo, Salil V; Sundt, Thoralf M

    2011-02-01

    In contrast to generalized aneurysmal dilatation of the aortic root, discrete sinus of Valsalva aneurysm is an uncommon condition most often affecting the right coronary sinus. We recently treated a patient without the known connective tissue disorder having discrete aneurysms of all three sinuses. PMID:21256260

  13. Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge

    Directory of Open Access Journals (Sweden)

    Katie L. Losenno

    2012-01-01

    Full Text Available The bicuspid aortic valve is the most common congenital cardiac anomaly in developed nations. The abnormal bicuspid morphology of the aortic valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of bicuspid aortic valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including aortic coarctation, hypoplastic left heart structures, and ascending aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of bicuspid aortic valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the aortic valve and the aorta and discerning individual indications for ongoing surveillance, medical management, and operative intervention. We review current concepts of anatomic classification, pathophysiology, natural history, and clinical management of bicuspid aortic valve disease with associated ascending aortic aneurysms.

  14. Renal replacement therapies after abdominal aortic aneurysm repair--a review.

    Science.gov (United States)

    Hudorović, Narcis; Lovricević, Ivo; Brkić, Petar; Ahel, Zaky; Vicić-Hudorović, Visnja

    2011-09-01

    The objective of this review is to assess the incidence of postoperative acute renal failure that necessitates the application of hemofiltration and to determine the factors that influence the outcome in patients undergoing surgical repair of abdominal aortic aneurysm. In addition, the review aims to assess the outcomes of postoperative early hemofiltration as compared to late intensive hemofiltration. Different forms of renal replacement therapies for use in abdominal aortic aneurysm surgery patients are discussed. Electronic literature searches were performed using Pubmed, Medline, Embase, Sumsearch, Cinahil, The Cochrane Central Register of Controlled Trials and Excerpta Medica. The search identified 419 potentially eligible studies, of which 119 were excluded based on the title and abstract. Of the remaining 300 studies, full articles were collected and re-evaluated. Forty-five articles satisfied our inclusion criteria, of which only 12 were of the IA Level of evidence. The search results indicated that the underlying disease, its severity and stage, the etiology of acute renal failure, clinical and hemodynamic status of the patient, the resources available, and different costs of therapy might all influence the choice of the renal replacement therapy strategy. However, clear guidelines on renal replacement therapy duration are still lacking. Moreover, it is not known whether in acute renal failure patients undergoing abdominal aortic aneurysm surgery, renal replacement therapy modalities can eliminate significant amounts of clinically relevant inflammatory mediators. This review gives current information available in the literature on the possible mechanisms underlying acute renal failure and recent developments in continuous renal replacement treatment modalities. PMID:22384777

  15. Phantom-based experimental validation of computational fluid dynamics simulations on cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Sun Qi; Groth, Alexandra; Bertram, Matthias; Waechter, Irina; Bruijns, Tom; Hermans, Roel; Aach, Til [Philips Research Europe, Weisshausstrasse 2, 52066 Aachen (Germany) and Institute of Imaging and Computer Vision, RWTH Aachen University, Sommerfeldstrasse 24, 52074 Aachen (Germany); Philips Research Europe, Weisshausstrasse 2, 52066 Aachen (Germany); Philips Healthcare, X-Ray Pre-Development, Veenpluis 4-6, 5684PC Best (Netherlands); Institute of Imaging and Computer Vision, RWTH Aachen University, Sommerfeldstrasse 24, 52074 Aachen (Germany)

    2010-09-15

    Purpose: Recently, image-based computational fluid dynamics (CFD) simulation has been applied to investigate the hemodynamics inside human cerebral aneurysms. The knowledge of the computed three-dimensional flow fields is used for clinical risk assessment and treatment decision making. However, the reliability of the application specific CFD results has not been thoroughly validated yet. Methods: In this work, by exploiting a phantom aneurysm model, the authors therefore aim to prove the reliability of the CFD results obtained from simulations with sufficiently accurate input boundary conditions. To confirm the correlation between the CFD results and the reality, virtual angiograms are generated by the simulation pipeline and are quantitatively compared to the experimentally acquired angiograms. In addition, a parametric study has been carried out to systematically investigate the influence of the input parameters associated with the current measuring techniques on the flow patterns. Results: Qualitative and quantitative evaluations demonstrate good agreement between the simulated and the real flow dynamics. Discrepancies of less than 15% are found for the relative root mean square errors of time intensity curve comparisons from each selected characteristic position. The investigated input parameters show different influences on the simulation results, indicating the desired accuracy in the measurements. Conclusions: This study provides a comprehensive validation method of CFD simulation for reproducing the real flow field in the cerebral aneurysm phantom under well controlled conditions. The reliability of the CFD is well confirmed. Through the parametric study, it is possible to assess the degree of validity of the associated CFD model based on the parameter values and their estimated accuracy range.

  16. Lumbar and iliac artery aneurysms in Menkes' disease: endovascular cover stent treatment of the lumbar artery aneurysm

    International Nuclear Information System (INIS)

    We report lumbar and iliac artery aneurysms in a 3-month-old boy with Menkes' disease. The iliac artery aneurysm thrombosed spontaneously, documented by follow-up colour Doppler sonography. The lumbar artery aneurysm was successfully treated using a cover stent. There was no filling of the lumbar artery aneurysm and no stenosis of the cover stent during the 9-month follow-up. (orig.)

  17. Immunologic, hemodynamic, and adrenal incompetence in cirrhosis

    DEFF Research Database (Denmark)

    Risør, Louise Madeleine; Bendtsen, Flemming; Møller, Søren

    2015-01-01

    Acute kidney injury (AKI) is one of the most severe complications of cirrhosis and is associated with significant morbidity and mortality. Liver fibrosis and liver insufficiency, portal hypertension, systemic vasodilation, and a subsequent hyperdynamic circulation undermine the renal and cardiac...... function, making cirrhotic patients more susceptible to hemodynamic incidents. In addition, the immune system is impaired in cirrhosis, leading to an exaggerated production of vasoactive mediators, and the adrenal cortisol response is insufficient, which causes further impairment of the vascular tonus...... dysfunction, but is not responsive to volume expansion. Recent research indicates that development of hepatic nephropathy represents a continuous spectrum of functional and structural dysfunction and may be precipitated by the inherent immunologic, adrenal, and hemodynamic incompetence in cirrhosis. New...

  18. FLUID AND HEMODYNAMIC MANAGEMENT IN SEVERE DENGUE.

    Science.gov (United States)

    Wongsa, Adisorn

    2015-01-01

    In the critical phase of dengue fever, the leakage of intravascular fluid into interstitial space and 3rd space can cause hemoconcentration and severe complications such as dengue shock syndrome (DSS), and it can lead to multiple organ failure, followed by death. Close monitoring, early detection and prompt management are the keys in successful treatment. In a hemodynamically unstable patient, crystalloid is the fluid of choice in initial management. However, if they are not responsive despite adequate resuscitation, a careful search for others causes is mandatory and fluids should be switched from crystalloid to colloid. If the leakage leads to restriction of the use of fluids (pulmonary edema), the addition of a vasopressor such as norepinephrine needs to be considered. After stabilizing the hemodynamics and clinical improvement, the physician has to know when to reduce and discontinue the fluid to avoid congestion and others complications. PMID:26506738

  19. Fenestrations accompanied by intracranial aneurysms assessed with magnetic resonance angiography

    Directory of Open Access Journals (Sweden)

    Zhen-Kui Sun

    2012-01-01

    Full Text Available Background and Purpose: The aim of this study was to evaluate the anatomical changes and investigate the prevalence in intracranial aneurysm with fenestrations using magnetic resonance angiography (MRA. Materials and Methods: Between June 2008 and October 2010, 4652 patients (aged 23-73 years with suspected intracranial aneurysm or other cerebrovascular diseases underwent MRA examination. MRA was performed using a three-dimensional time-of-flight technique (3D-TOF with volume rendering (VR and maximum intensity projection reconstruction methods. The presence and location of fenestrations and aneurysms was reviewed. When fenestrations were present in combination with aneurysms, we noted the relationship of the locations. The classification of fenestration accompanied by intracranial aneurysm was divided into three types according to the anatomical relationship as follows: Type I, aneurysm adjacent to but not on a fenestration; Type II, aneurysm located on the fenestration; type III, aneurysm located at a position remote from a fenestration. Results: Among the 4652 patients examined, 409 patients were defined with 412 intracranial aneurysms, and the prevalence of aneurysms was 8.8%. One hundred and forty-one patients were identified with fenestrations; 24 of these patients were confirmed with intracranial aneurysms. Seven cases were classified as type I, three as type II and 14 as type III. The prevalence of intracranial aneurysm with fenestrations was 17.0%, with significant statistical difference compared with aneurysms unaccompanied with fenestrations (P=0.0064. Conclusion: The anatomical relationship between fenestrations and intracranial aneurysms was visualized by MRA with VR, which displayed pathologies with sufficient clarity to enable diagnosis. Furthermore, the results of this study suggest that physicians should be alerted to the occurrence of intracranial aneurysm following the detection of fenestrations by MRA.

  20. Does Myocardial Bridging Affect Coronary Hemodynamics?

    OpenAIRE

    Onur Sildiroglu; Ferhat Cuce; Zafer Isilak; Muzaffer Saglam; Mehmet Incedayi; Kemal Kara; Ersin Ozturk

    2013-01-01

    Objective. The aim of our study was to evaluate the relationship between a myocardial bridge (MB) and its effects over the coronary artery hemodynamics by using multislice computed tomography (MSCT). Material and Methods. A total of 412 patients examined with coronary computed tomography (CT) angiography were reviewed retrospectively for an MB of the left anterior descending (LAD) coronary artery. We evaluated the correlation between the depth of an MB and the degree of compression to the...

  1. Hemodynamic Traveling Waves in Human Visual Cortex

    OpenAIRE

    Kevin M Aquino; Schira, Mark M.; P A Robinson; Drysdale, Peter M.; Michael Breakspear

    2012-01-01

    Functional MRI (fMRI) experiments rely on precise characterization of the blood oxygen level dependent (BOLD) signal. As the spatial resolution of fMRI reaches the sub-millimeter range, the need for quantitative modelling of spatiotemporal properties of this hemodynamic signal has become pressing. Here, we find that a detailed physiologically-based model of spatiotemporal BOLD responses predicts traveling waves with velocities and spatial ranges in empirically observable ranges. Two measurabl...

  2. Non-invasive measurements of tissue hemodynamics with hybrid diffuse optical methods

    Science.gov (United States)

    Durduran, Turgut

    Diffuse optical techniques were used to measure hemodynamics of tissues non-invasively. Spectroscopy and tomography of the brain, muscle and implanted tumors were carried out in animal models and humans. Two qualitatively different methods, diffuse optical tomography and diffuse correlation tomography, were hybridized permitting simultaneous measurement of total hemoglobin concentration, blood oxygen saturation and blood flow. This combination of information was processed further to derive estimates of oxygen metabolism (e.g. CMRO 2) in tissue. The diffuse correlation measurements of blood flow were demonstrated in human tissues, for the first time, demonstrating continous, non-invasive imaging of oxygen metabolism in large tissue volumes several centimeters below the tissue surface. The bulk of these investigations focussed on cerebral hemodynamics. Extensive validation of this methodology was carried out in in vivo rat brain models. Three dimensional images of deep tissue hemodynamics in middle cerebral artery occlusion and cortical spreading depression (CSD) were obtained. CSD hemodynamics were found to depend strongly on partial pressure of carbon dioxide. The technique was then adapted for measurement of human brain. All optical spectroscopic measurements of CMRO2 during functional activation were obtained through intact human skull non-invasively. Finally, a high spatio-temporal resolution measurement of cerebral blood flow due to somatosensory cortex activation following electrical forepaw stimulation in rats was carried out with laser speckle flowmetry. New analysis methods were introduced for laser speckle flowmetry. In other organs, deep tissue hemodynamics were measured on human calf muscle during exercise and cuff-ischemia and were shown to have some clinical utility for peripheral vascular disease. In mice tumor models, the measured hemodynamics were shown to be predictive of photodynamic therapy efficacy, again suggesting promise of clinical utility

  3. Endovascular Treatment of Thoracic Aortic Dissection: Hemodynamic Shear Stress Study

    Science.gov (United States)

    Tang, Yik Sau; Lai, Siu Kai; Cheng, Stephen Wing Keung; Chow, Kwok Wing

    2012-11-01

    Thoracic Aortic Dissection (TAD), a life threatening cardiovascular disease, occurs when blood intrudes into the layers of the aortic wall, creating a new artificial channel (the false lumen) beside the original true lumen. The weakened false lumen wall may expand, enhancing the risk of rupture and resulting in high mortality. Endovascular treatment involves the deployment of a stent graft into the aorta, thus blocking blood from entering the false lumen. Due to the irregular geometry of the aorta, the stent graft, however, may fail to conform to the vessel curvature, and would create a ``bird-beak'' configuration, a wedge-shaped domain between the graft and the vessel wall. Computational fluid dynamics analysis is employed to study the hemodynamics of this pathological condition. With the `beaking' configuration, the local hemodynamic shear stress will drop below the threshold of safety reported earlier in the literature. The oscillating behavior of the shear stress might lead to local inflammation, atherosclerosis and other undesirable consequences. Supported by the Innovation and Technology Fund of the Hong Kong Government.

  4. Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Yilmaz Yozgat

    2013-01-01

    Full Text Available Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs. Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA.

  5. Importance of close follow-up in the fetus with premature atrial contractions accompanied by atrial septal aneurysm: a case report.

    Science.gov (United States)

    Yozgat, Yilmaz; Kilic, Ayhan; Karadeniz, Cem; Ozdemir, Rahmi; Doksoz, Onder; Mese, Timur; Unal, Nurettin

    2013-01-01

    Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA) on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA. PMID:24455349

  6. Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms.

    Science.gov (United States)

    Manhas, Amitoz; Nimjee, Shahid M; Agrawal, Abhishek; Zhang, Jonathan; Diaz, Orlando; Zomorodi, Ali R; Smith, Tony; Powers, Ciarán J; Sauvageau, Eric; Klucznik, Richard P; Ferrell, Andrew; Golshani, Kiarash; Stieg, Philip E; Britz, Gavin W

    2015-10-01

    Aneurysmal subarachnoid hemorrhage (SAH) remains an important health issue in the United States. Despite recent improvements in the diagnosis and treatment of cerebral aneurysms, the mortality rate following aneurysm rupture. In those patients who survive, up to 50% are left severely disabled. The goal of preventing the hemorrhage or re-hemorrhage can only be achieved by successfully excluding the aneurysm from the circulation. This article is a comprehensive review by contemporary vascular neurosurgeons and interventional neuroradiolgists on the modern management of cerebral aneurysms. PMID:26072457

  7. Multiple Intracranial Aneurysms Associated with Behçet's Disease

    Science.gov (United States)

    Ha, Sangwoo; Kim, Jaeho; Kim, Chong-gue

    2016-01-01

    Behçet's disease is an inflammatory disorder involving multiple organs. Its cause is still unknown, but vasculitis is the major pathologic characteristic. The common vascular lesions associated with Behçet's disease are aneurysm formation, arterial or venous occlusive diseases, and varices. Arterial aneurysms mostly occur in large arteries. Intracranial aneurysms hardly occur with Behçet's disease. We would like to present a 41-year-old female patient with Behçet's disease who showed symptoms of severe headache due to subarachnoid hemorrhage. Brain computed tomography revealed multiple aneurysms. We also present a literature review of intracranial arterial aneurysms associated with Behçet's disease.

