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Sample records for artery pseudoaneurysm treated

  1. Hepatic artery pseudoaneurysm treated using stent-graft implantation and retrograde gastroduodenal artery coil embolization

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    Basile, Antonio; Patti, Maria Teresa [Ospedale Ferrarotto, Department of Diagnostic and Interventional Radiology, Catania (Italy); Ragazzi, Salvatore; Piazza, Diego [Ospedale Vittorio Emanuele, Department of Surgery I, Catania (Italy); Tsetis, Dimitrios [University Hospital of Heraklion, Medical School of Crete, Department of Radiology, Heraklion (Greece); Lupattelli, Tommaso [Multimedica Holding, Department of Interventional Radiology, Sesto S. Giovanni (Italy)

    2008-11-15

    Endovascular treatment options for visceral artery pseudoaneurysms depend on lesion location and size. Exclusion methods fall into two categories, embolization and stent placement, and these procedures aim to exclude the pseudoaneurysm from the circulation and if possible to maintain distal blood flow. Embolization of the afferent artery can be used in pseudoaneurysms that arise from a donor artery without collateral supply such as a visceral branch, whereas in the case of visceral arteries with well-established collateral supply, the embolization of both proximal and distal branches to the pseudoaneurysm is mandatory in preventing backflow from the collateral circulation. A direct embolization delivering coils or glue into the sac can also be performed if the aneurismal neck is narrow. Stent-graft placement represents another option to exclude the pseudoaneurysm, in the case of wide neck, reduced arterial tortuosity and large-diameter arteries. We present a case of common hepatic artery pseudoaneurysm involving the gastroduodenal artery origin treated by a combination of techniques. An hepatic stent-graft implantation plus retrograde embolization of the gastroduodenal artery through the pancreaticoduodenal anastomosis from the superior mesenteric artery was performed. (orig.)

  2. Spontaneous pseudoaneurysm of the uterine artery during pregnancy treated by direct thrombin injection: A case report

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    Hong, Jung Hee; Kim, See Hyung; Kim, Young Hwan [Dept. Radiology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu (Korea, Republic of)

    2016-04-15

    Pseudoaneurysm of uterine artery during pregnancy is a very rare disease. It is mostly associated with uterine artery injury, usually occurring after proceeding conditions such as history of gynecologic operation and infection. However, the best treatment modality has not been established yet. Herein, we reported a case of spontaneous formation of uterine artery pseudoaneurysm during pregnancy treated by direct thrombin injection without any complication or recurrence.

  3. Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization

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    Long Sun; Yong-Song Guan; Hua Wu; Wei-Min Pan; Xiao Li; Qing He; Yuan Liu

    2006-01-01

    A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives.

  4. Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization

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    Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr; Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr; Subhani, Aqeel, E-mail: drsubhani07@gmail.com [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Hequet, Delphine, E-mail: delphine.hequet@gmail.com [Universite Paris-Diderot (France); Fargeaudou, Yann, E-mail: yannfargeaudou4@hotmail.com [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Morel, Olivier, E-mail: olivier.morel17@gmail.com [Maternite Universitaire de Nancy, Universite Henri Poincare Nancy 1 (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France); Gayat, Etienne, E-mail: etienne.gayat@9online.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Anesthesiology and Intensive Care Medicine (France); Barranger, Emmanuel, E-mail: emmanuel.barranger@lrb.aphp.fr [Universite Paris-Diderot (France); Dref, Olivier Le, E-mail: olivier.ledref@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Abdominal and Interventional Imaging (France)

    2013-10-15

    Objective: This study was designed to determine the incidence of arterial pseudoaneurysm in patients presenting with postpartum hemorrhage (PPH), to analyze the angiographic characteristics of pseudoaneurysms that cause PPH, and to evaluate the effectiveness of pelvic arterial embolization for the treatment of this condition.Study designEighteen women with pelvic arterial pseudoaneurysm were retrieved from a series of 588 consecutive patients with PPH treated by arterial embolization. Clinical files, angiographic examinations, and procedure details were reviewed. Results: The incidence of pseudoaneurysm was 3.06 % (18/588; 95 % confidence interval (CI): 1.82-4.8 %). A total of 20 pseudoaneurysms were found; 15/20 (75 %) were located on the uterine arteries. Angiography revealed extravasation of contrast material from pseudoaneurysm indicating rupture in 9 of 18 (50 %) patients. Arterial embolization was performed using gelatin sponge alone in 12 of 18 (67 %) patients or in association with metallic coils in 5 of 18 (28 %) patients or n-butyl-2-cyanoacrylate in 1 of 18 (6 %) patients. Arterial embolization allowed controlling the bleeding in all patients after one or two embolization sessions in 17 of 18 (94 %) and 1 of 18 patients (6 %) respectively, without complications, obviating the need for further surgery. Conclusions: Pseudoaneurysm is rarely associated with PPH. Arterial embolization is an effective and safe procedure for the treatment of PPH due to uterine or vaginal artery pseudoaneurysm. Our results suggest that gelatin sponge is effective for the treatment of ruptured pseudoaneurysms, although we agree that our series does not contain sufficient material to allow drawing definitive conclusions with respect to the most effective embolic material.

  5. Endovascular Thrombin Injection for a Pulmonary Artery Pseudoaneurysm: Case Report

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    Shin, Jin Ho; Shin, Ji Hoon; Yoon, Hyun Ki [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    Massive hemoptysis caused by pulmonary artery pseudoaneurysms is uncommon, and endovascular treatment such as coil embolization is the first choice for treating pulmonary artery pseudoaneurysms. Various embolic agents could be used according to the angiographic findings, yet embolization with thrombin injection is very rare. Herein, we describe a case of a pulmonary artery pseudoaneurysm that was successfully treated by endovascular thrombin injection using a microcatheter because of the difficulty in performing a coil embolization due to a short feeding artery.

  6. Pseudoaneurysm of the Profunda Femoris Artery following Blunt Trauma Treated by Endovascular Coil Embolization: Review of Two Cases and Relevant Literature

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    McNerney, Patrick; Kiproff, Paul

    2017-01-01

    Profunda femoris artery (PFA) pseudoaneurysm after blunt trauma without associated femur fracture is a rare occurrence. Most of the reported cases of PFA pseudoaneurysm in the English literature developed after penetrating trauma, surgical procedures, and femur fractures. We present two such cases following blunt trauma and without any associated long bone injury. After initial imaging failed to show any long bone fracture, CT angiography confirmed pseudoaneurysm of the branch of the PFA. Both patients were then treated with emergent coil embolization of the bleeding vessel. Pseudoaneurysms typically present late and signs of persistent hip pain, thigh swelling, presence of a pulsatile mass, and even unexplained anemia all may suggest the diagnosis. Recognition of PFA pseudoaneurysm requires high index of suspicion and is often difficult to diagnose clinically because of its location. PMID:28246563

  7. Iatrogenic subclavian artery pseudoaneurysm close to the origin of the vertebral artery: an endovascular strategy

    Institute of Scientific and Technical Information of China (English)

    XU Gao-feng; Dae Chul Suh

    2006-01-01

    Subclavian artery pseudoaneurysm that induced from central venous catheterization through the internal jugular vein is relatively uncommon. However, the management of subclavian artery pseudoaneurysm remains a challenge because of their non-compressibility of deep locality and relationship to important surrounding anatomy, such as the origin of vertebral artery. In this paper, the authors report a patient with larger iatrogenic subclavian arterial pseudoaneurysm near the origin of vertebral artery, that was treated successfully by endovascular covered stent and coils.

  8. Study on intraluminal embolization with microcoils treating traumatic pseudoaneurysms in common carotid artery in rabbits

    Institute of Scientific and Technical Information of China (English)

    刘云松; 马廉亭; 吴佐泉

    2004-01-01

    Objective: To evaluate the long-term effect of endovascular occlusion with microcoils on traumatic pseudoaneurysms (TPAs) in the common carotid artery in rabbits.Methods: TPAs in the right common carotid artery were surgically made in 16 rabbits. At 3-4 weeks after operation, the survived 12 models were randomly divided into a control group (n = 3 ) with no treatment and an experimental group (n = 9), in which TPAs were intraluminally embolized with microcoils and corresponding therapy was given. Three months after embolization, the TPAs were examined with digital subtraction angiography and pathology.Results: The 3 rabbits in the control group all died of rupture of TPA. Among the 9 TPAs occluded with microcoils, 4 were completely occluded, 4 were partially occluded, and 1 was excluded due to the microcoils migrating into the parent artery. Three months after embolization, the 4 TPAs which were completely occluded remained obliterated as determined by digital subtraction angiographic findings. The parent artery remained unobstructed and the structure of the TPAs were replaced by a mass of scar tissues. The 4 TPAs which were partially occluded remained unruptured and the microcoils were compressed.Conclusions: The lumen in TPA can be completely occluded by microcoils and the parent artery is unblocked.Partial occlusion of the lumen can also prevent the rupture of TPA.

  9. Endovascular repair for a huge vertebral artery pseudoaneurysm caused by Behcet's disease

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    DONG Zhi-hui; FU Wei-guo; GUO Da-qiao; XU Xin; CHEN Bin; JIANG Jun-hao; YANG Jue; SHI Zheng-yu; WANG Yu-qi

    2006-01-01

    @@ Behcet's disease (BD), a multisystem chronic autoimmune process of unknown etiology,usually leads to arterial impairment. Isolated case reports have described BD-related arterial dissections, pseudoaneurysms or aneurysms.1-4 Recently, we successfully treated a huge vertebral artery pseudoaneurysm (VAPA) in a patient with BD by stent-grafting with preservation of the affected vertebral artery.

  10. Transcatheter Arterial Embolization of Cystic Artery Pseudoaneurysm in Acalculous Cholecystitis: A Case Report

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    Lee, Hyung Ook; Lee, Young Hwan [Dept. of Radiology, Daegu Catholic University College of Medicine, Daegu (Korea, Republic of); Kim, Young Hwan [Dept. of Diagnostic Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2011-04-15

    A pseudoaneurysm of the cystic artery is a rare complication of cholecystitis, and is manifested by hemobilia or hematemesis. An early diagnosis is required for the successful treatment by cholecystectomy and ligation of the cystic artery. Herein, we report a case of a pseudoaneurysm of the cystic artery diagnosed by color Doppler ultrasonography and CT, and successfully treated by transcatheter arterial embolization with N-butyl cyanoacrylate in a high-risk surgical patient.

  11. Management of femoral artery pseudoaneurysm due to addictive drug injection

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    李建文; 王三明; 陈小东

    2004-01-01

    Objective: To study surgical management for patients with femoral pseudoaneurysm resulting from addictive druginjection.Methods: Clinical data of 34 patients with femoral pseudoaneurysm resulting from addictive drug injection were retrospectively reviewed.Results: Thirteen patients underwent bypass graft ( end to side) of external iliac artery and superficial femoral artery using expanded polytetrafluoroethylene (ePTFE).Three patients who had an autogenous saphenous vein graft in situs, one of whom was then performed an ePTFE graft when rupture and bleeding occurred at the anastomotic site. Color Doppler image showed patent grafted blood vessels in all the patients after operation. Eighteen patients had their femoral arteries ligated. Limbs of all the 34 patients were saved.Conclusions: Ligating femoral artery is an effective way to treat femoral artery pseudoaneurysm if autogenous saphenous vein graft or artificial vessel graft is notapplicable.

  12. PSEUDOANEURYSM OF INTERNAL ILIAC ARTERY

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    Seema Khanna

    2014-04-01

    Full Text Available An unusual cause of vaginal beeding after total abdominal hysterectomy is being reported. Histopathology revealed adenomyosis uteri and bilateral ovarian cyst. On examination there was a single lump in the hypogastrium and left iliac fossa. Auscultation revealed a faint continuous hum. On digital rectal examination, a bulge was felt, while per vaginum examination revealed mucosal congestion and bulging of mucosa. Ultrasound revealed a mass posterior to the urinary bladder. Duplex study demonstrated the yin-yang sign suggestive of a pseudo-aneurysm .CT Angiography was confirmatory and demonstrated a pseudoaneurysm arising from the left internal iliac artery. Patient underwent surgery.Postoperative period was uneventful . The commonest cause of IIA aneurysm is atherosclerosis. Other causes are arteritis ,collagen vascular disease, infection, trauma. An important subgroup is young females, who have undergone difficult delivery, forceps delivery or caesarian section or abdominal hysterectomy IIA aneurysms are usually discovered incidentally on pelvic imaging for any other indication. Surgery is the mainstay of treatment but endovascular procedures are gaining ground . [Natl J Med Res 2014; 4(2.000: 181-182

  13. Anterior Tibial Artery Pseudoaneurysm: Case Report

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    Funda Tor

    2012-06-01

    Full Text Available The aneurysmsatic changes of the infrapopliteal arteries are rarely seen. They are pseudoaneurysms rather than true aneursyms. The most important cause of them is trauma. There is not a standart treatment for infrapopliteal aneursyms. In this study, we have evaluated a case operated for anterior tibial artery pseudoaneurysm developed after penetrant trauma and diagnosed two weeks later. [Cukurova Med J 2012; 37(3.000: 172-175

  14. Superficial Temporal Artery Pseudoaneurysm: A Case Report

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    Younus, Syed Muneeb; Imran, Muhammad; Qazi, Rabia

    2015-01-01

    Pseudoaneurysms of the superficial temporal artery are an uncommon vascular lesion of the external carotid system and most often the result of blunt head trauma. The frequency of pseudoaneurysms of the superficial temporal artery developing after craniotomy is exceedingly low and only a few cases have been reported. We present a case of pseudoaneurysm of this type in a 45-year-old male who underwent craniotomy for excision of meningioma. One month postoperatively, the craniotomy flap exhibited an enormous diffuse pulsate swelling. The suspected diagnosis of pseudoaneurysm arising from superficial temporal artery was confirmed on angiography. Surgical excision was done and no recurrences of the tumor or aneurysm were noted on subsequent follow up. PMID:26501064

  15. 17 Pseudoaneurysms Treated by Padding and Compression

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    WANGLu-ping; MEIXiao-rong; XUYu-lan; LIUYi; ZHENGCheng-fei; WANGGang

    2004-01-01

    To introduce the method and curative effect of treating pseudoaneurysms by padding and compression. Method: retrospectively analyze the curative effect of treating 17 pseudoaneurysms bypadding hard things and compression. Result: 15 of them was completely recovered by doing so,murmur disappeared and the local skin became even, there was no recurrences and complications after 0.5-3year's following up,but the other two were the same as before the therapy. Conclusion: pseudoaneurysms can be treated effectively by padding and compression

  16. Telescoping Dual Covered Stent Graft Construct for Endovascular Treatment of a Giant Extracranial Carotid Artery Pseudoaneurysm.

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    Ding, Dale; Starke, Robert M; Moriarty, Maurice; Brew, Stefan

    2016-12-01

    Large pseudoaneurysms which compress the parent vessel are challenging lesions to successfully treat with endovascular therapy. We describe the endovascular treatment of a giant extracranial carotid artery (ECCA) pseudoaneurysm resulting in substantial mass effect on the common carotid artery (CCA) bifurcation using a telescoping dual covered stent graft construct. A 56-year-old male was diagnosed with an 8.5 cm × 13 cm pseudoaneurysm arising from the left CCA bifurcation, which was causing luminal narrowing of the CCA and proximal internal carotid artery (ICA). The patient underwent endovascular intervention, during which a balloon-expandable covered stent was deployed within a heparin-bonded covered stent, such that the overall construct spanned from the CCA to the lower cervical ICA. The employment of a telescoping dual covered stent technique can successfully treat appropriately selected patients with large or giant ECCA pseudoaneurysms, with the concomitant goals of excluding the pseudoaneurysm and restoring the luminal caliber of the parent artery.

  17. Pseudoaneurysm of the internal maxillary artery: A case report of facial trauma and recurrent bleeding

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    Nivaldo Alonso

    2016-01-01

    Conclusion: This case reports the long-term follow up and natural history of a patient with a post-traumatic pseudoaneurysm of the internal maxillary artery and the successful use of endovascular embolization to treat the lesion.

  18. Delayed Presentation of Catheter-Related Subclavian Artery Pseudoaneurysm

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    Hwa Rim Kang

    2015-08-01

    Full Text Available Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here we report the rare case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient was treated for aspiration pneumonia with respiratory failure in another hospital. The patient's chest wall swelling began two weeks after the initial catheterization in the other hospital, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery. Her condition improved, and she was discharged to her home.

  19. Iliac artery pseudoaneurysm after lumbar disc hernia operation

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    Mehmet Atay

    2016-03-01

    Full Text Available Lumbar disc herniation surgery is usually performed through a posterior approach. Vascular injuries can be counted among the complications. 39 years old male patient had lower extremity pain which has started after lumbar disc herniation surgery and continued for a month. Iliac arterial pseudoaneurysm has been detected in computerized tomography. It was successfully treated with vascular surgery [Cukurova Med J 2016; 41(0.100: 5-7

  20. Deep Circumflex Iliac Artery Pseudoaneurysm as a Complication of Paracentesis

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    Bhawna Satija

    2012-01-01

    Full Text Available We report a case of a pseudoaneurysm arising from the deep circumflex iliac artery, in an end-stage renal disease patient with gross ascitis, presenting with an anterior abdominal wall hematoma following paracentesis. Duplex Doppler sonography confirmed the presence of the pseudoaneurysm and multidetector computed tomography angiography delineated the detailed arterial anatomy.

  1. Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst

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    Micković Saša

    2011-01-01

    Full Text Available Introduction. Pancreatic pseudocyst presented as pseudoaneurysm of the splenic artery is a potential serious complication in patients with chronic pancreatitis. Case report. A 42-year-old male patient with a long-standing evolution of chronic pancreatitis and 8-year long evolution of pancreas pseudocyst was referred to the Military Medical Academy, Belgrade due to worsening of the general condition. At admission, the patient was cachectic, febrile, and had the increased values of amylases in urine and sedimentation (SE. After clinical and diagnostic examination: laboratory assessment, esophagogastroduodenoscopy (EGDS, ultrasonography (US, endoscopic ultrasonography (EUS, multislice computed scanner (MSCT angiography, pseudoaneurysm was found caused by the conversion of pseudocyst on the basis of chronic pancreatitis. The patient was operated on after founding pancreatic pseudocyst, which caused erosion of the splenic artery and their mutual communication. Postoperative course was duly preceded without complications with one year follow-up. Conclusion. Angiography is the most reliable and the safest method for diagnosing hemorrhagic pseudocysts when they clinically present as pseudoaneurysms. A potentially dangerous complication in the presented case was treated surgically with excellent postoperative results.

  2. Hepatic artery pseudoaneurysms arising from within a hepatocellular carcinoma

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    Chingkoe, C M; Chang, S D; Legiehn, G M; Weiss, A

    2010-01-01

    We report a case of a 70-year-old man with a large hepatocellular carcinoma (HCC) containing two pseudoaneurysms measuring up to 2 cm in diameter. The pseudoaneurysms and part of the HCC were supplied by branches from the middle colic artery, which arises from the superior mesenteric artery. This complex arterial vasculature was visualised on CT and confirmed with conventional angiography. PMID:21088082

  3. Internal iliac artery pseudoaneurysm in primary total hip arthroplasty

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    Sanjay Agarwala

    2016-01-01

    Full Text Available Vascular injury is one of the rare complications of primary total hip arthroplasty (THA. We report an unusual case of lobulated pseudoaneurysm arising from one of the branches of the left internal iliac artery during acetabulum preparation in THA, which was successfully treated with coil embolization and multidisciplinary care. After 6 years follow up, patient did not have any symptoms related to the hip replacement. We recommend that surgeons should be extremely cautious while drilling medial wall of the acetabulum for depth assessment. Aggressive multidisciplinary approach, including possible support from an interventional radiologist is required for the treatment of such vascular injuries.

  4. Pseudoaneurysm of the inferior epigastric artery: a rare complication of laparoscopic ventral hernia repair.

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    Nichols-Totten, Kysha; Pollema, Travis; Moncure, Michael

    2012-02-01

    Pseudoaneurysm of the inferior epigastric artery (IEA) is a recognized complication of surgery; however, it is a very rare clinical occurrence. The anatomic position of the IEA subjects patients to possible IEA injury during abdominal wall procedures that are close to the artery, such as insertions of drains, Tenckhoff catheters, laparoscopic trocars, or paracentesis. Treatment options include open surgery, percutaneous coil embolization, embolization with N-butyl cyanoacrylate, sonographic-guided thrombin injection, or sonographic-guided compression. We report the first case of a pseudoaneurysm arising from the IEA after a laparoscopic ventral hernia repair. To our knowledge, 17 IEA pseudoaneurysms have been reported, only 3 of which were spontaneous. The pseudoaneurysm in our patient was successfully treated by percutaneous injection of thrombin by interventional radiology.

  5. Pseudoaneurysm of the splenic artery mimicking a solid lesion

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    Raffaele Pezzilli

    2016-08-01

    Full Text Available A 64-year-old man presented to the hospital because of hematemesis; on admission, he had weakness and pale skin, tachycardia and hypotension. Laboratory tests revealed severe anemia (hemoglobin 7.8 g/dL; liver, renal and pancreatic function tests were normal. An upper digestive endoscopy revealed a gastric ulcer of the cardia, treated with metallic clips and adrenalin injection. The patient was treated with fluids and was transfused with three units of red blood cells. In the previous two months, due to the presence of bloating and diarrhea, associated with abdominal distension, a colon-computed tomography (CT revealed a large retroperitoneal hypodense mass, 53x37 mm in size, without contrast enhancement localized between the body and the tail of the pancreas and the stomach, near the splenic artery and without signs of infiltration. To better define the mass, endoscopic ultrasound and biopsy were performed; however histopathology of multiple biopsies was not diagnostic, because of the presence of necrotic tissue and inflammatory cells. Since hematemesis recurred, the patient underwent a second upper digestive endoscopic examination, but no source of bleeding was found. Then a new contrast enhanced CT was performed that showed a size reduction of the mass, the presence of blood in the stomach and a small pseudoaneurysm of the splenic artery. Because of these findings an angiograpghic study was carried out; angiography confirmed a splenic artery pseudoaneurysm that was successfully embolized with metal microcoils.

  6. Vertebral artery pseudoaneurysms secondary to blunt trauma: Endovascular management by means of neurostents and flow diverters.

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    Cohen, José E; Gomori, John M; Rajz, Gustavo; Rosenthal, Guy; El Hassan, Hosni Abu; Moscovici, Samuel; Itshayek, Eyal

    2016-10-01

    Extracranial vertebral pseudoaneurysms that develop following blunt trauma to the cervical area may have a benign course; however, embolic or ischemic stroke and progressive pseudoaneurysm enlargement may occur. We review the presentation and endovascular management of pseudoaneurysms of the cervical vertebral artery (VA) due to blunt trauma in nine patients (eight male, mean age 27years). Pseudoaneurysms occurred in dominant vessels in seven patients and coexisted with segmental narrowing in six. We favored endovascular intervention during the acute phase only in cases with significant narrowing of a dominant VA, especially when anticoagulation was contraindicated. Four patients were treated during the acute stage (contraindication to anticoagulation, mass effect, severely injured dominant VA/impending stroke); five during the chronic phase (pseudoaneurysm growth, ischemic stroke on aspirin prophylaxis, patient preference). Reconstructive techniques were favored over deliberate endovascular occlusion when dominant vessels were involved. Arterial reconstruction was performed in eight of nine patients using a flow-diverter implant (5 patients), stent-assisted coiling (1), overlapping stent implant (1), or implantation of a balloon-expandable stent (1). Deliberate VA occlusion with coils was performed in one of nine patients due to suboptimal expansion of the stented artery after flow-diverter implant. No neurological complications occurred during follow-up. All cases treated by reconstructive techniques showed complete, persistent pseudoaneurysm occlusion and full arterial patency. Endovascular therapy of traumatic VA pseudoaneurysms using neurostents and flow-diverters resulted in occlusion of the pseudoaneurysms, preservation of the parent vessel, and no periprocedural or delayed clinical complications, supporting the feasibility and safety of the approach.

  7. Pseudoaneurysm of the superior gluteal artery following polytrauma.

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    Lee, Dennis; Legiehn, Gerald M; Munk, Peter L

    2007-09-01

    Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis.

  8. Delayed presentation of a traumatic brachial artery pseudoaneurysm.

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    Forde, James C

    2009-09-01

    Delayed presentation of a brachial artery pseudoaneurysm following penetrating trauma is infrequently reported. We report the case of a 23-year-old male who presented three months following a penetrating trauma to his antecubital fossa with a sudden exacerbation of swelling and tenderness of his elbow. Doppler ultrasound and computed tomography arteriography confirmed the presence of a large pseudoaneurysm. Surgical reconstruction was performed using the long saphenous vein as an interposition vein graft, restoring normal arterial circulation.

  9. Pseudoaneurysm of the superior gluteal artery following polytrauma

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    Lee, Dennis [Vancouver General Hospital, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Legiehn, Gerald M. [Vancouver General Hospital, Interventional Radiology, University of British Columbia and Department of Radiology, Vancouver, BC (Canada); Munk, Peter L. [Vancouver General Hospital, MSK Section, University of British Columbia and Department of Radiology, Vancouver, BC (Canada)

    2007-09-15

    Gluteal artery aneurysms are rare and often secondary to pelvic fractures, blunt or penetrating trauma. We describe a case of a superior gluteal artery pseudoaneurysm that presented as back pain with numbness and weakness of the lower extremities. Diagnosis was confirmed by color Doppler sonography and angiography. A proximal and distal control was obtained over the aneurysm neck via coil embolization with excellent hemostasis within the pseudoaneurysm and maintenance of perfusion to the left pelvis. (orig.)

  10. Hemorrhage associated with hepatic artery pseudoaneurysms after regional chemotherapy with floxuridine: case report.

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    Samaras, Panagiotis; Pfammatter, Thomas; Pestalozzi, Bernhard C

    2008-07-11

    Pseudoaneurysms of the hepatic artery are a rare complication in patients with primary or secondary liver tumors treated with intra-arterial chemotherapy. We present two patients who developed this complication after placement of a catheter system into the gastroduodenal artery and initiation of regional chemotherapy with floxuridine. Diagnosis was made after symptomatic bleeding occurred, necessitating emergency angiography with coil embolization. Pseudoaneurysms usually occur after mechanical damage of the vessel wall, but the chemical toxicity of floxuridine may add to the development of vascular impairment.

  11. Endovascular treatment of a ruptured internal mammary artery pseudoaneurysm presenting as massive hemothorax in a patient with type I neurofibromatosis

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    Yeh, Dae Wook; Kim, Soo Jin; Kim, Chang Won; Kim, Suk; Lee, Tae Hong; Moon, Tae Yong; Chung, Sung Woon [Pusan National University Hospital, Pusan (Korea, Republic of)

    2005-07-15

    We report a case of an acute hemothorax caused by a rupture of a left internal mammary artery pseudoaneurysm in a 45-year-old woman with a type I neurofibromatosis, which was successfully treated using endovascular coil embolization.

  12. Endovascular management of postoperative pseudoaneurysms of the external carotid artery.

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    Cohen, José E; Gomori, John M; Moscovici, Samuel; Grigoriadis, Savvas; Ramirez de Noriega, Fernando; Itshayek, Eyal

    2012-05-01

    Hemorrhage secondary to postoperative pseudoaneurysm is a rare event, but may complicate the clinical course of straightforward and common interventions such as sinonasal procedures, tonsillectomy, and maxillofacial and plastic surgeries. We report our experience with the endovascular management of iatrogenic pseudoaneurysm in eight patients who had undergone recent craniomaxillofacial surgery. Computed tomography (CT), including CT-angiography, detected only three of the eight lesions. In all patients, endovascular embolization achieved successful occlusion of the pseudoaneurysm without local or general procedure-related complications. Immediate proximal arterial occlusion with detachable coils was performed in every case, and pseudoaneurysm coiling was performed in three cases presenting with active hemorrhage. Endovascular therapy proved to be safe and effective in the management of postoperative pseudoaneurysms. Surgeons involved in the craniomaxillofacial procedures should be aware of this complication and its management.

  13. Splenic artery pseudoaneurysm due to acute pancreatitis in a 6-year-old boy with acute lymphoblastic leukaemia treated with L-aspariginase

    DEFF Research Database (Denmark)

    Larsen, Cæcilie Crawley; Laursen, Christian B; Dalby, Kasper;

    2014-01-01

    Acute pancreatitis is a rare phenomenon in children but its incidence seems to be increasing. In children, it is generally caused due to systemic illness, biliary disease, trauma, idiopathy and side effects of medicines like L-aspariginase. Acute pancreatitis is difficult to diagnose in children...... pseudoaneurysm due to acute pancreatitis in a 6-year-old boy with acute lymphoblastic leukaemia treated with L-aspariginase. He presented with fever, irritability and pain in his left groin region....

  14. Successful treatment of coronary artery pseudoaneurysm by graft stent, which developed after the implantation of bare metal stent

    Directory of Open Access Journals (Sweden)

    Utku Şenol

    2013-03-01

    Full Text Available Although coronary artery pseudoaneurysm which couldoccur following percutaneous coronary interventions is arare complication, it can be mortal. As soon as the pseudoaneurysmis diagnosed, it should be treated by percutaneousintervention or surgery. Graft stent implantationis a preferred treatment for appropriate patients. In thiscase report, we presented a successful treatment of coronaryartery pseudoaneurysm by graft stent; which developedafter the implantation of bare metal stent into theleft anterior descending coronary artery. J Clin Exp Invest2013; 4 (1: 126-129Key words: Coronary artery, pseudoaneurysm, graft stent

  15. Uterine Artery Pseudoaneurysm in the Setting of Delayed Postpartum Hemorrhage: Successful Treatment with Emergency Arterial Embolization

    Directory of Open Access Journals (Sweden)

    Ankur M. Sharma

    2011-01-01

    Full Text Available Postpartum hemorrhage is a major cause of maternal mortality. Though uncommon, uterine artery pseudoaneurysm can follow uterine dilatation and curettage (D + C and needs to be considered in the differential diagnosis. This 30-year-old G1P1 woman presented with right upper quadrant pain and vaginal bleeding. She was afebrile but her white blood count was significantly increased (22.2×109 /L. One week prior, she had undergone a Cesarean delivery which was complicated by hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP, fetal dystocia, and chorioamnionitis. Uterine dilatation and curettage (D & C and placement of a Bakri intrauterine balloon, performed for suspected retained products of conception, failed to control her postpartum bleeding. The patient wished to have a hysterectomy only as a last resort in order to preserve fertility. Emergency uterine artery angiography revealed a left uterine artery pseudoaneurysm and contrast extravasation. The patient was successfully treated with selective embolization. Computed tomography (CT later revealed dehiscence of her uterine Cesarean section incision with an intra-abdominal fluid collection. This collection was drained. She also developed disseminated intravascular coagulopathy (DIC syndrome as well as multiple pulmonary emboli which were both successfully treated. We discuss this unique case of uterine artery pseudoaneurysm with associated uterine dehiscence.

  16. Idiopathic Splenic Artery Pseudoaneurysm Rupture as an Uncommon Cause of Hemorrhagic Shock

    Directory of Open Access Journals (Sweden)

    Richard A. Schatz MD

    2015-04-01

    Full Text Available Splenic artery pseudoaneurysms are infrequently encountered but critical to recognize. Limited literature to date describes associations with pancreatitis, trauma, and rarely peptic ulcer disease. Hemorrhage and abdominal pain are the most common manifestations. There is typically overt gastrointestinal blood loss but bleeding can also extend into the peritoneum, retroperitoneum, adjacent organs, or even a pseudocyst. Most patients with ruptured splenic artery pseudoaneurysms present with hemodynamic instability. Here, we describe a patient recovering from acute illness in the intensive care unit but with otherwise no obvious risk factors or precipitants for visceral pseudoaneurysm. He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock. The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation. He was successfully treated with arterial coiling and embolization. Thus, we herein emphasize the importance of prompt recognition of hemorrhagic shock and of aggressive hemodynamic stabilization, as well as a focused diagnostic approach to this problem with specific treatment for splenic artery pseudoaneurysm. Finally, we recommend that multidisciplinary management should be the standard approach in all patients with splenic artery pseudoaneurysm.

  17. Telescoping dual covered stent graft construct for endovascular treatment of a giant extracranial carotid artery pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Dale Ding

    2016-01-01

    Full Text Available Large pseudoaneurysms which compress the parent vessel are challenging lesions to successfully treat with endovascular therapy. We describe the endovascular treatment of a giant extracranial carotid artery (ECCA pseudoaneurysm resulting in substantial mass effect on the common carotid artery (CCA bifurcation using a telescoping dual covered stent graft construct. A 56-year-old male was diagnosed with an 8.5 cm × 13 cm pseudoaneurysm arising from the left CCA bifurcation, which was causing luminal narrowing of the CCA and proximal internal carotid artery (ICA. The patient underwent endovascular intervention, during which a balloon-expandable covered stent was deployed within a heparin-bonded covered stent, such that the overall construct spanned from the CCA to the lower cervical ICA. The employment of a telescoping dual covered stent technique can successfully treat appropriately selected patients with large or giant ECCA pseudoaneurysms, with the concomitant goals of excluding the pseudoaneurysm and restoring the luminal caliber of the parent artery.

  18. Significance of transcatheter arterial embolization in the treatment of pseudoaneurysm complicating pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Gyee; Joo, Jung Hyun; Kim, Young Cheol; Kim, Jae Kyu; Jeong, Yong Yeon; Kang, Heoung Keun [Chonnam Univ. School of Medicine, Kwangju (Korea, Republic of); Oh, Hee Yeon [Namkwang Hospital, Kwangju (Korea, Republic of)

    1998-11-01

    To evaluate the significance of transcatheter arterial embolization(TAE) of pseudoaneurysm complicating pancreatitis. This study was based on a retrospective analysis of eight cases, in which TAE for control of pseudoaneurysm complicating pancreatitis was attempted. All patients were males, and were aged between 35 and 65(mean, 47) years. Seven had a history of episodes of chronic pancreatitis and one case was the result of acute pancreatitis. All patients underwent diagnostic angiography and superselective embolization. Arteries in which pseudoaneurysm had occurred were the gastroduodenal (n=3D5), inferior pancreaticoduodenal (n=3D1), superior mesenteric artery root (n=3D1), and the celiac axis (n=3D1). Six cases were treated successfully without complications, but in two, embolization failed due to a wide aneurysmal neck arising from the superior mesenteric artery root and celiac axis. In four successful cases, pseudoaneurysms were completely resolved within three to six months of embolization. One of the other two remained as a pseudocyst, while in the other, also a pseudocyst, surgery was performed. Because TAE in patients with pseudoaneurysm complicating pancreatitis has a high success rate, and also leads to absolute resorption of a pseudocyst, TAE is the preferred pre-surgical treatment mode.=20.

  19. Direct Needle Puncture and Embolization of Splenic Artery Pseudoaneurysm in Case of Chronic Atrophic Calcific Pancreatitis

    Science.gov (United States)

    Shrivastava, Amit; Rampal, Jagadeesh Singh; Reddy, D. Nageshwar; Rao, Guduru Venkat

    2016-01-01

    Summary Background Gastro-Intestinal bleeding remains a frequent clinical dilemma and common cause of hospitalization, morbidity and mortality. Case Report We report a case of pseudo aneurysm of splenic artery developed after an episode of acute on chronic pancreatitis which was treated by direct percutaneous puncture of pseudoaneurysm and embolization by coils. Conclusions The aim was to preserve the main splenic artery and avoid the complications of splenic artery embolization like infarcts and abscess. PMID:27757174

  20. Parent vessel occlusion for traumatic pseudoaneurysm of P3 segment of posterior cerebral artery:A case report and review of literatures

    Institute of Scientific and Technical Information of China (English)

    Xu Gaofeng; Xie Wanfu; Li Ruichun; Wang Maode

    2011-01-01

    Traumatic intracranial pseudoaneurysms (TIPA) are rare and pseudoaneurysm of P3 segment of the posterior cerebral artery (PCA) is extremely rarely reported. A 27-year-old man suffered from blunt head injury and underwent diagnostic procedure with head CT scans,cerebral CT angiograms (CTA) and digital subtraction angiograms (DSA). An abnormal high-density lesion was detected at the left side of quadrigeminal cistern and a pseudoaneurysm showed at the P3 segment of PCA. The pseudoaneurysm was successfully treated with parent artery occlusion (PAO). Making an exact preoperative diagnosis of traumatic intracranial pseudoaneurysms is of great importance. Endovascular techniques allow a safe approach to complex intracranial lesion,so endovascular management of PCA pseudoaneurysms becomes safe and effective. However,the pseudoaneurysm may not be amenable to coil placement under some conditions,thus,occlusion of the parent vessel may be a preferable treatment.

  1. Balloon Tamponade Treatment of a Stent-graft Related Rupture with a Splenic Artery Pseudoaneurysm: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, See Hyung; Kim, Young Hwan [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2009-09-15

    An arterial rupture resulting from stent-graft placement of a splenic artery pseudoaneurysm is a life-threatening complication and immediate endovascular or surgical treatment is indicated. We report a case of a stentgraft related splenic artery rupture treated solely with a prolonged balloon catheter tamponade, which resulted in preservation of vessel patency

  2. Uncontrolled Epistaxis Secondary to Traumatic Pseudoaneurysm of the Maxillary Artery

    Directory of Open Access Journals (Sweden)

    Eelam Adil

    2011-01-01

    Full Text Available We describe a rare case of traumatic pseudoaneurysm of the maxillary artery following a fall. The patient presented with epistaxis that could not be controlled with anterior and posterior nasal packing. She was urgently taken to the angiography suite for evaluation and ultimately underwent embolization of a left maxillary artery pseudoaneurysm with 500–700 micron Contour PVA followed by coiling with two 3 mm Tornado coils. Bleeding subsided after embolization, and the patient suffered no neurologic sequelae.

  3. Traumatic middle meningeal artery pseudoaneurysms: diagnosis and endovascular treatment of two cases and review of the literature.

    Science.gov (United States)

    Jussen, D; Wiener, E; Vajkoczy, P; Horn, P

    2012-10-01

    Intracranial pseudoaneurysms are rare and mostly associated with a history of head trauma. Only little is known about their natural development. They are characterized by an unpredictable course with a possibility of causing secondary intracranial hemorrhage with significant morbidity and mortality. We present two cases of traumatic pseudoaneurysms of the middle meningeal artery (MMA) treated via endovascular coil occlusion and review of literature. Pseudoaneurysms of the middle meningeal artery carry a potential risk of rupture. They can be detected via a computed tomography angiogram (CT-A). An endovascular embolization followed by catheter angiography may represent a safe treatment of traumatic middle meningeal artery pseudoaneurysms. Considering the risk of secondary rupture and the potentially catastrophic consequences, we recommend a CT-A in all patients with skull base fractures and intracranial hemorrhage.

  4. Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients

    Institute of Scientific and Technical Information of China (English)

    Dong Yi Kim; Jae Kyoon Joo; Seong Yeob Ryu; Young Jin Kim; Shin Kon Kim; Yong Yeon Jung

    2003-01-01

    We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.

  5. Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

    Institute of Scientific and Technical Information of China (English)

    Shailendra Singh; Sumit Arora; Ankit Thora; Ram Mohan; Sumit Sural; Anil Dhal

    2013-01-01

    Dynamic hip screw fixation is a commonly performed procedure for internal fixation of intertrochanteric femoral fractures.Arterial injury following the operative fixation is a rare but serious event.We present a patient who developed pseudoaneurysm of profunda femoris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw.The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.

  6. Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Sildiroglu, Onur; Saad, Wael E.; Hagspiel, Klaus D.; Matsumoto, Alan H.; Turba, Ulku Cenk, E-mail: Turba@me.com [University of Virginia Health System, Department of Radiology (United States)

    2012-12-15

    Purpose: Our purpose was to evaluate iatrogenic renal pseudoaneurysms, endovascular treatment, and outcomes. Methods: This retrospective study (2003-2011) reported the technical and clinical outcomes of endovascular therapy for renal pseudoaneurysms in eight patients (mean age, 46 (range 24-68) years). Renal parenchymal loss evaluation was based on digital subtraction angiography and computed tomography. Results: We identified eight iatrogenic renal pseudoaneurysm patients with symptoms of hematuria, pain, and hematoma after renal biopsy (n = 3), surgery (n = 3), percutaneous nephrolithotomy (n = 1), and endoscopic shock-wave lithotripsy (n = 1). In six patients, the pseudoaneurysms were small-sized (<20 mm) and peripherally located and were treated solely with coil embolization (n = 5). In one patient, coil embolization was preceded by embolization with 500-700 micron embospheres to control active bleeding. The remaining two patients had large-sized ({>=}50 mm), centrally located renal pseudoaneurysms treated with thrombin {+-} coils. Technical success with immediate bleeding cessation was achieved in all patients. There were no procedure-related deaths or complications (mean follow-up, 23.5 (range, 1-67) months). Conclusions: Treatment of renal pseudoaneurysms using endovascular approach is a relatively safe and viable option regardless of location (central or peripheral) and size of the lesions with minimal renal parenchymal sacrifice.

  7. Splenic Artery Pseudoaneurysm Presenting as Massive Hematemesis: A Diagnostic Dilemma

    Directory of Open Access Journals (Sweden)

    Peeyush Varshney

    2014-01-01

    Full Text Available Introduction. Splenic artery Pseudoaneurysm, a complication of chronic pancreatitis, presenting as massive hematemesis is a rare presentation. Case Report. We present a case of 38-year-old male admitted with chief complaints of pain in the upper abdomen and massive hematemesis for the last 15 days. On examination there was severe pallor. On investigating the patient, Hb was 4.0 gm/dL, upper GI endoscopy revealed a leiomyoma in fundus of stomach, and EUS Doppler also supported the UGI findings. On further investigation of the patient, CECT of the abdomen revealed a possibility of distal pancreatic carcinoma encasing splenic vessels and infiltrating the adjacent structure. FNA taken at the time of EUS was consistent with inflammatory pathology. Triple phase CT of the abdomen revealed a splenic artery pseudoaneurysm with multiple splenic infarcts. After resuscitation we planned an emergency laparotomy; splenic artery pseudoaneurysm densely adherent to adjacent structures and associated with distal pancreatic necrosis was found. We performed splenectomy with repair of the defect in the stomach wall and necrosectomy. Postoperative course was uneventful and patient was discharged on day 8. Conclusion. Pseudoaneurysm can be at times a very difficult situation to manage; options available are either catheter embolisation if patient is vitally stable, or otherwise, exploration.

  8. Traumatic pseudoaneurysm of the brachiocephalic artery following medianoscopy: initial endovascular repair followed by open surgery--a case report.

    Science.gov (United States)

    Biebl, Matthias; Neuhauser, B; Perkmann, R; Tauscher, T; Waldenberger, P; Fraedrich, G

    2003-06-01

    Endovascular stent graft repair of traumatic vessel injuries is gaining worldwide acceptance as a minimally invasive alternative to open surgical repair. However, effective endovascular repair fails if the aneurysm is not completely excluded. Conversion to open surgery may be unavoidable in such cases. Herein we describe the case of a 45-year-old man who was referred to our hospital with a pseudoaneurysm of the proximal brachiocephalic artery caused by biopsy during diagnostic medianoscopy. The pseudoaneurysm was primarily treated by stent-graft implantation into the proximal brachiocephalic artery. As a result of the unfavorable location of the lesion exclusion of the aneurysm failed and the initial therapy had to be extended to open reconstruction of the brachiocephalic artery. A bypass procedure from the aortic arch to the right common carotid artery was performed with reinsertion of the right subclavian artery to exclude the pseudoaneurysm.

  9. Periesophageal Pseudoaneurysms: Rare Cause of Refractory Bleeding Treated with Transarterial Embolization

    Science.gov (United States)

    Shah, Rachit D.; Komorowski, Daniel J.; Smallfield, George B.

    2016-01-01

    A 43-year-old female with history of systemic lupus erythematosus, prior cytomegalovirus esophagitis treated with ganciclovir, and long segment Barrett's esophagus (Prague class C8 M9) with high grade dysplasia treated with radiofrequency ablation presented to the hospital with hematemesis. An upper gastrointestinal endoscopy showed multiple esophageal ulcers with active arterial spurting which could not be controlled with endoscopic interventions including placement of hemostatic clips. An emergent angiogram demonstrated actively bleeding saccular dilations (pseudoaneurysms) in the esophageal branches of the lower thoracic aorta as well as left gastric artery for which gelfoam and coil embolization was initially successful. Due to recurrence of massive bleeding, she subsequently underwent emergent esophagectomy and bipolar exclusion. Pathology demonstrated submucosal hemorrhage, esophagitis with dysplastic Barrett's mucosa, and an ulcer containing cytomegaloviral inclusions. We report the first case of arterial bleeding from periesophageal pseudoaneurysms as well as use of angiographic embolization for arterial bleeding in the esophagus.

  10. Arteriovenous fistula and pseudoaneurysm as complications of renal biopsy treated with percutaneous intervention

    Institute of Scientific and Technical Information of China (English)

    JIANG Wen-xia; WANG Hui-fang; MA Jun; HAN Hong-jie

    2010-01-01

    @@ Symptomatic arteriovenous fistula (AVF) with pseudoaneurysm after percutaneous renal biopsy is an uncommon anomaly, occurring from 0.34% to 6.3%.1Most of these vascular lesions are of little clinical importance. However, severe bleeding,2 persistent hematuria, or acute urinary retention may occur, requiring treatment. Here we report a case of gross hematuria and acute urinary retention after renal biopsy in a male patient.An arteriovenous fistula with pseudoaneurysm was detected by renal ultrasound, confirmed by angiography and then successfully treated by transcatheter arterial embolization3 without damage to renal parenchyma.

  11. Mirizzi syndrome associated with hepatic artery pseudoaneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Anderson Oliver

    2008-11-01

    Full Text Available Abstract Introduction This is the first case report of Mirizzi syndrome associated with hepatic artery pseudoaneurysm. Case presentation A 54-year-old man presented with painful obstructive jaundice and weight loss. Computed tomography showed a hilar mass in the liver. Following an episode of haemobilia, angiography demonstrated a pseudoaneurysm of a branch of the right hepatic artery that was embolised. At surgery, a gallstone causing Mirizzi type II syndrome was found to be responsible for the biliary obstruction and a necrotic inflammatory mass and haematoma were found to be extending into the liver. The mass was debrided and drained, the obstructing stones removed and the bile duct drained with a t-tube. The patient made a full recovery. Conclusion This case highlights another situation where there may be difficulty in differentiating Mirizzi syndrome from biliary tract cancer.

  12. Therapeutic angiography for giant bleeding gastro-duodenal artery pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    Ram; Elazary; Mahmoud; Abu-Gazala; Avraham; Schlager; Noam; Shussman; Avraham; I; Rivkind; Allan; I; Bloom

    2010-01-01

    We present the case of an 18-year-old female transferred to our center from an outside hospital due to persistent gastrointestinal bleeding. Two weeks prior to her transfer she underwent duodenal omentopexy for a perforated duodenal peptic ulcer. The patient underwent a computed tomography angiogram which identified the source of bleeding as a giant gastroduodenal artery (GDA) pseudoaneurysm. The patient was taken to interventional radiology where successful microcoil embolization was performed. We present ...

  13. Interventional radiology in the management of visceral artery pseudoaneurysms: A review of techniques and embolic materials

    Energy Technology Data Exchange (ETDEWEB)

    Madhusudhan, Kumble Seetharama; Venkatesh, Hosur Ananthashayana; Gamanagatti, Shivanand; Garg, Pramod; Srivastava, Deep Narayan [All India Institute of Medical Sciences, New Delhi (India)

    2016-06-15

    Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.

  14. Endovascular treatment of a Superior Mesenteric Artery Syndrome variant secondary to traumatic pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Abercrombie John F

    2010-03-01

    Full Text Available Abstract Pseudoaneurysms related to the superior mesenteric artery (SMA are a recognised complication of trauma to the vessel, and successful treatment with stenting has been previously described. We report the case of a patient who presented with obstruction of the fourth part of the duodenum secondary to a traumatic pseudoaneurysm, a hitherto unreported variant of superior mesenteric artery syndrome. Exclusion of the pseudoaneurysm and relief of the duodenal obstruction were simultaneously achieved by placement of a covered stent.

  15. Novel use of carbon dioxide arteriography in renal artery pseudoaneurysm in patients with poor renal function

    Science.gov (United States)

    Said, Mohammed A; McGuire, Barry B; Liu, Joceline S; Resnick, Scott A; Nadler, Robert B

    2014-01-01

    Renal artery pseudoaneurysm (RAP) is a rare complication of partial nephrectomy, but is usually effectively managed with renal vessel embolisation. We report a particularly challenging case of a patient with chronic kidney disease (CKD) who developed a RAP following a laparoscopic heminephrectomy and was treated using superselective renal vessel coil embolisation with carbon dioxide (CO2) as the primary contrast agent for arteriographic localisation of the RAP and feeder artery. To the best our knowledge we report the first utilisation of CO2 arteriography in the definitive diagnosis and treatment of RAP following heminephrectomy in a patient with severe CKD. PMID:25498109

  16. Late hepatic artery pseudoaneurysm: A rare complication after resection of hilar cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Javier Brice(n)o; (A)lvaro Naranjo; Rubén Ciria; Juan Manuel Sánchez-Hidalgo; Luis Zurera; Pedro López-Cillero

    2008-01-01

    We report an unusual pathological entity of a pseudoaneurysm of the right hepatic artery, which developed two years after the resection of a type n hilar cholangiocarcinoma and secondary to an excessive skeletonization for regional lymphadenectomy and neoadjuvant external-beam radiotherapy. After a sudden and massive hematemesis, a multidetector computed tomographic angiography (MDCTA) showed a hepatic artery pseudoaneurysm. Angiography with embolization of the pseudoaneurysm was attempted using microcoils with adequate patency of the hepatic artery and the occlusion of the pseudoaneurysm. A new episode of hematemesis 3 wk later revealed a partial revascularization of the pseudoaneurysm. A definitive interventional radiological treatment consisting of transarterial embolization (TAE) of the right hepatic artery with stainless steel coils and polyvinyl alcohol particles was effective and well- tolerated with normal liver function tests and without signs of liver infarction.

  17. Polyvinyl alcohol and gelatin sponge particle embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Yong-Song Guan; Long Sun; Xiang-Ping Zhou; Xiao Li; Ze-Jun Fei; Xiao-Hua Zheng; Qing He

    2005-01-01

    AIM: To assess the effectiveness of and complications associated with polyvinyl alcohol (PVA) and gelatin sponge particles embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis.METHODS: A 42-year-old man with splenic artery pseudoaneurysm formation secondary to chronic alcoholic pancreatitis was admitted. We used PVA and gelatin sponge partides embo lization of splenic artery pseudoaneurysm by superselective embolization techniques.RESULTS: The splenic artery pseudoaneurysm was successfully controlled with splenic embolization. The patient was discharged in 9 d with complete recovery. CONCLUSION: This case confirms that superselective transcatheter embolization by PVA and gelatin sponge particles may represent an effective treatment for pseudoaneurysm caused by chronic alcoholic pancreatitis in the absence of other therapeutic alternatives.

  18. Cervical internal carotid artery pseudoaneurysm complicating malignant otitis externa: first case report.

    Science.gov (United States)

    Baker, Andrew; Rizk, Habib; Carroll, William; Lambert, Paul

    2015-03-01

    Pseudoaneurysm of the internal carotid artery (ICA) is a rare complication of head and neck infections. To date, three cases of petrous ICA pseudoaneurysm have been described as a complication of otogenic infection, including only one secondary to malignant otitis externa. We present here the first case of cervical ICA pseudoaneurysm as a complication of malignant otitis externa, and stress the importance of timely diagnosis to avoid fatal outcomes.

  19. Radiological management of multiple hepatic artery pseudoaneurysms associated with cholangitic abscesses

    Directory of Open Access Journals (Sweden)

    Ankur Goyal

    2016-01-01

    Full Text Available Hepatic artery pseudoaneurysms (HAP are uncommon, occurring mostly as a complication of trauma (accidental or iatrogenic. Liver abscess rarely causes HAP and multiple HAP associated with cholangitic abscesses have not been reported in the literature. We present a patient of acute necrotizing pancreatitis with stent block cholangitis and multiple cholangitic abscesses who developed hemorrhagic output through drainage catheter in the liver abscess. A multiphasic CT angiography demonstrated three HAP, which were treated with a combination of endovascular coil embolization and percutaneous thrombin injection. The fact that cholangitic abscesses may be associated with pseudoaneurysms should not be neglected, considering the potentially catastrophic complication and relatively easy radiological management. CT angiography permits accurate diagnosis and lays down the roadmap for endovascular procedures.

  20. The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Mallarini, Giorgio (Dept. of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari (Italy)), email: lucasaba@tiscali.it; Anzidei, Michele; Lucatelli, Pierleone (Dept. of Radiological Sciences, Univ. of Rome La Sapienza, Rome (Italy))

    2011-06-15

    Splenic artery aneurysm is the most frequent visceral artery aneurysm and rupture of the aneurysm is associated with a high mortality rate. It is important to discriminate between a true aneurysm and a pseudoaneurysm that may be caused by pancreatitis, iatrogenic and postoperative causes, trauma and peptic ulcer disease. Multidetector-row CT angiography (MDCTA) allows detailed visualization of the vascular anatomy and may allow identification of aneurysms and pseudoaneurysms that affect the splenic artery. The objective of this article is to provide a review of the general characteristics of splenic artery aneurysms and pseudoaneurysms and to describe the findings of MDCTA

  1. [Ruptured pseudoaneurysm of the renal artery associated with segmental arterial mediolysis].

    Science.gov (United States)

    Mizutani, Kosuke; Kikuchii, Mina; Kondo, Hiroshi; Moriyama, Yoji; Tsuchiya, Tomohiro; Masahiro, Nakano; Hidetoshi, Ehara; Deguchii, Takashi; Shinoda, Ikuo

    2008-07-01

    We present a 71-year-old woman with spontaneous perinephric hematoma due to a rupture of pseudoaneurysm of the right renal artery on the fourth day after radical cystectomy and bilateral ureterocutaneostomy for bladder cancer. This patient received steroid therapy for chronic rheumatoid arthritis for several years. The digital subtraction angiography of the right renal artery showed two pseudoaneurysms in the anterior inferior segmental branch and the posterior inferior segmental branch. Transarterial coil embolization of the right renal artery proximally and distally to the two aneurysms was performed without complications. Moreover, the additional angiography showed typical string-of-beads appearance and small aneurysms in abdominal visceral arteries, suggesting segmental arterial mediolysis (SAM) as a possible etiology. Differential diagnoses of SAM are discussed.

  2. Spontaneous healing of cervical pseudoaneurysm in vertebral artery dissection under anticoagulant therapy

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, A.; Neff, W.; Schwartz, A. [Department of Neurology, Klinikum Mannheim, Medical Faculty, University of Heidelberg, Theodor-Kutzer-Ufer 1, D-68132 Mannheim (Germany)

    1998-04-01

    We report a 41-year-old woman with embolic stroke of the mid-pons attributed to embolism from vertebral artery dissection. Angiography revealed an occluded artery on one side and an incidental pseudoaneurysm of the midcervical portion of the vertebral artery on the other. After 3 months of warfarin therapy control angiography showed complete occlusion of the pseudoaneurysm. We discuss therapeutic choices and review the literature. (orig.) With 4 figs., 8 refs.

  3. Pseudoaneurysm of the occipital artery: an unusual cause of persisting headache after minor head injury.

    LENUS (Irish Health Repository)

    Aquilina, K

    2012-02-03

    Post-traumatic pseudoaneurysms of the extracranial arteries in the scalp are uncommon sequelae of head injury. We report on a patient who presented four weeks after a minor head injury with a tender, pulsating and enlarging mass in the course of the left occipital artery. There was associated headache radiating to the vertex. Computed tomographic angiography confirmed the lesion to be a pseudoaneurysm of the occipital artery. The lump was resected with complete resolution of symptoms.

  4. Embolotherapy for Gastric Variceal Bleeding from Pseudoaneurysm of Short Gastric Artery: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jae Han; Kim, Young Dae; Kim, Dong Hyun [Chosun University, Gwangju (Korea, Republic of)

    2008-12-15

    The complications of pancreatitis, such as pseudocyst or abscesses, are well known to radiologists. Yet formation of a pseudoaneurysm of the short gastric artery is an uncommon complication of acute pancreatitis. It is also very rare for a psuedoaneurysm of the short gastric artery to cause splenic vein occlusion and the final result is gastric varices. We report here on a case that showed the dramatic effect of embolotherapy for a pseudoaneurysm of the short gastric artery that caused gastric variceal bleeding

  5. Endovascular Treatment of an Iatrogenic Right Internal Jugular Vein- Right Subclavian Artery Fistula and Pseudoaneurysm During the Attempt of a Hemodialysis Catheter Insertion: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eui Min; Kim, Hyun Lee; Kim, Dong Hyun [Chosun University, Gwangju (Korea, Republic of)

    2009-02-15

    Complications during the placement of a central venous catheter, via the right internal jugular vein puncture include local hematoma, hemothorax, pneumothorax, central vein thrombosis, and hemopericardium. Iatrogenic right internal jugular vein-right subclavian artery fistula with the formation of right subclavian artery pseudoaneurysms is an extremely rare complication in patients undergoing a central vein puncture. We report the case of a patient who developed a local hematoma at the vein puncture site and dyspnea due to a right internal jugular vein-subclavian artery fistula and a right subclavian artery pseudoaneurysm at the mediastinum after puncture of right internal jugular vein. The patient was successfully treated by embolization using microcoils.

  6. Incidental traumatic pseudoaneurysm of the middle meningeal artery: case report and literature review.

    Science.gov (United States)

    Nayil, Khursheed; Ramzan, Altaf; Makhdoomi, Rumana; Wani, Abrar; Zargar, Javeed; Shaheen, Feroze

    2012-01-01

    Traumatic pseudoaneurysm of the middle meningeal artery is rare and is associated with high mortality. Skull fracture is usually an associated feature of this entity. An elderly male was brought to our hospital in a stage of coma. The details of ictus were not known. The Glasgow coma scale score was 9/15. Examination revealed a pseudo-aneurysm arising from the posterior branch of the left middle meningeal artery which was excised. The case is presented for its rarity and its characteristic radiology. Traumatic pseudoaneurysm of middle meningeal artery is rare. It is important to recognize this treatable entity.

  7. "To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms.

    Science.gov (United States)

    Mahmoud, Mustafa Z; Al-Saadi, Mohammed; Abuderman, Abdulwahab; Alzimami, Khalid S; Alkhorayef, Mohammed; Almagli, Babikir; Sulieman, Abdelmoneim

    2015-05-28

    Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of "to-and-fro" waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of "to-and-fro" waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of "to-and-fro" waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and "to-and-fro" flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional "to-and-fro" waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the "to-and-fro" waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.

  8. "To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms

    Institute of Scientific and Technical Information of China (English)

    Mustafa; Z; Mahmoud; Mohammed; Al-Saadi; Abdulwahab; Abuderman; Khalid; S; Alzimami; Mohammed; Alkhorayef; Babikir; Almagli; Abdelmoneim; Sulieman

    2015-01-01

    Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of "to-and-fro" waveform at duplex Doppler ultrasonography(DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of "to-and-fro" waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of "toand-fro" waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and "to-and-fro" flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional "toand-fro" waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the "to-andfro" waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.

  9. Location of femoral artery puncture site and the risk of postcatheterization pseudoaneurysm formation.

    Science.gov (United States)

    Gabriel, Marcin; Pawlaczyk, Katarzyna; Waliszewski, Krzysztof; Krasiński, Zbigniew; Majewski, Wacław

    2007-08-21

    Iatrogenic causes constitute increasingly frequent sources of pseudoaneurysms due to endovascular interventions. However, till now, all analyses focused on evaluating different risk factors contributing to the development of pseudoaneurysm, overlooking the issue of localization of femoral puncture. The aim of this study was to assess the influence of position of femoral artery puncture on the risk of pseudoaneurysm formation. 116 patients were evaluated for the site of catheter insertion into femoral arteries. Another group of 273 patients, suspected of vascular complications after endovascular procedures, were diagnosed with pseudoaneurysms which were analyzed for the location of arterial wall disruption. Puncture sites of groin arteries, i.e. EIA (2.7%), CFA (77.5%), SFA and DFA (19.8%), correlated with pseudoaneurysm location reaching 7.6% (EIA), 54.3% (CFA) and 38.1% (SFA, DFA). Type of procedure influenced these values. Duplex ultrasound mapping of CFA before the endovascular intervention eliminated discrepancies between the incidence of pseudoaneurysm formation and the frequency of arterial puncture in the selected vascular segments. Pseudoaneurysms formed in 4.5% of patients undergoing traditional palpation-guided vessel cannulation and in 2.6% of patients after ultrasound-guided puncture of the femoral artery. Upon further analysis, we concluded that the likelihood of the development of pseudoaneurysm depends on the artery punctured in the groin. This risk increases dramatically for external iliac artery, superficial and deep femoral arteries. A simple means of prevention of this dangerous complication of femoral artery puncture is duplex ultrasound mapping of the groin arteries.