  8. Operative strategy of complex internal carotid artery-posterior communicating artery aneurysms Defensive effect on perioperative nerve injury

    Institute of Scientific and Technical Information of China (English)

    Xinmin Wang; Wende Xiong; Xuqin Li

    2007-01-01

    BACKGROUND: The two problems in treating intracranial aneurysm are the vascular reconstruction and brain protection, especially for complex internal carotid artery-posterior communicating artery (ICA-PComA)aneurysms.OBJECTIVE: To analyze the anatomic features and operative technique of complex ICA-PComA aneurysms, and investigate how to better protect the brain tissue.DESIGN: A retrospective case analysis.SETTING: Department ofNeurosurgery, Dalian Central Hospital.PARTICIPANTS: Totally 154 inpatients with ICA-PComA aneurysms were selected from the Department of Neurosurgery, Dalian Central Hospital from January 1998 to December 2006, including 19 cases (12.3%)of complex ICA-PComA aneurysms, 8 males and 11 females, 38 - 67 years of age. Informed contents for surgery and observation were obtained from all the patients or their relatives.METHODS: The clinical manifestations, including initial symptoms and Hunt&Hess grading, were observed. Corresponding strategies were selected for different types of ICA-PComA aneurysms. The patients were followed up at 3 months postoperatively. According to the results of Glasgow scoring, the curative effects were classified as good (4 - 5 points), bad (2 - 3 points) and dead (1 point). The results at discharge were taken as early results, whereas the follow-up results as late results.MAIN OUTCOME MEASURES: Clinical manifestations and curative effects of the patients.RESULTS: All the 19 patients with ICA-PComA were involved in the analysis of results. For clinical manifestations, the initial symptoms were subarachnoid hemorrhage (n =15), paralysis of oculomotor nerve (n =3), and occasional attack (n =1); The Hunt&Hess grading was grade Ⅰ in 4 cases, grade Ⅱ in 6 cases,grade Ⅲ in 6 cases, grade Ⅳ in 2 cases, and grade Ⅴ in 1 case. The curative effects were that aneurysm breakage and bleeding occurred in 6 cases perioperatively, uncomplete clipping of aneurysm in 2 cases and constriction of parent artery in 1 case. The

  9. An in vitro assessment of the cerebral hemodynamics through three patient specific circle of Willis geometries.

    Science.gov (United States)

    Fahy, Paul; Delassus, Patrick; McCarthy, Peter; Sultan, Sheriff; Hynes, Niamh; Morris, Liam

    2014-01-01

    The Circle of Willis (CoW) is a complex pentagonal network comprised of fourteen cerebral vessels located at the base of the brain. The collateral flow feature within the circle of Willis allows the ability to maintain cerebral perfusion of the brain. Unfortunately, this collateral flow feature can create undesirable flow impact locations due to anatomical variations within the CoW. The interaction between hemodynamic forces and the arterial wall are believed to be involved in the formation of cerebral aneurysms, especially at irregular geometries such as tortuous segments, bends, and bifurcations. The highest propensity of aneurysm formation is known to form at the anterior communicating artery (AcoA) and at the junctions of the internal carotid and posterior communicating arteries (PcoAs). Controversy still remains as to the existence of blood flow paths through the communicating arteries for a normal CoW. This paper experimentally describes the hemodynamic conditions through three thin walled patient specific models of a complete CoW based on medical images. These models were manufactured by a horizontal dip spin coating method and positioned within a custom made cerebral testing system that simulated symmetrical physiological afferent flow conditions through the internal carotid and vertebral arteries. The dip spin coating procedure produced excellent dimensional accuracy. There was an average of less than 4% variation in diameters and wall thicknesses throughout all manufactured CoW models. Our cerebral test facility demonstrated excellent cycle to cycle repeatability, with variations of less than 2% and 1% for the time and cycle averaged flow rates, respectively. The peak systolic flow rates had less than a 4% variation. Our flow visualizations showed four independent flow sources originating from all four inlet arteries impacting at and crossing the AcoA with bidirectional cross flows. The flow paths entering the left and right vertebral arteries dissipated

  10. Aneurysms of the superficial venous system: classification and treatment

    Directory of Open Access Journals (Sweden)

    Ronald G. Bush

    2014-11-01

    Full Text Available Superficial venous aneurysms are rarely described and they may remain indolent or become the source for pulmonary emboli. A system of classification and treatment protocol according to size and location is proposed. Three hundred thirty patients were evaluated for symptomatic venous disease (C2-C6 over a 2-year period. A proposed designation for venous aneurysm is described. Patients fulfilling this criterion are described in reference to site of involvement, histologic findings, and method of treatment. Five percent of patients met the criteria for venous aneurysm. Nine aneurysms of the greater saphenous vein were identified. Three aneurysms were proximal to the subterminal valve and the rest were distal. Six aneurysms of the anterior accessory greater saphenous vein (AAGSV were identified. Three aneurysms of the AAGSV spontaneously thrombosed. Two patients presented with aneurysms of the small saphenous vein. Histology revealed thickened intima, smooth muscle and adventitia. Aneurysm designation relates to diameter of normal and contiguous vein. All superficial venous aneurysms in close proximity to the junction of the femoral or popliteal vein should be ligated. Classification of venous aneurysms should include the AAGSV, which may present with spontaneous thrombosis.

  11. Non-enhanced MR imaging of cerebral aneurysms: 7 Tesla versus 1.5 Tesla.

    Directory of Open Access Journals (Sweden)

    Karsten H Wrede

    Full Text Available PURPOSE: To prospectively evaluate 7 Tesla time-of-flight (TOF magnetic resonance angiography (MRA in comparison to 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced magnetization-prepared rapid acquisition gradient-echo (MPRAGE for delineation of unruptured intracranial aneurysms (UIA. MATERIAL AND METHODS: Sixteen neurosurgical patients (male n = 5, female n = 11 with single or multiple UIA were enrolled in this trial. All patients were accordingly examined at 7 Tesla and 1.5 Tesla MRI utilizing dedicated head coils. The following sequences were obtained: 7 Tesla TOF MRA, 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced MPRAGE. Image analysis was performed by two radiologists with regard to delineation of aneurysm features (dome, neck, parent vessel, presence of artifacts, vessel-tissue-contrast and overall image quality. Interobserver accordance and intermethod comparisons were calculated by kappa coefficient and Lin's concordance correlation coefficient. RESULTS: A total of 20 intracranial aneurysms were detected in 16 patients, with two patients showing multiple aneurysms (n = 2, n = 4. Out of 20 intracranial aneurysms, 14 aneurysms were located in the anterior circulation and 6 aneurysms in the posterior circulation. 7 Tesla MPRAGE imaging was superior over 1.5 and 7 Tesla TOF MRA in the assessment of all considered aneurysm and image quality features (e.g. image quality: mean MPRAGE7T: 5.0; mean TOF7T: 4.3; mean TOF1.5T: 4.3. Ratings for 7 Tesla TOF MRA were equal or higher over 1.5 Tesla TOF MRA for all assessed features except for artifact delineation (mean TOF7T: 4.3; mean TOF1.5T 4.4. Interobserver accordance was good to excellent for most ratings. CONCLUSION: 7 Tesla MPRAGE imaging demonstrated its superiority in the detection and assessment of UIA as well as overall imaging features, offering excellent interobserver accordance and highest scores for all ratings. Hence, it may bear the potential to serve as a

  12. Basilar Artery Aneurysm at a Persistent Trigeminal Artery Junction

    Science.gov (United States)

    Aguiar, G.B.; Conti, M.L.M.; Veiga, J.C.E.; Jory, M.; Souza, R.B.

    2011-01-01

    Summary The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  13. Spontaneous thrombosis of a recurrent clipped intracranial aneurysm.

    Science.gov (United States)

    Hassan, F; Taschner, C-A; Thines, L; Lejeune, J-P; Pruvo, J-P; Leclerc, X

    2009-06-01

    Spontaneous thrombosis of an intracranial aneurysm is a rare event. It is predominantly observed with aneurysms that are large and have relatively narrow necks. We report here a case of a 48-year-old woman presenting with subarachnoid hemorrhage (SAH) due to rupture of a 2-mm aneurysm of the anterior cerebral artery treated by microsurgical clipping. Six months after treatment of the aneurysm, the patient presented with severe headache. SAH was excluded, but computed tomographic angiography (CTA) revealed the recurrence of a large aneurysm (7 mm) that was confirmed by cerebral angiography (DSA). Endovascular treatment was scheduled for several days later, but DSA also revealed spontaneous occlusion of the recurrent aneurysm. On the control CTA performed one week later, the recurrent aneurysm had again reappeared, again confirmed by DSA, and was subsequently treated by coil embolization. PMID:19144409

  14. Giant aneurysm in 6 years old child - case report

    International Nuclear Information System (INIS)

    Intracranial saccular aneurysms rare in childhood is. Even among the reported series of childhood aneurysms, it is unusual to find their occurrence in children less than 7 years old. The pathogenesis of these lesions is also a matter of debate and speculations. The peak age of incidence of juvenile cerebral aneurysms appear to be 12 years, occurrence below the age of 7 being rarity. We show a case of 6 years old boy with giant aneurysm. found because of episodes of headache and vomiting. Discussion of pathogenesis for the rare pathology. After discussion of multidisciplinary team, of neuroradiologist and neurosurgeons was decided to be perform endovascular embolization, because of the better outcome for the patient. We performed endovascular treatment of the aneurysm with achieving total embolization. The patient recovery completely, and after 4 days went home. (authors) Key words: GIANT ANEURYSM. SACCULAR ANEURYSM. EMBOLIZATION. STENT ASSISTED COILING

  15. Computertomography in subarachnoid haemorrhage and aneurysm

    International Nuclear Information System (INIS)

    59 patients with SAH and an aneurysm were investigated by CT and angiography. In the 59 patients 67 aneurysms were found. The mean interval between SAH and CT was 8 days, between SAH and angiography 11 days. Blood in the CSF space was visualized up to the 9th day in the patients and 67% of those investigated showed blood in the CSF-space in the CT. In 31% of the patients an aneurysm, in 29% an intracerebral haemorrhage and in 19% a recent infarct was found. A hydrocephalus was seen in 13% of the patients. Of 12 patients with recent infarcts 8 showed vasospasm which correlated in time and location with the infarct. (Author)

  16. Drug Therapy for Small Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Ramachandran Meenakshisundaram

    2010-03-01

    Full Text Available Abdominal aortic aneurysm is often asymptomatic, less recognized, and causes considerable mortalityand morbidity, if missed. The incidence varies from country to country and the occurrence is influencedby modifiable (smoking, coronary heart disease, hypertension, dyslipidemia, and prolonged steroid therapyand non-modifiable risk factors (increasing age, male gender, and positive family history. Most ofthe patients with such aneurysm do not exhibit symptoms and the diagnosis is made accidentally duringroutine medical investigations, abdominal ultrasonography, or by an astute surgeon during an abdominalprocedure. Sometimes the diagnosis is made in an emergency room, if the attending resident/doctor isaware of it. Despite good diagnosis and effective management, the outcomes of complicated cases arepoor and the treatment cost is prohibitive. Hence, we reviewed the literature to find out the pathogenesisof such aneurysms and the usefulness of available drugs in its prevention.

  17. Giant and thrombosed left ventricular aneurysm

    Institute of Scientific and Technical Information of China (English)

    Jose; Alberto; de; Agustin; Jose; Juan; Gomez; de; Diego; Pedro; Marcos-Alberca; Jose; Luis; Rodrigo; Carlos; Almeria; Patricia; Mahia; Maria; Luaces; Miguel; Angel; Garcia-Fernandez; Carlos; Macaya; Leopoldo; Perez; de; Isla

    2015-01-01

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur,including heart failure,thromboembolism,or tachyarrhythmias. We report the case of a 78-yearold male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded,and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm,causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  18. Noninvasive diagnosis of a false left ventricular aneurysm with radioisotope gated cardiac blood pool imaging. Differentiation from true aneurysm

    International Nuclear Information System (INIS)

    Unlike the true left ventricular aneurysm, false aneurysms have recently been shown to be subject to late rupture. Rarely diagnosed before surgery or autopsy, the false aneurysm has never been identified by noninvasive techniques. We report the first such noninvasive diagnosis employing radioisotope gated cardiac blood pool imaging. Due to the unique and possibly life-threatening clinical course and potential for surgical cure of false left ventricular aneurysm, early noninvasive diagnosis by imaging techniques may be critical. The methods shown here are generally applicable, becoming widely available and may help in evaluation of false left ventricular aneurysm as a cause of sudden death

  19. Integrating the theories of Darwin and Bernoulli: maladaptive baroreceptor network dysfunction may explain the pathogenesis of aortic aneurysms.

    Science.gov (United States)

    Conley, Buford R; Doux, John D; Lee, Patrick Y; Bazar, Kimberly A; Daniel, Stephanie M; Yun, Anthony J

    2005-01-01

    Current treatment options for aortic aneurysms are suboptimal and their pathogenic mechanisms remain unclear. We propose the existence of a coordinated multi-node baroreceptor network that measures pressures at all vascular bifurcations and enables system-wide hemodynamic coordination and vasomotor regulation, in accordance with the principle of Bernoulli. While the presence of baroreceptors at bifurcations remains unknown, behavior at the level of systems predicts their existence, possibly as glomus cell derivatives. We propose that pressure misregistration among sensor nodes at different vascular bifurcations can precipitate feed-forward dysfunctions that promote thrombosis, inflammation, and vasomotor dysregulation resulting in aneurysm formation. One example of this phenomenon is aortic aneurysm, which is currently attributed to focal anatomic defects. As plaque builds in the infrarenal aorta, the increased blood velocity through this segment can widen the difference between pressures sensed at the iliac and the renal artery bifurcations. Due to the Bernoulli effect, this change creates an incorrect impression of reduced dynamic pressure at the kidneys. The erroneous perception of hypovolemia can induce a pernicious cycle of maladaptive adrenergia and associated coagulation and thrombosis, particularly in the infrarenal aortic segment as the body attempts to normalize renal perfusion. Atherosclerosis can further exacerbate baroreceptor dysfunction by interfering with sensor biology in feed-forward fashion. Hypertension may be a consequence as well as a source of atherosclerosis and aneurysm. The described system may have evolved when trauma-related hypovolemia was a far more prevalent driver of natural selection but may be rendered maladaptive in the setting of modern stressors. Failure to address these factors may explain the suboptimal long-term outcomes with current surgical and endovascular treatments for aneurysms. Implications for other potential sensor

  20. Lung effect on the hemodynamics in pulmonary artery

    Science.gov (United States)

    Tsai, S. F.; Sheu, Tony W. H.; Chang, T. M.