  10. Radiofrequency Ablation for Iatrogenic Thyroid Artery Pseudoaneurysm: Initial Experience.

    Science.gov (United States)

    Jun, Ye Kyeong; Jung, So Lyung; Byun, Ho Kyun; Baek, Jung Hwan; Sung, Jin Yong; Sim, Jung Suk

    2016-10-01

    Eight iatrogenic thyroid pseudoaneurysms (ITPAs) after thyroid biopsy are reported. The mean ITPA diameter was 7.2 mm (range 4 to 12 mm). Ultrasound (US)-guided compression was initially performed at the neck of the ITPA in all cases. Among them, 4 ITPAs persisted (50%) in which radiofrequency (RF) ablation was performed. Mean RF ablation time and power were 13.5 seconds (range 5 to 24 seconds) and 20 W (range 10 to 50 W), respectively. All 4 cases were treated with RF ablation without any complications.

  11. Balloon catheterization for hemostasis during the operation of ruptured femoral artery pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    SHI De-bing; FU Wei-guo; WANG Yu-qi; GUO Da-qiao; CHEN Bin; SHI Zhen-yu

    2007-01-01

    @@ Pseudoaneurysms of the femoral artery usually progress and can rupture if left untreated. Therefore,intraoperative hemostasis is of the paramount importance in the management of these emergent situations,especially for the patients with poor general health.

  12. Pseudoaneurysm of uterine artery: as a cause of secondary post partum haemorrhage

    Directory of Open Access Journals (Sweden)

    Prabha Devi Kodey

    2015-12-01

    Conclusions: Uterine artery embolization is an effective and reliable method for control of haemorrhage in pseudoaneurysm. One should have doubt about pseudoaneurysm in cases of secondary PPH where the bleeding is recurrent and cause not acertainable and to be referred in time where the facility of uterine artery embolization is available. [Int J Reprod Contracept Obstet Gynecol 2015; 4(6.000: 1821-1824

  13. Posttraumatic pseudoaneurysm of medial plantar artery in a child: treatment with percutaneous thrombin injection

    Directory of Open Access Journals (Sweden)

    Fabrício Neto Ladeira

    2014-03-01

    Full Text Available Pseudoaneurysms of the medial plantar artery are rare. The authors describe a case of a pseudoaneurysm of the medial plantar artery of a child who had suffered a penetrating laceration injury. Diagnosis can be confirmed using Doppler ultrasound and magnetic resonance angiography. As an alternative to the conventional surgery technique, percutaneous Doppler ultrasound-guided thrombin injection is a safe and effective treatment.

  14. Hepatic artery pseudoaneurysm after surgical treatment for pancreatic cancer: Minimally invasive angiographic techniques as the preferred treatment

    Directory of Open Access Journals (Sweden)

    Sucandy Iswanto

    2014-01-01

    Full Text Available Background: Delayed intra-abdominal bleeding related to hepatic artery pseudoaneurysm is a potentially lethal complication after pancreaticoduodenectomy for pancreatic cancer. Locally advanced tumors, which result in vessel erosion or extensive operative skeletonization, may contribute to weakness of the arterial wall. Reoperation is often technically difficult with high rate of mortality; therefore, alternative less invasive options are ideal. Aims: The study was to present an alternative endovascular treatment of a large hepatic artery pseudoaneurysm after pancreatic resection for locally advanced multicystic adenocarcinoma. Materials and Methods: Transcatheteric mesenteric angiography with deployment of detachable coils in the pseudoaneurysm sac was utilized to manage the hepatic artery pseudoaneurysm. Results: Completion angiography confirmed cessation of contrast enhancement in the pseudoaneurysm sac with preservation of normal antegrade hepatic artery flow. Conclusion: Minimally invasive angiographic technique is the preferred treatment for hepatic artery pseudoaneurysm after pancreatic resections.

  15. Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report.

    Science.gov (United States)

    Nimjee, Shahid M; Smith, Tony P; Kanter, Ronald J; Ames, Warwick; Machovec, Kelly A; Grant, Gerald A; Zomorodi, Ali R

    2015-06-01

    Large cerebral aneurysms of the basilar apex are difficult to treat. Recently, endovascular treatment has mitigated much of the morbidity associated with treating these lesions. However, the morphology of aneurysms of the vertebrobasilar system can preclude endovascular treatment. Rapid ventricular pacing (RVP) facilitates open surgical treatment of cerebral aneurysms. It can assist in reducing the pressure of the neck of the aneurysm, allowing safe application of a clip. The authors present a case of a pediatric patient who developed a basilar artery pseudoaneurysm that required surgery. Given the large size of the aneurysm, RVP was performed, allowing the surgeons to dissect the dome of the aneurysm from the surrounding tissue and pontine perforating branches away from the lesion to safely clip the lesion. The patient had an uneventful recovery. To the authors' knowledge, this represents the first known case of RVP to aid in basilar artery clip occlusion in a pediatric patient.

  16. Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Eveno, Clarisse, E-mail: clarisse.eveno@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Dautry, Raphael, E-mail: raphael.dautry@lrb.aphp.fr; Guerrache, Youcef, E-mail: docyoucef05@yahoo.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Camus, Marine, E-mail: marine.camus@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Gayat, Etienne, E-mail: etienne.gayat@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Dref, Olivier Le, E-mail: olivier.ledref@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr; Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France)

    2015-08-15

    PurposeTo assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).Materials and MethodsSeventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.ResultsSeventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53 %). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88 %). Technical success rate of TAE was 100 %. TAE was performed using metallic coils in all patients (100 %), in association with gelatin sponge in 5/17 patients (29 %). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94 %). In 1/17 patient (6 %), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12 %, respectively. Morbidity consisted in coil migration in 1/17 patient (6 %) and transient serum liver enzyme elevation in 1/17 patient (6 %).ConclusionTAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94 %. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA.

  17. Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

    Institute of Scientific and Technical Information of China (English)

    Yoshitsugu Tajima; Tamotsu Kuroki; Ryuji Tsutsumi; Ichiro Sakamoto; Masataka Uetani; Takashi Kanematsu

    2007-01-01

    AIM: To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery.METHODS: We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepatobiliary pancreatic surgery between June 1992 and April 206. We paid special attention to the extrahepatic arterial collaterals to the liver which may affect post-TAE liver damage and patient outcome.RESULTS: The underlying diseases were all malignancies, and the surgical procedures included hepatopancreatoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenectomy in 2. A total of 11 pseudoaneurysm developed: 4in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful hemostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery,were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection,the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arterial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic artery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE.CONCLUSION: When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral pathways to the liver created by the primary surgical procedure and a short postoperative interval may

  18. Iatrogenic pseudoaneurysm of the superior gluteal artery presenting as pelvic mass with foot drop and sciatica: case report and review of literature.

    Science.gov (United States)

    Ge, Phillip S; Ng, Gladys; Ishaque, Brandon M; Gelabert, Hugh; de Virgilio, Christian

    2010-01-01

    We report an unusual case of a pseudoaneurysm of the superior gluteal artery as a complication of bone marrow biopsy. A 51-year-old man presented with sciatic pain and foot drop after undergoing bone marrow biopsy and was initially diagnosed as having degenerative disc disease based on his past medical history. Pelvic magnetic resonance imaging (MRI) revealed a large heterogeneous mass suggestive of a neurogenic tumor, but pulsatile blood was instead encountered during computed tomography (CT)-guided needle biopsy. Subsequent workup established the diagnosis of a superior gluteal artery pseudoaneurysm, which was treated with coil embolization, followed by surgical evacuation of the hematoma, which relieved his sciatic pain. However, the patient continues to have a persistent foot drop. Gluteal artery pseudoaneurysms are exceedingly uncommon but should be considered in the workup of a patient with gluteal pain or sciatic nerve palsy following trauma or medical procedures in the gluteal region.

  19. Hemobilia in a child due to right hepatic artery pseudoaneurysm: Multidetector-row computed tomography demonstration

    Directory of Open Access Journals (Sweden)

    Nisar A Wani

    2011-01-01

    Full Text Available We present a case of a 12-year-old boy who developed upper gastrointestinal bleeding in the form of hematemesis and melena 1 month after blunt trauma to liver. Computed tomography (CT angiography with multidetector-row CT demonstrated pseudoaneurysm of right hepatic artery related to old liver laceration to be the cause of the bleeding. Pseudoaneurysm was resected using the roadmap provided by CT angiography findings.

  20. Misdiagnosis and management of iatrogenic pseudoaneurysm of vertebral artery after Harms technique of C1-C2 fixation

    Institute of Scientific and Technical Information of China (English)

    MIN Li; SONG Yue-ming; XIE Xiao-dong; WANG Chao-hua; LIU Li-min

    2012-01-01

    Harms technique of C1-C2 fixation for atlantoaxial complex becomes more popular due to good fusion rate and low vertebral artery injury (VAI) rate.But considering the unique and variable anatomy of atlantoaxial complex,iatrogenic VAI will result in catastrophic consequences and provides particular surgical challenges for surgeons.To our knowledge,comparing with iatrogenic VAI in the screw hole,iatrogenic VAI in the "open space" is much rarer during the Harms technique of C1-C2 fixation.In this article,we present a case of iatrogenic vertebral artery pseudoaneurysm after Harms technique of posterior C1-C2 fixation.This case of iatrogenic VAI effectively treated by endovascular coil occlusion and external local compression was initially misdiagnosed as VAI by pedicle screw perforation.It can be concluded that intraoperative or postoperative computed angiography is very helpful to diagnose the exact site of VAI and the combination of endovascular coil occlusion as well as external local compression can further prevent bleeding and abnormal vertebral artery flow in the pseudoaneurysm.However,patients treated require further follow-up to confirm that there is no recurrence of the pseudoaneurysm.

  1. Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Yeon Hwa Yu; Joo Hyun Sohn; Tae Yeob Kim; Jae Yoon Jeong; Dong Soo Han; Yong Cheol Jeon; Min Young Kim

    2012-01-01

    Hepatic artery pseudoaneurysm (HAP) is a very rare disease but in cases of complication,there is a very high mortality.The most common cause of HAP is iatrogenic trauma such as liver biopsy,transhepatic biliary drainage,cholecystectomy and hepatectomy.HAP may also occur with complications such as infections or inflammation associated with septic emboli.HAP has been reported rarely in patients with acute pancreatitis.As far as we are aware,there is no report of a case caused by acute idiopathic pancreatitis,particularly.We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman.The woman initially presented with acute pancreatitis due to unknown cause.After conservative management,her symptoms seemed to have improved.But eight days after admission,abdominal pain abruptly became worse again.Abdominal computed tomography (CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT.Endoscopic retrograde cholangiopancreatography (ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain.ERCP confirmed hemobilia by observing fresh blood clots at the opening of the ampulla and several filling defects in the distal common bile duct on cholangiogram.Without any particular treatment such as embolization or surgical ligation,HAP thrombosed spontaneously.Three months after discharge,abdominal CT demonstrated that HAP in the left lateral segment had disappeared.

  2. Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Ferro, Carlo; Rossi, Umberto G., E-mail: urossi76@hotmail.com; Seitun, Sara [IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Department of Radiology and Interventional Radiology (Italy); Scarano, Flavio; Passerone, Giancarlo [IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Department of Cardiac Surgery (Italy); Williams, David M. [University of Michigan Medical Center, Department of Radiology, Division of Vascular and Interventional Radiology (United States)

    2013-04-15

    To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up. Sixty-one patients (39 men; mean {+-} standard deviation age 66.1 {+-} 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 {+-} 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III). Among the 48 patients, 26 (54 %; 17 men, aged 64.3 {+-} 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 {+-} 9.5 months (range 12-42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness >10 mm; width and length >20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved. Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.

  3. Life-threatening hemobilia caused by hepatic artery pseudoaneurysm:A rare complication of chronic cholangitis

    Institute of Scientific and Technical Information of China (English)

    Tsu-Te Liu; Ming-Chih Hou; Han-Chieh Lin; Full-Young Chang; Shou-Dong Lee

    2003-01-01

    Hemobilia is one of the causes of obscure gastrointestinal haemorrhage. Most cases of hemobilia are of iatrogenic or traumatic origin. Hemobilia caused by a hepatic artery pseudoaneurysm due to ascending cholangitis is very rare and its mechanism is undear. We report a 74-year-old woman with a history of surgery for choledocholithiasis 30 years ago, suffering from a protracted course of life-threatening gastrointestinal bleeding. A small intestines series and endoscopic retrograde cholangiopancreatography revealed a chronic cholangitis with marked contrast reflux into the biliary tree. Angiography confirmed the bleeding from a pseudoaneurysm of the middle hepatic artery. Coil embolization achieved successful hemostasis. We discussed the mechanism and reviewed the literature.

  4. Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome

    Institute of Scientific and Technical Information of China (English)

    Andres; Vargas-Estrada; Dianna; Edwards; Mohammad; Bashir; James; Rossen; Firas; Zahr

    2015-01-01

    Saphenous vein grafts(SVG) pseudoaneurysms,especially giant ones,are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina,dyspnea,myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain,dyspnea and was noted to have significantly engorged neck veins. In the emergency department,a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery(RPDA). This imaging modality also demonstrated compression of the superior vena cava(SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films,a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVCcompression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary,saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications,the patency of the affected vein graft and the involved myocardial territory viability.

  5. Contrast-enhanced ultrasound in detection and follow-up of pancreaticoduodenal artery pseudoaneurysm: a case report

    Institute of Scientific and Technical Information of China (English)

    ZHOU Lu-yao; XIE Xiao-yan; CHEN Dong; L(U) Ming-de

    2011-01-01

    Pancreaticoduodenal artery pseudoaneurysm is one kind of rare splanchnic artery aneurysm.Hemorrhage from the lesion could be life-threatening.We present a case which color Doppler ultrasound and computed tomography angiography (CTA) only showed pancreatic pseudocyst on the background of chronic pancreatitis at first,but contrast-enhanced ultrasound detected blood flow in the pseudocyst and a pancreaticoduodenal artery pseudoaneurysm was worked up several days after.Finally,the pancreaticoduodenal artery pseudoaneurysm was confirmed by digital subtracted angiography.It might suggest the potential advantage of contrast-enhanced ultrasound in evaluating this kind of disease in comparison of CTA.

  6. Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma

    Science.gov (United States)

    Hammer, Frank; Tombal, Bertrand

    2017-01-01

    Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications.

  7. Subclavian Artery Pseudoaneurysm Formation 3 Months after a Game of Rugby Union

    Directory of Open Access Journals (Sweden)

    T. Evans

    2015-01-01

    Full Text Available Pseudoaneurysms of the subclavian artery remain a rare complication after fracture of the clavicle. We report a case of delayed diagnosis of a subclavian artery pseudoaneurysm after a closed fracture of the clavicle in a 15-year-old patient, 3 months after the original injury while playing rugby union. Despite several attendances to the Emergency Department with vague symptoms, the final diagnosis was confirmed by duplex ultrasound and Computed Tomography of the thorax. Surgical repair was indicated due to acute limb ischaemia from distal embolisation from a large pseudoaneurysm, with the patient making a full recovery. This case highlights the need for clinical vigilance when assessing patients, particularly on repeated occasions when their recovery appears to be impaired. A thorough history and clinical examination can raise suspicion of even rare occurrences and aid prompt management.

  8. Osler's nodes, pseudoaneurysm formation, and sepsis complicating percutaneous radial artery cannulation.

    Science.gov (United States)

    Cohen, A; Reyes, R; Kirk, M; Fulks, R M

    1984-12-01

    Percutaneous arterial cannulation is useful for hemodynamic monitoring and frequent arterial blood gas determinations in selected intensive care patients. However, this procedure is not without risk. We report a case of localized Osler node formation, distal to a radial artery catheter, associated with sepsis, pseudoaneurysm formation, and thrombosis at the site of catheterization. Complications of this technique require aggressive medical and, in selected cases, surgical intervention.

  9. Subclavian artery pseudoaneurysm: a rare and serious complication of central venous catheterization in an infant

    Energy Technology Data Exchange (ETDEWEB)

    Koklu, Esad; Poyrazoglu, Hakan [Erciyes University School Medicine, Department of Paediatrics, Division of Paediatric Intensive Care Unit, Kayseri (Turkey); Yikilmaz, Ali [Erciyes University, Department of Radiology, Kayseri (Turkey); Canpolat, Mehmet; Konuskan, Bahadir [Erciyes University, Department of Paediatrics, Kayseri (Turkey)

    2008-02-15

    Serious complications of central venous access occur in 0.4-9.9% of patients undergoing attempted central venepuncture. We report an unusual case of an 18-month-old infant in whom a right subclavian artery pseudoaneurysm developed rapidly after attempted subclavian vein catheterization without US guidance failed. (orig.)

  10. Iatrogenic pseudoaneurysm of the middle meningeal artery after external ventricular drain placement.

    Science.gov (United States)

    Grandhi, Ramesh; Zwagerman, Nathan T; Lee, Philip; Jovin, Tudor; Okonkwo, David O

    2015-01-01

    External ventricular drain (EVD) placement is often a routine but lifesaving neurosurgical procedure performed throughout the world. Misadventures involving the procedure are well documented throughout the literature. However, we present a unique case of middle meningeal artery pseudoaneurysm formation after EVD placement not before described and provide a review of the literature.

  11. Popliteal pseudoaneurysm after total knee arthroplasty secondary to intraoperative arterial injury with a surgical pin: review of the literature.

    Science.gov (United States)

    Sandoval, Enrique; Ortega, Francisco Javier; García-Rayo, Manuel Ramón; Resines, Carlos

    2008-12-01

    Pseudoaneurysms of the popliteal artery after total knee arthroplasty are rare. Although many possible explanations are proposed in the literature, no intimate mechanism of injury to the artery is previously described. We report on a case of popliteal pseudoaneurysm after a total knee arthroplasty that presented clinically on the second postoperative day. Open vascular surgery with resection of the pseudoaneurysm and end-to-end bypass of contralateral saphena vein graft was successfully performed. At the time of the surgery, a hole was clearly identified on the anterior wall of the popliteal artery due to a perforation with a pin used during the knee arthroplasty. The patient had no further complications.

  12. Comparison of ultrasound-guided thrombin injection and compression repair in treatment of iatrogenic femoral arterial pseudoaneurysms

    Institute of Scientific and Technical Information of China (English)

    QIN Jun; GAO Yun-hua; ZHUO Zhong-xiong; HUANG Lan; LI Ai-min; SONG Yao-ming; JIN Jun; YU Xue-jun; GENG Zhao-hua; ZHOU Xia-bo; LIN Chun-mei

    2006-01-01

    Objective:To retrospectively compare the efficacy and safety of ultrasound-guided thrombin injection (UGTI) with ultrasound-guided compression repair (UGCR) in patients with postcatheterizational femoral arterial pseudoaneurysms (PSA). Methods: Thirty patients of this iatrogenic PSA [8males, 22 females, average age (66.5± 5.2) years] in our nstitution from 1997 to 2004 were retrospectively analyzed. Among them, 11 patients were treated with UGCR, 2 under continuous ultrasonographic (US) guidance and 9 under the guidance of femoral arterial bruit auscultation and dorsalis pedis artery palpation. Because UGCR was failed in 5 patients, consecutively 24 patients were treated with UGTI. Wine thrombin solution at a concentration of 200 U/ml was injected percutaneously using 22-25 gauge needles under color Doppler US. Demographics, clinical variables, pseudoaneurysm characteristics, and results of the 2 groups were compared by using Fisher's exact test and Student's t test. Results: The initial success rate of UGCR was 36.4% (4/11) nd the overall success rate was 45.5% (5/11). Ten of 11 patients suffered from local pain during the compression, but there was no any complication in UGTI group. The average dose of injected thrombin was (180±82) U for PSA of a single loculus and (315±150) U for multiloculated PSA. The initial success rate of UGTI was 89.5% (17/19) and the verall uccess rate was 100% (24/24). Conclusion:UGTI offers a safe, quick and effective means of definitively treating femoral pseudoaneurysms and seems superior to UGCR. The amount of thrombin applied on our people seems smaller compared with others' work.

  13. Imaging diagnosis--celiac artery pseudoaneurysm associated with a migrating grass awn.

    Science.gov (United States)

    Llabrés-Díaz, Francisco J; Brissot, Hervé; Ibarrola, Patricia

    2010-01-01

    The ultrasound and computed tomography findings of a retroperitoneal pseudoaneurysm associated with a grass awn are described in a 10-month-old dog. Ultrasound was used to localize the lesion and surrounding reaction as well as to determine its relationship with the celiac artery, but inadequate Doppler settings hindered the diagnosis of its vascular nature. Dual phase CT enabled further characterization, particularly its close relationship with the major retroperitoneal vessels. The imaging examination was fundamental in recommending nonsurgical therapy. The dog died as a consequence of the rupture of this pseudoaneurysm. A grass awn was confirmed.

  14. Glue embolization of a ruptured celiac trunk pseudoaneurysm via the gastroduodenal artery

    Energy Technology Data Exchange (ETDEWEB)

    Schoder, M.; Cejna, M.; Hittmaier, K.; Lammer, J. [Department of Radiology, Division of Angiography and Interventional Radiology, University of Vienna, Vienna (Austria); Laengle, F. [Department of Surgery, Division of General Surgery, University of Vienna, Vienna (Austria)

    2000-08-01

    Percutaneous transcatheter embolization of splanchnic artery aneurysms is a minimally invasive and alternative therapy to conventional surgical intervention. Due to a high-grade stenosis at the origin of the celiac trunk, a retrograde approach to the celiac trunk pseudoaneurysm via the gastroduodenal artery was necessary. To prevent undesirable embolization into the peripheral left gastric artery initial occlusion of the central portion of the left gastric artery was performed with microcoils using a Tracker catheter. Complete occlusion of the celiac trunk itself and the short adjacent segments of the celiac artery was achieved by using a mixture of N-butyl-2-cyanoacrylate and ethiodized oil as the embolizing agent. (orig.)

  15. Gluteal artery pseudoaneurysm, a rare cause of sciatic pain: case report and literature review.

    Science.gov (United States)

    Yurtseven, Taşkin; Zileli, Mehmet; Göker, Ege N Tavmergen; Tavmergen, Erol; Hoşcoşkun, Cüneyt; Parildar, Mustafa

    2002-08-01

    This article describes a very unusual case of sciatic pain and motor dysfunction resulting from gluteal artery pseudoaneurysm. A 36-year-old woman with primary infertility sustained an iatrogenic injury to her left gluteal artery during transvaginal ultrasound-guided follicle aspiration. Twenty-five days after the procedure she developed severe left sciatic pain and motor dysfunction. Pelvic computed tomography and magnetic resonance imaging revealed a huge pelvic hematoma. Angiography demonstrated a gluteal artery pseudoaneurysm. Because endovascular occlusion of the aneurysm did not relieve the pain, the patient underwent surgery for evacuation of the hematoma and release of the lumbosacral plexus. This eliminated all her sciatic pain and restored her motor dysfunction completely. The English literature details only five other cases of sciatic pain resulting from gluteal artery aneurysm, and these reports are also discussed.

  16. Embolisation of Posttraumatic Superior Mesenteric Artery Pseudoaneurysm in a Patient with Short Bowel Syndrome Preceding Bowel Transplantation

    Directory of Open Access Journals (Sweden)

    Vinko Vidjak

    2011-01-01

    Full Text Available Penetrating abdominal trauma often causes bowel injuries which may lead to “short bowel syndrome” which is a potential indication for bowel transplantation. Posttraumatic pseudoaneurysms of abdominal arteries are often a result of penetrating abdominal trauma. We report a successful embolisation of posttraumatic superior mesenteric artery (SMA branch pseudoaneurysm using microcoil, in a patient with short bowel syndrome who was successfully transplanted three months after embolisation.

  17. Expanding pseudoaneurysm compressing the coronary arteries and causing cardiogenic shock.

    Science.gov (United States)

    Maliske, Seth M; Alshawabkeh, Laith; Schouweiler, Katie; Sigurdsson, Gardar

    2015-01-01

    A 37-year-old man who recently underwent aortic valve replacement after endocarditis presented with cardiogenic shock. A large expansile pseudoaneurysm was subsequently discovered using multiple imaging modalities. Although transesophageal echocardiography is important in diagnosing valve endocarditis, coronary CT angiography of prosthetic valves is feasible and image quality is good. In this case, coronary CT angiography allowed for better understanding of transesophageal echocardiography images and earlier diagnosis of coronary involvement as cause for left ventricular dysfunction.

  18. Endovascular Treatment of Persistent Epistaxis due to Pseudoaneurysm Formation of the Ophthalmic Artery Secondary to Nasogastric Tube

    Energy Technology Data Exchange (ETDEWEB)

    Selcuk, Hakan, E-mail: hakanselcuk73@yahoo.com; Soylu, Nur; Albayram, Sait; Selcuk, Dogan; Ozer, Harun; Kocer, Naci; Islak, Civan [Cerrahpasa Medical School, Istanbul University, Department of Radiology, Division of Neuroradiology (Turkey)

    2005-04-15

    We present the case of a 60-year-old man with persistent epistaxis for 20 days that had started 2 weeks after removal of a nasogastric tube placed for an abdominal operation. There was no pathologic finding at selective facial and internal maxillary artery injections. An injury to the ethmoidal branches of the ophthalmic arteries or other arterial origins of bleeding was suspected. The internal carotid artery angiography revealed a pseudoaneurysm of an anterior ethmoidal branch of the left ophthalmic artery. The pseudoaneurysm was occluded with NBCA-histoacryl (25%) injection.

  19. Internal carotid artery pseudoaneurysm with life-threatening epistaxis as a complication of deep neck space infection.

    Science.gov (United States)

    da Silva, Paulo Sérgio Lucas; Waisberg, Daniel Reis

    2011-05-01

    Pseudoaneurysm of the cervical internal carotid artery is a very rare, potentially fatal complication of a neck space infection in children associated with high mortality and morbidity. A 3-year-old boy presented with spontaneous massive epistaxis 45 days after a deep neck space infection caused by a peritonsillar abscess. During nasopharyngeal packing, he evolved with cardiac arrest. Intra-arterial angiography was then performed that revealed a large pseudoaneurysm. Endovascular treatment using detachable balloons achieved complete exclusion of the pseudoaneurysm. The child made an uneventful recovery and was discharged with mild left hemiparesis and no deficit of sensory or cognitive functions. Pseudoaneurysms of the internal carotid artery after a deep neck space infection can be associated with delayed and potentially fatal massive epistaxis. Furthermore, a regional (ie, extranasal) blood vessel should be promptly investigated when there are signs of hypovolemic shock. A high level of suspicion and definitive treatment are essential for successful management of these patients.

  20. Hybrid treatment of bullet embolism at the abdominal aortic bifurcation, complicated with thoracoabdominal aorta pseudoaneurysm and common iliac artery occlusion: case report

    Directory of Open Access Journals (Sweden)

    Patrick Bastos Metzger

    2014-03-01

    Full Text Available Embolization due to a firearm projectile entering the bloodstream is a rare event that is unlikely to be suspected during initial treatment of trauma patients. We describe and discuss a case of bullet embolism of the abdominal aortic bifurcation, complicated by a pseudoaneurysm of the thoracoabdominal aorta and occlusion of the right common iliac artery, but successfully treated using a combination of endovascular methods and conventional surgery.

  1. Cavernous carotid artery pseudo-aneurysm treated by stenting in acromegalic patient Pseudoaneurisma da artéria carótida cavernosa tratado com "stent" em paciente acromegálica

    Directory of Open Access Journals (Sweden)

    Jorge Marcondes de Souza

    2003-06-01

    Full Text Available We report on a case of endovascular management of pseudoaneurysm of the cavernous segment of the internal carotid artery with covered stent reconstruction. A 36 years-old woman with a history of previous transsphenoidal approach for pituitary macroadenoma and false aneurysma formation was studied in a protocol that included balloon test occlusion and cerebral blood flow evaluation. An endovascular covered stent deployment in the area of the carotid laceration was performed with isolation of the aneurysm from the circulation and maintenance of the carotid flow. Helical angio-CT and cerebral digital subtraction angiography showed the carotid preservation without stenosis in the stented area. In conclusion, endovascular stent reconstruction for post-transsphenoidal carotid artery laceration and false aneurysm is demonstrated as useful technical adjunct in the management strategy and with the potential for carotid sacrifice morbidity avoidance.Relatamos um caso de manuseio com "stent" recoberto por pseudoaneurisma do segmento cavernoso da artéria carótida interna. A paciente de 36 anos, tinha história de cirurgia trans-esfenoidal para macroadenoma de hipófise e desenvolvimento de falso aneurisma na região cavernosa da ACI, foi estudado com protocolo para avaliação de reserva circulatória carotídea com teste de oclusão por balão e estudo de fluxo sanguíneo cerebral com tomografia computorizada de emissão de fóton único (SPECT. Instalação de "stent" recoberto no segmento lesado isolou o aneurisma da circulação, com manutenção do fluxo carotídeo. Angio-tomografia helicoidal e angiografia digital por subtração demonstraram a reconstrução carotídea sem estenose local. Em conclusão, reconstrução carotídea com "stent" recoberto é possível na estratégia para manuseio de pseudo-aneurisma com potencial para prevenção da morbidade do sacrifício terapêutico carotídeo.

  2. Haematochezia from a Splenic Artery Pseudoaneurysm Communicating with Transverse Colon: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    James O’Brien

    2016-01-01

    Full Text Available Splenic artery aneurysms (SAA are the third most common intra-abdominal aneurysm. Complications include invasion into surrounding structures often in association with preexisting pancreatic disease. We describe an 88-year-old female, with no history of pancreatic disease, referred with lower gastrointestinal bleeding. CT angiography showed a splenic artery pseudoaneurysm with associated collection and fistula to the transverse colon at the level of the splenic flexure. The pseudoaneurysm was embolised endovascularly with metallic microcoils. Rectal bleeding ceased. The patient recovered well and follow-up angiography revealed no persistence of the splenic artery pseudoaneurysm. SAA rupture results in 29%–50% mortality. Experienced centres report success with the endovascular approach in haemodynamically unstable patients, as a bridge to surgery, and even on a background of pancreatic disease. This case highlights the importance of prompt CT angiography, if endoscopy fails to identify a cause of gastrointestinal bleeding. Endovascular embolisation provides a safe and effective alternative to surgery, where anatomical considerations and local expertise permit.

  3. Three-dimensional computed tomography angiography for the investigation of superficial temporal artery pseudoaneurysms--two case reports--.

    Science.gov (United States)

    Higashino, Takuya; Kawashima, Masatou; Mannoji, Hiromichi

    2005-03-01

    An 89-year-old man and a 60-year-old man presented with superficial temporal artery (STA) pseudoaneurysms which developed secondary to trauma. Conventional cerebral angiography and three-dimensional computed tomography (3D CT) angiography clearly demonstrated the STA pseudoaneurysms. The patients underwent surgical excision of the aneurysms based on the conventional cerebral angiography findings in one patient and 3D CT angiography findings in other patient. 3D CT angiography is an excellent noninvasive diagnostic method for detecting extracranial aneurysms such as STA pseudoaneurysm, especially the relationship between the aneurysm and surrounding structures, including the calvarium.

  4. Successful surgical repair of impending rupture of a pseudoaneurysm of the brachiocephalic artery with prior reconstruction of the carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Miyahara, Ken; Maeda, Masanobu; Sakai, Yoshimasa; Sakurai, Hajime; Murayama, Hiroomi; Hasegawa, Hiroki [Social Insurance Chukyo Hospital, Nagoya (Japan)

    2003-01-01

    We report the successful repair of impending rupture of a pseudoaneurysm of the brachiocephalic artery (BCA) in a 70-year-old man. He had undergone a mediastinal tumor resection through a median sternotomy in 1995. Pathological examination revealed non-Hodgkin's lymphoma. Two years later, he underwent radiation therapy of 65 Gray for metastasis to the supraclavicular lymph nodes. On January 18, 2000, plastic surgeons planned to perform a pectoralis major musculocutaneous flap to repair a radiation skin ulcer. During the operation, the BCA was lacerated, possibly in an area of radiation tissue damage. We performed a prosthetic graft (10-mm Gelseal) replacement of the BCA. The right subclavian artery had to be ligated. Postoperative digital subtraction angiography (DSA) showed excellent reconstruction of the artery. Magnetic resonance angiography of the brain showed a deficit in the anterior communicating artery and stenosis of the posterior communicating artery, which indicated that the reconstruction procedure was reasonable. Seven months later, on August 18, 2000, the patient was transferred to our hospital because of swelling of the right neck and oozing from the previous cutaneous wound. CT scan and DSA demonstrated the presence of a pseudoaneurysm of the proximal anastomosis site, which required emergency surgery. Before this third sternotomy, a saphenous vein graft was interposed between both external carotid arteries. Removal of the prosthetic graft and resection of the pseudoaneurysm were performed under mild hypothermia and cardiopulmonary bypass with left common carotid arterial perfusion. Then, the wound was closed completely using a left pectoralis major musculocutaneous flap. The postoperative course was uneventful and DSA showed good patency of the graft and intracranial arteries. The patient was discharged without neurological complications. We conclude that prior reconstruction of the carotid artery is a safe and effective procedure for patients

  5. Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology

    Energy Technology Data Exchange (ETDEWEB)

    Saad, Wael E. A., E-mail: wspikes@yahoo.com; Dasgupta, Niloy; Lippert, Allison J.; Turba, Ulku C.; Davies, Mark G. [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States); Kumer, Sean [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States); Gardenier, Jason C.; Sabri, Saher S.; Park, Auh-Whan [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States); Waldman, David L. [University of Rochester Medical Center, Department of Imaging Sciences (United States); Schmitt, Timothy [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States); Matsumoto, Alan H.; Angle, John F. [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States)

    2013-02-15

    To characterize extrahepatic pseudoaneurysm regarding incidence and etiology and determine the effectiveness of endovascular management. A retrospective audit of 1,857 liver transplants in two institutions was performed (1996-2009). Recipients' demographics, clinical presentation, transplant type, biliary anastomosis, and presence of biliary endoprostheses were noted. Pseudoaneurysms were classified into iatrogenic (associated with biliary endoprosthesis or angioplasty) or spontaneous extrahepatic pseudoaneurysms. Spontaneous and iatrogenic pseudoaneurysms were compared for time from transplant, presenting symptoms, location in the arterial anatomy, and 3-month graft survival. Arterial patency and 6-month graft survival were calculated. Twenty pseudoaneurysms were found (1.1 %, 20/1,857): 9 (0.5 % of transplants, 9/1,857) were spontaneous and 11 (0.6 % of transplants, 11/1,857) were 'iatrogenic' (due to minimally invasive procedures: 4 angioplasty and 7 biliary endoprostheses). Sixty percent (12/20) underwent endovascular management (4 coil embolization and 8 stent-grafts). Technical success was 83 % (10/12) with a mean arterial patency of 70 % (follow-up mean, 4.9; range, 0-18 months). The 1-, 3-, and 6-month graft survival was 70, 40, and 35 %, respectively. Due to minimally invasive procedures, posttransplant extrahepatic pseudoaneurysms are no longer an exclusive complication of the transplant surgery itself. Endovascular management is effective to stabilize patients but has not improved historic postsurgical graft survival.

  6. Hybrid approach in a difficult case of pseudoaneurysm of right common carotid artery.

    Science.gov (United States)

    Kumar, Dilip; Chakraborty, Saujatya; Banerjee, Sunip

    2015-12-01

    We present the case of a 65-year-old gentleman, who presented with a symptomatic pseudoaneurysm of the right common carotid artery. Because of high surgical risk, endovascular approach was decided upon. However, taking hardware across the lesion via the aortic arch provided us with insurmountable difficulties. Therefore, a hybrid approach was resorted to, in which an arteriotomy was done in the carotid artery followed by direct implantation of the stent. We were thus able to create a favorable trade-off between the high surgical risk of a full surgical procedure and the peri-operative benefit of an endovascular approach.

  7. Ultrasound and magnetic resonance angiography features of post-traumatic ulnar artery pseudoaneurysm: a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Coll Gimenez, David; Valencoso Gilabert, Oscar; Yanguas Muns, Carles [Fundacio Althaia. Xarxa Assistencial de Manresa, Department of Radiology, Barcelona (Spain); Gimenez Ruiz, Joan [Institut Medic per la Imatge, Department of Radiology, Barcelona (Spain); Badal Alter, Josep [Fundacio Althaia, Xarxa Assistencial de Manresa, Department of Pathology, Barcelona (Spain); Rosines Cubells, M.D. [Fundacio Althaia, Xarxa Assistencial de Manresa, Department of Orthopaedic Surgery, Barcelona (Spain)

    2009-09-15

    Ulnar artery pseudoaneurysms are very uncommon. The least common etiological mechanism is a single direct trauma. It is important to identify these lesions, which may have important clinical complications such as distal thrombosis with digital ischemia or gangrene. This report describes the features of sonography and magnetic resonance angiography of a histologically confirmed ulnar artery pseudoaneurysm. (orig.)

  8. Atypical presentation of a hepatic artery pseudoaneurysm: A case report and review of the literature

    Science.gov (United States)

    Luckhurst, Casey M; Perez, Chelsey; Collinsworth, Amy L; Trevino, Jose G

    2016-01-01

    Classically, hepatic artery pseudoaneurysms (HAPs) arise secondary to trauma or iatrogenic causes. With an increasing prevalence of laparoscopic procedures of the hepatobiliary system the risk of inadvertent injury to arterial vessels is increased. Pseudoaneurysm formation post injury can lead to serious consequences of rupture and subsequent hemorrhage, therefore intervention in all identified visceral pseudoaneurysms has been advocated. A variety of interventional methods have been proposed, with surgical management becoming the last step intervention when minimally invasive therapies have failed. The authors present a case of a HAP in a 56-year-old female presenting with jaundice and pruritis suggestive of a Klatskin’s tumor. This presentation of HAP in a patient without any significant past medical or surgical intervention is atypical when considering that the majority of HAP cases present secondary to iatrogenic causes or trauma. Multiple minimally invasive approaches were employed in an attempt to alleviate the symptomology which included jaundice and associated inflammatory changes. Ultimately, a right hepatic trisegmentectomy was required to adequately relieve the mass effect on biliary outflow obstruction and definitively address the HAP. The presentation of a HAP masquerading as a malignancy with jaundice and pruritis, rather than the classic symptoms of abdominal pain, anemia, and melena, is unique. This presentation is only further complicated by the absent history of either trauma or instrumentation. It is important to be aware of HAPs as a potential cause of jaundice in addition to the more commonly thought of etiologies. Furthermore, given the morbidity and mortality associated with pseudoaneurysm rupture, intervention in identifiable cases, either by minimally invasive or surgical interventions, is recommended. PMID:27366305

  9. Atypical presentation of a hepatic artery pseudoaneurysm:A case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Casey; M; Luckhurst; Chelsey; Perez; Amy; L; Collinsworth; Jose; G; Trevino

    2016-01-01

    Classically, hepatic artery pseudoaneurysms(HAPs) arise secondary to trauma or iatrogenic causes. With an increasing prevalence of laparoscopic procedures of the hepatobiliary system the risk of inadvertent injury to arterial vessels is increased. Pseudoaneurysm formation post injury can lead to serious consequences of rupture and subsequent hemorrhage, therefore intervention in all identified visceral pseudoaneurysms has been advocated. A variety of interventional methods have been proposed, with surgical management becoming the last step intervention when minimally invasive therapies have failed. The authors present a case of a HAP in a 56-year-old female presenting with jaundice and pruritis suggestive of a Klatskin’s tumor. This presentation of HAP in a patient without any significant past medical or surgical intervention is atypical when considering that the majority of HAP cases present secondary to iatrogenic causes or trauma. Multiple minimally invasive approaches were employed in an attempt to alleviate the symptomology which included jaundice and associated inflammatory changes. Ultimately, a right hepatic trisegmentectomy was required to adequately relieve the mass effect on biliary outflow obstruction and definitively address the HAP. The presentation of a HAP masquerading as a malignancy with jaundice and pruritis, rather than the classic symptoms of abdominalpain, anemia, and melena, is unique. This presentation is only further complicated by the absent history of either trauma or instrumentation. It is important to be aware of HAPs as a potential cause of jaundice in addition to the more commonly thought of etiologies. Furthermore, given the morbidity and mortality associated with pseudoaneurysm rupture, intervention in identifiable cases, either by minimally invasive or surgical interventions, is recommended.

  10. Subclavian artery pseudoaneurysm complicating central venous catheterization: endovascular treatment with Amplatzer Vascular Plug 4 and covered stent.

    Science.gov (United States)

    Rossi, Umberto G; Petrocelli, Francesco; Ferro, Carlo

    2013-12-01

    Central venous catheterization is a routine vascular access procedure; however, it may be associated with life-threatening complications such as arterial puncture, leading to pseudoaneurysm formation. We report a case of a 41-year-old female that developed an iatrogenic left subclavian pseudoaneurysm complicating the attempt of left internal jugular vein cannulation for temporary hemodialysis therapy. The patient underwent urgent endovascular treatment with deployment of covered stent into the left subclavian artery (SCA) after embolization of the origin of the left internal mammary artery with Amplatzer Vascular Plug 4. The patient's recovery was unremarkable. Follow-up till 24 months reveals total exclusion of the pseudoaneurysm of the left SCA with patency of the distal branches.

  11. Splenic artery pseudoaneurysm due to seatbelt injury in a glucose-6-phosphate dehydrogenase-deficient adult.

    Science.gov (United States)

    Lau, Yu Zhen; Lau, Yuk Fai; Lai, Kang Yiu; Lau, Chu Pak

    2013-11-01

    A 23-year-old man presented with abdominal pain after suffering blunt trauma caused by a seatbelt injury. His low platelet count of 137 × 10(9)/L was initially attributed to trauma and his underlying hypersplenism due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Despite conservative management, his platelet count remained persistently reduced even after his haemoglobin and clotting abnormalities were stabilised. After a week, follow-up imaging revealed an incidental finding of a pseudoaneurysm (measuring 9 mm × 8 mm × 10 mm) adjacent to a splenic laceration. The pseudoaneurysm was successfully closed via transcatheter glue embolisation; 20% of the spleen was also embolised. A week later, the platelet count normalised, and the patient was subsequently discharged. This case highlights the pitfalls in the detection of a delayed occurrence of splenic artery pseudoaneurysm after blunt injury via routine delayed phase computed tomography. While splenomegaly in G6PD may be a predisposing factor for injury, a low platelet count should arouse suspicion of internal haemorrhage rather than hypersplenism.

  12. Pancreatitis-associated pseudoaneurysm of the splenic artery presenting as lower gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Khalife, Mohammad; Faraj, Walid; Mukherji, Deborah; Haydar, Ali

    2012-12-03

    Pancreatitis is a known cause of pseudoaneurysms of the peripancreatic arteries, which can rarely rupture into various adjacent structures and become a source of life-threatening bleeding. The management is challenging and requires an individualised approach and multidisciplinary care. Herein, we present the case of a 24-year-old man in whom a splenic pseudoaneurysm ruptured into the adjacent infected pseudocyst, communicating with the colon by a fistulous tract, causing massive lower gastrointestinal bleeding. This was successfully managed by transcatheter arterial embolisation (TAE).

  13. Diagnosis and treatment of spontaneous coronary artery pseudoaneurysm: Rare anomaly with potentially significant clinical implications.

    Science.gov (United States)

    Kar, Subrata; Webel, Richard R

    2017-03-04

    Spontaneous coronary artery pseudoaneurysm (PSA, false aneurysm) is an extremely rare occurrence with the precise incidence unknown. It is defined as an outwardly bulging monolayer or double layer within the coronary artery that lacks all 3 layers (intima, media, and adventitia) of the arterial wall. Coronary PSA commonly occurs from arterial dissection or perforation induced by catheter intervention, infection, pregnancy, or trauma. Traumatic dissection or perforation of the coronary artery after a percutaneous coronary intervention (PCI) remains the most common cause. Such cases may progress to myocardial ischemia, acute myocardial infarction, or acute coronary artery rupture causing death from cardiac tamponade. Intravascular ultrasound or cardiac computed tomography may aid in the diagnosis. Treatment options include PCI with a covered stent, bare or drug-eluting stent, coil embolization, coronary artery bypass graft with isolation of the PSA, or conservative management with vigilant clinical follow-up. In this review, we sought to describe the diagnosis, etiology, treatment, and the limited literature on spontaneous coronary artery PSA. © 2017 Wiley Periodicals, Inc.

  14. Pseudoaneurysm of gastroduodenal artery due to duodenal ulcer causing jaundice and interstitial pancreatitis but not gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Jovanović Miodrag

    2004-01-01

    Full Text Available Aneurysms and pseudoaneurysms of the gastroduodenal artery are rare with less then 50 cases reported. Most frequently they are one of the consequences of pancreatitis much rarer duodenal ulcer or operative trauma during gastrectomy for duodenal ulcer or choledochotomy. We report on a 47 year-old man, chronic heavy alcohol consumer in whom a chronic postbulbar duodenal ulcer destroyed much of the back wall of the duodenum, eroded gastroduodenal artery causing pseudo-aneurysm but without noticeable gastrointestinal bleeding. The patient had jaundice of obstructive type and elevated amilase. After Billroth II gastrectomy, suture of the gastroduodenal artery, cholecystectomy and T tube drainage of the common bile duct the patient developed intestinal obstruction caused by two interintestinal abscesses so that he had to be reoperated. After that he had a successful recovery, his general health greatly improved, he gained 15 kg in weight but two years after surgery he again started with heavy drinking and soon died due to serious brain damage. The case is rare and unusual at least for few reasons: First, the pseudoaneurysm was caused by duodenal ulcer. Second, a serious gastrointestinal bleeding did not take place. Third, the pseudoaneurysm was diagnosed by Doppler ultrasonography while angiography failed to opacity it due to thrombosis of the artery.

  15. A rare cause of bleeding after laparoscopic sleeve gastrectomy : pseudo-aneurysm of the gastro-omental artery.

    Science.gov (United States)

    Mege, D; Louis, G; Berthet, B

    2013-01-01

    A serious complication of laparoscopic sleeve gastrectomy (LSG) is bleeding that is primarily located along the staples lines. Bleeding may be due to several causes, including hematomas, trocar sites, or visceral pseudo-aneurysms. We reported here a case of bleeding related to a pseudo-aneurysm of the gastro-omental artery. An LSG was performed on a 43-year-old woman (BMI = 46 kg/m2) without apparent surgical complications. Fifteen days later, she was admitted to the emergency department for hematemesis and symptoms of hemorrhagic shock. Abdominal computed tomography angiography revealed blood in the stomach, without a digestive leak, and active bleeding from a pseudo-aneurysm of the gastro-omental artery. An arterial embolisation was performed with the sandwich technique and angiographic guide wires and the placement of several detachable coils. The patient was discharged two days later. We demonstrated for the first time that post-LSG bleeding may involve a pseudo-aneurysm of the gastro-omental artery.

  16. Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography.

    Science.gov (United States)

    Rahman, Shahid; Abdul-Waheed, Mohammed; Helmy, Tarek; Huffman, Lynn C; Koshal, Vipin; Guitron, Julian; Merrill, Walter H; Lewis, David F; Dunlap, Stephanie; Shizukuda, Yukitaka; Weintraub, Neal L; Meyer, Christopher; Cilingiroglu, Mehmet

    2009-04-01

    We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures.

  17. Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography

    Directory of Open Access Journals (Sweden)

    Weintraub Nealw F

    2009-04-01

    Full Text Available Abstract We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures.

  18. Sudden sensorineural hearing loss associated with internal carotid artery pseudoaneurysm: causal or incidental?

    Science.gov (United States)

    Palma, Silvia; Soloperto, Davide; Casoni, Federica; Rovati, Raffaella; Galassi, Giuliana

    2013-03-01

    Sudden deafness is acute onset of impaired hearing which develops within hours to few days. The commonly accepted audiometric criterion is a decrease in hearing of ≥ 30 dB, affecting at least three consecutive frequencies. Hearing loss is thought to involve several causative factors, including internal ear circulatory disturbances. We report the case of a female with an internal carotid artery (ICA) pseudoaneurysm in the distal cervical tract and unilateral sudden sensorineural hearing loss (SSNHL). As putative risk vascular factor, the patient had history of migraine since youth. Extensive screenings for autoimmune, rheumatic diseases, virological, and microbiological infections were negative. The patient denied recent cervical trauma. Furosemide and oral prednisone were given with initial benefit and withdrawn in 3 weeks. The patient experienced short-lasting episodes of headache, tinnitus, vertigo. Five weeks after first onset, she underwent magnetic resonance imaging (MRI) angiogram which revealed fusiform dilatation of left ICA in the cervical tract. It can be proposed, but it remains to be proved, that the pseudoaneurysm of the cervical ICA plays a role in the patient SSNHL in relation to turbulent flow or thromboembolism of branches to the inner ear.

  19. The occurrence of a pseudoaneurysm of the hepatic artery within the thrombosed portal vein of a patient with chronic pancreatitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Soo; Jang, Kyung Mi; Kim, Min Jeong; Yoon, Hoi Soo; Lee, Hyun; Jeon, Eui Yong; Lee, Kwan Seop; Lee, Yul [College of Medicine, Hallym University, Anyang (Korea, Republic of)

    2008-04-15

    A pseudoaneurysm is an uncommon but important life threatening complication of chronic pancreatitis. The arteries most commonly affected by a pseudoaneurysm are (in decreasing percent occurrence), the splenic (40%), gastroduodenal (30%), pancreaticoduodenal (20%), gastric (5%), hepatic (2%), and others (superior mesenteric, jejunal, ileocecal, and aorta) (1-3%). Thrombosis of the splenic or portal vein is another important complication of chronic pancreatitis. In this case report, we present a rare complication in the form of a right hepatic artery pseudoaneurysm which developed within the thrombosed right portal vein of a 35-year-old woman afflicted with chronic pancreatitis.

  20. Two cases of cystic artery pseudoaneurysm rupture due to acute cholecystitis with gallstone impaction in the neck.

    Science.gov (United States)

    Kaida, Shogo; Arahata, Kyouko; Itou, Asako; Takarabe, Sakiko; Kimura, Kayoko; Kishikawa, Hiroshi; Nishida, Jiro; Fujiyama, Yoshiki; Takigawa, Yutaka; Matsui, Junichi

    2016-09-01

    A cystic artery aneurysm is a rare cause of hemobilia. Herein, we report two cases of acute cholecystitis with a ruptured cystic artery pseudoaneurysm. Two patients (a 69-year-old man and an 83-year-old man) were admitted to our hospital because of acute cholecystitis with gallstone impaction in the neck. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed for both patients. After a few days of PTGBD, gallbladder hemorrhage was observed. Abdominal angiography showed cystic artery aneurysm. A transcatheter arterial embolization was therefore performed, followed by an open cholecystectomy.

  1. Blunt traumatic superior gluteal artery pseudoaneurysm presenting as gluteal hematoma without bony injury: A rare case report

    Institute of Scientific and Technical Information of China (English)

    Annu Babu; Amit Gupta; Pawan Sharma; Piyush Ranjan; Atin Kumar

    2016-01-01

    Blunt traumatic injuries to the superior gluteal artery are rare in clinic.A majority of injuries present as aneurysms following penetrating trauma,fracture pelvis or posterior dislocation of the hip joint.We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury.The gluteal hematoma was suspected clinically,confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma.Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery,which was successfully angioembolized.The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma.This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling.Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.

  2. Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting

    Institute of Scientific and Technical Information of China (English)

    Cynthia Sudar Singh; Kamini Giri; Renuka Gupta; Mohammed Aladdin; Harinder Sawhney

    2006-01-01

    A 41-year old alchoholic male with a history of chronic pancreatitis was admitted for nausea, vomiting and weight loss. Angiogram was performed and demonstrated an aneurysmal sac with a narrow neck originating from the inferior aspect of the distal portion of the proper hepatic artery. The origin of the pseudoaneurysm was covered with a 5 mm × 2.5 cm Viabahn cover stent (Gore). A repeat angiogram showed some leak and a second stent (6 mm × 2.3 cm)was deployed and overlapped with the first stent by 3 mm. Contrast was injected and a repeat angiogram demonstrated complete exclusion of the aneurysm. A repeat computerized axial tomography (CAT) scan of the abdomen after 24 h showed successful stenting. The patient had an uneventful post-operative course.

  3. Life-threatening rupture of an external iliac artery pseudoaneurysm caused by necrotizing fasciitis following laparoscopic radical cystectomy: a case report

    OpenAIRE

    Hata, Shinro; Satoh, Ryuta; Shin, Toshitaka; Mori, Kenichi; Sumino, Yasuhiro; Satoh, Fuminori; Mimata, Hiromitsu

    2014-01-01

    Background Pseudoaneurysms are caused by trauma, tumors, infections, vasculitis, atherosclerosis and iatrogenic complications. In this paper, we report about a patient with rupture of an external iliac artery pseudoaneurysm, which lead to hemorrhagic shock, after undergoing laparoscopic radical cystectomy and extended pelvic lymphadenectomy. Case presentation The patient was a 68-year-old Japanese male diagnosed with invasive bladder cancer. Laparoscopic radical cystectomy and extended pelvic...

  4. Endovascular Treatment of Two Pseudoaneurysms Originating From the Left Ventricle

    Energy Technology Data Exchange (ETDEWEB)

    Cwikiel, Wojciech, E-mail: wcwikiel@gmail.com; Keussen, Inger [Skane University Hospital, Department of Radiology (Sweden); Gustafsson, Ronny; Mokhtari, Arash [Skane University Hospital, Department of Thoracic Surgery (Sweden)

    2013-12-15

    A 67-year-old woman resented with an acute type A aortic dissection, which was treated surgically with aortic valve replacement as a composite graft with reimplantation of the coronary arteries. At the end of surgery, a left-ventricular venting catheter was placed through the apex and closed with a buffered suture. Consecutive computed tomography (CT) examinations verified a growing apex pseudoaneurysm. Communication between the ventricle and the pseudoaneurysm was successfully closed with an Amplatz septal plug by the transfemoral route. Follow-up CT showed an additional pseudoaneurysm, which also was successfully closed using the same method.

  5. Endovascular therapy using flow diversion for giant internal carotid artery pseudoaneurysm arising in the setting of an invasive pituitary macroadenoma

    Science.gov (United States)

    Syed, Almas; Marashi, Keyan B.; O'Rourke, Brian D.; Hise, Joseph H.; Opatowsky, Michael J.; Layton, Kennith F.

    2017-01-01

    This report illustrates the unusual occurrence of a pseudoaneurysm arising in the setting of a skull base mass and describes the first reported use of endovascular flow diversion therapy in such a setting. A 63-year-old man with occasional headaches during the preceding month presented with the acute onset of severe left retroorbital headache and oculomotor nerve palsy. Computed tomography (CT) and CT angiogram revealed a destructive skull base mass with an associated giant probable pseudoaneurysm of the cavernous segment of the left internal carotid artery. The patient underwent endoscopic transsphenoidal biopsy with a subsequent diagnosis of prolactinoma. Endovascular therapy utilizing two Pipeline™ flow diversion embolization devices was performed with subsequent resolution of the patient's headache and improvement in his cranial nerve deficits/cavernous sinus syndrome. PMID:28127130

  6. Pulmonary artery stenosis caused by a large aortic arch pseudoaneurysm detected 10 years after a minor trauma

    Directory of Open Access Journals (Sweden)

    Jalal Zamani

    2016-03-01

    Full Text Available Pseudoaneurysm of aorta is a rare condition usually seen after aortic surgeries or serious accidents. Here we report a 60 years old man without any previous medical condition who presented with non-specific symptoms and underwent different investigations for more than 1 year, until the presence of a continuous murmur raised suspicion toward his cardiovascular system. In echocardiographic and computed tomography (CT angiographic studies a large pseudoaneurysm of aortic arch with compression effect on pulmonary artery was detected. At this stage he remembered having suffered a minor trauma 10 years ago. He finally underwent operation and his aortic wall was repaired successfully with a patch. This case highlights the importance of thorough history taking and physical examination in patients irrespective of symptoms and high index of suspicion to detect this life-threatening condition.

  7. A New Flow Control Technique Using Diluted Epinephrine in the N-butyl-2-cyanoacrylate Embolization of Visceral Artery Pseudoaneurysms Secondary to Chronic Pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Morishita, Hiroyuki, E-mail: hmorif@koto.kpu-m.ac.jp [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Yamagami, Takuji [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan); Takeuchi, Yoshito [National Cancer Center, Division of Diagnostic Radiology (Japan); Matsumoto, Tomohiro; Asai, Shunsuke; Masui, Koji [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Sato, Hideki [Japan Red Cross Kyoto Daiichi Hospital, Department of Gastroenterology (Japan); Taniguchi, Fumihiro [Japan Red Cross Kyoto Daiichi Hospital, Department of Surgery (Japan); Sato, Osamu [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan)

    2012-08-15

    Although n-butyl-2-cyanoacrylate (NBCA) has been used as an effective liquid embolization material, its indication for pseudoaneurysms has seemingly been limited because of the technical difficulties of using NBCA, such as reflux to the parent artery and causing significant infarction. Thus, considerable skill in using NBCA or a device to control blood flow during its polymerization is required to achieve embolization without severe complications. We report our new technique for controlling blood flow using diluted epinephrine in transcatheter arterial NBCA embolization of five pseudoaneurysms in four cases secondary to hemosuccus pancreaticus.

  8. Pseudoaneurysm after arthroscopic procedure in the knee

    Directory of Open Access Journals (Sweden)

    Edmar Stieven Filho

    2015-04-01

    Full Text Available The aim of this study was to review all cases of pseudoaneurysm in the literature, in predominantly arthroscopic procedures on the knee, and to report on a case of pseudoaneurysm that we treated. A bibliographic search was conducted for scientific articles published in Brazilian and foreign periodicals over the last 23 years. Forty-seven cases were found, in 40 articles. In addition to these 47 cases, there was the case that we treated, which was also included in the data. Among the operations that progressed with formation of a pseudoaneurysm, 60% were cases of meniscal injuries and 23%, anterior cruciate ligament injuries. In 46% of the cases, the artery affected with the popliteal, and in 21%, the inferomedial genicular artery. The commonest clinical symptom was pain (37%, followed by pulsating tumor (31%, edema of the calf (12% and hemarthrosis (11%. The median time taken to make the diagnosis was 11 days, but it ranged from one day to 10 weeks after the procedure. Although rare, pseudoaneurysms are a risk that is inherent to arthroscopic surgery. All patients should be made aware of the vascular risks, even in small-scale procedures.

  9. Ultrasound-guided Thrombin Injection: An Alternative Treatment for Femoral Artery Pseudoaneurysm with Better Efficiency and Safety

    Institute of Scientific and Technical Information of China (English)

    Qinghai YAO; Hongliang CONG; Shangqin WU; Shan SUN; Qike DONG; Dongmei CHEN; Peng LI

    2008-01-01

    The aim of this study was to evaluate the efficiency and safety of ultrasound-guided thrombin injection on femoral pseudoaneurysm (FPA) as compared to ultrasound-guided local oppression. Eleven cases of FPA were enrolled and 7 cases received ultrasound-guide thrombin injection (injection group), and the remaining 4 cases were treated with local oppression (oppression group). Efficiency and safety were analyzed by ultrasound and subsequent follow-up. The results showed that 1 case relapsed in oppression group while no relapse occurred in thrombin injection group. Ultrasound-guided thrombin injection is better for treatment of FPA in terms of effectiveness and safety.