    2001-06-01

    The present study investigates blood flow in a pulmonary artery. The aim is to gain a better understanding of offset value in vascular circulation through a two-dimensional analysis of the Navier-Stokes equations. In this study, the hemodynamics in a blood vessel with truncated outlets at which constant pressure is specified is examined. To simplify the analysis, the vessel walls are regarded as being rigid. In quadratic elements, the streamline upwind Petrov-Galerkin finite element model is employed to simulate the incompressible Newtonian blood flow. The adopted finite element model introduces artificial damping terms solely in the streamline direction. With these terms added to the formulation, the discrete system is enhanced while solution accuracy is maintained without deterioration due to numerical diffusion errors. Copyright

  1. Idiopathic aneurysm of pulmonary artery

    Energy Technology Data Exchange (ETDEWEB)

    Pacheco, Julio B. Cota; Pimentel, Patricia N.; Knust, Beatriz S., E-mail: jcota@uol.com.br [Clinica de Cardiologia Cota Pacheco, Mogi das Cruzes, SP (Brazil)

    2015-07-15

    Because it is a very rare isolated lesion, we decided to present this case of idiopathic pulmonary artery aneurysm (IPAA) and review the cases published in the literature in order to correlate our clinical and imaging findings, as well as management based on patient data. IPAA was first described in a case of autopsy by Bristowe in 1860 and later in 1947 by Deterling and Claggett, whose prevalence was lower than eight to one hundred thousand. Although the use of diagnostic imaging methods has been applied in a very large population in recent decades, this lesion has been most often described in postmortem examinations. Therefore, it is important to be aware of possible clinical symptoms, at times non-specific, as well as the signs on imaging studies. In this study, therefore, the report of a case of an asymptomatic patient whose diagnosis was done through color Doppler echocardiography in a routine test in 2012, later confirmed by simple chest computed tomography (chest CT) and cardiac catheterization as IPAA and its branches. We discussed the literature available and the possibilities for treatment and the use of color Doppler echocardiography as an initial diagnostic tool for such a rare and intriguing disease. (author)

  2. Idiopathic aneurysm of pulmonary artery

    International Nuclear Information System (INIS)

    Because it is a very rare isolated lesion, we decided to present this case of idiopathic pulmonary artery aneurysm (IPAA) and review the cases published in the literature in order to correlate our clinical and imaging findings, as well as management based on patient data. IPAA was first described in a case of autopsy by Bristowe in 1860 and later in 1947 by Deterling and Claggett, whose prevalence was lower than eight to one hundred thousand. Although the use of diagnostic imaging methods has been applied in a very large population in recent decades, this lesion has been most often described in postmortem examinations. Therefore, it is important to be aware of possible clinical symptoms, at times non-specific, as well as the signs on imaging studies. In this study, therefore, the report of a case of an asymptomatic patient whose diagnosis was done through color Doppler echocardiography in a routine test in 2012, later confirmed by simple chest computed tomography (chest CT) and cardiac catheterization as IPAA and its branches. We discussed the literature available and the possibilities for treatment and the use of color Doppler echocardiography as an initial diagnostic tool for such a rare and intriguing disease. (author)

  3. Factors Influencing the Management of Unruptured Intracranial Aneurysms

    Science.gov (United States)

    Podraza, Katherine M; Luthra, Nijee; Origitano, Thomas C; Schneck, Michael J

    2016-01-01

    Background Deciding how to manage an unruptured intracranial aneurysm can be difficult for patients and physicians due to controversies about management. The decision as to when and how to intervene may be variable depending on physicians’ interpretation of available data regarding natural history and morbidity and mortality of interventions. Another significant factor in the decision process is the patients’ conception of the risks of rupture and interventions and the psychological burden of harboring an unruptured intracranial aneurysm. Objective  To describe which factors are being considered when patients and their physicians decide how to manage unruptured intracranial aneurysms.  Materials & methods  In a retrospective chart review study, we identified patients seen for evaluation of an unruptured intracranial aneurysm. Data was collected regarding patient and aneurysm characteristics. The physician note pertaining to the management decision was reviewed for documented reasons for intervention. Results  Of 88 patients included, 36 (41%) decided to undergo open or endovascular surgery for at least one unruptured intracranial aneurysm. Multiple aneurysms were present in 14 (16%) patients. Younger patients and current smokers were more likely to undergo surgery, but gender and race did not affect management. Aneurysm size and location strongly influenced management. The most common documented reasons underlying the decision of whether to intervene were the risk of rupture, aneurysm size, and risks of the procedure. For 23 aneurysms (21%), there were no factors documented for the management decision.  Conclusion  The risk of rupture of unruptured intracranial aneurysms may be underestimated by currently available natural history data. Major factors weighed by physicians in management decisions include aneurysm size and location, the patient's age, and medical comorbidities along with the risk of procedural complications. Additional data is needed to

  4. Factors Influencing the Management of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Gillani, Rebecca L; Podraza, Katherine M; Luthra, Nijee; Origitano, Thomas C; Schneck, Michael J

    2016-01-01

    Background Deciding how to manage an unruptured intracranial aneurysm can be difficult for patients and physicians due to controversies about management. The decision as to when and how to intervene may be variable depending on physicians' interpretation of available data regarding natural history and morbidity and mortality of interventions. Another significant factor in the decision process is the patients' conception of the risks of rupture and interventions and the psychological burden of harboring an unruptured intracranial aneurysm. Objective  To describe which factors are being considered when patients and their physicians decide how to manage unruptured intracranial aneurysms.  Materials & methods  In a retrospective chart review study, we identified patients seen for evaluation of an unruptured intracranial aneurysm. Data was collected regarding patient and aneurysm characteristics. The physician note pertaining to the management decision was reviewed for documented reasons for intervention. Results  Of 88 patients included, 36 (41%) decided to undergo open or endovascular surgery for at least one unruptured intracranial aneurysm. Multiple aneurysms were present in 14 (16%) patients. Younger patients and current smokers were more likely to undergo surgery, but gender and race did not affect management. Aneurysm size and location strongly influenced management. The most common documented reasons underlying the decision of whether to intervene were the risk of rupture, aneurysm size, and risks of the procedure. For 23 aneurysms (21%), there were no factors documented for the management decision.  Conclusion  The risk of rupture of unruptured intracranial aneurysms may be underestimated by currently available natural history data. Major factors weighed by physicians in management decisions include aneurysm size and location, the patient's age, and medical comorbidities along with the risk of procedural complications. Additional data is needed to define

  5. Comparison of the association of sac growth and coil compaction with recurrence in coil embolized cerebral aneurysms.

    Directory of Open Access Journals (Sweden)

    Anna L Hoppe

    Full Text Available In recurrent cerebral aneurysms treated by coil embolization, coil compaction is regarded as the presumptive mechanism. We test the hypothesis that aneurysm growth is the primary recurrence mechanism. We also test the hypothesis that the coil mass will translate a measurable extent when recurrence occurs.An objective, quantitative image analysis protocol was developed to determine the volumes of aneurysms and coil masses during initial and follow-up visits from 3D rotational angiograms. The population consisted of 15 recurrence and 12 non-recurrence control aneurysms initially completely coiled at a single center. An investigator sensitivity study was performed to assess the objectivity of the methods. Paired Wilcoxon tests (p<0.05, one-tailed were performed to assess for aneurysm and coil growth. The translation of the coil mass center at follow-up was computed. A Mann Whitney U-Test (p<0.05, one-tailed was used to compare translation of coil mass centers between recurrence and control subjects.Image analysis protocol was found to be insensitive to the investigator. Aneurysm growth was evident in the recurrence cohort (p=0.003 but not the control (p=0.136. There was no evidence of coil compaction in either the recurrence or control cohorts (recurrence: p=0.339; control: p=0.429. The translation of the coil mass centers was found to be significantly larger in the recurrence cohort than the control cohort (p=0.047.Aneurysm sac growth, not coil compaction, was the primary mechanism of recurrence following successful coil embolization. The coil mass likely translates to a measurable extent when recurrence occurs and has the potential to serve as a non-angiographic recurrence marker.

  6. Occupational exposure in hemodynamic; Exposicao ocupacional em hemodinamica

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Amanda J.; Fernandes, Ivani M.; Silva, Paula P. Nou; Sordi, Gian Maria A.A.; Carneiro, Janete C.G.G., E-mail: ajsilva@ipen.b, E-mail: imfernandes@ipen.b, E-mail: ppsilva@ipen.b, E-mail: gmsordi@ipen.b, E-mail: janetegc@ipen.b [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2011-10-26

    This paper has an objective to perform a radiometric survey at a hemodynamic service. Besides, it was intended to evaluate the effective dose of health professionals and to provide data which can contribute with minimization of exposures during the realization of hemodynamic procedure. The radiometric survey was realized in the real environment of work simulating the conditions of a hemodynamic study with a ionization chamber

  7. Assessment of contrast flow modification in aneurysms treated with closed-cell self-deploying asymmetric vascular stents (SAVS).

    Science.gov (United States)

    Ionita, Ciprian N; Wang, Weiyuan; Bednarek, Daniel R; Rudin, Stephen

    2010-01-01

    The Asymmetric Vascular Stent (AVS) for intracranial aneurysm (IA) treatment is an experimental device, specially designed for intra-aneurysmal blood flow diversion and thrombosis promotion. The stent has a low-porous patch to cover only the aneurysm neck while the rest of the stent is very porous to avoid blockage of adjacent branches. The latest AVS design is similar to state-of-art, closed-cell, self-expanding, neurovascular stent. The stents were used to treat sixteen rabbit-elastase aneurysm models. The treatment effect was analyzed using normalized-time-density-curves (NTDC) measured by pixel-value integration over a region-of-interest containing the aneurysm. Normalization constant was the total bolus injection determined angiographically. Based on NTDC measurement, five quantities were derived to describe the contrast flow. Two are related to the amount of contrast entering the aneurysm: NTDC peak and NTDC input slope. The other three are related to contrast presence in the aneurysmal dome: time-to-peak (TTP), wash-out-time (WOT) and mean-transit-time (MTT). Flow modification descriptions using the contrast related quantities were expressed as a pre-/post-stented NTDC parameter ratio, while the time related quantities were expressed as a post-/pre-stented ratio, so that ratios smaller than one indicate a desired effect. Thirteen aneurysms were treated successfully and achieved significant aneurysm occlusion. For these cases, the resulting average parameters were: peak-ratio=0.17±0.21; input-slope-ratio=0.19±0.24, TTP-ratio=0.17±0.21, WOT-ratio=0.58±0.73 and MTT-ratio=0.65±0.97). All the quantities revealed decreased aneurysmal flow due to blood flow diversion using the new self-expanding asymmetrical vascular stent (SAVS). Treatment outcome results and angiographic analysis indicate that the new self-deploying stent design has great potential for clinical implementation. PMID:21243093

  8. Endovascular coil embolization of aneurysm neck for the treatment of ruptured intracranial aneurysm with bleb formation

    OpenAIRE

    Wan, Jun; Gu, Weijin; Zhang, Xiaolong; Geng, Daoying; Lu, Gang; Huang, Lei; Zhang, Lei; Ge, Liang; Ji, Lihua

    2014-01-01

    Background Ruptured intracranial aneurysm (ICA) with bleb formation (RICABF) is a special type of ruptured ICA. However, the exact role and effectiveness of endovascular coil embolization (ECE) in RICABF is unknown. We aimed to investigate the effectiveness and safety of ECE of aneurysm neck for RICABF treatment. Material/Methods We retrospectively assessed consecutive patients who were hospitalized in our endovascular intervention center between October 2004 and May 2012. Overall, 86 patient...

  9. Multiple soft tissue aneurysmal cysts: An occurrence after resection of primary aneurysmal bone cyst of fibula

    Directory of Open Access Journals (Sweden)

    Karkuzhali P

    2007-01-01

    Full Text Available We report a case of multiple extraosseous aneurysmal cysts occurring in the muscle and subcutaneous plane of postero-lateral aspects of the upper right leg. They appeared about 15 months after resection of aneurysmal bone cyst of the upper end of the fibula. They varied in size from 2 cm to 5 cm. Radiologically they were well-defined lesions with central septate areas surrounded by a rim of calcification. Histologically they showed central cystic spaces separated by septa consisting of fibroblasts, osteoclast type of giant cells and reactive woven bone. Thus they showed histological similarity with aneurysmal bone cysts, but did not show any connection with the bone. Only very few examples of aneurysmal cysts of soft tissue had been described in the past one decade and they were reported in various locations including rare sites such as arterial wall and larynx. Recent cytogenetic analyses have shown abnormalities involving 17p11-13 and/or 16q22 in both osseous and extraosseous aneurysmal cysts indicating its probable neoplastic nature. Our case had unique features like multiplicity and occurrence after resection of primary aneurysmal bone cyst of the underlying bone.

  10. Aneurisma da Artéria Renal: caso clínico Renal Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Joana Moreira

    2011-12-01

    Full Text Available Apresenta-se o caso clínico de um doente com volumoso aneurisma da artéria renal esquerda. Do sexo masculino, de 22 anos de idade, com lombalgia à esquerda com algumas semanas de evolução. Recorreu ao médico assistente que solicitou estudo imagiológico por ecografia abdominal. Detectada imagem sugestiva de aneurisma da aorta abdominal. Este achado motivou a transferência para o nosso Hospital onde foi admitido consciente e orientado, hemodinamicamente estável, apresentando uma massa pulsátil epigástrica, com frémito e sopro sistólico à auscultação. Angio-TC revelou um aneurisma da artéria renal esquerda com 16 cm de diâmetro. Dada a estabilidade clínica e topografia lesional optou-se por tentar embolizar, sem sucesso, o tronco da artéria renal esquerda antes da abordagem cirúrgica. O doente foi então submetido a Nefrectomia total esquerda por via toraco-abdominal. Pós-operatório sem complicações, locais ou sistémicas. Alta ao 8ºdia, mantendo boa função renal e com níveis normais de hemoglobina. Diagnóstico de aneurisma da artéria renal confirmado por estudo anátomo-patológico da peça operatória.One case of a large left renal artery aneurysm in a young patient 22 years old is presented. He appealed to his assistant physician a few weeks after development of left back pain. Abdominal ultrasound imaging study has been requested. Suggestive abdominal aortic aneurysm was detected. This finding led to the transfer to our hospital where he was admitted conscious and hemodynamically stable. A pulsatile epigastric mass with a systolic murmur on auscultation and thrill were detected. Angio-CT scan revealed a left renal artery aneurysm, 16 cm in diameter. Given the clinical stability and lesional topography we decide a previous embolization of left renal artery, unsuccessfully. The patient underwent then left total nephrectomy, through thoraco-abdominal incision. No local or systemic complications in the postoperative

  11. Investigation of the velocity field in a full-scale model of a cerebral aneurysm

    International Nuclear Information System (INIS)

    Highlights: • We investigate flow fields inside a phantom model of a full-scale cerebral aneurysm. • An artificial blood fluid is used matching viscosity and density of real blood. • We present Particle Tracking results of fluorescent tracer particles. • Instantaneous model inlet velocity profiles and volume flow rates are derived. • Trajectory fields at three of six measurement planes are presented. -- Abstract: Due to improved and now widely used imaging methods in clinical surgery practise, detection of unruptured cerebral aneurysms becomes more and more frequent. For the selection and development of a low-risk and highly effective treatment option, the understanding of the involved hemodynamic mechanisms is of great importance. Computational Fluid Dynamics (CFD), in vivo angiographic imaging and in situ experimental investigations of flow behaviour are powerful tools which could deliver the needed information. Hence, the aim of this contribution is to experimentally characterise the flow in a full-scale phantom model of a realistic cerebral aneurysm. The acquired experimental data will then be used for a quantitative validation of companion numerical simulations. The experimental methodology relies on the large-field velocimetry technique PTV (Particle Tracking Velocimetry), processing high speed images of fluorescent tracer particles added to the flow of a blood-mimicking fluid. First, time-resolved planar PTV images were recorded at 4500 fps and processed by a complex, in-house algorithm. The resulting trajectories are used to identify Lagrangian flow structures, vortices and recirculation zones in two-dimensional measurement slices within the aneurysm sac. The instantaneous inlet velocity distribution, needed as boundary condition for the numerical simulations, has been measured with the same technique but using a higher frame rate of 20,000 fps in order to avoid ambiguous particle assignment. From this velocity distribution, the time

  12. What to Do When the Doctor Sees Double: Identical Twins with Nearly Identical Aneurysms

    OpenAIRE

    Porter, P.J.; Tymianski, M.; Muller, P. J.; TerBrugge, K. G.