  10. Ruptured pseudoaneurysm of the middle meningeal artery presenting with a temporal lobe hematoma and a contralateral subdural hematoma

    Directory of Open Access Journals (Sweden)

    Eric Marvin

    2016-01-01

    Conclusions: The presence of a fracture over the MMA and intraparenchymal hematoma should prompt suspicion for a traumatic pseudoaneurysm. Pseudoaneurysms of the MMA can cause catastrophic bleeding, and prompt treatment is necessary. Endovascular embolization is an effective method that decreases the hemorrhage risk of MMA pseudoaneurysms.

  11. Traumatic basilar pseudoaneurysm with a basilar-cavernous arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Connor, S.E.J.; Deasy, N.P.; Jeffree, M.A. [Dept. of Neuroradiology, King' s Coll. Hospital, London (United Kingdom); Martin, A.J.; Strong, A.J. [Dept. of Neurosurgery, King' s Coll. Hospital, London (United Kingdom)

    2001-03-01

    A traumatic pseudoaneurysm of the basilar artery with a basilar-cavernous sinus arteriovenous fistula was diagnosed in a 12-year-old girl using CT, MRI and angiography. It was successfully treated by coil embolisation. We speculate on the mode of formation of this rare traumatic lesion. (orig.)

  12. Segmental embolization of the gastroduodenal artery in a case of a perforated pseudoaneurysm and gastrointestinal bleeding; Segmentembolisation der Arteria gastroduodenalis bei perforiertem Pseudoaneurysma und gastrointestinaler Massivblutung

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany); Inst. fuer Diagnostische und Interventionelle Radiologie der Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany); Cavallaro, A.; Bautz, W. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany)

    2004-07-01

    We present the history of a woman suffering from an extensive gastrointestinal bleeding due to liver cirrhosis and chronic pancreatitis. Selective angiogram of the celiac artery revealed a pseudoaneurysm of the gastroduodenal artery caused by inflammatory wall penetration. The life-threatening hemorrhage was completely stopped by embolization with three stainless steel coils after microcatheter engagement of the gastroduodenal artery. The particularity of this case is the restricted embolization of the aneurysm vessel segment, so the collateral circulation of the gastroduodenal and pancreaticoduodenal artery could be preserved. (orig.)

  13. Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lagana, Domenico [Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese (Italy); Carrafiello, Gianpaolo [Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese (Italy)]. E-mail: gcarraf@tin.it; Mangini, Monica [Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese (Italy)]. E-mail: monica.mangini@tin.it; Dionigi, Gianlorenzo [Department of Surgery, University of Insubria, Varese (Italy); Caronno, Roberto [Vascular Surgery, University of Insubria, Varese (Italy); Castelli, Patrizio [Vascular Surgery, University of Insubria, Varese (Italy); Fugazzola, Carlo [Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese (Italy)

    2006-07-15

    Purpose: To assess the feasibility and the effectiveness of endovascular treatment of visceral arteries aneurysms (VAAs) using a 'multimodal approach'. Material and methods: Twenty-five patients (mean age 60.1 years) with 29 VAAs (13 splenic, 4 hepatic, 3 gastroduodenal, 6 renal, 2 pancreatic-duodenal, 1 superior mesenteric) were considered suitable for endovascular treatment; 8/29 were ruptured. Saccular aneurysms (9/29) were treated by sac embolization with coils (in 4 cases associated with cyanoacrylate or thrombin) with preservation of artery patency. Fusiform aneurysms (6/29), were treated by an 'endovascular exclusion'. In 10/29 cases, supplied by a terminal branch, we performed an embolization of the afferent artery, with coils and cyanoacrylate or thrombin. 2/29 cases were treated with a stent-graft and 2/29 cases with a percutaneous ultrasound-guided thrombin injection and coils embolization of the afferent artery. The follow-up was performed by ultrasonography and/or CT-angiography 1 week after the procedure and then after 1, 6, and 12 months and thereafter annually. Results: In 29/29 cases we obtained an immediate exclusion. Two patient died for other reasons. Complication rate was 27.6% (7 spleen ischemia and 1 stent-graft occlusion). During the follow-up (range: 7 days-36 months, mean 18.7 months), we observed 3/29 (10.3%) cases of reperfusion in the first month, all treated successfully with a further endovascular procedure. Primary technical success was 89.7%; secondary technical success was 100%. Conclusion: Endovascular therapy can be considered a feasible and effective approach for VAAs with good primary and secondary success rates.

  14. Endoscopic ultrasound guided thrombin injection of angiographically occult pancreatitis associated visceral artery pseudoaneurysms:Case series

    Institute of Scientific and Technical Information of China (English)

    Shivanand; Gamanagatti; Usha; Thingujam; Pramod; Garg; Surajkumar; Nongthombam; Nihar; Ranjan; Dash

    2015-01-01

    Pseudoaneurysm is a known complication of pancreatitis associated with significant mortality and morbidity. Imaging plays an important role in the diagnosis and management. Computed tomography(CT) helps localize the lesion and the severity of the background pancreatitis but digital subtraction angiography with coil embolization is recommended to avoid bleeding and inadvertent surgery. However, in cases where angiographic coil embolization is not feasible due to technical reasons, thrombin injection via CT or ultrasound guidance remains a viable option and often described in literature. In this series, effort has been made to highlight the role of endoscopic ultrasound guided thrombin instillation especially in patients with poorly visualized pseudoaneurysm on ultrasound thereby avoiding surgery and the associated mortality and morbidity.

  15. Use of Intrauterine Balloon Tamponade Test to Determine the Feasibility of Dilation and Evacuation as a Treatment for Early Uterine Artery Pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Liangcheng Wang

    2016-12-01

    Full Text Available Uterine artery embolization is the most common treatment for uterine vascular abnormalities. Herein, we report the successful use of dilation and evacuation as a treatment for uterine artery pseudoaneurysm. A 36-year-old woman complained of vaginal bleeding after an uncomplicated vaginal delivery. Ultrasonography showed a 12.8-mm anechoic area inside the uterus. Color Doppler revealed a to-and-fro sign, indicating an arteriovenous malformation. A blood test showed a low level of human chorionic gonadotropin. Therefore, a diagnosis of early uterine artery pseudoaneurysm following spontaneous delivery was suspected. Under monitoring with transabdominal color Doppler sonography, intrauterine balloon tamponade induced complete disappearance of abnormal blood flow. With bleeding determined to be under control with balloon tamponade, dilation and evacuation was performed. The patient had a favorable postoperative course.

  16. Post-traumatic hepatic pseudoaneurysms in children

    Energy Technology Data Exchange (ETDEWEB)

    Sidhu, M.K. [Department of Diagnostic Imaging, Children`s Hospital Oakland, CA (United States); Shaw, D.W.W. [Department of Radiology, Children`s Hospital and Medical Center, Seattle, Washington (United States); Daly, C.P. [Department of Radiology, University of Washington Hospital and Medical Center, Seattle, Washington (United States); Waldhausen, J.H. [Department of Surgery, Children`s Hospital and Medical Center, Seattle, Washington (United States); Coldwell, D. [Department of Radiology, Denver General Hospital, Denver, Colorado (United States)

    1999-01-01

    Background. Post-traumatic hepatic artery pseudoaneurysms are rarely seen in children. Materials and methods. We retrospectively reviewed the radiologic studies and medical records of three patients treated at our institution and reviewed the literature. The patients (ages 5-13 years) presented immediately to 2 months after blunt (two patients) and penetrating (one patient) trauma. The hepatic pseudoaneurysms were discovered during work-up for fever (one patient), gastrointestinal bleeding and hyperbilirubinemia (one patient), or widened mediastinum (one patient) on chest radiograph. In two patients, the diagnosis was initially suspected by computed tomography (CT) examination and confirmed by angiography. In the third patient, the diagnosis was made initially by angiography. All three pseudoaneurysms were treated with transcatheter embolization. Results. All three embolizations were initially technically successful. However, there was recurrence in one case, in which embolization distal to the neck of the pseudoaneurysms was not technically possible. With conservative management, however, the residual lesion demonstrated spontaneous occlusion by ultrasound (US) at 6 months. Conclusion. This uncommon complication of liver trauma in children can have a delayed presentation, can be clinically unsuspected, and can follow blunt or penetrating trauma. Endovascular embolotherapy is the treatment of choice. (orig.) With 3 figs., 22 refs.

  17. Interventional Therapy of Splenic Artery Aneurysms and Pseudoaneurysms%脾动脉瘤的介入治疗

    Institute of Scientific and Technical Information of China (English)

    宋进华; 顾建平; 楼文胜; 何旭; 陈亮; 陈国平; 苏浩波; 汪涛

    2012-01-01

    Objective To evaluate the value of the endovascular interventional therapy in treatment of splenic artery an-eurysms and pseudoaneurysms. Methods Sixteen patients with splenic artery aneurysms (n - 10) and false aneurysms (n=6) proveded by color doppler ultrasound, CT and DSA angiography were collected in the study. Embolization with coils were carried out to the artery aneurysms or parent artery in 14 cases. Coils were deployed into the aneurysms assisted by stents in 2 case. Routine blood tests and serum amylase were checked at 3 and 7 days after the procedure. Enhanced CT was performed at 7 days, 3 and 6 months after the procedure. Results The splenic artery has been embolized successfully in 14 cases. The aneurysms and pseudoaneurysms in all patients were not enhanced on CT angiography at 3 or 6 months after embolization. Complete aneurysms thrombosis and normal splenic artery branching has been showed on CT images 3 or 6 months after the stents and coils implanted in 2 cases. Low grade fever and bellyache were occurred after embolization in 7 and 8 cases respectively, which were relieved after 3 to 5 days. Transient elevation of serum aniylase was recovered in 1 week in 5 patients. Conclusion Endovascular treatment is a simple ,minimally invasive, safe and effective treatment for splenic artery aneurysms and pseudoaneurysms.%目的 探讨介入血管腔内治疗脾动脉瘤的临床价值.方法 16例脾动脉瘤患者,其中真性脾动脉瘤10例,假性脾动脉瘤6例,介入治疗术前均经血管超声、CT及DSA明确诊断.14例行弹簧圈动脉瘤或载瘤动脉栓塞术,2例采用支架辅助弹簧圈瘤体内填塞.患者术后3天和1周复查血常规和血淀粉酶;术后1周、3个月、6个月CT增强扫描复查.结果 14例弹簧圈栓塞患者术后CT增强扫描均未见栓塞以远脾动脉主干显影,动脉瘤体无对比剂填充,2例支架辅助弹簧圈瘤体内填塞患者术后3个月、6个月CT增强扫描示脾动脉主干及

  18. [Late complication of surgical repair of aortic coarctation: ruptured pseudoaneurysm of the aorta treated by thoracic endovascular aortic repair].

    Science.gov (United States)

    Varejka, P; Lubanda, J C; Prochazka, P; Heller, S; Beran, S; Dostal, O; Charvat, F; Horejs, J; Semrad, M; Linhart, A

    2010-06-01

    Aortic coarctation is a frequent congenital defect requiring early surgical treatment. Late complications of these surgical procedures can be fatal as in the case of a ruptured anastomotic pseudoaneurysm. We present a case of a 49-year-old man presenting with hemorrhagic shock due to this complication who was successfully treated by endovascular techniques with implantation of two stent grafts. This case illustrates the fact that endovascular aortic repair is feasible, certainly less invasive and very efficient for this type of complication when used in an experienced center.

  19. Percutaneous Ultrasound-Guided Thrombin Injection in Iatrogenic Arterial Pseudoaneurysms: Effectiveness and Complications

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Young Hwan [Boramae Hospital, Seoul (Korea, Republic of); Kim, Hak Soo; Kim, Hyung Sik; Min, Seung Kee [Gachon Medical School, Incheon (Korea, Republic of)

    2005-09-15

    To evaluate and describe the efficacy and side effects of a percutaneous thrombin injection under ultrasonography guidance for the treatment of iatrogenic pseudo aneurysms Eighteen consecutive iatrogenic pseudo aneurysm cases were treated with a thrombin injection. The thrombin was injected into the pseudo aneurysm cavity using a 22-gauge needle under ultrasonographic guidance. The causes of the pseudo aneurysms are as follows: post coronary angiography (9 cases), percutaneous coronary balloon angioplasty (5 cases), cerebral angiography (1 case), transhepatic chemo embolization (1 case), percutaneous trans femoral arterial stent insertion (1 case) and bone marrow aspiration for a marrow transplant (1 case). Only one case required a secondary thrombin injection due to recurrent flow in the pseudo aneurysm lumen, which was detected at the follow up Doppler ultrasound. Other seventeen cases were successfully treated on the first trial. There were no technical failures or complication related to the procedure. The average amount of thrombin injected was 733 IU. Nine out of 18 treated patients (50%) showed mild reactions to the thrombin including mild fever (4 cases), chilling sensation (3 cases), a chilling sensation with mild dyspnea (1 case), mild chest discomfort (1 case) after the thrombin injection. All these side effects were transient and improved several hours later. All the iatrogenic pseudo aneurysms were treated successfully with an ultrasound-guided percutaneous thrombin injection. There was a high rate of hypersensitivity to the bovine thrombin, which precaution should be taken to prevent more serious side effects

  20. Embolization of a Large Pancreatic Pseudoaneurysm Converted from Pseudocyst (Hemorrhagic Pseudocyst

    Directory of Open Access Journals (Sweden)

    Karlo Novacic

    2008-05-01

    Full Text Available Context Bleeding pancreatic pseudoaneurysms are a rare complication of chronic pancreatitis with a severe prognosis and high mortality. Conversion of a pancreatic pseudocyst into a pseudoaneurysm is a potentially lethal complication because, when rupture occurs, there is a high mortality rate. Case report We describe a case of pancreatic pseudoaneurysm converted from a pseudocyst. A 57-year-old man with chronic pancreatitis and alcoholic liver cirrhosis presented with abdominal pain in the upper epigastric region. CT and a selective angiogram of the superior mesenteric artery showed a large bleeding pancreatic pseudoaneurysm. The pseudoaneurysm was successfully treated with coil embolization of the feeding artery. Conclusion Endovascular trans-catheter embolization for the treatment of pancreatic pseudoaneurysms is a safe, effective and repeatable procedure with high success rates and it should be used as a treatment of choice in appropriate patients, either as a temporizing measure to control active bleeding and allow hemodynamic stabilization for a surgical procedure or as a definitive treatment.

  1. Synchronous infection of the aorta and the testis: emphysematous epididymo-orchitis, abdominal aortic mycotic aneurysm, and testicular artery pseudoaneurysm diagnosed by use of MDCT.

    Science.gov (United States)

    Hegde, Rahul G; Balani, Ankit; Merchant, Suleman A; Joshi, Anagha R

    2014-07-01

    We report clinical details and imaging findings for a case of emphysematous epididymo-orchitis with co-existing mycotic abdominal aortic aneurysm and a testicular artery pseudoaneurysm in a diabetic 65-year-old male. We report imaging findings from ultrasonography (USG) and contrast-enhanced multidetector computed tomography (MDCT). Use of MDCT to identify, confirm, and define the extent of the disease, and its utility in understanding the pathogenesis of this rare condition are highlighted. For such lethal infections, early diagnosis and intervention can be lifesaving; imaging can be of crucial importance in this.

  2. Pseudo-aneurysm of the anterior tibial artery, a rare cause of ankle swelling following a sports injury

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    McAteer Eamon

    2005-10-01

    Full Text Available Abstract Background Ankle pain and swelling following sports injuries are common presenting complaints to the accident and emergency department. Frequently these are diagnosed as musculoskeletal injuries, even when no definitive cause is found. Vascular injuries following trauma are uncommon and are an extremely rare cause of ankle swelling and pain. These injuries may however be limb threatening and are important to diagnose early, in order that appropriate treatment can be delivered. We highlight the steps to diagnosis of these injuries, and methods of managing these injuries. It is important for clinicians to be aware of the potential for this injury in patients with seemingly innocuous trauma from sports injuries, who have significant ankle pain and swelling. Case presentation A young, professional sportsman presented with a swollen, painful ankle after an innocuous hyper-plantar flexion injury whilst playing football, which was initially diagnosed as a ligamentous injury after no bony injury was revealed on X-Ray. He returned 2 days later with a large ulcer at the lateral malleolus and further investigation by duplex ultrasound and transfemoral arteriogram revealed a Pseudo-Aneurysm of the Anterior Tibial Artery. This was initially managed with percutaneous injection of thrombin, and later open surgery to ligate the feeding vessel. The patient recovered fully and was able to return to recreational sport. Conclusion Vascular injuries remain a rare cause of ankle pain and swelling following sports injuries, however it is important to consider these injuries when no definite musculo-skeletal cause is found. Ultrasound duplex and Transfemoral arteriogram are appropriate, sensitive modalities for investigation, and may allow novel treatment to be directed percutaneously. Early diagnosis and intervention are essential for the successful outcome in these patients.

  3. Giant Pseudoaneurysm Associated with Arteriovenous Fistula of the Brachial and Femoral Arteries following Gunshot Wounds: Report of Two Cases

    Science.gov (United States)

    Daniel, Handy Eone; Firmin, Ankouane; Angele, Pondy O.; Esthelle, Minka Ngom; Freddy, Bombah; Bernadette, Ngo Nonga

    2015-01-01

    Posttraumatic pseudoaneurysm associated with arteriovenous fistula of the upper or lower limb is exceptional. We are reporting herein the history of two cases in civil life that have been followed and repaired in our service. Both patients were shot more than a year before being referred to our tertiary hospital for an enlarging mass which was a pseudoaneurysm associated with an arteriovenous fistula. The aneurysm was repaired and the fistula closed. Due to the absence of well-trained professionals, vascular injuries and their complications are usually discovered late in Cameroon while these pseudoaneurysms can reach very dramatic sizes. This presentation intends to raise the attention on a careful clinical exam and search of vascular lesion in the case of penetrating wound of the limb associated with profuse bleeding. PMID:25705543

  4. Giant Pseudoaneurysm Associated with Arteriovenous Fistula of the Brachial and Femoral Arteries following Gunshot Wounds: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Handy Eone Daniel

    2015-01-01

    Full Text Available Posttraumatic pseudoaneurysm associated with arteriovenous fistula of the upper or lower limb is exceptional. We are reporting herein the history of two cases in civil life that have been followed and repaired in our service. Both patients were shot more than a year before being referred to our tertiary hospital for an enlarging mass which was a pseudoaneurysm associated with an arteriovenous fistula. The aneurysm was repaired and the fistula closed. Due to the absence of well-trained professionals, vascular injuries and their complications are usually discovered late in Cameroon while these pseudoaneurysms can reach very dramatic sizes. This presentation intends to raise the attention on a careful clinical exam and search of vascular lesion in the case of penetrating wound of the limb associated with profuse bleeding.

  5. Onyx embolization of an intraosseous pseudoaneurysm of the middle meningeal artery in a patient with meningiomatosis, McCune-Albright syndrome, and gray platelet syndrome.

    Science.gov (United States)

    Settecase, Fabio; Nicholson, Andrew D; Amans, Matthew R; Higashida, Randall T; Halbach, Van V; Cooke, Daniel L; Dowd, Christopher F; Hetts, Steven W

    2016-03-01

    A 13-year-old boy with meningiomatosis, McCune-Albright syndrome, and gray platelet syndrome presented with an enlarging "lump" on his right forehead. A head CT scan revealed a polyostotic fibrous dysplasia involving the entire skull. A 3.4-cm right frontal osseous cavity and an overlying right forehead subcutaneous soft-tissue mass were seen, measuring 5.2 cm in diameter and 1.6 cm thick. Ultrasound of the cavity and overlying mass showed swirling of blood and an arterialized waveform. MRI revealed an en plaque meningioma underlying the cavity. An intraosseous pseudoaneurysm fed by 3 distal anterior division branches of the right middle meningeal artery (MMA) with contrast extravasation was found on angiography. Two MMA feeders were embolized with Onyx, with anterograde filling of the intraosseous cavity with Onyx. A small pocket of residual intracavity contrast filling postembolization from a smaller third MMA feeder eventually thrombosed and the forehead lump regressed.

  6. Pseudoaneurisma de artéria genicular após cirurgia artroscópica de joelho: Relato de dois casos Geniculate artery pseudoaneurysm after arthroscopic knee surgery: Two case reports

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    Edgard dos Santos Pereira Junior

    2010-01-01

    Full Text Available A artroscopia do joelho é considerado um procedimento cirúrgico muito seguro, com um número relativamente pequeno de complicações. Relatamos o caso de dois pacientes do sexo masculino que foram submetidos à artroscopia de joelho (para meniscectomia parcial e reconstrução do ligamento cruzado anterior com parafuso transverso femoral e interferência tibial que desenvolveram um pseudoaneurisma de artéria genicular superior lateral após o procedimento. A ultrassonografia com Doppler realizou o diagnóstico e os pacientes foram tratados cirurgicamente com ligadura arterial. Um paciente apresentou extenso hematoma na coxa e foi necessária reposição volêmica. Estes casos exemplificam uma complicação vascular rara, nem sempre benigna, em uma cirurgia minimamente invasiva do joelho.Arthroscopy of the knee is a very safe surgical procedure, with relatively few complications. Here we present the cases of two patients submitted to arthroscopic surgery for partial meniscectomy and reconstruction of the anterior cruciate ligament with femoral transverse screw and tibial interference screw that developed a superior lateral genicular artery pseudoaneurysm. Doppler ultrasonography was performed for diagnostic purposes and the patients were treated by direct arterial suture. One patient developed a large haematoma requiring volemic replacement. These cases illustrate a rare, and not always benign vascular complication, in a minimally invasive arthroscopic surgery.

  7. Intrahepatic Pseudoaneurysms Complicating Transjugular Liver Biopsy in Liver Transplantation Patients: Three Case Reports

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Seung Won; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Sung, Kyu Bo [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2010-04-15

    An intrahepatic pseudoaneurysm is a rare complication following transjugular liver biopsy. Transarterial embolization is considered a safe and effective treatment for treating pseudoaneurysms. Herein we report three cases of intrahepatic pseudoaneurysms following transjugular liver biopsies. The three pseudoaneurysms were managed by the following methods: transarterial embolization, percutaneous transhepatic embolization, and close observation

  8. Hemobilia secondary to hepatic artery pseudoaneurysm:An unusual complication of bile leakage in a patient with a history of a resected Ⅲb Klatskin tumor

    Institute of Scientific and Technical Information of China (English)

    Dimitrios Siablis; Zafiria G. Papathanassiou; Dimitrios Karnabatidis; Nikolaos Christeas; Constantine Vagianos

    2005-01-01

    we report a case of a 74-year-old woman with a 16-year history of a double bilo-enteric anastomosis due to resected hilar cholangiocarcinoma [Type Ⅲb Klatskin tumor]. The patient presented with cholangitis secondary to benign anastomotic stenosis which resulted in a large intrahepatic biloma. In order to restore the patency of the anastomosis and overcome cholangitis, several attempts took place,including endobiliary stenting, balloon-assisted biloplasty and transhepatic billiary drainage. Anastomotic patencywas achieved, complicated, however, by persistent upper gastro-intestinal bleeding, presented as hemobilia. A biloma-induced pseudoaneurysm of the left hepatic artery was diagnosed. This had ruptured into the biliary tract,and presented the actual cause of the hemobilia. Selective embolism of the pseudoaneurysm resulted in control of the hemorrhage, and was successfully combined with transhepatic dilatation of the anastomosis and percutaneous drainage of the biloma. The patient was ultimately cured and seems to be in excellent condition, 5 mo after treatment.

  9. Giant renal artery pseudoaneurysm caused by rupture of renal angiomyolipoma following pregnancy: Endovascular treatment and review of the literature

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    Ilkay S Idilman

    2014-01-01

    Full Text Available Renal angiomyolipoma is a hamartomatous, benign tumor composed of blood vessels, fatty tissue and smooth muscle cells, and is often detected incidentally. It can also be associated with the tuberous-sclerosis complex (TSC. Pregnancy and use of oral contraceptives are known to be associated with an increased risk of tumoral rupture and bleeding. Herein, we report a unique case of renal angiomyolipoma associated with TSC who presented with hypovolemic shock as a result of spontaneous rupture of a giant renal pseudoaneurysm, immediately after pregnancy. Emergency endovascular treatment was successful with sparing of most of the affected kidney as demonstrated by follow-up computed tomography imaging.

  10. Iliac Pseudoaneurysm from Endoleak

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    Peter Moffett

    2015-12-01

    Full Text Available A 65-year-old male presented to the emergency department complaining of two hours of severe lower abdominal pain radiating into his left testicle. The patient described a vascular procedure in the past but did not recall the details. An emergent bedside ultrasound was performed to evaluate the abdominal aorta. During the exam an echogenic object consistent with a prior endovascular stent was discovered in the distal aorta prompting further ultrasound evaluation of the iliac artery (Figure. A true lumen (thin black arrow was visualized with evidence of leak (white arrows during color Doppler evaluation. The patient was taken emergently to computed tomography and the diagnosis of an iliac artery pseudoaneurysm from an endoleak was confirmed.

  11. Surgical exclusion of postsurgical pseudoaneurysm of the ascending aorta

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    Ramachandra Barik

    2014-01-01

    Full Text Available Pseudoaneurysm of ascending aorta after cardiac surgery is rare in children. We report a case of successful surgical exclusion of ascending aortic pseudoaneurysm in a 15-year-old boy. The neck of the aneurysm was in close proximity to the right coronary artery (RCA.

  12. Surgical treatment of traumatic lower limb pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    Pan Zhongjie; Zhang Hua; Li Li; Jia Yutao; Tian Rong

    2014-01-01

    Objective:To summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.Methods:Twenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012.The treatment protocols included interventional covered-stent placement (10 cases),spring coil embolization (2 cases),and surgical operation (8 cases).Surgical operations included pseudoaneurysm repair (2 cases),autologousvein transplantation (1 case),and artificial-vessel bypass graft (5 cases).Results:All the patients were successfully treated without aggravating lower limb ischemia.Pseudoaneurysm disappeared after treatment.A surgical operation is suitable to most pseudoaneurysms,but its damage is relatively obvious and usually leads to more bleeding.It also requires a longer operating time.Compared to a surgical operation,interventional therapy is less traumatic and patients usually have a quicker recovery (P<0.05).All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination.There were no cases of pseudoaneurysm recurrence.Conclusion:Both surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.

  13. The Radiological Management of Pseudoaneurysms Complicating Pancreatitis

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    John G Pollock

    2012-11-01

    Full Text Available Context Pseudoaneurysms associated with pancreatitis are rare, and bleeding pseudoaneurysms are associated with a high mortality. Objective The aim of this study was to report the outcomes of endovascular and percutaneous therapy in the management of pseudoaneurysms secondary to pancreatitis. Patients Patients who underwent angiography for pseudoaneurysms associated with pancreatitis from 2005 to 2011 were identified from the angiography database. Main outcome measures Patient demographics, clinical presentation, radiological findings, treatment, and outcomes were retrospectively reviewed. Results Nineteen pseudoaneurysms associated with pancreatitis in 13 patients were identified. The diagnosis of a pseudoaneurysm was made by computerised tomography angiography in seven patients, followed by portal venous phase contrast enhanced CT (n=4, duplex ultrasound (n=1 and angiography (n=1. At angiography, coil embolisation was attempted in 11 patients with an initial success rate of 82% (n=9. One patient underwent successful embolisation with percutaneous thrombin injection. The recurrence rate following initial successful embolisation was 11% (n=1. There were no episodes of re-bleeding following embolisation but re-bleeding following thrombin injection was observed in one case. The morbidity and mortality rate in the 12 patients that were successfully treated was 25% (n=3 and 8% (n=1, respectively. All 12 patients that were successfully treated demonstrated radiological resolution of their pseudoaneurysms, with a median follow-up of 20 months. Conclusion Endovascular embolisation is a suitable first-line management strategy associated with low recurrence rates. The role of percutaneous thrombin injection is yet to be defined

  14. Cardiac Penetrating Injuries and Pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    CHEN Shifeng

    2002-01-01

    Objective To discuss the early diagnosis and treatment of cardiac penetrating injuries and pseudoaneurysm. Methods 18 cases of cardiac penetrating injuries, in which 2 cases were complicated with pseudoaneurysm, were diagnosed by emergency operation and color Doppler echocardiography between May 1973 and Dec. 2001 in our hospital. The basis for emergency operation is the injured path locating in cardiac dangerous zone, severe shock or pericardial tamponade. ResultsAmong 18 cases of this study, 17 cases underwent emergency operation. During the operation, 11 cases were found injured in right ventricle, 2 cases were found injured in right atrium, 1 case was found injured in pulmonary artery,4 cases were found injured in left ventricle, 2 cases were found complicated with pseudoaneurysm. 17cases underwent cardiac repair including 1 case of rupture of aneurysm. 1 case underwent elective aneurysm resection. In whole group, 15 cases survived(83.33% ), 3 cases died( 16.67%). The cause of death is mainly hemorrhagic shock. Conclusion Highly suspicious cardiac penetrating injuries or hemopericaridium should undergo direct operative exploration. Pseudoaneurysm should be resected early,which can prevent severe complications.

  15. Uterine artery embolization to treat uterine fibroids

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    Machan, L.; Martin, M. [Univ. of British Columbia Hospital, Dept. of Radiology, Vancouver, BC (Canada)

    2001-06-01

    The first reported application of uterine artery embolization, in 1979, was to treat life-threatening hemorrhage after a failed hysterectomy. Since then, uterine artery embolization has been used very successfully to control acute or delayed post-partum hemorrhage, post-surgical hemorrhage and hemorrhage from ectopic pregnancy, to treat uterine arteriovenous malformations and as prophylaxis before high-risk surgery, such as cesarean delivery in women with placenta previa. In contrast to these proven but underutilized applications, uterine embolization for fibroids has, in a short time, achieved significant notice in the lay press and is being widely offered. Ravina and colleagues, first reported uterine fibroid shrinkage after embolization for the treatment of acute bleeding. Since then, his group has performed over 100 procedures with up to a 6-year follow-up. The cumulative clinical success rate for the treatment of abnormal uterine bleeding due to fibroids is reported to be approximately 85% and for treatment of pain or pressure symptoms, about 75%. Six-month follow-up sonography reveals an average reduction of fibroid size of approximately 40%. However, to date, no studies have compared patients who undergo embolization with a nontreatment cohort or with surgical intervention. (author)

  16. Traumatic aneurysm of superficial temporal artery. CT demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Sharma, A.; Tyagi, G.; Sahai, A.; Baijal, S.S. (G.B. Pant Hospital and M.A. Medical Coll., New Delhi (India). Dept. of Neurosurgery G.B. Pant Hospital and M.A. Medical Coll., New Delhi (India). Dept. of Radiology)

    1991-12-01

    A case of traumatic pseudo-aneurysm of the superficial temporal artery documented on Computed tomography (CT) and angiography is described in a 55-year-old female, who was treated by surgical excision. Computed tomographic appearance of this lesion is illustrated. This represents, to our knowledge, the first CT demonstration of traumatic aneurysm of superficial temporal artery within a large subgaleal haematoma. (orig.).

  17. Hypogastric artery autograft treating hemorrhage with infection of external iliac artery secondary to renal transplantation

    Institute of Scientific and Technical Information of China (English)

    WANG Ze-hou; YI Shan-hong; YAO Zhi-yong; SUN Bin; HONG Quan; ZHANG Zhi-chao

    2008-01-01

    @@ Massive hemorrhage from infected anastomosed site between the graft artery and the external iliac artery is one of the most serious complications of renal transplantation. Clinically, it is a rare but fatal occasion. We reported here one case of hemorrhage with infection in the iliac artery anastomosed site treated successfully with hypogastric artery autograft interposition in March 2003.

  18. Aneurisma de artéria poplítea com rotura e formação de pseudo-aneurisma Popliteal artery aneurysm with rupture and pseudoaneurysm formation

    Directory of Open Access Journals (Sweden)

    Heraldo Antônio Barbato

    2006-06-01

    Full Text Available Paciente relatava história aguda de dor e edema em membro inferior direito há 5 dias, e a semiologia caracterizava pulsos poplíteos amplos e perfusão distal satisfatória. Exames laboratoriais mostraram insuficiência renal, e o exame de ultra-som duplex evidenciou um aneurisma de artéria poplítea à direita roto, com formação de pseudo-aneurisma e um aneurisma de artéria poplítea à esquerda. O paciente foi submetido à exploração cirúrgica por via de acesso posterior, sendo evidenciado pseudo-aneurisma secundário a aneurisma de artéria poplítea roto e realizada endoaneurismorrafia com interposição de veia. A evolução pós-operatória foi boa. A ruptura de um aneurisma de artéria poplítea é uma complicação rara, e apenas um relato de formação espontânea de pseudo-aneurisma foi encontrado na literatura.The patient presented with a 5-day history of acute pain and swelling in the right lower limb. On physical examination, wide popliteal pulses and satisfactory distal perfusion were observed. The laboratory work-up showed renal failure and the duplex ultrasound examination was suggestive of a ruptured right popliteal artery aneurysm with pseudoaneurysm formation and a left popliteal artery aneurysm. The patient underwent urgent surgery through a posterior popliteal approach. A ruptured aneurysm with pseudoaneurysm formation was found and repaired by endoaneurysmorrhaphy with interposition of a short saphenous vein segment. The postoperative period was unremarkable. Rupture of a popliteal artery aneurysm is a rare complication: a single report of spontaneous popliteal pseudoaneurysm was found in the literature.

  19. Thyrocervical trunk pseudoaneurysm following central venous catheterization.

    Science.gov (United States)

    Mazzei, Valerio; Benvenuto, Domenico; Gagliardi, Massimo; Guarracini, Stefano; Di Mauro, Michele

    2011-11-01

    A 71-year-old female developed a painless neck mass three months following an aortic valve replacement, mitral commissurotomy, and coronary artery bypass. A cervical trunk angio revealed a pseudoaneurysm supplied from a branch of the thyrocervical trunk, which was successfully excised.

  20. Celiac artery stenosis/occlusion treated by interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)

    2009-08-15

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  1. Surgical management of infected pseudoaneurysms of femoral artery caused by narcotics injection%注射毒品致股动脉感染性假性动脉瘤的外科治疗

    Institute of Scientific and Technical Information of China (English)

    李全明; 舒畅; 姜晓华; 黎明; 李鑫; 何昊

    2009-01-01

    目的:探讨注射毒品致股动脉感染性假性动脉瘤的外科治疗.方法:回顾性分析因注射毒品致股动脉感染性假性动脉瘤患者63例的临床资料.结果:假性动脉瘤破裂52例,住院期间再次或多次出血者26例.行髂外动脉-股浅动脉旁路带环人工血管重建术49例,行髂外动脉或股动脉结扎术14例.围手术期无死亡.1例住院期间出现移植物感染,5例随诊期间出现移植物感染,感染的移植物取出后同时行髂外动脉或股动脉结扎保肢成功.1例行股动脉结扎患者术后出现肢体坏死行大腿截肢.其余手术患者均恢复良好.36例复诊彩超检查示人工血管通畅.结论:尽早外科手术是抢救因注射毒品致感染性假性动脉瘤患者生命的唯一途径;彻底清创引流、髂外动脉-股浅动脉旁路带环人工血管重建以及控制感染是治疗的有效方法;在感染严重且局部条件无法重建血管的情况下,结扎髂外动脉或股动脉也是一种救治患者的可行选择.%Objective To investigate the surgical management of infected pseudoaneurysms of femoral artery caused by narcotics injection.Methods The clinical data of 63 cases of infected pseudoaneurysms of femoral artery caused by narcotics injection were reviewed retrospectively.Results The tumors in 52 cases ruptured. Rupture hemorrhoea first occurred in 45 patients before admission and in 7 during hospitalization. Twenty-six patients suffered from recurrent or multiple hemorrhoea while in hospital. Forty-nine patients received external iliac artery-superficial femoral artery extra-anatomic bypass reconstruction with banded vascular grafts and the other 14 received ligation operations of the external iliac artery or the femoral artery. No one died in the perioperative period. One patient with vascular graft reconstruction developed graft infection during hospitalization and 5 developed graft infection during the follow-up. No ischemic necrosis occurred

  2. Radial pseudoaneurysm following diagnostic coronary angiography

    Directory of Open Access Journals (Sweden)

    Shankar Laudari

    2015-06-01

    Full Text Available The radial artery access has gained popularity as a method of diagnostic coronary catheterization compared to femoral artery puncture in terms of vascular complications and early ambulation. However, very rare complication like radial artery pseudoaneurysm may occur following cardiac catheterization which may give rise to serious consequences. Here, we report a patient with radial pseudoaneurysm following diagnostic coronary angiography. Adequate and correct methodology of compression of radial artery following puncture for maintaining hemostasis is the key to prevention.DOI: http://dx.doi.org/10.3126/jcmsn.v10i3.12776 Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3, 48-50

  3. Surgical Treatment of Left Ventricular Pseudoaneurysm

    Science.gov (United States)

    Mujanovic, Emir; Bergsland, Jacob; Avdic, Sevleta; Stanimirovic-Mujanovic, Sanja; Kovacevic-Preradovic, Tamara; Kabil, Emir

    2014-01-01

    Introduction: Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wall rupture leads to fatal pericardial tamponade. Rupture of the free wall of the left ventricle is a cata­strophic complication of myocardial infarction, occurring in approximately 4% of pa­tients with infarcts, resulting in immediate collapse of the patient and electromechanical dissociation. In rare cases the rupture is contained by pericardial and fibrous tissue, and the result is a pseudoaneurysm. The left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall-no myocardial tissue. Because such aneurysms have a strong tendency to rupture, this disorder may lead to death if it is left surgically untreated. Case report: In this case report, we present a patient who underwent successful repair of a left ventricular pseudoaneurysm, which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients. PMID:25568538

  4. Diagnosis of gynecological pseudoaneurysms and embolization with cyanoacrylate.

    Science.gov (United States)

    Fernández Bermúdez, M J; Fernández Martínez, A M; Domitrovic, L A; Balboa Arregui, Ó

    2016-12-21

    Pseudoaneurysms of the uterine artery are an uncommon cause of severe gynecological bleeding secondary to surgical manipulation of the pelvis or to instrumental delivery. The different imaging techniques are of vital importance in the diagnosis. Angiography is the technique used for confirmation and also for treatment in many cases. Endovascular treatment by embolizing the pseudoaneurysm has become established as the treatment of choice, making it possible to avoid hysterectomy in women of childbearing age. This article presents two cases of gynecological bleeding due to pseudoaneurysms (one secondary to surgery and one secondary to childbirth) that were embolized in a novel way using cyanoacrylate.

  5. Rupture of the Left External Iliac Artery and Right Groin Pseudoaneurysm Formation following Angioplasty in a Patient with Neurofibromatosis Type 1 and Undiagnosed Bilateral Phaeochromocytoma

    Directory of Open Access Journals (Sweden)

    Brett Doleman

    2013-01-01

    Full Text Available Neurofibromatosis type 1 (NF1 is a genetic condition, which affects 1 in every 3000 births. Patients with NF1 are at increased risk of a variety of vascular abnormalities. This report presents the case of a 60-year-old male with NF1 who suffered a left external iliac rupture and a right pseudoaneurysm following angioplasty. In addition, these were further complicated by previously undiagnosed, bilateral phaeochromocytomas. The inherent weakness in vessel wall architecture found in NF1 coupled with the hypertension evident during and after the procedure contributed to haemorrhage and pseudoaneurysm formation. Caution must be taken in such patients when considering vascular intervention.

  6. Questions and Answers about Treating Arterial Stenosis and Preventing Stroke

    Science.gov (United States)

    ... and Answers About Treating Arterial Stenosis and Preventing Stroke A stroke is any sudden event affecting the ... and high cholesterol. How does stenosis contribute to stroke? Atherosclerosis can activate cells involved in blood clotting. ...

  7. A case of pseudoaneurysm due to fungus ball within the progressive massive fibrosis in a patient with pneumoconiosis: Computed tomography-pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Geun; Ryu, Dae Shick; Park, Man Soo; Choi, Soo Jung; Kang, Chae Hoon; Shin, Dong Rock; Ahn, Jae Hong [Dept. of Radiology, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung (Korea, Republic of)

    2016-09-15

    We reported a case of pseudoaneurysm in the upper lobar branch of the right pulmonary artery, which was caused by a fungus ball within the progressive massive fibrosis (PMF) in a patient with pneumoconiosis. Coil embolization of the pseudoaneurysm initially stopped the bleeding. After right upper lobe lobectomy to prevent the recurrent hemoptysis, pathology confirmed pseudoaneurysm within the PMF due to aspergilloma.

  8. Pseudoaneurysm after pancreatoduodenectomy: diagnosis and embolization on angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Jun Yong [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Lee, Sang Hyun; Kim, Sam Soo; Han, Heon; Chung, Hye Won [Seoul City Boramae Hospital, Seoul (Korea, Republic of); Youn, Byung Jae; Han, Joon Koo; Choi, Byung Ihn; Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2002-08-01

    To evaluate the efficacy of angiography in the diagnosis and treatment of pseudoaneurysm manifesting arterial hemorrhage as a significant complication following pancreatoduodenectomy. For 51 months, of a total of 298 patients who had undergone pancreatoduodenectomy, 19 patients (6.4%) developed clinically significant hemorrhage and nine patients proved to have a pseudoaneurysm of angiography. These nine patients (3.0%) were managed by transcatheter arterial embolization. We analyzed clinical feature, angiography findings and hemostatic effect of embolization retrospectively. In nine patients (3.0%), pseudoaneurysm was diagnosed on angiography (common hepatic artery in four, gastroduodenal artery in three, proper hepatic artery in one, and left gastroepoploic artery in on patient). The size ranged from 0.3 cm to 6.5 cm (mean 1.9 cm). And extravasation was noted in five patients (55.6%). The remained ten patients showed no evidence of bleeding on angiography. Those who manifested as early bleeding (within two weeks) or delayed bleeding ( later than two weeks) were five and four patients respectively. Before the onset of major bleeding, among the nine pseudoaneurysm patients, seven patients (77.8%) had experienced percutaneous drainage due to intra-abdominal fluid collection with or without abscess resulting from anastomotic leak, and all nine patients had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseucoaneurysm followed by transcatheter arterial embolization (microcoil in eight patients, gelfoam in one) and achieved complete hemostasis yielding a success rate of 100%. Overall, no patients experienced complications related directly to the transcatheter arterial embolization technique. During the follow-up period (72-1, 336days, mean 640), no recurrence of bleeding was note. Although pseudoaneurysm is a rare complication, it is important as a cause of hemorrhage after pancreatoduodenectomy. Angiography followed by

  9. Stent-graft repair of carotid endarterectomy-related pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    Manuela Carnini; Gabriele Piffaretti; Chiara Lomazzi

    2013-01-01

    Objective: Carotid endarterectomy-related pseudoaneurysms are rare lesions challenging to be treated with conventional open surgery. Endovascular stent-graft has been rarely adopted with encouraging results. We present a case of a huge carotid pseudoaneurysm treated with a stent-graft and managed with a stent-graft and reviewed the available literature on the management and results of this technique for these challenging lesions.

  10. Delayed diagnosis of a pseudoaneurysm with recurrent hemarthrosis of the knee joint.

    Science.gov (United States)

    Becher, Christoph; Burger, Ulrike L; Allenberg, Jens R; Kaufmann, Guenter W; Thermann, Hajo

    2008-06-01

    This is a case report of recurrent hemarthrosis of the knee joint over 3 months. The patient, a 47-year-old male had three arthroscopic procedures with multiple joint punctures over a 3-month-period prior to our initial consultation. The first procedure (arthroscopic synovectomy) was done for suspected infection following a series of hyaluronic acid injections. Recurrent hemarthrosis developed subsequent to this. Upon further evaluation, a pseudoaneurysm of the superior middle genicular artery was detected and successfully treated with selective angiographic embolization.

  11. Bypass grafting with vascular prosthesis for treatment of infected femoral artery pseudoaneurysm%人工血管旁路移植治疗感染性股动脉假性动脉瘤

    Institute of Scientific and Technical Information of China (English)

    武国; 陈开; 郑江华; 戴毅

    2011-01-01

    目的 探讨人工血管旁路移植术治疗感染性股动脉假性动脉瘤的效果.方法 回顾性分析2005年1月-2010年12月40例感染性股动脉假性动脉瘤的临床资料,40例患者均为吸毒者,均接受了假性动脉瘤切除、彻底清创及人工血管旁路移植术.结果 围手术期内无死亡患者,且均保肢成功,创口均二期愈合.34例(85.0%)术后获得随访3 ~12个月,平均7.4个月.随访期内发生移植物感染3例(8.8%),取出感染的移植物后2例保肢成功,1例最终因肢体缺血坏死而接受截肢术;彩超检查发现人工血管腔内部分血栓形成4例(11.8%),给予抗血小板治疗,远端肢体均无缺血坏死.结论 人工血管旁路移植术是治疗注射吸毒所致感染性股动脉假性动脉瘤的安全、有效的方法.%Objective To evaluate the effect of the treatment of infected femoral artery pseudoaneurysm using bypass grafting with vascular prosthesis. Methods The clinical data of 40 patients with infected femoral artery pseudoaneurysm admitted to our hospital from January 2005 to December 2010 were analyzed retrospectively. All the 40 patients were drug abusers, and underwent pseudoaneurysm excision, radical debridement and vascular prosthesis bypass grafting operation. Results No death occurred and the patients' limbs were all successfully salvaged during the perioperative period. All wounds were healed by secondary intervention. Thirty-four patients were followed up for 3 to 12 months ( average of 7. 4 months ). Prosthetic graft infection occurred in three patients (8.8%) during the follow-up period, two of whom had their limbs salvaged after removal of the infected graft, and one finally underwent amputation because of ischemic limb necrosis. Thrombus formation was detected by color Doppler ultrasound in some parts of the lumen of prosthetic graft in four patients (11.8%), however, no ischemic necrosis occurred in the affected limbs of the four patients after

  12. Pseudoaneurysm Accompanied by Crowe Type IV Developmental Dysplasia of the Hip: A Case Report

    Directory of Open Access Journals (Sweden)

    Hirotake Yo

    2012-01-01

    Full Text Available We report the case of a 72-year-old woman whose pseudoaneurysm was difficult to diagnose and treat. The patient had a history of congenital dislocated hip and was undergoing anticoagulation therapy with warfarin due to the mitral valve replacement. Her chief complaint was pain and enlargement of the left buttock, and the laboratory tests revealed severe anemia. However, her elderly depression confused her chief complaint, and she was transferred to a psychiatric hospital. Two months after the onset of the symptoms, she was finally diagnosed with a pseudoaneurysm by contrast-enhanced CT and angiography. IDC coils were used for embolization. A plain CT showed hemostasis as well as a reduced hematoma at 2 months after the embolization. The possible contributing factors for the pseudoaneurysm included bleeding due to warfarin combined with an intramuscular hematoma accompanied by Crowe type IV developmental dysplasia of the hip that led to an arterial rupture by impingement between pelvis and femoral head. Since the warfarin treatment could not be halted due to the valve replacement, embolization was chosen for her treatment, and the treatment outcome was favorable.

  13. Tamponade by an expanding left ventricular pseudoaneurysm: A unique presentation.

    Science.gov (United States)

    Mahesh, Balakrishnan; Ong, Ping; Kutty, Ramesh; Abu-Omar, Yasir

    2015-10-01

    Left ventricular free wall rupture secondary to myocardial infarction is an uncommon but catastrophic event requiring emergency surgery. We describe a unique presentation of left ventricular free wall rupture as delayed tamponade caused by a gradually expanding pseudoaneurysm compressing the left atrium, leading to pulmonary congestion that required increasing respiratory support to maintain oxygenation, and necessitated emergency surgery. We discuss the options available to treat pseudoaneurysms due to left ventricular free wall rupture.

  14. Stent-Graft Placement with Early Debridement and Antibiotic Treatment for Femoral Pseudoaneurysms in Intravenous Drug Addicts

    Energy Technology Data Exchange (ETDEWEB)

    Fu, Qining, E-mail: cqmufqn@163.com; Meng, Xiyun, E-mail: 383274177@qq.com; Li, Fenghe, E-mail: lfh-cqmu@gmail.com; Wang, Xuehu, E-mail: 184037696@qq.co; Cheng, Jun, E-mail: cqdcj@163.com; Huang, Wen, E-mail: dhuangwen@hotmail.com; Ren, Wei, E-mail: renwei9771@yahoo.com.cn; Zhao, Yu, E-mail: zhaoyu-cqmu@126.com [The First Affiliated Hospital of Chongqing Medical University, Department of Vascular Surgery (China)

    2015-06-15

    PurposeExplore the application of endovascular covered stent-graft (SG) placement in femoral pseudoaneurysms in intravenous drug addicts.Materials and MethodsWe evaluated a consecutive series of pseudoaneurysm in intravenous drug addicts treated with SGs from August 2010 to December 2013.Results15 patients with 16 arterial pseudoaneurysms were enrolled in this study. All were males with a mean age of 36.9 years. Hemorrhage was the most common reason (93.8 %) for seeking medical care, and 3 of these patients were in hemorrhagic shock at admission. All patients received broad-spectrum antibiotics, and debridement and drainage were implemented after SG placement. 7 of the 13 cases which had microbiologic results showed mixed infections, while gram-negative bacteria were the major pathogens. Except for 2 patients, who were lost to follow-up, two new pseudoaneurysms formed due to delayed debridement, and one stent thrombosis occurred, none of the remaining cases had SG infection or developed claudication.ConclusionsSG placement controls massive hemorrhage rapidly, gives enough time for subsequent treatment for pseudoaneurysms due to intravenous drug abuse, and reduces the incidence of postoperative claudication. With appropriate broad-spectrum antibiotics and early debridement, the incidence of SG infection is relatively low. It is an effective alternative especially as temporary bridge measure for critical patients. However, the high cost, uncertain long-term prospects, high demand for medical adherence, and the risk of using the conduits for re-puncture call for a cautious selection of patients. More evidence is required for the application of this treatment.

  15. Spontaneous closure of a large left ventricular pseudoaneurysm after mitral valve replacement.

    Science.gov (United States)

    Inoue, Takahiro; Hashimoto, Kazuhiro; Sakamoto, Yoshimasa; Nagahori, Ryuichi; Yoshitake, Michio; Matsumura, Yoko; Takagi, Tomomitsu; Kinami, Hiroo

    2016-06-01

    Left ventricular pseudoaneurysm is a rare, but potentially fatal, condition that generally occurs as a complication of myocardial infarction, infective endocarditis, or cardiac surgery. Surgical repair is the treatment of first choice because of the marked risk of rupture, but deteriorated hemodynamics and complicated procedures to treat the pseudoaneurysm may lead to a high mortality rate. We report a 62-year-old woman with a large left ventricular pseudoaneurysm after mitral valve replacement for rheumatic mitral valve stenosis. Surgical repair was not performed due to the patient's refusal, but her pseudoaneurysm resolved spontaneously by 2 years after mitral valve replacement. Spontaneous obliteration of a large left ventricular pseudoaneurysm is very rare in a patient on warfarin therapy. This case suggests that a left ventricular pseudoaneurysm with a narrow neck may resolve spontaneously in rare settings.

  16. Tratamento endovascular de pseudo-aneurisma da artéria subclávia em criança hemofílica Endovascular treatment of subclavian artery pseudoaneurysm in a hemophiliac child

    Directory of Open Access Journals (Sweden)

    Emanuella Galvão de Sales e Silva

    2006-06-01

    Full Text Available O uso de cateteres venosos centrais em pacientes hemofílicos é muito freqüente, devido às próprias características terapêuticas da doença. As complicações desses procedimentos, tais como pseudo-aneurisma, geralmente são mais graves nesses pacientes. A correção cirúrgica do pseudo-aneurisma que acomete a artéria subclávia constitui um dos maiores desafios da cirurgia vascular. Em pacientes hemofílicos, à dificuldade habitual de exposição cirúrgica somam-se os problemas de alteração no processo normal de coagulação. Como alternativa ao tratamento cirúrgico convencional, a utilização de técnicas endovasculares constitui uma solução segura e com bons resultados.The placement of central venous catheters in hemophiliac patients is very frequent, due to the specific treatment characteristics of the disease. The complications of these procedures, such as pseudoaneurysm, are generally worse in such patients. Surgical treatment of subclavian artery pseudoaneurysm is known to be one of the greatest surgical challenges in vascular surgery. In hemophiliac patients, the alterations in the normal cascade of coagulation are added to the difficult surgical exposure. As an alternative to the usual surgical treatment, the use of endovascular techniques is a safe method and has good outcomes.

  17. Recurrent Hemarthrosis Following Knee Arthroplasty Treated with Arterial Embolization.

    Science.gov (United States)

    Weidner, Zachary D; Hamilton, William G; Smirniotopoulos, John; Bagla, Sandeep

    2015-11-01

    Recurrent hemarthrosis is an uncommon but troublesome complication following knee arthroplasty. This study reports the results for 13 patients with spontaneous recurrent hemarthrosis after knee arthroplasty treated with arterial embolization. The average interval between arthroplasty and embolization was 47 months (range, 2-103 months), and the average time from onset of hemarthrosis to embolization was 4.1 months (range, 1-11 months). Geniculate arterial embolization lead to resolution of hemarthrosis in 12 of 13 patients (92.3%). The one clinical failure likely represented a case of misdiagnosed periprosthetic joint infection. Two patients experienced transient cutaneous ischemia related to distal particulate embolization that resolved spontaneously. Selective geniculate arterial embolization is an effective and safe treatment modality for recurrent hemarthrosis after knee arthroplasty.

  18. [Proximal anastomotic pseudoaneurysms].

    Science.gov (United States)

    De Monti, M; Ghilardi, G; Sgroi, G; Scorza, R

    1995-04-01

    Abdominal aortic pseudoaneurysms development in patients submitted to endoaneurysmectomy or bifurcated aorto-peripheral by pass was, for a long time, considered a rare complication of aortic surgery. In old papers it was referred prevalence of abdominal PSA which rambled on values less than 1%. The diagnosis was always reached in concomitance with fissurations, ruptures or aorto-digestive fistulas. Recent papers, in which were reported results of accurate instrumental (echo and TC) follow-up of patients with aortic prosthesis, demonstrated a really higher prevalence of abdominal aortic pseudoaneurysms (about 6%). A retrospective analysis of PSA admitted to the General and Cardiovascular Institute of the University of Milan and the First Surgical Division of the General Hospital of Treviglio-Caravaggio (BG), demonstrated a high morbidity and mortality of complicated aortic pseudoaneurysms surgery. Considering the data reported in the international literature and the results of the surgery of complicated aortic PSA, the Authors point out the necessity of accurate periodical instrumental follow-up of subjects with aortic prosthesis in order to identify anastomotic pseudoaneurysm and to evaluate incidental evolution of aneurysmatic disease.

  19. Idiopathic pseudoaneurysm in a patient with breast implants

    DEFF Research Database (Denmark)

    Khorasani, Hoda; Eiberg, Jonas; Bigaard, Janne

    2016-01-01

    implant surgery. After clinical assessment, the patient underwent surgery with resection of the aneurysm and ligation of the arterial branch. No early postoperative complications were reported. Pseudoaneurysms in small vessels such as the IMA or its branches are not well described in the literature...

  20. Pseudoaneurysm of the Breast after Core Needle Biopsy: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hyun Kyung [Dept. of Radiology, Inje University Haeundae Paik Hospital, Busan (Korea, Republic of)

    2012-08-15

    Pseudoaneurysm of the breast is rare. To date only a, few cases related to blunt trauma, core needle biopsy, vacuum-assisted biopsy, or surgery have been reported. The author reports on a case of pseudoaneurysm after 14-gauge core needle biopsy, which was treated successfully with manual compression.

  1. Characteristics of Pseudoaneurysms in Southern India; Risk Analysis, Clinical Profile, Surgical Management and Outcome

    Directory of Open Access Journals (Sweden)

    Hafeezulla Lone

    2015-04-01

    Full Text Available Objective: To determine the risk factors, clinical characteristics, surgical management and outcome of pseudoaneurysm secondary to iatrogenic or traumatic vascular injury. Methods: This was a cross-sectional study being performed in department of cardiovascular and thoracic surgery skims soura during a 4-year period. We included all the patients referring to our center with primary diagnosis of pseudoaneurysm. The pseudoaneurysm was diagnosed with angiography and color Doppler sonography. The clinical and demographic characteristics were recorded and the risk factors were identified accordingly. Patients with small swelling (less than 5-cm and without any complication were managed conservatively. They were followed for progression and development of complications in relation to swelling. Others underwent surgical repair and excision. The outcome of the patients was also recorded. Results: Overall we included 20 patients with pseudoaneurysm. The mean age of the patients was 42.1±0.6 years. Among them there were 11 (55% men and 9 (45% women. Nine (45% patients with end stage renal disease developed pseudoaneurysm after inadvertent femoral artery puncture for hemodialysis; two patients after interventional cardiology procedure; one after femoral embolectomy; one developed after fire arm splinter injury and one formed femoral artery related pseudoaneurysm after drainage of right inguinal abscess. The most common site of pseudoaneurysm was femoral artery followed by brachial artery. Overall surgical intervention was performed in 17 (85% patients and 3 (15% were managed conservatively. Conclusion: End stage renal disease is a major risk factor for pseudoaneurysm formation. Coagulopathy, either therapeutic or pathological is also an important risk factor. Patients with these risk factors need cannulation of venous structures for hemodialysis under ultrasound guide to prevent inadvertent arterial injury. Patients with end stage renal disease who

  2. Drug-Induced Acute Pancreatitis and Pseudoaneurysms: An Ominous Combination

    Directory of Open Access Journals (Sweden)

    Diogo Branquinho

    2016-11-01

    Full Text Available Rupture of pseudoaneurysms is rare but can be life-threatening complications of acute or chronic pancreatitis, usually due to enzymatic digestion of vessel walls crossing peripancreatic fluid collections. We report the case of a 40 year-old female, with multisystemic lupus and anticoagulated for prior thrombotic events, admitted for probable cyclosporine-induced acute pancreatitis. Hemodynamic instability occurred due to abdominal hemorrhage from two pseudoaneurysms inside an acute peri-pancreatic collection. Selective angiography successfully embolized the gastroduodenal and pancreatoduodenal arteries. The hemorrhage recurred two weeks later and another successful embolization was performed and the patient remains well to date. The decision to restart anticoagulants and to suspend cyclosporine was challenging and required a multidisciplinary approach. Despite rare, bleeding from a pseudoaneurysm should be considered when facing a patient with pancreatitis and sudden signs of hemodynamic instability.

  3. Pseudoaneurysm associated with complicated pancreatic pseudocysts

    Directory of Open Access Journals (Sweden)

    Laura Larrey-Ruiz

    Full Text Available A pseudoaneurysm associated with a pseudocyst is a serious and unusual complication of chronic pancreatitis. Its treatment is complex due to its elevated mortality and the need for multidisciplinary management. Initial measures consist of locating the hemorrhage through computerized dynamic tomography and arteriography. The treatment of choice is controversial due to the lack of controlled studies. For managing hemorrhages in stable patients, the most accepted initial measure is currently arterial embolization. In the event of failure of the same, hemodynamic instability or the impossibility of drainage of the pseudocyst, surgery is the subsequent therapeutic option.

  4. An Unusual Cause of a Pain in the Neck: Pseudoaneurysm from Tuberculous Lymphadenitis

    Directory of Open Access Journals (Sweden)

    B. Kennedy

    2012-01-01

    Full Text Available A pseudoaneurysm is a haematoma which is surrounded by connective tissue and communicates with the lumen of a ruptured blood vessel. It has no true defined capsule. We describe a case of tuberculous pseudoaneurysm. This is a rare complication of tuberculosis. The clinical presentation of these lesions is highly variable. Definitive diagnosis should consist of contrast-enhanced CT and arteriography. Treatment should include repair of the arterial wall by surgery, endovascular stent-graft insertion, or embolization followed by a full course of antituberculous chemotherapy. Our case is highly unusual in that the pseudoaneurysm arose from the subclavian vasculature in a patient with extrapulmonary tuberculosis only.

  5. Femoral pseudoaneurysms in drug addicts

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Rørdam, Peter; Jensen, L P

    1997-01-01

    OBJECTIVE: To evaluate the outcome of treatment of femoral pseudoaneurysms in drug addicts. METHODS: The records of eight patients undergoing vascular surgery for femoral pseudoaneurysms from substance abuse identified from a vascular database were reviewed. RESULTS: Were good in four out of five...