    2001-01-01

    This report details the case of identical twins, both of whom had an aneurysm in the same anatomic location. Such aneurysms should be considered as a discrete subset of familial aneurysms. The implications for patient management are discussed.

  13. Differential Gene Expression in Well-healed and Poorly Healed Experimental Aneurysms after Coil Treatment1

    OpenAIRE

    Kadirvel, Ramanathan; Ding, Yong-Hong; Dai, Daying; Lewis, Debra A.; Kallmes, David F

    2010-01-01

    Increased gene expression in densely packed aneurysms was associated with adhesion molecules, proteases, and cytokines in the rabbit aneurysm model; loosely packed aneurysms showed increased expression of multiple structural molecules, including collagens.

  14. Hemodynamic and metabolic effects of cerebral revascularization.

    Science.gov (United States)

    Leblanc, R; Tyler, J L; Mohr, G; Meyer, E; Diksic, M; Yamamoto, L; Taylor, L; Gauthier, S; Hakim, A

    1987-04-01

    Pre- and postoperative positron emission tomography (PET) was performed in six patients undergoing extracranial to intracranial bypass procedures for the treatment of symptomatic extracranial carotid occlusion. The six patients were all men, aged 52 to 68 years. Their symptoms included transient ischemic attacks (five cases), amaurosis fugax (two cases), and completed stroke with good recovery (one case). Positron emission tomography was performed within 4 weeks prior to surgery and between 3 to 6 months postoperatively, using oxygen-15-labeled CO, O2, and CO2 and fluorine-18-labeled fluorodeoxyglucose. Cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral metabolic rates for oxygen and glucose (CMRO2 and CMRGlu), and the oxygen extraction fraction (OEF) were measured in both hemispheres. Preoperatively, compared to five elderly control subjects, patients had increased CBV, a decreased CBF/CBV ratio, and decreased CMRO2, indicating reduced cerebral perfusion pressure and depressed oxygen metabolism. The CBF was decreased in only one patient who had bilateral carotid occlusions; the OEF, CMRGlu, and CMRO2/CMRGlu and CMRGlu/CBF ratios were not significantly different from control measurements. All bypasses were patent and all patients were asymptomatic following surgery. Postoperative PET revealed decreased CBV and an increased CBF/CBV ratio, indicating improved hemodynamic function and oxygen hypometabolism. This was associated with increased CMRO2 in two patients in whom the postoperative OEF was also increased. The CMRGlu and CMRGlu/CBF ratio were increased in five patients. Changes in CBF and the CMRO2/CMRGlu ratio were variable. One patient with preoperative progressive mental deterioration, documented by serial neuropsychological testing and decreasing CBF and CMRO2, had improved postoperative CBF and CMRO2 concomitant with improved neuropsychological functioning. It is concluded that symptomatic carotid occlusion is associated with altered

  15. CHARACTERIZATION OF PATIENTS WITH ENDOVASCULAR TREATMENT OF DISSECTING ANEURYSMS OF POSTERIOR CEREBRAL CIRCULATION IN CARTAGENA DE INDIAS

    Directory of Open Access Journals (Sweden)

    Rueda-Tamayo Leidy

    2015-12-01

    Full Text Available Introduction: the intracraneal aneurysms are local and permanent dilations in the artery. Objective: to describe the clinical, imagenologic and effectiveness of endovascular treatment in terms of its independence and mortality in patients with dissecting aneurysms of posterior cerebral circulation in Cartagena. Methods: a descriptive study was carried out with patients 18 years or older with a diagnosis of dissecting aneurysms of posterior cerebral circulation who received endovascular treatment in the period between January 2007 and December 2014 in the medical center Neurodinamia. The variables related to personal medical history, diagnosis and characteristics of the aneurysm, devices used for treatment, time clinical and imagenologic follow-up and complications were measured. Descriptive statistical analysis was performed according to the nature of the variables. Results: nineteen patients were analyzed to receive endovascular treatments. The average of age was 55 years. The subarachnoid hemorrhage was the most frequent clinical case; this was diagnosed with CT in 89.5%. The location in the PICA and vertebral artery were 36.8% and 31.6%, respectively. The devices used were coils in 36.8%, followed by coils and stent with 31.6%, and Onyx with 21.0%. At the end of VTE this was classified as favorable outcome in 18 patients (94.7%; however, there was one death during hospital care (5.3%. The Rankin scale showed improvement in 84.2% (16 patients. Conclusions: the endovascular treatment of dissecting aneurysms posterior cerebral circulation and the aneurysm occlusion showed high success rates 94.7%, patients (84.2% showed positive results after 30 days of treatment. Rev.cienc.biomed. 2015;6(2:298-308 KEY WORDS Aneurysm; Neurosurgery; Radiology interventional.

  16. Intracranial aneurysms: evaluation in 200 patients with spiral CT angiography

    International Nuclear Information System (INIS)

    The goal of this study was to assess the usefulness of spiral CT angiography (CTA) with three- dimensional reconstructions in defining intracranial aneurysms, particularly around the Circle of Willis. Two hundred consecutive patients with angiographic and/or surgical correlation were studied between 1993 and 1998, with CTA performed on a GE HiSpeed unit and Windows workstation. The following clinical situations were evaluated: conventional CT suspicion of an aneurysm; follow-up of treated aneurysm remnants or of untreated aneurysms; subarachnoid haemorrhage (SAH) and negative angiography; family or past aneurysm history; and for improved definition of aneurysm anatomy. Spiral CTA detected 140 of 144 aneurysms, and an overall sensitivity of 97%, including 30 of 32 aneurysms 3 mm or less in size. In 38 patients with SAH and negative angiography, CTA found six of the seven aneurysms finally diagnosed. There was no significant artefact in 17 of 23 patients (74%) with clips. The specificity of CTA was 86% with 8 false-positive cases. Spiral CTA is very useful in demonstrating intracranial aneurysms. (orig.)

  17. Endovascular treatment of renal aneurysms: A series of 18 cases

    International Nuclear Information System (INIS)

    Purpose: To retrospectively analyze the results and complications of the endovascular treatment of 18 renal aneurysms. Methods: From 2002 to 2011, 15 patients (aged 31–76), with 18 renal aneurysms, were admitted in our institution for treatment by embolization. Except one, all were wide-necked aneurysms. One aneurysm was treated by occluding the parent artery considering its distal location; a small-necked aneurysm was treated by simple coiling, and the remaining 16 were embolized utilizing adjunctive techniques to protect the parent artery. We analyzed the rates of technical success, complication and clinical consequence, post-operative occlusion and recurrence. Results: There was a 100% technical success rate. 15 aneurysms showed a total occlusion on the post-treatment angiogram. 2 aneurysms demonstrated neck remnants, and one had an intrasaccular residual in-flow. Two minor post-operative complications were encountered but resolved over time. No delayed clinical complications were observed and the long-term angiographic follow-up demonstrated stability of the occlusion of the target renal aneurysm with no major recurrence. Conclusion: Complications of the embolization of renal aneurysms are rare. Endovascular treatment should therefore be considered at first for the treatment of renal aneurysms.

  18. Pain and hemodynamic effects in aortofemoral angiography

    International Nuclear Information System (INIS)

    Two new contrast media, iohexol (non-ionic monomer) and ioxaglate (monoacidic dimer), were compared with the non-ionic metrizamide during aortofemoral angiography in a single blind randomized trial in 2 groups of patients with 20 in each. The degree of heat and pain produced by iohexol and ioxaglate did not differ significantly from that produced by metrizamide, while subsequent injections of metrizoate caused significantly more heat and pain. The hemodynamic effects recorded in 10 patients in each group showed that iohexol and ioxaglate induced a decrease in vascular resistance, decrease in blood pressure and increase in heart rate not differing significantly from that induced by metrizamide. (Auth.)

  19. Ruptured carotid artery aneurysms of the ophthalmic (C6) segment: clinical and angiographic long-term follow-up of a multidisciplinary management strategy

    OpenAIRE

    Sherif, Camillo; Gruber, Andreas; Dorfer, Christian; Bavinzski, Gerhard; Standhardt, Harald; Knosp, Engelbert

    2009-01-01

    Abstract Background: The management of ruptured C6 aneurysms remains controversial. Detailed long-term outcome data are still lacking. Thus, the present study provided a detailed long-term follow-up for a multidisciplinary approach combining microsurgical clipping, endovascular embolization and parent artery occlusion with/without bypass-protection. Methods: In our single-centre analysis of 64 consecutive patients, indications for microsurgery were: superior aneurysm pro...

  20. Combined Endovascular and Microsurgical Management of Complex Cerebral Aneurysms

    Directory of Open Access Journals (Sweden)

    Omar eChoudhri

    2013-08-01

    Full Text Available Cerebral aneurysms are associated with a 50% mortality rate after rupture and patients can suffer significant morbidity during subsequent treatment. Neurosurgical management of both ruptured and unruptured aneurysms has evolved over the years. The historical practice of using microsurgical clipping to treat aneurysms has benefitted in the last two decades from tremendous improvement in endovascular technology. Microsurgery and endovascular therapies are often viewed as competing treatments but it is important to recognize their individual limitations. Some aneurysms are considered complex, due to several factors such as aneurysm anatomy and a patient’s clinical condition. A complex aneurysm often cannot be completely excluded with a single approach and its successful treatment requires a combination of microsurgical and endovascular techniques. Planning such an approach relies on understanding aneurysm anatomy and thus should routinely include 3D angiographic imaging. In patients with ruptured aneurysms, endovascular coiling is a well-tolerated early treatment and residual aneurysms can be treated with intervals of definitive clipping. Microsurgical clipping also can be used to reconstruct the neck of a complex aneurysm, allowing successful placement of coils across a narrow neck. Endovascular techniques are assisted by balloons, which can be used in coiling and testing parent vessel occlusion before sacrifice. In some cases microsurgical bypasses can provide alternate flow for planned vessel sacrifice. We present current paradigms for combining endovascular and microsurgical approaches to treat complex aneurysms and share our experience in 67 such cases. A dual microsurgical–endovascular approach addresses the challenge of intracranial aneurysms. This combination can be performed safely and produces excellent rates of aneurysm obliteration. Hybrid angiographic operating-room suites can foster seamless and efficient complementary application

  1. Direct detection of incidental asymptomatic aneurysm by computed tomography

    International Nuclear Information System (INIS)

    Incidental asymptomatic aneurysms were found in 9 of 52 patients with intracranial aneurysms from February, 1978 to March, 1980. They had only mild initial symptoms, namely, headache, dysarthria, aphasis, light hemiparesis and others. No patients had severe neurological deficits. In eight of 9 patients with asymptomatic aneurysm, except one case of hypertensive intracerebral hematoma, 9 aneurysms (8 patients) were directly detected by high resolution CT (GE CT/T 8800) and confirmed by angiography. Location of these aneurysms as follows: three at the middle cerebral artery trifurcation, two at the internal carotisposterior communicans junction, one at anterior communication artery, one at the basilar top, one at the basilaris artery-superior cerebelli artery junction and one at the posterior cerebral artery. The smallest aneurysm detected by CT as 5 x 4 x 4 mm in size on angiography. The aneurysm may be suggested by small round or oval defect in the Sylvian fissure or suprasellar cistern, defect of the edge of the so called ''pentagon'' in the plain CT and then if its density is highly and homogeneously increased after contrast-enhanced (CE) scan. As the circle of Willis and other major cerebral arteries can often be demonstrated on CE.CT images, the aneurysm is frequently seen on these cerebral arteries. Limiting factors to direct CT detection of intracranial aneurysms are seemed to be size and location of aneurysm, anatomic location of circle of Willis and motion of patients etc. It may be considered, in our experiences, that the CT is useful in diagnosis of asymptomatic aneurysm and the higher direct CT detection rate to aneurysms, small or medium sized as well as giant aneurysms, will be obtained by devising scanning method, namely, multiprojection scans, multiple overlapping method and improvement of enhanced method. (author)

  2. A case of angiographically occult, distal small anterior inferior cerebellar artery aneurysm

    OpenAIRE

    Hisashi Kubota; Yasuhiro Sanada; Kazuhiro Nagatsuka; Amami Kato

    2015-01-01

    Background: A small aneurysm at an unusual location, such as a distal anterior inferior cerebellar artery (AICA) aneurysm, may conceal as a computed tomography angiography (CTA) and digital subtraction angiography (DSA)-occult aneurysm. Case Description: We herein present the case of a patient suffering from a subarachnoid hemorrhage (SAH) with two aneurysms in which the AICA aneurysm was negative by CTA and DSA. CTA demonstrated a right anterior choroidal artery aneurysm, which was revea...

  3. Endovascular Management of Splenic Arteriovenous Fistula with Giant Venous Aneurysmal Dilatation

    OpenAIRE

    Hamed Ibrahim, Wael; M Bassurrah, Hana

    2012-01-01

    Although splenic artery aneurysm is the commonest visceral and third most common intra abdominal aneurysm after aorta and iliac artery, aneurysm of splenic artery along with aneurysm of splenic vein and arteriovenous fistula is a rare entity. Most of them are 10 cm have been reported. We report a case of 11 cm × 8 cm giant splenic vein aneurysm with splenic arteriovenous fistula as the 1st case of giant splenic venous aneurysm with arteriovenous fistula managed by endovascular treatment.

  4. Effects of Intraoperative Hemodynamics on Incidence of Postoperative Delirium in Elderly Patients: A Retrospective Study.