  6. Pseudo-aneurisma de artéria tibial posterior pós-tratamento de fratura de perna com fixador externo: relato de caso e revisão da literatura Pseudoaneurysm of the posterior tibial artery after external fixation for leg fracture: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Domingos de Morais Filho

    2007-06-01

    Full Text Available Este trabalho descreve um caso de pseudo-aneurisma da artéria tibial posterior devido ao uso de fixador externo para tratamento de fratura dos ossos da perna (técnica de Ilizarov, bem como as técnicas utilizadas para seu tratamento. A compressão guiada por ultra-som e a injeção de trombina guiada por ultra-som foram realizadas, sem sucesso. O tratamento definitivo do pseudo-aneurisma e reconstrução arterial foi conseguido através do tratamento cirúrgico clássico, usando enxerto interposto de veia safena magna homóloga invertida. As indicações, vantagens e desvantagens das técnicas de tratamento não invasivo (compressão guiada por ultra-som e injeção de trombina guiada por ultra-som e as possíveis causas de sua incapacidade na obliteração do pseudo-aneurisma são discutidas. Também foi realizada a revisão de casos de pseudo-aneurisma da artéria tibial posterior na literatura médica, encontrando-se apenas um caso semelhante, entre 24 publicados.We describe a case of pseudoaneurysm in the posterior tibial artery following treatment for tibial and fibula fractures using external fixation (Ilizarov technique, as well as the techniques used for its treatment. Ultrasound-guided compression and ultrasound-guided thrombin injection were unsuccessfully performed. Definite treatment of pseudoaneurysm and arterial reconstruction was achieved through the traditional surgical treatment, using interposed graft of inverted homologous great saphenous vein. Indications, advantages and disadvantages of noninvasive treatment techniques (ultrasound-guided compression and ultrasound-guided thrombin injection and the possible causes of their inability in obliterating the pseudoaneurysm are discussed. A literature review of pseudoaneurysms of the posterior tibial artery was also carried out, resulting in only one similar case out of 24 published cases.

  7. Sinus of Valsalva Pseudoaneurysm as a Sequela to Infective Endocarditis

    Science.gov (United States)

    Siegel, Robert J.

    2016-01-01

    Pseudoaneurysm is an uncommon sequela of infective endocarditis. We treated a 44-year-old man who had an active case of group B streptococcal infective endocarditis of the aortic valve despite no evidence of valvular dysfunction or vegetation on his initial transesophageal echocardiogram. After completing 6 weeks of intravenous antibiotic therapy, the patient developed a sinus of Valsalva pseudoaneurysm and severe aortic regurgitation caused by partial detachment of the left coronary cusp. We used a pericardial patch to close the pseudoaneurysm and repair the coronary cusp. This case shows the importance of routine clinical follow-up evaluation in infective endocarditis, even after completion of antibiotic therapy. Late sequelae associated with infective endocarditis or its therapy include recurrent infection, heart failure caused by valvular dysfunction (albeit delayed), and antibiotic toxicity such as aminoglycoside-induced nephropathy and vestibular toxicity. PMID:27047285

  8. Treatment strategies and indications for interventional management of pseudoaneurysms

    Institute of Scientific and Technical Information of China (English)

    ZHU Xiao-li; NI Cai-fang; LIU Yi-zhi; JIN Yong-hai; ZOU Jian-wei; CHEN Long

    2011-01-01

    Background Pseudoaneurysms (PAs) are common vascular abnormalities predominantly arising from a disruption in the integrity of the arterial wall. The potential complications of PAs are usually unpredictable and carry high rates of morbidity and mortality. This paper presents our experience with various treatment strategies for PAs.Methods Fifty-four patients with 55 PAs were diagnosed by non-invasive imaging examination. The etiology of PAs included trauma (33/55), infection (5/55), iatrogenic (6/55), and idiopathic (11/55). Different procedures including ultrasound (US)-guided compression, endovascular treatment, and surgery were performed depending on the location of PAs, size of the sac and neck, and characteristics of the donor artery. The methods of endovascular treatment included embolization of parent artery, the PA sac, or implantation of a stent-graft. Follow-up was performed using US or CT and ranged from 1 day to 24 months (average 16.7 months).Results In all 54 patients, 3 patients with superficial PAs were treated by US-guided compression, while 44 patients with 45 PAs located in the head and neck (n=20), viscera (n=10) or extremities (n=15) were treated by endovascular treatment. Nine patients with PAs located in the head and neck (n=2) or extremities (n=7) were treated by surgery. Among them, one patient underwent endovascular treatment combined with surgery and 1 was treated by surgery after unsuccessful US-guided compression. In the 3 patients treated with US-guided compression, 2 were successfully treated while the remaining patient required additional surgery. Primary technical success of endovascular management was 97.7% (43/44) and the cure rate was 95.5% (42/44). In the surgery group, 4 patients recovered well, 1 patient was cured by endovascular treatment combined with surgery, 2 cases underwent amputation, 1 patient died of multi-organ failure and 1 patient was paralysed.Conclusions Minimally invasive interventional techniques are

  9. Apoptosis-based therapy to treat pulmonary arterial hypertension

    Science.gov (United States)

    Suzuki, Yuichiro J.; Ibrahim, Yasmine F.; Shults, Nataliia V.

    2016-01-01

    Pulmonary arterial hypertension (PAH) is rare, but patients who are diagnosed with this disease still suffer from a lack of satisfactory treatment strategies to prolong survival. While currently approved drugs for PAH have some benefits, these vasodilators only have limited efficacy for eliminating pulmonary vascular remodeling and reducing mortality. Thus, our laboratory has been exploring the use of aggressive drugs, which are capable of causing apoptotic cell death, to treat PAH. We have so far found that three classes of anti-tumor agents, including anthracyclines, taxanes, and proteasome inhibitors, are capable of reducing pulmonary vascular thickness in rats with PAH. These drugs kill cells in remodeled pulmonary vessels without affecting the normal, healthy pulmonary vasculature, revealing that proliferating vascular cells in PAH patients are more sensitive to drug-induced apoptosis compared to the differentiated phenotype that is physiologically important for smooth muscle contraction. Since many apoptosis-inducing drugs cause cardiotoxicity in cancer patients, and because PAH patients already have a weakened heart, we focus on finding biological mechanisms that may reverse pulmonary vascular remodeling without promoting cardiotoxicity. We found two agents, dexrazoxane and pifithrin-α, that selectively inhibit cardiac muscle apoptosis without affecting the drug-induced apoptosis of the proliferating pulmonary vascular cells. Thus, we propose that the addition of apoptosis-inducing drugs and cardioprotectants to PAH therapies may be effective in treating patients and preventing right heart failure.

  10. A case of bilateral hemarthrosis due to pseudoaneurysms in a patient on anticoagulation therapy.

    Science.gov (United States)

    Son, Kyeong Min; Kim, Ja Kyung; Seo, Young Il; Kim, Hyun Ah

    2013-06-01

    Hemarthrosis can occur in patients with a predisposition to hemorrhage, such as hemophiliacs or patients on anticoagulation therapy. If hemarthrosis recurs after supportive treatment, however, other etiologies such as anatomical abnormalities should be considered. Spontaneous articular pseudoaneurysm associated with anticoagulation treatment has not been reported previously. We describe a patient on anticoagulation therapy with bilateral hemarthrosis due to pseudoaneurysms. After failing to respond to the correction of over-anticoagulation, magnetic resonance imaging led to the diagnosis of articular pseudoaneurysm. The patient was treated successfully by transarterial embolization.

  11. Percutaneous N-Butyl cyanoacrylate embolization of a pancreatic pseudoaneurysm after failed attempts of transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ri Hyeon; Yoo, Roh Eul; Kim, Hyo Cheol [Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul (Korea, Republic of)

    2014-10-15

    One common complication after major pancreatic surgery is bleeding. Herein we describe a case of pancreatic pseudoaneurysm which developed after pylorous preserving pancreaticoduodenectomy for common bile duct cancer. Three attempts of transcatheter embolization failed since feeders to the pseudoaneurysm had unfavorable anatomy. Direct percutaneous N-butyl cyanoacrylate injection was performed under fluoroscopy-guidance and the pseudoaneurysm was successfully treated. Percutaneous fluoroscopy-guided direct N-butyl cyanoacrylate injection may be a useful alternative when selective transcatheter embolization fails or is technically challenging.

  12. Combined endovascular intervention and percutaneous thrombin injection in the treatment of iatrogenic pseudoaneurysm. Case report.

    Science.gov (United States)

    Gabriel, M; Juszkat, R; Pukacki, F; Waliszewski, K

    2007-06-01

    One of the basic techniques of treatment of iatrogenic pseudoaneurysms is percutaneous thrombin injection. Unfortunately, success rate of this treatment can be limited in cases associated with extensive damage to arterial wall. Our paper presents one case of combined treatment involving endovascular occlusion of the entry to the false aneurysm and percutaneous thrombin injection into the pseudoaneurysm chamber. In our opinion this technique can be successfully applied in patients with contraindications for compression therapy, surgical intervention or failure of traditional injection due to large entry, multiple arterial wall damage or accompanying arteriovenous fistula.

  13. 注射毒品致股动脉感染性假性动脉瘤破裂出血的手术治疗%Surgical treatment for rupture and hemorrhage of infected femoral artery pseudoaneurysm caused by drug injection

    Institute of Scientific and Technical Information of China (English)

    付强; 郭晓静

    2013-01-01

    Objective To explore the surgical treatment for rupture and hemorrhage of infected femoral artery pseudoaneurysms(IFAP) caused by drug injection.Methods A total of 17 patients with rupture and hemorrhage of IFAP caused by drug injection were treated with emergency operation.The proximate external iliac artery was exposed by making a incision perpendicular to the groin,after the external iliac artery was clamping tentatively,the blood flow signals of pedal artery were observed by Doppler flow detector.Fourteen patients with blood flow signals of pedal artery were treated with simple femoral artery ligation and aneurysm excision.Three patients without blood flow signals of pedal artery were treated with aneurysm excision and reconstructive vascular operation.Among the three cases,one case was treated with autogenous saphenous vein grafting in situ,the other two cases were treated with iliofemoral vascular prosthesis bypass grafting.Results A total of 17 patients were successfully performed with debridement and excision of IFAP,the incisions in 10 cases were primary healing,the incisions in 6 cases were per secunda intentionem,the unstitched incisions in 1 case healed by changing dressings 2 months later,the average stay was(21.0 ± 4.5)days.The leucocyte count and neutrophil ratio at the moment of leaving hospital were significantly lower than those before operation(P < 0.05).The peripheral saturation of blood oxygen of affected extremity in the 3 cases with vascular reconstruction after operation was significantly higher than that before operation(P < 0.05) ;3 weeks after operation,the ultrasound examination showed that the grafts were smooth.All of the patients were followed-up for(10.2 ± 2.6)months,there was no amputation and death,10 patients with mild intermittent claudication recovered within 1 year; the basic walking function in all patients were restored.Conclusions Selective vascular reconstruction operation for rupture and hemorrhage of IFAP caused by

  14. The use of contrast-enhanced ultrasound in the treatment of limb pseudoaneurysm with percutaneous prothrombin injection

    Directory of Open Access Journals (Sweden)

    Zhong CHEN

    2014-03-01

    Full Text Available Objective To explore the safety and effectiveness of contrast-enhanced ultrasound (CEUS-guided percutaneous injection of prothrombin for the treatment of limb pseudoaneurysm (PSA. Methods Sixteen cases of lower limb pseudoaneurysms were treated with contrast-enhanced ultrasound (CEUS-guided percutaneous injection of prothrombin, and the size of the pseudoaneurysm, width and length of the pseudoaneurysm neck, times for compression, duration of each compression, and dose of prothrombin injection were recorded. Results In 16 pseudoaneurysm patients, there were 20 pseudoaneurysm sacs in total. One pseudoaneurysm sac was present in 13 patients, 2 sacs were present in 2, and there were 3 sacs in one patient. The mean maximum diameter of the sacs was 41.1±11.9mm. The mean width and length of these pseudoaneurysm necks were 1.9±0.5mm and 4.4±2.3mm respectively. During the process of treatment, the mean duration for compression was 6.0±2.0min, and the mean number of times of compression was 1.2±0.4. The mean dose of prothrombin injection was 411.5±118.8U. The cure rate with one-injection was 100% (16/16, and the recurrence rate was 0%. No complications was observed. Conclusions CEUS-guided percutaneous injection of prothrombin for the treatment of lower limb pseudoaneurysms is safe and effective. The size of the pseudoaneurysm sac and length of the pseudoaneurysm neck are important factors that may affect the result of the treatment. Timely recompression is an important step for increasing the cure rate. DOI: 10.11855/j.issn.0577-7402.2014.01.09

  15. Interventional radiology in the diagnosis, management, and follow-up of pseudoaneurysms.

    LENUS (Irish Health Repository)

    Keeling, A N

    2009-01-01

    Arterial wall disruption, as a consequence of inflammation\\/infection, trauma (penetrating or blunt), or iatrogenic causes, may result in pseudoaneurysm formation. Currently, iatrogenic causes are increasing as a result of the growth of endovascular intervention. The frequency of other causes also seems to be increasing, but this may simply be the result of increased diagnosis by better imaging techniques, such as multidetector contrast-enhanced computed tomography. Clinically, pseudoaneurysms may be silent, may present with local or systemic signs, or can rupture with catastrophic consequences. Open surgical repair, previously the mainstay of treatment, has largely been replaced by image-guided occlusion methods. On the basis of an experience of over 100 pseudoaneurysms, treatments at various anatomical sites, imaging modalities used for accurate diagnosis, current changing therapeutic options for pseudoaneurysm management, approved embolization agents, and clinical follow-up requirements to ensure adequate treatment will be discussed. Image-guided direct percutaneous and endovascular embolization of pseudoaneurysms are established treatment options with favorable success rates and minimal morbidity. The pendulum has now swung from invasive surgical repair of pseudoaneurysms to that of image-guided interventional radiology.

  16. Prediction of arterial blood gas values from arterialized earlobe blood gas values in patients treated with mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Honarmand Azim

    2008-01-01

    Full Text Available Background/Objective: Arterial blood gas (ABG analysis is useful in evaluation of the clinical condition of critically ill patients; however, arterial puncture or insertion of an arterial catheter may sometimes be difficult and cause many complications. Arterialized ear lobe blood samples have been described as adequate to gauge gas exchange in acute and chronically ill pediatric patients. Purpose: This study evaluates whether pH, partial pressure of oxygen (PO 2 , partial pressure of carbon dioxide (PCO 2 , base excess (BE, and bicarbonate (HCO 3 values of arterialized earlobe blood samples could accurately predict their arterial blood gas analogs for adult patients treated by mechanical ventilation in an intensive care unit (ICU. Setting: A prospective descriptive study Methods: Sixty-seven patients who were admitted to ICU and treated with mechanical ventilation were included in this study. Blood samples were drawn simultaneously from the radial artery and arterialized earlobe of each patient. Results: Regression equations and mean percentage-difference equations were derived to predict arterial pH, PCO 2 , PO 2 , BE, and HCO 3 -values from their earlobe analogs. pH, PCO 2 , BE, and HCO 3 all significantly correlated in ABG and earlobe values. In spite of a highly significant correlation, the limits of agreement between the two methods were wide for PO 2 . Regression equations for prediction of pH, PCO 2 , BE, and HCO3- values were: arterial pH (pHa = 1.81+ 0.76 x earlobe pH (pHe [r = 0.791, P < 0.001]; PaCO 2 = 1.224+ 1.058 x earlobePCO 2 (PeCO 2 [r = 0.956, P < 0.001]; arterial BE (BEa = 1.14+ 0.95 x earlobe BE (BEe [r= 0.894, P < 0.001], and arterial HCO 3 - (HCO 3 -a = 1.41+ earlobe HCO 3 (HCO 3 -e [r = 0.874, P < 0.001]. The predicted ABG values from the mean percentage-difference equations were derived as follows: pHa = pHe x 1.001; PaCO 2 = PeCO 2 x 0.33; BEa = BEe x 0.57; and HCO 3 -a = HCO 3 -e x 1.06. Conclusions: Arterialized

  17. Efficacy Evaluation Of Bio Trombina ® 400 In Mini Mall Y Invasive Treatment of Complications (Pseudoaneurysms, After Venipuncture for Diagnostic Purposes. Authors’ Own Experience – Case Study of 38 Patients

    Directory of Open Access Journals (Sweden)

    Iłżecki Marek

    2014-08-01

    Full Text Available Common use of venipuncture on upper and lower limbs for diagnostic purposes (such as coronarography or arteriography, and also during the course of treatment (angioplasty, very often bares a complication in the form of pseudoaneurysms. According to various reports, the incidence of pseudoaneurysms ranges from 0.005% to 0.5% of all vascular procedures requiring arterial cannulation (Common Femoral Artery, Brachial Artery, Radial Artery. The use of Bio Trombina® 400 in the embolization of pseudoaneurysms allows minimally invasive and effective treatment.

  18. Left ventricular pseudoaneurysm caused by coronary spasm, myocardial infarction, and myocardial rupture.

    Science.gov (United States)

    Mahilmaran, Asha; Nayar, Pradeep G; Sheshadri, Mukundan; Sudarsana, Gurijala; Abraham, K A

    2002-01-01

    We report a very rare case of a 47-year-old man who had coronary spasm that resulted in a silent myocardial infarction, a ruptured myocardial wall, and a nonruptured left ventricular pseudoaneurysm. The patient presented with a 6-month history of dyspnea on exertion, without evidence of fixed coronary artery stenosis. Coronary angiography showed severe coronary spasm of the left anterior descending and left circumflex arteries; the spasm was relieved promptly by nitroglycerin. Echocardiography and left ventricular angiography revealed the large left ventricular pseudoaneurysm posterolateral to the left ventricle. We performed surgical resection of the pseudoaneurysm and patch repair of the ruptured left ventricular wall, with excellent results. We present this case because of the highly unusual sequence of events. Early surgical intervention resulted in the patient's recovery.

  19. Blister-like supraclinoid internal carotid artery pseudoaneurysm in a 15-year-old male: case report and review of the literature.

    Science.gov (United States)

    Haji, Faizal Aminmohamed; Boulton, Melfort R; de Ribaupierre, Sandrine

    2011-01-01

    With an incidence of less than 1-3 per million, pediatric aneurysms are rare clinical entities. A traumatic etiology is implicated in a large proportion of these cases, leading to the formation of both 'false' and 'true' aneurysms. These occur most often in the distal circulation, but have also been described in the supraclinoid distal internal carotid artery (ICA). Blood blister aneurysms are also found in this location; however, they have not been described in the pediatric population. We report the case of a 15-year-old male who presented following cranial trauma with diffuse basal subarachnoid hemorrhage and limited additional intracranial pathology. Computed tomography angiography demonstrated a small, 2-mm blister-like aneurysm arising from the dorsal surface of the left supraclinoid ICA at a non-branching site. Despite early endovascular treatment with Guglielmi detachable coils, the lesion continued to grow over subsequent studies, necessitating open surgical clipping. At the time of surgery, gross pathology of the native ICA was observed, raising the possibility of a preexisting blood-blister aneurysm. We review the epidemiology, pathophysiology and diagnostic considerations of these lesions. The endovascular and surgical management of these complex non-branching supraclinoid ICA aneurysms is also discussed.

  20. Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Villegas, Miguel O.; Mereles, Alberto Perez; Tamashiro, Gustavo A.; Dini, Andres E.; Mollon, Ana P.; De Candido, Laura V.; Zelaya, Denis A.; Soledispa-Suarez, Carlos I.; Denato, Sergio; Tamashiro, Alberto; Diaz, Jose A., E-mail: joseantoniodiaz@hotmail.com [Hospital Nacional Prof. Alejandro Posadas, Department of Cardiology, Section of Hemodinamia (Argentina)

    2013-04-15

    We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2-L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.

  1. Diffuse coronary artery spasm treated by extracorporeal membrane oxygenation.

    Science.gov (United States)

    Smith, Chez; Akowuah, Enoch; Theodore, Sanjay; Brown, Robin

    2009-07-01

    Diffuse coronary vasospasm is an unpredictable and serious complication following coronary artery bypass surgery. The treatment of this emergency is dependent on patient suitability for angiography and direct injection of vasodilators into the affected vessels. In patients unable to proceed to angiography the diagnosis can only be suspected but treatment is nevertheless still towards reinstitution of coronary blood flow. We present one such case in which re-grafting and extracorporeal membranous oxygenation proved successful in restoring cardiac function in a patient with diffuse coronary artery spasm.

  2. Pulmonary artery dissection in a patient with Eisenmenger syndrome treated with heart and lung transplantation

    DEFF Research Database (Denmark)

    Tønder, Niels; Køber, Lars; Hassager, Christian

    2004-01-01

    We report the case of a patient with known Eisenmenger syndrome due to congenital ventricular septal defect, who developed pulmonary artery dissection. The patient was successfully treated with heart and lung transplantation.......We report the case of a patient with known Eisenmenger syndrome due to congenital ventricular septal defect, who developed pulmonary artery dissection. The patient was successfully treated with heart and lung transplantation....

  3. Management of bleeding from pseudoaneurysms following pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    Hyung; Geun; Lee; Jin; Seok; Heo; Seong; Ho; Choi; Dong; Wook; Choi

    2010-01-01

    AIM:To review the clinical course and the management of pseudoaneurysms post-pancreaticoduodenectomy.METHODS: Medical records of 907 patients who underwent pancreaticoduodenectomies from January 1995 to May 2007 were evaluated retrospectively. The clinical course, management strategy, and outcome of ruptured pseudoaneurysms cases were analyzed.RESULTS: Twenty-seven (3.0%) of 907 cases had post-operative hemorrhage from ruptured pseudoan-eurysms. Pancreatic fistula was evident in 12 (44%) cases. Sentinel ble...

  4. Spontaneous occlusion of post-traumatic splenic pseudoaneurysm: report of two cases in children

    Energy Technology Data Exchange (ETDEWEB)

    Raghavan, Ashok; Wong, Christopher Kah Fook; Lam, Albert; Stockton, Vivienne [Department of Medical Imaging, The Children' s Hospital at Westmead, Sydney (Australia)

    2004-04-01

    Conservative therapy for splenic injuries is widely advocated. The advantages of conservative therapy for splenic injuries include the preservation of splenic immune function, prevention of overwhelming post-splenectomy sepsis, and avoidance of laparotomy and its associated early and late complications. Pseudoaneurysms of the splenic artery branch are encountered because of the prevalence of conservative management and widespread use of imaging techniques in the follow-up of these cases. We report two cases of post-traumatic splenic pseudoaneurysm in children which thrombosed spontaneously, one during the diagnostic angiogram examination and another on follow-up studies. (orig.)

  5. A Case Report: Balloon Occlusion Of Vertebral Artery In A Giant Vertebral Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    K. Edraki

    2005-08-01

    Full Text Available Introduction & Background: True aneurysms of extra cranial vertebral arteries are rare. The usual pathogenesis of aneurysms in this location is either penetrating or blunt trauma with resultant pseudo- aneurysm formation. We report a patient with a presumed pseudo-aneurysm of the extra- cranial vertebral artery presenting with painful neck mass, without obvious history of trauma. Case description: A 59-year old man presented with painful left lateral neck mass from 3 month ago with a bruit over it on physical examination. Patient had a history of long term anticoagulant therapy because of chronic lower extremity DVT. Patient was referred to our DSA (Department for angiography. After color Doppler US, CT scan and MR-angiography were performed and a giant aneurysm in left vertebral artery was detected. The lesion was successfully treated by an endovascular technique of balloon occlusion of the verte-bral artery.

  6. Extracranial Vertebral Artery Aneurysm Presenting as a Chronic Cervical Mass Lesion

    Directory of Open Access Journals (Sweden)

    Lampis C. Stavrinou

    2010-01-01

    Full Text Available Background. Aneurysms of the extracranial vertebral artery are rare and can provide a diagnostic and therapeutic challenge. Methods. We reviewed the clinical history of a patient presenting with cervical radiculopathy, who harboured an extracranial vertebral artery aneurysm eroding the cervical spine. Results. CT Angiography and MR Angiography set the diagnosis, by revealing a left C5-C6 vertebral artery aneurysm with cervical root impingement. Bony reconstruction depicted enlargement of the C6 transverse foramen and a marked enlargement of the C6-C7 intravertebral foramen. The lesion was treated by intravascular proximal vertebral artery occlusion. Conclusions. Extracranial vertebral artery aneurysms require a high index of clinical suspicion. This is the first report of a vertebral artery pseudoaneurysm presenting with bony erosion, which supports a less minacious portrayal of vertebral artery aneurysms.

  7. Use of scintiangiography with technetium 99m in the diagnosis of traumatic pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Hayek, M.E.; Ludwig, M.A.; Fischer, K.; Sisler, C.

    1988-03-01

    Pseudoaneurysm formation is a known complication of peripheral arterial access procedures. Although standard contrast angiography has been considered the diagnostic study of choice to identify pseudoaneurysms, isotope angiography has been described as an alternative method. In this study, we examined the role of /sup 99m/Tc-tagged red blood cell scans in the diagnosis of traumatic pseudoaneurysm. Forty patients underwent scans; 25 scans were reported as abnormal and 15 as normal. There were no false-negative results; one scan had false-positive results (2.5%). The presence of pseudoaneurysm among the patients with abnormal scans was verified at operation in 23 of 25 patients. The one false-positive test was verified by ultrasound. All patients with normal scans were followed up for verification. Follow-up time ranged from 2 to 28 months. Radionuclide vascular flow study appears to give information similar to that of conventional angiography. With a series false-positive rate of 2.5%, the examination has a high specificity. The /sup 99m/Tc-tagged red blood cell scan is a viable alternative to conventional angiography for the diagnosis of traumatic pseudoaneurysms and is associated with less radiation and morbidity

  8. Management of a chronic carotid artery pseudoaneurysm.

    Science.gov (United States)

    Baker, Aaron C; Arko, Frank R; Zarins, Christopher K; Lee, Eugene S

    2010-01-01

    An 82-year-old female with a history of right carotid endarterectomy with patch closure 12 years prior presents with a pulsatile right neck mass with skin erosion and bleeding. The patient had been previously evaluated but refused the surgical intervention because a median sternotomy was recommended to obtain adequate proximal control. Her aneurysm was successfully repaired using a combination of open and endovascular method. The repair was performed through a right-hand side anterior sternocleidomastoid neck incision, and proximal vascular control was obtained with an 8.5-mm balloon positioned under fluoroscopic guidance via a femoral puncture.

  9. [Hepatic artery pseudoaneurysm: report of two cases].

    Science.gov (United States)

    Tun-Abraham, Mauro Enrique; Martínez-Ordaz, José Luis; Romero-Hernández, Teodoro

    2014-01-01

    Antecedentes: el pseudoaneurisma de la arteria hepática es una alteración rara y potencialmente mortal. El daño directo a la pared vascular, la erosión diatérmica a través de los clips, la fuga biliar y la infección secundaria son los factores precipitantes. La principal manifestación es la hemorragia intraabdominal. Objetivo: describir dos casos de pseudoaneurisma de la arteria hepática. Casos clínicos: Caso 1: paciente masculino de 43 años de edad con antecedentes de lesión hepática grado IV por traumatismo cerrado de abdomen tratado quirúrgicamente. Caso 2: paciente masculino de 67 años de edad con lesión en la vía biliar por colecistectomía laparoscópica. Ambos ingresaron con fuga biliar y sepsis abdominal. Durante la evolución posoperatoria sufrieron hemorragia intraabdominal. Por angiotomografía se observó un pseudoaneurisma de la arteria hepática en los dos pacientes. Se les realizó embolización superselectiva proximal y distal a la lesión, con buenos resultados. Durante su seguimiento no hubo nuevos episodios de hemorragia. Conclusiones: el pseudoaneurisma de la arteria hepática es muy raro y, por lo general, secundario a una lesión de la vía biliar, con lesión vascular concomitante por colecistectomía o traumatismo hepático. La angiotomografía es diagnóstica y la arteriografía con embolización es el recurso diagnóstico y terapéutico más recomendado. La intervención quirúrgica está indicada ante inestabilidad hemodinámica, embolización fallida y resangrado. El diagnóstico temprano reduce la morbilidad y mortalidad de esta complicación.

  10. Endovascular repair of blunt popliteal arterial injuries

    Energy Technology Data Exchange (ETDEWEB)

    Zhong, Shan; Zhang, Xiquan; Chen, Zhong; Zhu, Wei; Pan, Xiaolin [Dept. of nterventional Vascular, The 148th Hospital of Chinese People' s Liberation Army, Zibo (China); Dong, Peng; Sun, Yequan [Dept. of Medical Imaging, Weifang Medical University, Weifang (China); Qi, Deming [Dept. of Medical Imaging, Qilu Medical University, Zibo (China)

    2016-09-15

    To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries. Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18–24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up. Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.

  11. Life-threatening hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy: report of a case

    Directory of Open Access Journals (Sweden)

    Wu Hurng-Sheng

    2010-07-01

    Full Text Available Abstract Background Hemobilia is a rare but lethal biliary tract complication. There are several causes of hemobilia which might be classified as traumatic or nontraumatic. Hemobilia caused by pseudoaneurysm might result from hepatobiliary surgery or percutaneous interventional hepatobiliary procedures. However, to our knowledge, there are no previous reports pertaining to hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy. Case presentation A 65-year-old male was admitted to our hospital because of acute calculous cholecystitis and cholangitis. He underwent cholecystectomy, choledocholithotomy via a right upper quadrant laparotomy and a temporary T-tube choledochostomy was created. However, on the 19th day after operation, he suffered from sudden onset of hematemesis and massive fresh blood drainage from the T-tube choledochostomy. Imaging studies confirmed the diagnosis of pseudoaneurysm associated hemobilia. The probable association of T-tube choledochostomy with pseudoaneurysm and hemobilia is also demonstrated. He underwent emergent selective microcoils emobolization to occlude the feeding artery of the pseudoaneurysm. Conclusions Pseudoaneurysm associated hemobilia may occur after T-tube choledochostomy. This case also highlights the importance that hemobilia should be highly suspected in a patient presenting with jaundice, right upper quadrant abdominal pain and upper gastrointestinal bleeding after liver or biliary surgery.