    Science.gov (United States)

    Yang, Lin; Sun, De-Feng; Han, Jun; Liu, Ruochuan; Wang, Li-Jie; Zhang, Zhen-Zhen

    2016-01-01

    BACKGROUND Postoperative delirium (POD) is a common complication in the elderly. This retrospective study investigated the effect of intraoperative hemodynamics on the incidence of POD in elderly patients after major surgery to explore ways to reduce the incidence of POD. MATERIAL AND METHODS Based on the incidence of POD, elderly patients (81±6 y) were assigned to a POD (n=137) or non-POD group (n=343) after elective surgery with total intravenous anesthesia. POD was diagnosed based on the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the confusion assessment method. The hemodynamic parameters, such as mean arterial pressure, were monitored 10 min before anesthesia (baseline) and intraoperatively. The incidence of intraoperative hypertension, hypotension, tachycardia, and bradycardia were calculated. RESULTS At 30 min and 60 min after the initiation of anesthesia and at the conclusion of surgery, the monitored hemodynamic parameter values of the POD group, but not those of the non-POD group, were significantly higher than at baseline. Multivariate logistic regression analysis showed that intraoperative hypertension and tachycardia were significantly associated with POD. CONCLUSIONS Intraoperative hypertension and tachycardia were significantly associated with POD. Maintaining intraoperative stable hemodynamics may reduce the incidence of POD in elderly patients undergoing surgery. PMID:27038856

  5. [Study of sharing platform of web-based enhanced extracorporeal counterpulsation hemodynamic waveform data].

    Science.gov (United States)

    Huang, Mingbo; Hu, Ding; Yu, Donglan; Zheng, Zhensheng; Wang, Kuijian

    2011-12-01

    Enhanced extracorporeal counterpulsation (EECP) information consists of both text and hemodynamic waveform data. At present EECP text information has been successfully managed through Web browser, while the management and sharing of hemodynamic waveform data through Internet has not been solved yet. In order to manage EECP information completely, based on the in-depth analysis of EECP hemodynamic waveform file of digital imaging and communications in medicine (DICOM) format and its disadvantages in Internet sharing, we proposed the use of the extensible markup language (XML), which is currently the Internet popular data exchange standard, as the storage specification for the sharing of EECP waveform data. Then we designed a web-based sharing system of EECP hemodynamic waveform data via ASP. NET 2.0 platform. Meanwhile, we specifically introduced the four main system function modules and their implement methods, including DICOM to XML conversion module, EECP waveform data management module, retrieval and display of EECP waveform module and the security mechanism of the system. PMID:22295686

  6. Endovascular treatment of abdominal aortic aneurysms.

    Science.gov (United States)

    Buck, Dominique B; van Herwaarden, Joost A; Schermerhorn, Marc L; Moll, Frans L

    2014-02-01

    Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR. PMID:24343568

  7. Totally thrombosed giant anterior communicating artery aneurysm

    Directory of Open Access Journals (Sweden)

    V R Roopesh Kumar

    2015-01-01

    Full Text Available Giant anterior communicating artery aneurysmsarerare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass.At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery.The difficulty in preoperative diagnosis and relevant literature are reviewed.

  8. Inferior vena cava aneurysm. A case report

    International Nuclear Information System (INIS)

    Aneurysmal dilatation of the inferior vena cava can occur in patients with heart disease or, very likely, with congenital weakness of the vascular wall. Chest x-ray discloses a mass in right cardiophrenic angle. The diagnosis can be confirmed by ultrasound, more invasive measures being unnecessary. (Author) 6 refs

  9. Endovascular treatment of scalp cirsoid aneurysms

    Directory of Open Access Journals (Sweden)

    Gupta A

    2008-01-01

    Full Text Available Background: Scalp is the most common site of soft tissue arteriovenous fistulae and surgical excision has been the primary mode of treatment. Endovascular treatment has evolved as an alternative to the surgery. Aims: To evaluate the effectiveness of percutaneous direct-puncture embolization of cirsoid aneurysms. Materials and Methods: From January 1995 to December 2004, 15 patients underwent percutaneous direct-puncture embolization of cirsoid aneurysms. Plain X-ray, computerized tomography scan and complete selective cerebral angiogram were done in all. Seven patients had forehead lesions, four had temporal and the remaining four patients had occipital region cirsoid aneurysms. Lesions were punctured with 21-gauge needle and embolized with 20-50% cyanoacrylate-lipiodol mixture. Circumferential compression was applied during injection. Results: Post-embolization angiogram showed complete obliteration in 11 patients. The remaining four patients required adjunctive transarterial embolization with polyvinyl alcohol particles for complete lesion devascularization. Two patients had post procedure surgery for removal of disfiguring and hard glue cast. There were no major procedure-related complications. No patients had any recurrence in the follow-up. Conclusion: Percutaneous direct puncture embolization of cirsoid aneurysms is a safe and effective procedure. It can be effectively used as an alternative to surgery. Sometimes adjunctive transarterial embolization is also required to deal with deeper feeders.

  10. Natural history of abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Perko, M J; Schroeder, T V; Olsen, P S;

    1993-01-01

    During a 10-year period in which 735 patients presented with abdominal aortic aneurysms to our clinic, 63 were not offered operative treatment. The primary reason for choosing conservative treatment was concomitant diseases that increased the risk of operation. After 2 years of followup, half of ...

  11. Outcomes After Elective Aortic Aneurysm Repair

    DEFF Research Database (Denmark)

    de la Motte, L; Jensen, L P; Vogt, K;

    2013-01-01

    OBJECTIVE: To assess outcomes after treatment for asymptomatic abdominal aortic aneurysm (AAA) in Denmark in a period when both open surgery (OR) and endoluminal repair (EVAR) have been routine procedures. METHODS: We performed a retrospective nationwide cohort study of patients treated for asymp...

  12. Cardiovascular syphilis complicated by Lower thoracic and upper abdominal aneurysm – A rare case report

    Science.gov (United States)

    Gayathri, K.; Shankar, S. Vijay; Venkatesan, S.; Kalaivani, S.

    2016-01-01

    A 50-year-old male presented with left lower abdominal pain, visible pulsation below xiphoid process, and tenderness in the left iliac fossa for the past 10 days. Chest X-ray revealed blunting of left cardiophrenic angle. Echocardiogram revealed descending thoracic aortic pseudoaneurysm. Contrast-enhanced computed tomography of the chest and abdomen revealed dissecting aneurysm of lower thoracic and upper abdominal aorta. Thoracoabdominal aortogram revealed erosion of D12 vertebra and infected aneurysm of adjacent thoracoabdominal aorta. Serum venereal disease research laboratory assay was positive in 1:4 dilution Treponema pallidum hemagglutination assay was positive. The patient was treated with Injection procaine penicillin for 20 days undercover of steroids. Cerebrospinal fluid analysis was normal. Aortic aneurysm repair with reconstruction was done. Histopathology was in favor of syphilitic etiology. This case is being presented as descending thoracic and upper abdominal aortic aneurysm due to syphilis complicated by dissection and erosion of vertebral body is rare and has not been reported nowadays to the best of our knowledge.

  13. Cardiovascular syphilis complicated by Lower thoracic and upper abdominal aneurysm - A rare case report.

    Science.gov (United States)

    Gayathri, K; Shankar, S Vijay; Venkatesan, S; Kalaivani, S

    2016-01-01

    A 50-year-old male presented with left lower abdominal pain, visible pulsation below xiphoid process, and tenderness in the left iliac fossa for the past 10 days. Chest X-ray revealed blunting of left cardiophrenic angle. Echocardiogram revealed descending thoracic aortic pseudoaneurysm. Contrast-enhanced computed tomography of the chest and abdomen revealed dissecting aneurysm of lower thoracic and upper abdominal aorta. Thoracoabdominal aortogram revealed erosion of D12 vertebra and infected aneurysm of adjacent thoracoabdominal aorta. Serum venereal disease research laboratory assay was positive in 1:4 dilution Treponema pallidum hemagglutination assay was positive. The patient was treated with Injection procaine penicillin for 20 days undercover of steroids. Cerebrospinal fluid analysis was normal. Aortic aneurysm repair with reconstruction was done. Histopathology was in favor of syphilitic etiology. This case is being presented as descending thoracic and upper abdominal aortic aneurysm due to syphilis complicated by dissection and erosion of vertebral body is rare and has not been reported nowadays to the best of our knowledge. PMID:27190418

  14. Cardiovascular syphilis complicated by Lower thoracic and upper abdominal aneurysm – A rare case report

    Directory of Open Access Journals (Sweden)

    K Gayathri

    2016-01-01

    Full Text Available A 50-year-old male presented with left lower abdominal pain, visible pulsation below xiphoid process, and tenderness in the left iliac fossa for the past 10 days. Chest X-ray revealed blunting of left cardiophrenic angle. Echocardiogram revealed descending thoracic aortic pseudoaneurysm. Contrast-enhanced computed tomography of the chest and abdomen revealed dissecting aneurysm of lower thoracic and upper abdominal aorta. Thoracoabdominal aortogram revealed erosion of D12 vertebra and infected aneurysm of adjacent thoracoabdominal aorta. Serum venereal disease research laboratory assay was positive in 1:4 dilution Treponema pallidum hemagglutination assay was positive. The patient was treated with Injection procaine penicillin for 20 days undercover of steroids. Cerebrospinal fluid analysis was normal. Aortic aneurysm repair with reconstruction was done. Histopathology was in favor of syphilitic etiology. This case is being presented as descending thoracic and upper abdominal aortic aneurysm due to syphilis complicated by dissection and erosion of vertebral body is rare and has not been reported nowadays to the best of our knowledge.

  15. Bayesian model comparison in nonlinear BOLD fMRI hemodynamics

    DEFF Research Database (Denmark)

    Jacobsen, Danjal Jakup; Hansen, Lars Kai; Madsen, Kristoffer Hougaard

    2008-01-01

    Nonlinear hemodynamic models express the BOLD (blood oxygenation level dependent) signal as a nonlinear, parametric functional of the temporal sequence of local neural activity. Several models have been proposed for both the neural activity and the hemodynamics. We compare two such combined models...

  16. The Effect of Neuraxial Anesthesia on Maternal Cerebral Hemodynamics

    NARCIS (Netherlands)

    Postma, Ineke R.; van Veen, Teelkien R.; Mears, Scott L.; Zeeman, Gerda G.; Haeri, Sina; Belfort, Michael A.

    2014-01-01

    Objective Neuraxial anesthesia is known to reduce sympathetic tone and mean arterial pressure. Effects on cerebral hemodynamics in pregnancy are not well known. We hypothesize that cerebral hemodynamic parameters will change with respect to baseline following regional analgesia/anesthesia. Study Des

  17. Cerebrovascular hemodynamics in patients with cerebral arteriosclerosis

    Institute of Scientific and Technical Information of China (English)

    Jianbo Yang; Changcong Cui; Chengbin Wu

    2011-01-01

    The present study observed hemodynamic changes in 26 patients with cerebral arteriosclerosis using a cerebral circulation dynamics detector and transcranial Doppler.In patients with cerebral arteriosclerosis the blood supply and flow rate in the bilateral carotid arteries and the blood flow rate in the anterior cerebral and middle cerebral arteries were similar to normal controls, but the cerebral vascular resistance, critical pressure and pulsatility index were increased, and cerebral arterial elasticity and cerebral blood flow autoregulation were decreased.Compared with the lesioned hemisphere of patients with cerebral infarction, the total blood supply and blood flow rate of patients with cerebral arteriosclerosis were higher.Compared with normal subjects, patients with cerebral arteriosclerosis exhibited cognitive disturbances, mainly in short-term memory, attention, abstract capability, and spatial and executive dysfunction.Results showed that cerebral arteriosclerosis does not directly affect the blood supply of a cerebral hemisphere, but affects cognitive function.The increased cerebral vascular resistance and reduced autoregulation of cerebral blood vessels may be important hemodynamic mechanisms of arteriosclerosis-induced cerebral infarction.

  18. Treatment of ruptured anterior communicating artery aneurysms with GDCs

    International Nuclear Information System (INIS)

    Objective: To summarize 45 cases of ruptured anterior communicating artery aneurysms treated with GDCs. Methods: All aneurysms were embolized with GDCs. Results: Complete embolization was achieved in 25 aneurysms, subtotal in 14, and partial in 6. Two cases were cured by the second time embolization. One case of recurrent aneurysm after G DC treatment was curved by surgical clipping. Brain infarction was noted in 7 cases after the endovascular procedure, and one of them died of pneumonia, another one remained in permanent coma. 1-20 months follow up showed stable result. 4 of 5 cases with multi-intracranial aneurysms had been treated with on of this procedure. Conclusions: The result of endo vascular treatment of anterior communicating artery aneurysms in the early period after rupture was good. Although there was a relatively high risk of local brain infarction, the clinical outcome was satisfactory

  19. Endovascular treatment of the posterior inferior cerebellar artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Bradac, G.B.; Bergui, M. [Neuroradiology, Univ. di Torino, Turin (Italy)

    2004-12-01

    Aneurysms may arise at various locations along the course of the posterior inferior cerebellar artery. Brainstem and cranial nerves manipulation make the surgical approach to proximal aneurysms difficult, while the occlusion of the parent vessel is sometimes unavoidable in peripheral aneurysms. Endovascular treatment can be a good alternative, but also with this approach the location of the aneurysm is critical. If occlusion of the parent vessel is planned, anatomical variations and vascular territories of the brainstem should be considered. We report our experience with 18 consecutive aneurysms (12 proximal, 6 peripheral) treated by coils. Complete occlusion was achieved in 14 patients and subtotal in 4. In three patients the parent vessel had to be sacrificed. During treatment two perforations occurred; aneurysms were completely occluded without clinical consequences. Two small asymptomatic cerebellar infarctions were seen on postoperative computed tomography. Clinical outcome was good in 16 patients. (orig.)

  20. Diagnosis of aortic aneurysms by scintigraphy and ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Caille, G. (Centre Hospitalier, Saint-Nazaire (France)); Chatal, J.F.; Tellier, J.L.; Talmant, C.; Guihard, R. (Centre Rene-Gauducheau, 44 - Nantes (France))

    1981-10-01

    Angioscintigraphy, performed on 50 patients suspected of aortic aneurysm and complemented by abdominal ultrasonography in 31 cases, disclosed: - Three cases of thoracic aortic aneurysm, 2 of which were confirmed by arteriography and surgery. It was impossible to perform surgery in the third case, no arteriography was done. Strict agreement with standard thoracic images had made the angioscintigraphic diagnosis seem correct. Twenty-seven cases of abdominal aortic aneurysms were confirmed by arteriography or surgery. Ultrasonography disclosed an abdominal aortic aneurysm in 26 cases, 20 of which were confirmed. The agreement of the two procedures in 10 unconfirmed cases led us to consider the diagnosis as correct. Angioscintigraphy appears to be a reliable procedure for detecting thoracic and abdominal aortic aneurysms. Ultrasonography is the simplest and least costly procedure for study of abdominal aortic aneurysms.

  1. Diagnosis of aortic aneurysms by scintigraphy and ultrasonography

    International Nuclear Information System (INIS)

    Angioscintigraphy, performed on 50 patients suspected of aortic aneurysm and complemented by abdominal ultrasonography in 31 cases, disclosed: - Three cases of thoracic aortic aneurysm, 2 of which were confirmed by arteriography and surgery. It was impossible to perform surgery in the third case, no arteriography was done. Strict agreement with standard thoracic images had made the angioscintigraphic diagnosis seems correct. - Twenty-seven cases of abdominal aortic aneurysms confirmed by arteriography or surgery. Ultrasonography disclosed an abdominal aortic aneurysm in 26 cases, 20 of which were confirmed. The agreement of the two procedures in 10 unconfirmed cases led us to consider the diagnosis as correct. Angioscintigraphy appears to be a reliable procedure for detecting thoracic and abdominal aortic aneurysms. Ultrasonography is the simplest and least costly procedure for study of abdominal aortic aneurysms

  2. Novel Molecular Imaging Approaches to Abdominal Aortic Aneurysm Risk Stratification.

    Science.gov (United States)

    Toczek, Jakub; Meadows, Judith L; Sadeghi, Mehran M

    2016-01-01

    Selection of patients for abdominal aortic aneurysm repair is currently based on aneurysm size, growth rate, and symptoms. Molecular imaging of biological processes associated with aneurysm growth and rupture, for example, inflammation and matrix remodeling, could improve patient risk stratification and lead to a reduction in abdominal aortic aneurysm morbidity and mortality. (18)F-fluorodeoxyglucose-positron emission tomography and ultrasmall superparamagnetic particles of iron oxide magnetic resonance imaging are 2 novel approaches to abdominal aortic aneurysm imaging evaluated in clinical trials. A variety of other tracers, including those that target inflammatory cells and proteolytic enzymes (eg, integrin αvβ3 and matrix metalloproteinases), have proven effective in preclinical models of abdominal aortic aneurysm and show great potential for clinical translation. PMID:26763279

  3. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

  4. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

    Energy Technology Data Exchange (ETDEWEB)

    Rai, Divyajeet; Velu, Ramesh; Tosenovsky, Patrik; Quigley, Francis [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); Wisniowski, Brendan; Walker, Philip J. [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia); Bradshaw, Barbara [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); Golledge, Jonathan [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia)

    2014-08-15

    Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

  5. Hemodynamic Consequences of Malignant Ascites in Epithelial Ovarian Cancer Surgery*: A Prospective Substudy of a Randomized Controlled Trial.

    Science.gov (United States)

    Hunsicker, Oliver; Fotopoulou, Christina; Pietzner, Klaus; Koch, Mandy; Krannich, Alexander; Sehouli, Jalid; Spies, Claudia; Feldheiser, Aarne

    2015-12-01

    Malignant ascites (MA) is most commonly observed in patients scheduled for epithelial ovarian cancer (EOC) surgery and is supposed as a major risk factor promoting perioperative hemodynamic deterioration. We aimed to assess the hemodynamic consequences of MA on systemic circulation in patients undergoing cytoreductive EOC surgery.This study is a predefined post-hoc analysis of a randomized controlled pilot trial comparing intravenous solutions within a goal-directed algorithm to optimize hemodynamic therapy in patients undergoing cytoreductive EOC surgery. Ascites was used to stratify the EOC patients prior to randomization in the main study. We analyzed 2 groups according to the amount of ascites (NLAS: none or low ascites [500 mL]). Differences in hemodynamic variables with respect to time were analyzed using nonparametric analysis for longitudinal data and multivariate generalized estimating equation adjusting the analysis for the randomized study groups of the main study.A total of 31 patients in the NLAS and 16 patients in the HAS group were analyzed. Although cardiac output was not different between groups suggesting a similar circulatory blood flow, the HAS group revealed higher heart rates and lower stroke volumes during surgery. There were no differences in pressure-based hemodynamic variables. In the HAS group, fluid demands, reflected by the time to reindication of a fluid challenge after preload optimization, increased steadily, whereas stroke volume could not be maintained at baseline resulting in hemodynamic instability after 1.5 h of surgery. In contrast, in the NLAS group fluid demands were stable and stroke volume could be maintained during surgery. Clinically relevant associations of the type of fluid replacement with hemodynamic consequences were particularly observed in the HAS group, in which transfusion of fresh frozen plasma (FFP) was associated to an improved circulatory flow and reduced vasopressor and fluid demands, whereas the

  6. Evaluation of the influence of inlet boundary conditions on computational fluid dynamics for intracranial aneurysms: a virtual experiment.

    Science.gov (United States)

    Pereira, V M; Brina, O; Marcos Gonzales, A; Narata, A P; Bijlenga, P; Schaller, K; Lovblad, K O; Ouared, R

    2013-05-31

    Inlet boundary conditions (BCs) are important inputs of computational fluid dynamics (CFD) in intracranial aneurysms (IAs). We performed sensibility analysis of CFD to different inlet BCs applied to illustrative patient-specific aneurysm-vessel geometry. BCs corresponding to generic and patient-specific pulsatile flow curves were applied to three vascular geometry models of carotid ophthalmic aneurysm-vessel geometry, in which the inlet lengths were different. CFD outcomes were compared to high frame rate Digital Subtraction Angiography (DSA) sequences. The streamlines were found to match contrast agent (CA) motion pattern in the case where the non-truncated inlet vessel model was coupled to generic Womersley BC solution. Even though dynamic pressure loss (55%) was equal for all models and different BCs, the minimum distance to wall of the fastest velocity fields for the non-truncated model was significantly larger (p=0.002) and mean vorticity sign was different. Significant difference in spatial distributions of wall shear stress (WSS) and oscillating shear stress index (OSI) was found in aneurysm between Womersley and Plugflow BC conditions, only. Reliable CFD for carotid ophthalmic aneurysm would require avoiding truncation of the inlet vessel to be independent of the solution applied to generate CFD. PMID:23602597

  7. Endovascular Aneurysm Repair: Is Imaging Surveillance Robust, and Does It Influence Long-term Mortality?

    Energy Technology Data Exchange (ETDEWEB)

    Waduud, Mohammed Abdul, E-mail: m.a.waduud@doctors.org.uk [Glasgow Royal Infirmary, Department of Surgery (United Kingdom); Choong, Wen Ling, E-mail: wenlingchoong@nhs.net [Aberdeen Royal Infirmary, NHS Grampian, Department of Surgery (United Kingdom); Ritchie, Moira, E-mail: moirasim9@gmail.com; Williams, Claire, E-mail: c.williams.3@research.gla.ac.uk [University of Glasgow, Institute of Health and Wellbeing Glasgow (United Kingdom); Yadavali, Reddi, E-mail: reddi.yadavali@nhs.net [Aberdeen Royal Infirmary, NHS Grampian, Department of Radiology (United Kingdom); Lim, Shueh, E-mail: s.lim.06@aberdeen.ac.uk [Royal Infirmary of Edinburgh, NHS Lothian, Department of Radiology (United Kingdom); Buchanan, Fraser, E-mail: f.buchanan.11@aberdeen.ac.uk [University of Aberdeen, The School of Medicine and Dentistry (United Kingdom); Bhat, Raj, E-mail: raj.bhat@nhs.net [Ninewells Hospital, NHS Tayside, Department of Radiology (United Kingdom); Ramanathan, Krishnappan, E-mail: k.ramanathan@dundee.ac.uk [University of Dundee, School of Medicine (United Kingdom); Ingram, Susan, E-mail: susan.ingram@luht.scot.nhs.uk; Cormack, Laura, E-mail: lgcormack@googlemail.com [Royal Infirmary of Edinburgh, NHS Lothian, Department of Radiology (United Kingdom); Moss, Jonathan G., E-mail: jon.moss@ggc.scot.nhs.uk [Gartnavel General Hospital, Department of Radiology (United Kingdom)

    2015-02-15

    PurposeEndovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality.MethodsA retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates.ResultsData were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0–38.6) and aneurysm-related mortality was 4.5 % (.8–7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2–58.6), 19.1 % (12.6–25.2), and 47.2 % (17.7–66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8–7.4), 4.4 % (2.2–8.9), and 9.5 % (2.5–33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2).ConclusionOnly half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance.

  8. Positron emission tomography (PET) evaluation of abdominal aortic aneurysm (AAA)

    OpenAIRE

    SakalihasanN, Natzi; Van Damme, Hendrik; Gomez, P.; RIGO, PIERRE; Lapiere, C. M.; Nusgens, Betty; Limet, Raymond

    2002-01-01

    Background: aneurysmal disease is associated with all inflammatory Cell infiltrate and enzymatic degradation of the vessel wall. Aim of the study: to detect increased metabolic activity in abdominal aortic aneurysms (AAA) by means of positron emission tomography (PET-imaging). Study design: twenty-six patients with AAA underwent PET-imaging Results: in tell patients, PET-imaging revealed increased, fluoro-deoxy-glucose (18-FDG) uptake at the level of the aneurysm. Patients with positive PET-i...

  9. Multiple aneurysms due to intimomedial mucoid degeneration: a short presentation

    Directory of Open Access Journals (Sweden)

    H Gajjar

    2009-11-01

    Full Text Available A 17 year-old female presented with abdominal pain, due to contained rupture of a left common iliac artery aneurysm. This was accompanied by abdominal aortic and superior mesenteric artery aneurysms. Despite emergency vascular surgery, the patient died a week later. Post-mortem examination revealed intimomedial mucoid degeneration. This rare condition has been described predominantly in South African black patients especially females, and occurs at a younger age than degenerative aortic aneurysms.

  10. Intracranial Non-traumatic Aneurysms in Children and Adolescents

    OpenAIRE

    Sorteberg, Angelika; Dahlberg, Daniel

    2013-01-01

    An intracranial aneurysm in a child or adolescent is a rare, but potentially devastating condition. As little as approximately 1200 cases are reported between 1939 and 2011, with many of the reports presenting diverting results. There is consensus, though, in that pediatric aneurysms represent a pathophysiological entity different from their adult counterparts. In children, there is a male predominance. About two-thirds of pediatric intracranial aneurysms become symptomatic with hemorrhage an...

  11. A Case of Giant Right Atrial Aneurysm in a Child.

    Science.gov (United States)

    Pawar, Ravindra S; Tiwari, Ashish; Suresh, P V; Raj, Vimal; Kaushik, Pradeepkumar

    2016-07-01

    Giant right atrial aneurysm is a rare entity in infants and children. It needs to be distinguished from an atrial diverticulum, which can have similar presentation. Generally, an incidental finding in children, it can present with varied symptoms. We report a case of a giant right atrial aneurysm in an asymptomatic child with a large clot in the dilated right atrium, who underwent successful resection of the atrial aneurysm. PMID:26884450

  12. Multilocular True Ulnar Artery Aneurysm in a Pediatric Patient

    OpenAIRE

    Stalder, Mark W.; Sanders, Christopher; Lago, Mary; Hilaire, Hugo St

    2016-01-01

    Summary: Ulnar artery aneurysms are an exceedingly rare entity in the pediatric population and have no consistent etiologic mechanism. We present the case of a 15-year-old male with a multilocular ulnar artery aneurysm in the setting of no antecedent history of trauma, no identifiable connective tissue disorders, and no other apparent etiological factors. Furthermore, the patient’s arterial palmar arch system was absent. The aneurysm was resected, and arterial reconstruction was successfully ...

  13. Giant aortic arch aneurysm complicating Kawasaki′s disease

    OpenAIRE

    Kaouthar Hakim; Rafik Boussada; Lilia Chaker; Fatma Ouarda

    2014-01-01

    Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small- and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented in studies, related reports on peripheral arterial and aortic aneurysms are scarce. We report the occurrence of a giant aortic aneurysm involving the horizontal part of aortic arch in a 28-month-old boy diagnosed with KD. This complication was m...

  14. Calcification of an aneurysm of the vein of Galen

    International Nuclear Information System (INIS)

    A 3 1/2 month old boy was diagnosed as having hydrocephalus secondary to an aneurysm of the vein of Galen. Cerebral angiography 2 1/2 years later showed the aneurysm to be completely occluded and CT demonstrated it to be thrombosed and completely calcified. Complete calcification of an aneurysm of the vein of Galen has only been described on two previous occasions and never in a child this young. (orig.)

  15. Nonlinear extension of a hemodynamic linear model for coherent hemodynamics spectroscopy.

    Science.gov (United States)

    Sassaroli, Angelo; Kainerstorfer, Jana M; Fantini, Sergio

    2016-01-21

    In this work, we are proposing an extension of a recent hemodynamic model (Fantini, 2014a), which was developed within the framework of a novel approach to the study of tissue hemodynamics, named coherent hemodynamics spectroscopy (CHS). The previous hemodynamic model, from a signal processing viewpoint, treats the tissue microvasculature as a linear time-invariant system, and considers changes of blood volume, capillary blood flow velocity and the rate of oxygen diffusion as inputs, and the changes of oxy-, deoxy-, and total hemoglobin concentrations (measured in near infrared spectroscopy) as outputs. The model has been used also as a forward solver in an inversion procedure to retrieve quantitative parameters that assess physiological and biological processes such as microcirculation, cerebral autoregulation, tissue metabolic rate of oxygen, and oxygen extraction fraction. Within the assumption of "small" capillary blood flow velocity oscillations the model showed that the capillary and venous compartments "respond" to this input as low pass filters, characterized by two distinct impulse response functions. In this work, we do not make the assumption of "small" perturbations of capillary blood flow velocity by solving without approximations the partial differential equation that governs the spatio-temporal behavior of hemoglobin saturation in capillary and venous blood. Preliminary comparison between the linear time-invariant model and the extended model (here identified as nonlinear model) are shown for the relevant parameters measured in CHS as a function of the oscillation frequency (CHS spectra). We have found that for capillary blood flow velocity oscillations with amplitudes up to 10% of the baseline value (which reflect typical scenarios in CHS), the discrepancies between CHS spectra obtained with the linear and nonlinear models are negligible. For larger oscillations (~50%) the linear and nonlinear models yield CHS spectra with differences within typical

  16. The curative effect of endovascular embolization on treating intracranial wide necked aneurysms%血管内栓塞治疗颅内宽颈动脉瘤

    Institute of Scientific and Technical Information of China (English)

    赵鹏; 岳军艳; 李奋保

    2014-01-01

    目的:探讨血管内不同栓塞方法治疗颅内宽颈动脉瘤的临床疗效。方法选择颅内宽颈动脉瘤患者50例,根据颅内宽颈动脉瘤的不同类型采用不同的栓塞方法,观察各种方法的临床疗效。结果不同栓塞技术的致密栓塞率情况:3D-GDC为75.0%,双微导管技术为85.7%,球囊辅助技术87.5%,血管内支架辅助技术85.7%。所有患者随访1 a ,其中20例CTA 复查,30例DSA 复查,均未发生动脉瘤复发及再出血。结论根据动脉瘤的形态、位置、大小及血流动力学特点,采用双微管技术、球囊或支架辅助技术可提高颅内宽颈动脉瘤治疗效果。%Objective To investigate the curative effect of endovascular embolization on treating intracranial wide necked aneurysms.Methods Fifty patients with intracranial wide necked aneurysms were selected and used different embolized meth-ods according to types of intracranial wide necked aneurysms.The curative effects of different embolized methods were com-pared.Results The aneurysm obliteration densification rate was 75% (3D-GDC) ,85.7% (double microcatheter technique) , 87.5% ( balloon assisted technique) and 85.7% (stent assisted endovascular technique). All patients were followed up for 1 year and reexamined by CTA or DSA ,there were no recurrence and rebleeding of aneurysm.Conclusion Double micropipette technique ,balloon or stent assisted technique can significantly improve the curative effect of intracranial wide necked aneurysms according to aneurysmal shape ,position ,size and hemodynamic characteristics.

  17. Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Bonilha Leonardo

    2001-01-01

    Full Text Available OBJECTIVE: Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding. METHODS: We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis, we applied the chi-squared test or Fisher's test using the pondered kappa coeficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5%. RESULTS: Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34%, while grade 3 of Fisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60%. Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively. Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and Fisher scale. CONCLUSION: Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability.

  18. In vivo characterization of a new abdominal aortic aneurysm mouse model with conventional and molecular MRI

    Science.gov (United States)

    Klink, Ahmed; Heynens, Joeri; Herranz, Beatriz; Lobatto, Mark E.; Arias, Teresa; Sanders, Honorius M. H. F.; Strijkers, Gustav J.; Merkx, Maarten; Nicolay, Klaas; Fuster, Valentin; Tedgui, Alain; Mallat, Ziad; Mulder, Willem J.M.; Fayad, Zahi A.

    2014-01-01

    Objectives To use non-invasive conventional and molecular magnetic resonance imaging (MRI) to detect and characterize abdominal aortic aneurysms (AAAs) in vivo. Background Collagen is an essential constituent of aneurysms. Non-invasive MRI of collagen may represent an opportunity to help detect and better characterize AAA and initiate intervention. Methods We used an AAA C57BL/6 mouse model where a combination of angiotensin-II infusion and TGF-β neutralization results in AAA formation with incidence of aortic rupture. High-resolution multi-sequence MRI was performed to characterize the temporal progression of AAA. To allow molecular MRI of collagen, paramagnetic/fluorescent micellar nanoparticles functionalized with a collagen-binding protein (CNA-35) were intravenously administered. In vivo imaging results were corroborated with immunohistochemistry and confocal fluorescence microscopy. Results High-resolution multi-sequence MRI allowed the visualization of the primary fibrotic response in the aortic wall. As the aneurysm progressed, the formation of a secondary channel or dissection was detected. Further analysis revealed a dramatic increase of the aortic diameter. Injection of CNA-35 micelles resulted in a significant higher MR signal enhancement in the aneurysmal wall compared to non-specific micelles. Histological studies demonstrated the presence of collagen in regions of MR signal enhancement and confocal microscopy proved the precise colocalization of CNA-35 micelles with collagen-I. In addition, in a proof of concept experiment, we have shown the potential of CNA-35 micelles to discriminate between stable AAA lesions and aneurysms that were likely to rapidly progress/rupture. Conclusion Multi-sequence MRI allowed longitudinal monitoring of AAA progression while the presence of collagen was visualized by nanoparticle-enhanced MRI. PMID:22133853

  19. EC-IC bypass for cavernous carotid aneurysms: An initial experience with twelve patients

    Science.gov (United States)

    Menon, G.; Jayanand, Sudhir; Krishnakumar, K.; Nair, S.

    2014-01-01

    Aims: Need for performing a bypass procedure prior to parent artery occlusion in patients with good cerebral vascular reserve is controversial. We analyze our experience of 12 giant internal carotid artery aneurysms treated with extracranial-intracranial (EC-IC) bypass and proximal artery occlusion. Materials and Methods: Retrospective analysis of the case records of all complex carotid aneurysms operated in our institute since January 2009. Results: The study included eleven cavernous carotid aneurysms and one large fusiform cervical carotid aneurysm reaching the skull base. Preoperative assessment of cerebral vascular reserve was limited to Balloon test occlusion with hypotensive challenge. Eleven patients who successfully completed a Balloon test occlusion (BTO) underwent low flow superficial temporal artery to middle cerebral artery (STA-MCA) bypass, while one patient with a failed BTO underwent a high flow bypass using a saphenous vein graft. Parent artery ligation was performed in all patients following the bypass procedure. Check angiogram revealed thrombosis of the aneurysm in all patients with a graft patency rate of 81.8%. We had one operative mortality, probably related to a leak from the anastomotic site. The only patient who had a high flow bypass developed contralateral hemispheric infarcts and remained vegetative. All the other patients had a good recovery and with a Glasgow outcome score of 5 at last follow-up. Conclusion: We feel that combining EC-IC bypass prior to parent vessel occlusion helps in reducing the risk of post operative ischemic complications especially in situations where a complete mandated cerebral blood flow studies are not feasible. PMID:25126123

  20. Plethyzmography in assessment of hemodynamic results of pacemaker functions programming

    Science.gov (United States)

    Wojciechowski, Dariusz; Sionek, Piotr; Peczalski, Kazimierz; Janusek, Dariusz

    2011-01-01

    The paper presents potential role of plethyzmography in optimization of heart hemodynamic function during pacemaker programming. The assessment of optimal stroke volume in patients, with implanted dual chamber pacemaker (DDD), by plethyzmography was a goal of the study. The data were collected during pacing rhythm. 20 patients (8 female and 12 male, average 77.4+/-4.6 years) with dual chamber pacemaker (DDD) and with pacing rhythm during routine pacemaker control and study tests were incorporated in the study group. Hemodynamic parameters were assessed during modification of atrio-ventricular delay (AVD) for pacing rhythm of 70 bpm and 90 bpm. The time of atrioventricular was programmed with 20 ms steps within range 100-200 ms and data were recorded with two minutes delay between two consecutive measurements. Stroke volume (SV) and cardiac output (CO) were calculated from plethyzmographic signal by using Beatscope software (TNO Holand). Highest SV calculated for given pacing rhythm was named optimal stroke volume (OSV) and consequently highest cardiac output was named maximal cardiac output (MCO). The time of atrio-ventricular delay for OSV was named optimal atrioventricular delay (OAVD). The results have showed: mean values of OAVD for 70 bpm - 152+/-33 ms and for 90 bpm -149+/-35 ms, shortening of the mean OAVD time caused by increase of pacing rate from 70 bpm to 90 bpm what resulted in statistically significant decrease of OSV with not statistically significant increase of MCO. The analysis of consecutive patients revealed three types of response to increase of pacing rhythm: 1. typical-shortening of OAVD, 2. neutral-no change of OAVD and 3.atypical-lengthening of OAVD.

  1. MR perfusion imaging study of the hepatic hemodynamics in pigs

    International Nuclear Information System (INIS)

    Objective: To evaluate the MR perfusion imaging in measuring the hemodynamics of liver. Methods: CT and MR perfusion imaging were performed in livers of 13 pigs. The hepatic artery perfusion (HAP), portal vein perfusion (PVP), total hepatic blood flow (THBF), portal vein perfusion index (PVI), distribution volume (DV) and mean transit time (MTT) were calculated and compared respectively. Hemodynamics of the liver from two kinds of imaging was compared by paired t-test, and the relativity was analyzed by Pearson correlation analysis. Results: In CT and MR perfusion imaging of the 13 pigs: the hepatic artery perfusion (HAP) were (37.71±7.38) and (35.80±7.31) ml·min-1 100 ml-1, the portal vein perfusion (PVP) were (123.16±35.89) and (121.40±36.81) ml·min-1· 100 ml-1, the total hepatic blood flow (THBF) were (160.88±37.05) and (157.21±38.71) ml·min-1 ·100 ml-1, the portal vein perfusion index (PVI) were (75.95±5.21)% and (76.63±5.24)%, the distribution volume (DV) were (35.10±11.17)% and (41.03±10.06)%, the mean transit time (MTT) were (14.08±1.40) and (14.94±1.32) s. There were no statistical diferences for HAP, PVP, THBF and PVI between CT and Mil perfusion imaging (t=1.263, 0.926, 1.225, -1.115, P>0.05). There were no statistical differences for DV and MTT (t=-3.345, -3.200, P0.85, P0.70, P<0.01). Conclusions: MR perfusion can quantify the blood flow parameters of liver accurately. It is close to that of the CT perfusion imaging. (authors)

  2. Coil embolization of mycotic pulmonary artery aneurysm: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeen Woo; Lee, Jae Kyo; Hwang, Mi Soo; Cho, Kil Ho [College of Medicine, Yeungnam University, Taegu (Korea, Republic of)

    2000-02-01

    Aneurysms of the pulmonary artery are rare, with mycotic aneurysms occurring most frequently. This latter type may also occur in association with a lung abscess or septicemia, particularly in drug addicts. As far as we are aware, the radiologic findings of mycotic aneurysm of the pulmanary artery have not been reported in Korea. We present the simple chest radiographs, as well as the CT and angiographic findings, of a case of aneurysm of the pulmonary artery which was successfully embolized using a coil. (author)

  3. Internal mammary artery aneurysm in Marfan syndrome: case report

    International Nuclear Information System (INIS)

    Marfan syndrome has a pleomorphic phenotype. Those affected have abnormalities in the eyes and in the nervous, cardiovascular and musculoskeletal systems. Among these abnormalities are many reported aneurysms, involving the ascending, descending thoracic and abdominal aorta, the sinus of Valsalva, and the internal carotid artery. We report a left internal mammary artery (LIMA) aneurysm in a patient with Marfan syndrome and no other known predisposition to such an aneurysm. No other case of LIMA aneurysm in Marfan syndrome has, to our knowledge, been reported. (author)

  4. Internal mammary artery aneurysm in Marfan syndrome: case report

    Energy Technology Data Exchange (ETDEWEB)

    Common, A.A.; Pressacco, J.; Wilson, J.K. [Univ. of Toronto, Dept. of Mecial Imaging, Toronto, Ontario (Canada)

    1999-02-01

    Marfan syndrome has a pleomorphic phenotype. Those affected have abnormalities in the eyes and in the nervous, cardiovascular and musculoskeletal systems. Among these abnormalities are many reported aneurysms, involving the ascending, descending thoracic and abdominal aorta, the sinus of Valsalva, and the internal carotid artery. We report a left internal mammary artery (LIMA) aneurysm in a patient with Marfan syndrome and no other known predisposition to such an aneurysm. No other case of LIMA aneurysm in Marfan syndrome has, to our knowledge, been reported. (author)

  5. RARE PRESENTATION OF SYMPTOMATIC BILATERAL PROXIMAL POPLITEAL ARTERY ANEURYSM

    Directory of Open Access Journals (Sweden)

    Thulasikumar Ganapathy

    2016-07-01

    Full Text Available True Popliteal artery aneurysm is the most common of all the peripheral artery aneurysms. We present a case of proximal popliteal artery aneurysm involvement both lower limb presented with gangrene in one lower limb and incapacitating claudication pain on the other lower limb. We have successfully repaired both sides aneurysm in the same sitting with Poly Tetra Fluro Ethylene (PTFE graft, as the patient also had multiple venous perforators’ involvement on both sides, which left us only with synthetic graft repair option rather than venous graft repair.

  6. Characterization of cerebral aneurysms using 3D moment invariants

    Science.gov (United States)

    Millan, Raul D.; Hernandez, Monica; Gallardo, Daniel; Cebral, Juan R.; Putman, Christopher; Dempere-Marco, Laura; Frangi, Alejandro F.

    2005-04-01

    The rupture mechanism of intracranial aneurysms is still not fully understood. Although the size of the aneurysm is the shape index most commonly used to predict rupture, some controversy still exists about its adequateness as an aneurysm rupture predictor. In this work, an automatic method to geometrically characterize the shape of cerebral saccular aneurysms using 3D moment invariants is proposed. Geometric moments are efficiently computed via application of the Divergence Theorem over the aneurysm surface using a non-structured mesh. 3D models of the aneurysm and its connected parent vessels have been reconstructed from segmentations of both 3DRA and CTA images. Two alternative approaches have been used for segmentation, the first one based on isosurface deformable models, and the second one based on the level set method. Several experiments were also conducted to both assess the influence of pre-processing steps in the stability of the aneurysm shape descriptors, and to know the robustness of the proposed method. Moment invariants have proved to be a robust technique while providing a reliable way to discriminate between ruptured and unruptured aneurysms (Sensitivity=0.83, Specificity=0.74) on a data set containing 55 aneurysms. Further investigation over larger databases is necessary to establish their adequateness as reliable predictors of rupture risk.

  7. [Giant aneurysm of the inter-atrial septum].

    Science.gov (United States)

    Akoudad, H; Cherti, M; Chaouki, S; Ztot, S; Haddour, L; el Mrabet, I; el Khadiri, A; Benmimoun, E G; Arharbi, A

    1999-01-01

    We report the case of a large atrial septal aneurysm and a review of the literature. Atrial septal aneurysm is found in 1-8% of normal subjects. Its prevalence is higher among patients with ischemic stroke. Transesophageal echocardiography is an optimal tool for the diagnosis of atrial septal aneurysm. The clinical course may be complicated by arterial embolism, but mechanical complications may also occur, as in this case. Due to the lack of general agreement, treatment options should be discussed on an individual basis for patients with atrial septal aneurysm. PMID:10093663

  8. Aneurysm of the superficial femoral artery in an infant

    International Nuclear Information System (INIS)

    An isolated arterial aneurysm in childhood is extremely rare. We report a 1-year-old girl with an aneurysm of the right superficial femoral artery, presenting as an asymptomatic mass of the thigh. The aneurysm involved the whole superficial femoral artery (9 cm in length), and surgical treatment would have required replacement of the affected artery. Conservative treatment was chosen, influenced by the patient's rapid growth at that time. Non-invasive, 3-D contrast-enhanced magnetic resonance angiography (MRA) was useful as an alternative to conventional angiography for detailed evaluation of the femoral arteries, including the aneurysm. (orig.)

  9. A1-segment aneurysms: Management protocol based on a new classification

    Directory of Open Access Journals (Sweden)

    Kamlesh Singh Bhaisora

    2014-01-01

    Full Text Available Background: Aneurysms of proximal (A1-segment of anterior cerebral artery (ACA constitute <1% of all intracranial aneurysms. Aim: Management dilemmas of A1-segment aneurysms were studied utilizing a new classification based upon their location on the longitudinal and circumferential axis of A1-segment. Setting and Design: Tertiary care referral center. Materials and Methods: This is a retrospective analysis of 14 patients (0.98%; mean age: 38.02 ± 15.74 years with A1-segment aneurysms. The data collected included clinical features, computed tomography (CT scan and CT-angiography (CTA/digital subtraction angiography (DSA findings, modified Hunt and Hess (H and H grade, surgical steps and difficulties encountered. Results: The modified Hunt and Hess (H and H grades in the 14 patients were: grade I in two, grade II in two, grade III in four, grade IV in five and grade V in 1. The mean ictus-admission duration was 5.07 ± 2.30 days (range: 1-10 days. Multiple aneurysms were two. Thirteen patients underwent clipping and one, wrapping. Bilateral lateral ventricle hemorrhage occurred in 8 (66% patients and frontal intracerebral hematoma in 2 (16.66% patients. In one patient, the aneurysm could only be detected following the third angiogram. A1-aneurysms were classified as proximal (n = 6, distal (n = 7, and mid-segment (n = 1; and, anterior (n = 2, posterior-inferior (n = 7 and posterior-superior (n = 5. Follow-up (range: 6 months-10 years, mean: 2.9 years recovery (assessed using Modified Rankin′s score or mRS correlated with preoperative status. The preoperative H and H grade and follow-up mRS status were as follows: H and H I (n = 2: mRS 0 (asymptomatic, n = 2; H and H II (n = 2: mRS 1 (minor symptoms without disability, n = 2; H and H III (n = 4:mRS 1 (n = 2 and mRS 2 (slight disability but performing unassisted activities of daily living, n = 1; H and H IV (n = 5: mRS 3 (moderate disability, requiring help for daily living but unassisted

  10. The pretzel sign: angiographic pattern of tortuous intra-aneurysmal blood flow in a giant serpentine aneurysm.

    LENUS (Irish Health Repository)

    Fanning, N F

    2012-02-03

    Giant serpentine aneurysms (GSAs) form a specific subgroup of giant cerebral aneurysms that have pathognomonic angiographic features. We report the angiographic findings of a GSA demonstrating a striking convoluted dynamic flow pattern, which we have called the \\'pretzel sign\\'. The aneurysm was successfully treated by permanent occlusion of the parent vessel using a detachable balloon. GSAs should be identified prior to treatment in view of their particular management requirements.

  11. Mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm and sustained ventricular tachycardia: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    GAO Xiao-jin; KANG Lian-ming; ZHANG Jian; DOU Ke-fei; YUAN Jian-song; YANG Yue-jin

    2011-01-01

    The case is a 54-year-old man with hypertrophic cardiomyopathy, mid-ventricular obstruction, apical aneurysm, and recurrence sustained monomorphic ventricular tachycardia (VT). A coronary angiogram revealed myocardial bridging located in the middle of the left anterior descending coronary artery (LAD), and the left ventriculogram showed an hour-glass appearance of the left ventricular cavity. There was a significant pressure gradient of 60 mmHg across the mid-ventricular obliteration at rest. A successful myectomy of the inappropriate hypertrophy myocardium and excision of the apical aneurysm were performed. Pathologic analysis demonstrated fibrosis in the apical aneurysm and thickened and narrowed vessels in the adjacent area. During the follow-up of eighteen months, the patient remained clinically stable and free from arrhythmic recurrence.

  12. Análise do comportamento hemodinâmico de conduto valvado de pericárdio bovino, implantado em posição aórtica de ovinos Analysis of hemodynamic performance of the bovine pericardium valved conduit, implanted in the aortic position in ovines

    Directory of Open Access Journals (Sweden)

    Josalmir José Melo do Amaral

    2010-12-01

    Full Text Available OBJETIVOS: A necessidade de substituição da valva, aorta ascendente e reimplante coronariano em pacientes onde a anticoagulação é indesejável, é crescente. Avaliamos em animais o comportamento hemodinâmico de um conduto valvado aórtico feito com pericárdio bovino tratado pelo glutaraldeído (CVAP. MÉTODOS: Para isto, implantamos CVAPs em oito ovinos e os explantamos após 150 dias de pós-operatório. Realizouse estudo angiográfico e hemodinâmico no pré-operatório e antes do explante. EcoDopplercardiogramas foram realizados nos dias 30 e 150 de pós-operatório (teste e também em cinco ovinos não operados. Após explantados, submetemos os CVAPs à avaliação macroscópica, radiológica e histológica por microscopia óptica. RESULTADOS: Na análise hemodinâmica, as pressões arterial e capilar pulmonar aumentaram (POBJECTIVE: The necessity for replacement of the valve, ascending aorta and aortic with coronary reimplantation in patients where anti-coagulation is undesirable, is increasing. We evaluated the hemodynamic performance of an aortic valved conduit made with glutaraldehyde treated bovine pericardium (AVCP in animals. METHODS: Therefore, AVCPs were implanted in eight young ovine and explanted after 150 days. Angiographic and hemodynamic study was performed at pre-operative and prior the explant. EchoDopplercardiograms were performed at day 30 and 150 of post-operative (test and also in five nonoperated ovines. After explanted, AVCPs were submitted to a macroscopical, radiological and histological evaluation by optic microscopy. RESULTS: In the hemodynamic analysis the arterial and pulmonary capillary pressure increased (P<0.05 between day 0 and 150. In the echoDoppercardiographic analysis, the test group presented higher values in the diastolic and systolic diameters of the left ventricle (P<0.05. In the test group, between day 30 and 150, occurred an increase of weight, thickness of the left ventricle walls, maximum

  13. Evaluation of 3D-CTA and flat detector DSA in diagnosing intracranial aneurysms:a comparative analysis%三维CT血管造影与平板DSA对颅内动脉瘤诊断价值的对比分析

    Institute of Scientific and Technical Information of China (English)

    游梦星; 虞希祥; 林永胜; 郝伟远; 吴宽

    2011-01-01

    Objective To evaluate three-dimension computed tomographic angiography (3D-CTA) and flat detector DSA in diagnosing intracranial aneurysms through a comparative analysis. Methods A total of 44 consecutive spontaneous suharachnoid hemorrhage (SSAH) patients with suspected aneurysms underwent both 3D-CTA and flat detector DSA (including both 2D-DSA and 3D-DSA) examinations simultaneously.According to the diameter of intracranial aneurysms the patients were divided into two groups : < 3 mm group and ≥ 3 mm group. Results A total of 46 aneuiysms, which were confirmecl by surgical operation or interventional therapy, were found in 36 patients. The sensitivity, specificity, positive predictive value and negative predictive value of 3D-CTA (2D-DSA, 3D-DSA-VR and 3D-DSA-MIP) in detecting intracranial aneurysms for all patients was 83.33% (77.78%, 100% and 94.44%) , 75% (75%, 100% and 100%), 75% (73.68%, 100% and 100%) and 66.67% (75%, 100% and 100%), respectively. No significant difference in the diameter of aneurysm (Z = -0.178, P = 0.859 > 0.1) existed between 3D-CTA (VR) and 3D-DSA (VR) when Wilcoxon paired signed-rank test was used. Statistically significant difference in displaying the aneurismal neck and its relation to the parent artery existed between 3D-CTA (VR) and 2D-DSA (P < 0.05) . and between 3D-CTA (VR) and 3D-DSA (VR) (P < 0.05) as well. although no significant difference was found between 3D-CTA (VR) and 3D-DSA (MIP) (P > 0.05). Conclusion For the diagnosis of intracranial aneurysms with diameter≥ 3 mm. 3D-CTA is quite effective and accurate. It can be used as a routine screening means. However. 3D-CTA carries high rate of missed diagnosis and misdiagnosis for intracranial aneurysms with the diameter < 3 mm. Therefore. 3D-DSA should be adopted in suspicious cases of SSAH in whom the intracranial aneurysms are not demonstrated on 3D-CTA. With the wide use of the flat detector DSA, 3D-DSA should be carried out

  14. Hemodynamic response alteration as a function of task complexity and expertise - An fNIRS study in jugglers

    Directory of Open Access Journals (Sweden)

    Daniel eCarius

    2016-03-01

    Full Text Available Detailed knowledge about online brain processing during the execution of complex motor tasks with a high motion range still remains elusive. The aim of the present study was to investigate the hemodynamic responses within sensorimotor networks as well as in visual motion area during the execution of a complex visuomotor task such as juggling. More specifically, we were interested in how far the hemodynamic response as measured with functional near infrared spectroscopy (fNIRS adapts as a function of task complexity and the level of the juggling expertise. We asked expert jugglers to perform different juggling tasks with different levels of complexity such as a 2-ball juggling, 3- and 5-ball juggling cascades. We here demonstrate that expert jugglers show an altered neurovascular response with increasing task complexity, since a 5-ball juggling cascade showed enhanced hemodynamic responses for oxy-Hb as compared to less complex tasks such as a 3- or 2- ball juggling pattern. Moreover, correlations between the hemodynamic response and the level of the juggling expertise during the 5-ball juggling cascade, acquired by cinematographic video analysis, revealed only a non-significant trend in M1, indicating that a higher level of expertise might be associated with lower hemodynamic responses.

  15. Hemodynamic Response Alteration As a Function of Task Complexity and Expertise-An fNIRS Study in Jugglers.

    Science.gov (United States)

    Carius, Daniel; Andrä, Christian; Clauß, Martina; Ragert, Patrick; Bunk, Michael; Mehnert, Jan

    2016-01-01

    Detailed knowledge about online brain processing during the execution of complex motor tasks with a high motion range still remains elusive. The aim of the present study was to investigate the hemodynamic responses within sensorimotor networks as well as in visual motion area during the execution of a complex visuomotor task such as juggling. More specifically, we were interested in how far the hemodynamic response as measured with functional near infrared spectroscopy (fNIRS) adapts as a function of task complexity and the level of the juggling expertise. We asked expert jugglers to perform different juggling tasks with different levels of complexity such as a 2-ball juggling, 3- and 5-ball juggling cascades. We here demonstrate that expert jugglers show an altered neurovascular response with increasing task complexity, since a 5-ball juggling cascade showed enhanced hemodynamic responses for oxygenated hemoglobin as compared to less complex tasks such as a 3- or 2-ball juggling pattern. Moreover, correlations between the hemodynamic response and the level of the juggling expertise during the 5-ball juggling cascade, acquired by cinematographic video analysis, revealed only a non-significant trend in primary motor cortex, indicating that a higher level of expertise might be associated with lower hemodynamic responses. PMID:27064925

  16. Hemodynamic Response Alteration As a Function of Task Complexity and Expertise—An fNIRS Study in Jugglers

    Science.gov (United States)

    Carius, Daniel; Andrä, Christian; Clauß, Martina; Ragert, Patrick; Bunk, Michael; Mehnert, Jan

    2016-01-01

    Detailed knowledge about online brain processing during the execution of complex motor tasks with a high motion range still remains elusive. The aim of the present study was to investigate the hemodynamic responses within sensorimotor networks as well as in visual motion area during the execution of a complex visuomotor task such as juggling. More specifically, we were interested in how far the hemodynamic response as measured with functional near infrared spectroscopy (fNIRS) adapts as a function of task complexity and the level of the juggling expertise. We asked expert jugglers to perform different juggling tasks with different levels of complexity such as a 2-ball juggling, 3- and 5-ball juggling cascades. We here demonstrate that expert jugglers show an altered neurovascular response with increasing task complexity, since a 5-ball juggling cascade showed enhanced hemodynamic responses for oxygenated hemoglobin as compared to less complex tasks such as a 3- or 2-ball juggling pattern. Moreover, correlations between the hemodynamic response and the level of the juggling expertise during the 5-ball juggling cascade, acquired by cinematographic video analysis, revealed only a non-significant trend in primary motor cortex, indicating that a higher level of expertise might be associated with lower hemodynamic responses. PMID:27064925

  17. Hemodynamic characteristics of early stage hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Hemodynamic characteristics were studied by using in vivo vascular imaging techniques in 17 resected early stage hepatocellular carcinoma (e-HCC) by comparing them with 49 resected advanced HCCs (ad-HCC) less than 3 cm in diameter. In this study, e-HCC was defined as the nodule being uniformly composed of well-differentiated HCC or adenomatous hyperplastic nodule containing well-differentiated HCC foci within the nodule. In vivo vascular imaging techniques are as follows; US angiography with intraarterial CO2 microbubbles were performed to assess the tumor arterial vascularity, and CT during arterial portography (CTAP) was performed to assess the portal perfusion within the nodule. Of 17 e-HCC nodules 5 were hypervascular, 5 were isovascular, 4 were hypovascular, and 3 were vascular spot in hypovascular pattern in contrast to 49 ad-HCC nodules, 43 of which were hypervascular and 6 were isovascular. Of 14 e-HCCs, 9 nodules showed perfusion defect and 5 did not on CTAP, whereas all 37 ad-HCCs on which CTAP was performed, showed perfusion defect. Forty-one percent (7/17) of e-HCC showed fatty metamorphosis in contrast to 8% (4/49) of ad-HCC. In conclusion, hemodynamic characteristics of e-HCC are summarized as follows. (1) Arterial tumor neovascularization is relatively low. (2) Portal perfusion is present in some of e-HCC cases. (3) Hypoperfusion state both from arterial and portal supply is present in some of e-HCC cases. (4) Vascular spot in hypovascular pattern is characteristic arterial pattern in AH containing HCC foci. (5) Fatty metamorphosis may be related with hypoperfusion state of the nodule in e-HCC. (author)

  18. Ionizing radiation occupational exposure in the hemodynamics services

    International Nuclear Information System (INIS)

    The purpose of this research is to study the ionizing radiation occupational exposure in the hemodynamic services of two large scale hospitals (Hospital A and Hospital B) of the Sao Paulo city. The research looked into annual doses that 279 professionals of the hemodynamic services were exposed to between 1991 and 2002. The data analyzed was collected from the database of the Instituto de Pesquisas Energeticas e Nucleares (IPEN) for Hospital A, and from the Radiological Protection Department of Hospital B. Besides this, measures of hands and crystalline lens equivalent doses were performed during hemodynamic procedures of the physicians, assistant physicians and nursing assistants with TL dosimeters (CaSO4:Dy + Teflon R) produced at IPEN. The safety procedures adopted by the hospitals were verified with the aid of a specific questionnaire for the hemodynamic services. Finally, a profile of the professionals that work in cardiac catheterism laboratories of the hemodynamic services was delineated, considering the variables of individual monitoring time, age and sex. This study allowed for observation of the behavior of the professionals' annual doses of these hemodynamic services in relation to the Comissao Nacional de Energia Nuclear and the Secretaria de Vigilancia Sanitaria limits. It showed that the annual doses of the same specialized occupations would vary from one hospital to another. It further showed the need of individual monitoring of the physicians' unprotected body parts (hands and crystalline lens) during the hemodynamic procedures. (author)

  19. Evidence for myocardial CT perfusion imaging in the diagnosis of hemodynamically significant coronary artery disease

    OpenAIRE

    Sun, Zhonghua

    2015-01-01

    This editorial discusses a recent paper published in the August issue of Radiology about the diagnostic value of myocardial computer tomography (CT) perfusion imaging in the detection of hemodynamically significant coronary stenosis when compared to single-photon emission CT (SPECT) imaging based on a secondary analysis of CORE320 study. Three aspects including high diagnostic sensitivity of CT perfusion imaging, moderate specificity of SPECT imaging and lack of use of attenuation correction ...

  20. Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

    Directory of Open Access Journals (Sweden)

    Jacek Brzost

    2015-01-01

    Full Text Available The extracranial internal carotid artery aneurysm (EICAA is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring 63×55×88 mm, stretching from the skull base to the angle of the mandible.