  12. PERIPANCREATIC ARTERIAL LIGATION COMBINED WITH ARTERIAL INFUSION REGIONAL CHEMOTHERAPY FOR TREATING PATIENTS WITH ADVANCED PANCREATIC CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To find out a new treatment method for advanced pancreatic carcinoma. Methods Twenty-nine patients with advanced pancreatic carcinoma and liver metastases were randomly divided into 2 groups.Group A (n=11) underwent bilio-enterostomy and/or gastro-enterostomy combined with systemic chemotherapy after operation;Group B(n=18) underwent bilio-enterostomy and/or gastro-enterostomy combined with peripancreatic arterial ligation and arterial infusion regional chemotherapy.The alleviation of clinical symptom,the change of carcinoma volume by BUS and CT scan,survival period and serum CEA were observed in two groups. Results The symptoms were alleviated apparently in most cases in Group B;BUS and CT scan showed that the tumor volume decreased apparently in Group B;The response rate was 67.7% in Group B,and 18.2% in Group A,respectively(P<0.01);the mean survival period was (4.8±0.6) months in Group A,and (12.5±1.2) months in Group B,respectively(P<0.01),there was significant difference between the two groups.The decrease of serum CEA was 54% in Group A and 60% in Group B,but the difference was not significant(P>0.05). Conclusion Peripancreatic arterial ligation combined with arterial infusion regional chmotherapy is believed to be effective against both pancreatic carcinoma and liver metastases,and it can alleviate the clinical symptoms,postpone the growth speed of tumor,and prolong the survival period.

  13. Symptomatic radial artery thrombosis successfully treated with endovascular approach via femoral access route

    Energy Technology Data Exchange (ETDEWEB)

    Pasha, Ahmed Khurshid [Department of Internal Medicine, University of Arizona (United States); Elder, Mahir D. [Heart and Vascular Institute, Detroit, MI (United States); Division of Cardiology, Wayne State University, Detroit, MI (United States); Malik, Umer Ejaz [Department of Internal Medicine, Texas Tech University Health Science Center at Permian Basin, TX (United States); Khalid, Abdullah Mian [Department of Internal Medicine, University of Pittsburg Medical Center, Mercy Hospital, Pittsburg, PA (United States); Noor, Zeeshan [Department of Internal Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI (United States); Movahed, Mohammad Reza, E-mail: rmova@aol.com [Department of Internal Medicine, University of Arizona (United States); Sarver Heart Center, University of Arizona (United States); CareMore HealthCare, AZ (United States)

    2014-09-15

    Radial access has been increasingly utilized for coronary intervention due to higher safety profile in comparison to femoral access site with lower bleeding rate. Radial artery occlusion is not uncommon with radial access site. This usually does not lead to any harm due to ulnar artery collaterals that are sufficient to prevent hand ischemia and is usually left alone. However, in the case of significant hand ischemia, treatment is often necessary. We are reporting an interesting case of symptomatic radial artery thrombosis leading to arm ischemia that was successfully treated percutaneously using femoral access. Using femoral access for radial artery intervention has not been reported previously. This case is followed by review of the literature.

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

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, Michael B.; Dappa, Evelyn; Jungmann, Florian; Kloeckner, Roman; Schotten, Sebastian; Wirth, Gesine M.; Mildenberger, Peter; Kreitner, Karl-Friedrich; Oberholzer, Katja; Dueber, Christoph [University Hospital of Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Mittler, Jens; Lang, Hauke [University Hospital of Mainz, Department of Abdominal, Visceral and Transplantation Surgery, Mainz (Germany)

    2015-07-15

    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.)

  15. Emergency and elective implantation of covered stent systems in iatrogenic arterial injuries

    Energy Technology Data Exchange (ETDEWEB)

    Goltz, J.P.; Kickuth, R. [Universitaetsklinikum Wuerzburg (Germany). Inst. fuer Roentgendiagnostik; Bastuerk, P.; Hoppe, H.; Triller, J. [Universitaetsspital Bern (Switzerland). Inst. fuer Diagnostische, Interventionelle und Paediatrische Radiologie

    2011-07-15

    Purpose: To evaluate the effectiveness and safety of covered stents for the management of iatrogenic arterial injury. Materials and Methods: Between 03/1998 and 12/2009, 31 patients underwent selective covered stent implantation after iatrogenic arterial injury. 12/31 of these patients (38.7 %) were hemodynamically unstable. Six different endovascular covered stent types were utilized. The primary endpoints of this study were technical and clinical success and rates of minor and major complications. Results: Initial angiograms demonstrated active extravasation in 19 (61.3 %) patients and pseudoaneurysms in 12 (38.7 %) patients. The following sites of bleeding origin were detected: axillary artery, subclavian artery, common iliac artery, external iliac artery, internal iliac artery, common femoral artery, superficial femoral artery, popliteal and fibular artery, femoro-popliteal and popliteo-crural bypasses, common hepatic artery, aberrant hepatic artery, cystic and gastroduodenal artery. In all patients bleeding was effectively controlled by covered stent implantation resulting in an immediate technical success of 100 %. Clinical success attributed to covered stent implantation was documented in 30 of the 31 patients (96.8 %). Major complications included death in four patients (11.1 %), acute thrombosis with arm ischemia in one patient (2.8 %) and stent fracture with associated pseudoaneurysm in another patient (2.8 %). In 2/31 patients (6.5 %) covered stent failure was detected and successfully treated by implantation of a second covered stent. Conclusion: Emergency and elective implantation of covered stents may be used for minimally invasive and effective management of iatrogenic arterial injury. (orig.)

  16. Diagnosis of ruptured superior mesenteric artery aneurysm mimicking a pancreatic mass

    Institute of Scientific and Technical Information of China (English)

    Stefano; Palmucci; Letizia; Antonella; Mauro; Pietro; Milone; Francesco; Di; Stefano; Antonino; Scolaro; Antonio; Di; Cataldo; Giovanni; Carlo; Ettorre

    2010-01-01

    Aneurysms and pseudoaneurysms of the superior mesenteric artery are potentially lethal and should be treated as urgently as possible.In a 52-year-old man with occasional epigastric pain,we accidentally discovered a superior mesenteric artery aneurysm that was ruptured with spontaneous tamponade in the uncinate process and in the head of the pancreas.The ruptured aneurysm had a heterogeneous appearance due to its thrombotic and hemorrhagic content,and it simulated a voluminous mass in the head and uncinate p...

  17. Iliac artery myointimal hyperplasia in rabbits submitted to angioplasty and treated with Moringa oleifera

    Directory of Open Access Journals (Sweden)

    Jânio Cipriano Rolim

    2016-02-01

    Full Text Available Objective: to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. Methods : we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10 - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10 - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. Results : there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. Conclusion : there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

  18. Diagnosis and management of ileocolic pseudoaneurysms.

    Science.gov (United States)

    Desai, Sapan S; Dua, Anahita; Shortell, Cynthia K; Thacker, Julie K

    2012-09-01

    Ileocolic pseudoaneurysmal disease is a rare splanchnic aneurysm that affects 3 out of 100 000 patients, and only 7 cases have been described in the past 40 years in patients without preexisting connective tissue disorders. Abdominal pain is the most common presenting symptom and nearly 30% of patients present with hemorrhage. Ileocolic pseudoaneurysms are diagnosed by contrasted computed tomography scans and verified by arteriography. We present a case report and review of the literature in which a patient was initially managed by coil embolization, followed by laparotomy and suture ligation due to pseudoaneurysm rupture.

  19. A Case of Polyarteritis Nodosa Associated with Vertebral Artery Vasculitis Treated Successfully with Tocilizumab and Cyclophosphamide

    Science.gov (United States)

    Watanabe, Kae; Rajderkar, Dhanashree A.; Modica, Renee F.

    2016-01-01

    Pediatric polyarteritis nodosa is rare systemic necrotizing arteritis involving small- and medium-sized muscular arteries characterized by aneurysmal dilatations involving the vessel wall. Aneurysms associated with polyarteritis nodosa are common in visceral arteries; however intracranial aneurysms have also been reported and can be associated with central nervous system symptoms, significant morbidity, and mortality. To our knowledge extracranial involvement of the vertebral arteries has not been reported but has the potential to be deleterious due to fact that they supply the central nervous system vasculature. We present a case of a 3-year-old Haitian boy with polyarteritis nodosa that presented with extracranial vessel involvement of his vertebral arteries. After thorough diagnostic imaging, including a bone scan, ultrasound, Magnetic Resonance Imaging/Angiography, and Computed Tomography Angiography, he was noted to have vertebral artery vasculitis, periostitis, subacute epididymoorchitis, arthritis, and myositis. He met diagnostic criteria for polyarteritis nodosa and was treated with cyclophosphamide, methylprednisolone, and tocilizumab, which resulted in improvement of his inflammatory markers, radiographic findings, and physical symptoms after treatment. To the authors' knowledge, this is the first report of vertebral artery vasculitis in polyarteritis nodosa as well as successful treatment of the condition using the combination cyclophosphamide and tocilizumab for this condition. PMID:27018080

  20. A Case of Polyarteritis Nodosa Associated with Vertebral Artery Vasculitis Treated Successfully with Tocilizumab and Cyclophosphamide

    Directory of Open Access Journals (Sweden)

    Kae Watanabe

    2016-01-01

    Full Text Available Pediatric polyarteritis nodosa is rare systemic necrotizing arteritis involving small- and medium-sized muscular arteries characterized by aneurysmal dilatations involving the vessel wall. Aneurysms associated with polyarteritis nodosa are common in visceral arteries; however intracranial aneurysms have also been reported and can be associated with central nervous system symptoms, significant morbidity, and mortality. To our knowledge extracranial involvement of the vertebral arteries has not been reported but has the potential to be deleterious due to fact that they supply the central nervous system vasculature. We present a case of a 3-year-old Haitian boy with polyarteritis nodosa that presented with extracranial vessel involvement of his vertebral arteries. After thorough diagnostic imaging, including a bone scan, ultrasound, Magnetic Resonance Imaging/Angiography, and Computed Tomography Angiography, he was noted to have vertebral artery vasculitis, periostitis, subacute epididymoorchitis, arthritis, and myositis. He met diagnostic criteria for polyarteritis nodosa and was treated with cyclophosphamide, methylprednisolone, and tocilizumab, which resulted in improvement of his inflammatory markers, radiographic findings, and physical symptoms after treatment. To the authors’ knowledge, this is the first report of vertebral artery vasculitis in polyarteritis nodosa as well as successful treatment of the condition using the combination cyclophosphamide and tocilizumab for this condition.

  1. 桡动脉感染性假性动脉瘤切除并内瘘成型术的围手术期护理%Perioperative care of a radial artery infective pseudoaneurysm excision and internal fistula plastic operation

    Institute of Scientific and Technical Information of China (English)

    黄春丽; 张雪燕; 刘莲清

    2014-01-01

    目的:总结桡动脉感染性假性动脉瘤切除并内瘘成型术的围手术期护理方法。方法:选择我院2008年1月~2013年12月治疗的桡动脉感染性假性动脉瘤患者46例,总结临床治疗和护理方法。结果:术后平均随访12个月,46例瘤切除并Ⅰ期内瘘成型术,46例均内瘘成熟后血流能满足血液透析需要。结论:术前强调规范的心理护理和预防瘤体破裂,术后加强并发症的观察并进行护理干预和指导,保证内瘘通畅,让患者在瘤切除同时行Ⅰ期内瘘成型术,可有效使用内瘘行血液透析从而提高患者的生活质量和生存率。%Objective:To discuss the effective care method of preoperative anti-fracturing of radial artery infective pseudoaneurysm and internal fistula plas-tic unblocking of postoperative maintenance Phase I. Methods:46 radial artery infective pseudoaneurysm patients received tumor excision and internal fistula plastic operation Phase I from January 2008 to December 2013 were selected for retrospective analysis of perioperative care. Results:Within the average fol-low-up visit period of 12 months after operation,in the 46 patients after maturity of internal fistula could meet the demand of hematodialysis. Conclusion:The regulated psychological care and prevention of tumor body fracturing were emphasized operation,the observation of complication was strengthened and care interference and guidance were made after operation to guarantee the unblocking of internal fistula and make the best efforts to make the patients receive tumor excision wile receiving internal fistula plastic operation Phase I,and the blood vessel available for the hematodialysis could effectively improve the pa-tients′life quality and survival rate.

  2. Infectious anastomotic pseudoaneurysm complicating renal allograft: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Chung MMT

    2017-02-01

    Full Text Available Marvin MT Chung, Yiu Che Chan, Yuk Law, Stephen WK Cheng Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong Abstract: Infectious anastomotic pseudoaneurysm complicating renal transplant is rare, but probably under-reported with <30 cases worldwide. We report a 45-year-old man with hypertension, diabetes mellitus and end stage renal failure, who had a renal transplant anastomosed to the right external iliac artery and vein. Postoperatively, he made a slow recovery with malaise and persistent vague right iliac fossa discomfort. Ultrasound scan 1 month postoperatively showed perinephric collection, and fluid culture grew Enterococcus faecium and Pseudomonas aeruginosa. He was started on vancomycin, daptomycin and colistin. MAG-3 scan also showed suboptimal function in the renal allograft. His symptoms persisted with fever, and blood culture yielded P. aeruginosa. Repeated ultrasound scan, and subsequent computed tomography scan a few weeks later, showed perinephric collection and a large, 3.8×3.5 cm pseudoaneurysm posteromedial to the graft kidney. He underwent emergency graft excision, together with resection of the pseudoaneurysm with in situ reversed great saphenous vein interposition graft, and made a good recovery on hemodialysis. The aneurysm wall grew P. aeruginosa, and he was put on imipenem and cilastatin (tienam, colistin, ciprofloxacin and daptomycin. To our knowledge, this is one of very few cases in the world’s literature in which a P. aeruginosa infectious anastomotic pseudoaneurysm developed after a renal allograft. Keywords: infectious anastomotic pseudoaneurysm, renal allograft artery, renal transplant, multidrug-resistant Pseudomonas aeruginosa, in situ interposition bypass graft

  3. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Marcelo A. Nakazone

    2010-01-01

    Full Text Available Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

  4. Incidental detection of a pseudoaneurysm at an amputation stump in a Tc-99m HMPAO labeled leukocyte scan

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Myung Hee; Jeong, Hwan Jeong; Lim, Seok Tae [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2007-08-15

    A 20-year-old man underwent a Tc-99m HMPAO labeled leukocyte scan for the evaluation of an infection at the stump of an AK amputation, which was conducted due to an open communicated fracture of the left lower leg. Blood-flow and blood-pool images demonstrated a pseudoaneurysm with a focus of intense activity medial to the stump, and centered within a large photopenic defect by surrounding hematoma. Delayed image obtained at 3 hours post-injection showed persistent intense and slight increased activity. Contrast angiography confirmed the presence of a pseudoaneurysm arising from a branch of the left superficial femoral artery.

  5. Management of Delayed Arterial Hemorrhage After Pancreato-Duodenectomy. A Case Report Study

    Directory of Open Access Journals (Sweden)

    Konstantinos Alexiou

    2015-07-01

    Full Text Available Context Delayed arterial hemorrhage after pancreatoduodenectomy is defined as bleeding 5 or more days postoperatively. Objective We present the management of delayed hemorrhage after PD, due to gastro-duodenal arterial stump aneurysm. Case report A sixty-nineyear- old man suffering from pancreatic head carcinoma underwent pancreatoduodenectomy. On the 12th postoperative day he developed melena. Endoscopic evaluation revealed occult bleeding coming from the afferent limb of the gastro-jejunal anastomosis. The patient was treated conservatively. On the 15th postoperative day the patient presented a new episode of melena and hematemesis. Upper abdominal series control by computer tomography, selective angiography of the celiac trunk and superior mesenteric artery set the diagnosis of a pseudoaneurysm of the gastro-duodenal arterial stump. The patient was managed by trans-catheter arterial embolization and complete hemostasis was achieved. Conclusion Delayed intraluminal hemorrhage after pancreatoduodenectomy may be caused after pseudoaneurysm due to some visceral arterial stem erosion. Initial management, both diagnostic and therapeutic, should be the angiographic control and trans-catheter embolization of the bleeding vessel. In case of hemodynamic instability or when angiographic embolism is unsuccessful reoperation is the proper treatment.

  6. Confluence at distal end of multiple coronary artery fistulae: two cases treated with interventional approach

    Institute of Scientific and Technical Information of China (English)

    SHEN Xiang-qian; HU Xin-qun; LI Jiang; ZHOU Tao; FANG Zhen-fei; ZHOU Sheng-hua; TANG Jian-jun; QI Shu-shan; L(U) Xiao-ling

    2008-01-01

    @@ Coronarv artery fistula(CAF), an uncommon congenital heart disease,often results in myocardial ischemia.1-3 In the last two decades,there are some reports about interventional treatment of CAF,4-6but few on transcatheter treatment of multiple CAFS.With different interventional procedures, we treated successfully two cases of percutaneous closure of two multiple CAFs which were confluent at the distal ends.

  7. Massive retroperitoneal hemorrhage from a giant renal angiomyolipoma treated by selective arterial embolization with an Amplatzer Vascular Plug II

    OpenAIRE

    Teichgräber, Ulf KM; de Bucourt, Maximilian

    2012-01-01

    We report on a 36-year-old Caucasian woman who presented to the emergency department with post-traumatic retroperitoneal bleeding diagnosed by computed tomography. After clinical stabilization of the patient, selective arterial embolization was performed. The angiomyolipoma's feeding artery was successfully treated with an 8-mm Amplatzer Vascular Plug Type II. The upper pole of the left kidney, which was supplied by a separate upper renal artery, was conserved. Consequently, the renal angiomy...

  8. Late presentation of an anomalous left coronary artery from the pulmonary artery treated with conservative surgical management with long-term cardiac magnetic resonance imaging follow-up

    Science.gov (United States)

    Gouda, Pishoy; Gouda, John; Butler, Craig; Welsh, Robert C

    2017-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery is rare congenital abnormality that most commonly presents in childhood and is associated with a high mortality. In the elderly, patients may present acutely with arrhythmias or signs of ischemia or with vague chronic presentations of shortness of breath and fatigue. In the high-risk elderly population, it is unclear as to whether conservative surgical management by means of suture ligation of the left coronary artery is associated with positive long-term outcomes. We present a case of a 69-year-old patient diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, which was treated with conservative surgical management and followed up for 15 years with cardiovascular magnetic resonance imaging, with positive outcomes.

  9. Blunt splenic injury in a child with situs inversus totalis treated with transcatheter arterial embolization

    Directory of Open Access Journals (Sweden)

    Naoki Hashizume

    2016-10-01

    Full Text Available We report the first case of blunt splenic rupture in a child with situs inversus totalis treated with transcatheter arterial embolization (TAE. A 12-year-old girl fell roughly 4 feet onto the pavement while riding her bicycle. Contrast-enhanced computed tomography revealed situs inversus totalis, a massive hemorrhage in the abdominal cavity, and a ruptured spleen with extravasation. Arteriography showed that the internal organs were located opposite their normal positioning. TAE was carried out with gelfoam and a micro coils at the branch of the upper lobe of the splenic artery. TAE is effective for blunt splenic injury with extravasation in a child with situs inversus. In TAE, there is no technical difference about situs inversus excepted mirror image of abdominal vascular formation.

  10. Pseudoaneureysm of Carotid Artery and Its Branches Caused by Local Suppuration A Report of 6 Cases%颈部感染性假性动脉瘤

    Institute of Scientific and Technical Information of China (English)

    王义; 张金哲

    1987-01-01

    作者三十年间共收治了6例颈部感染性假性动脉瘤.本文就该症的病理临床表现进行了总结.提出了治疗意见.%Caused by pyogenic infection of deep cervical lymph nodes, the pseudoaneurysms of the carotid artery and its branches in the neck are rare. Six cases were handled in the past 30 years. They were three cases of aneurysm of lignual artery, one of external carotid artery, one of internal carotid artery and one of an unidentified branch of the external carotid artery. Outstanding symptoms and signs are as follows: infection in the neck; hematemesis with or without choking resulting from the ruptured aneurysm into the throat; hoarseness, dysphagia, and Horner's syndrome caused by pres sure on vagus, hypoglossal, glossopharyngeal or sympathetic nerves. Pseudoaneurysm as a complication of local suppuration usually lacks of typical findings of an aneurysm, such as expansile pulsation and systolic bruit. It might be misdiagnosed as an abscess. And if incorrectly treated with incision and drainage, blood would gush out terribly from the wound. It should be emphasized that a experimental puncture is preferable. During operation, a temporary occlusion on the proximal part of the feeding vessels must be done before the exploration and ligation of the perforated artery. Thus treated, all the six cases survired without permanent neurologic sequelae.

  11. [Giant pseudoaneurysm of the ascending aorta following the aortic valve replacement;report of a case].

    Science.gov (United States)

    Kawahara, Yu; Inage, Yuichi; Masaki, Naoki; Toyama, Shuji; Fukasawa, Manabu

    2013-08-01

    56-year-old male, who had undergone re-aortic valve replacement (AVR) 33 years ago, received preoperative study for pancreatic surgery. Computed tomography (CT) revealed a giant pseudoaneurysm (7 cm diameter) of the ascending aorta. The ascending aorta was not dilated. A midline skin incision was performed, followed by full sternotomy. A tight pericardial adhesion was carefully dissected. Cardiopulmonary bypass was established by femoral arterial and bicaval venous cannulation. The pseudoaneurysm was incised under the retrograde cardioplegic protection. A communication between ascending aorta and aneurysm was found 1 cm distal to the previous aortic suture line. This communication coincided with the cardioplegic root cannulation site. The aortic prosthetic valve was intact. The ascending aorta was replaced with 26 mm prosthetic graft. Postoperative course was uneventful. In this case, CT was useful to select the approach to the complicated postoperative surgical site.

  12. Severe hypertension due to renal polar artery stenosis in an adolescent treated with coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Docx, Martine K. [Koningin Paola Kinderziekenhuis, Department of Paediatrics, Chronic Diseases and Hypertension, Antwerp (Belgium); Vandenberghe, Philippe [Koningin Paola Kinderziekenhuis, Department of Paediatric Cardiology, Antwerp (Belgium); Maleux, Geert [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Gewillig, Marc [University Hospitals Leuven, Department of Paediatric Cardiology, Leuven (Belgium); Mertens, Luc [Hospital for Sick Children, Paediatric Cardiology, Toronto (Canada)

    2009-11-15

    A 12-year-old boy presented with severe arterial hypertension due to a severe subsegmental renal artery stenosis. Treatment consisted of selective embolization of the stenosed polar artery, which resulted in near normalization of the arterial pressures. Renal artery stenosis should always be considered, even in young adolescents, as a cause for arterial hypertension. Only selective angiography was able to demonstrate the subsegmental artery stenosis in this patient. (orig.)

  13. Severe Pulmonary Arterial Hypertension in Patients Treated for Hepatitis C With Sofosbuvir.

    Science.gov (United States)

    Renard, Sébastien; Borentain, Patrick; Salaun, Erwan; Benhaourech, Sanaa; Maille, Baptiste; Darque, Albert; Bregigeon, Sylvie; Colson, Philippe; Laugier, Delphine; Gaubert, Martine Reynaud; Habib, Gilbert

    2016-03-01

    Development of direct-acting antiviral agents against hepatitis C virus (HCV) has changed the management of chronic HCV infection. We report three cases of newly diagnosed or exacerbated pulmonary arterial hypertension (PAH) in patients treated with sofosbuvir. All patients had PAH-associated comorbidities (HIV coinfection in two, portal hypertension in one) and one was already being treated for PAH. At admission, all patients presented with syncope, World Health Organization functional class IV, right-sided heart failure, and extremely severe hemodynamic parameters. After specific PAH therapy, the clinical and hemodynamic properties for all patients were improved. Severity and acuteness of PAH, as well as chronology, could suggest a causal link between HCV treatment and PAH onset. We hypothesize that suppression of HCV replication promotes a decrease in vasodilatory inflammatory mediators leading to worsening of underlying PAH. The current report suggests that sofosbuvir-based therapy may be associated with severe PAH.

  14. Clinical importance of the middle meningeal artery: A review of the literature

    Science.gov (United States)

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

    2016-01-01

    The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases. However, no systematic review describing the importance of MMA has been published. In this study, we used the PUBMED database to perform a review of the literature on the MMA to increase our understanding of its role in neurosurgery. After performing this review, we found that the MMA was commonly used to access DAVFs and meningiomas. Pseudoaneurysms and true aneurysms in the MMA can be effectively treated via endovascular or surgical removal. In MMD, the MMA plays a very important role in the development of collateral circulation and indirect revascularization. For recurrent CDSHs, after burr hole irrigation and drainage have failed, MMA embolization may be attempted. The MMA can also contribute to the occurrence and treatment of migraines. Because the ophthalmic artery can ectopically originate from the MMA, caution must be taken to avoid causing damage to the MMA during operations. PMID:27766029

  15. A Case of Intraparenchymal Pseudoaneurysms in Kidney Allograft

    Science.gov (United States)

    Lorentz, Liam Antony; Hlabangana, Linda Tebogo; Davies, Malcolm

    2016-01-01

    Patient: Male, 31 Final Diagnosis: Intraparenchymal pseudo-aneurysms in kidney transplant Symptoms: Asymptomatic Medication: — Clinical Procedure: Percutaneous renal biopsy Specialty: Transplantology Objective: Diagnostic/therapeutic accidents Background: Percutaneous needle biopsy is routinely performed for renal allograft management. Vascular complications of the procedure include pseudoaneurysm and arterio-venous fistulae formation. Delayed diagnosis of these complications is due to their mostly asymptomatic and indolent nature. Case Report: We present a case of extensive intraparenchymal pseudoaneurysm formation within the inferior pole of the allograft, diagnosed two years following the most recent biopsy procedure. Conclusions: Renal pseudoaneurysms may only be diagnosed years after their formation as they are typically asymptomatic. PMID:27510594

  16. Incidentally Detected Inoperable Malignant Pheochromocytoma with Hepatic Metastasis Treated by Transcatheter Arterial Chemoembolization

    Directory of Open Access Journals (Sweden)

    Joong Keun Kim

    2014-12-01

    Full Text Available Malignant pheochromocytoma (PCC is a rare condition. Although the liver is the second most frequent site of metastasis in malignant PCC, no definite treatments have been established. Herein, we report a case of liver metastasis of PCC that was successfully treated by transcatheter arterial chemoembolization (TACE. A 69-year-old man was admitted to the Department of Gastroenterology for evaluation of an incidental hepatic mass in August 2013. He had undergone right adrenalectomy in May 2005 and PCC had been confirmed on the basis of histopathological findings. Liver biopsy was performed, and metastatic PCC was diagnosed. The lesion appeared inoperable because of invasion of the portal vein and metastases in the lymph nodes along the hepatoduodenal ligament. Thus, TACE was performed instead. After TACE, symptoms including dizziness and cold sweating improved, and the patient's serum catecholamine levels decreased. On the basis of this case, we believe that TACE may be a useful treatment for liver metastasis in malignant PCC.

  17. Giant aneurysm of the left anterior descending coronary artery in a pediatric patient with Behcet's disease.

    Science.gov (United States)

    Cook, Amanda L; Rouster-Stevens, Kelly; Williams, Derek A; Hines, Michael H

    2010-07-01

    Behcet's disease is a rare autoimmune vasculitis characterized by oral aphthosis, genital ulcers, and ocular and cutaneous lesions. Vascular involvement usually affects the veins more commonly than the arteries, and coronary arterial involvement is extremely rare. We report an adolescent with Behcet's disease who developed a large pseudoaneurysm of the left anterior descending coronary artery requiring a coronary arterial bypass graft.

  18. Tuberculous iliac artery aneurysm in a pediatric patient.

    Science.gov (United States)

    Cox, Sharon Gail; Naidoo, Nadraj G; Wood, Richard John; Clark, Lizelle; Kilborn, Tracy

    2013-03-01

    Vascular complications of tuberculous infections are rare and occur even less frequently in the pediatric population. Tuberculous pseudoaneurysms can occur either as a result of contiguous spread from a neighboring focus-invariably infected lymph nodes-or by hematogenous spread and seeding of acid-fast bacilli that lodge in the adventitia or media via the vasa vasorum. We report a case of turberculous right common iliac artery pseudoaneurysm in a 12-year-old and review the relevant literature.

  19. Biological artificial vessel graft in distal arterial bypass for treating diabetic lower limb ischemia: a case report

    Institute of Scientific and Technical Information of China (English)

    GU Yong-quan; WU Ying-feng; QI Li-xing; GUO Lian-ri; LI Xue-feng; CUI Shi-jun; TONG Zhu; GUO Jian-ming; ZHANG Jian

    2011-01-01

    A 68-year-old female patient was treated for unhealed ulcer in the fourth toe of the left foot. Clinical examinations identified severe stenosis of the proximal segment and occlusion of the distal segment of the left anterior tibial artery, and occlusion of the left posterior tibial artery and the peroneal artery. The proximal stenotic segment of the left anterior tibial artery was dilated, but the distal occlusive part failed to be re-canalized. Left anterior tibial artery to dorsal pedal artery bypass was performed on the patient with an epoxide-crosslinked, special radicals antigen-sealed, porcine-derived biological graft; debridement of the left 4th digiti pedis was also performed. Postoperation course was uneventful. The pulse of the left dorsal pedal artery was strong. The ankle brachial index (ABI) increased from 0.60 to 1.09. Warfarin and two antiplatelet drugs were given after the operation. Six months after operation, computed tomographic angiogram (CTA)identified the patent graft.

  20. Embolization of the Middle Meningeal Artery Effectively Treats Refractory Chronic Subdural Hematoma: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Gobran Alfotih

    2014-10-01

    Full Text Available Chronic subdural hematoma (CSDH formation mechanism is very complex, and has not entirely understood. It represents a frequent type of intracranial hemorrhage, and is very common disease in Neurosurgery practice, especially in older patients. Various surgical treatments have been proposed for the treatment of CSDH. The rate of recurrence in CSDH after surgery ranges from 5% to 30%, repeated surgery must be considered. But in some cases subdural collections are still persistent. Endovascular embolization of the middle meningeal artery (MMA is an option for treatment of refractory CSDH. We review all cases that were treated with embolization to assess the effect of this intervention. Our review revealed 6 papers with a total enrollment of 14 patients were treated with MMA embolization for refractory chronic subdural hematoma without any postoperative complication or recurrence. In this study we suggest MMA embolization as an alternative for treatment of non-curable CSDH, especially for old people with systematic diseases, who cannot tolerate repeat surgery.

  1. Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

    Science.gov (United States)

    Touma, Masanao; Ohno, Nobuhisa; Yoshikawa, Eiji; Yoshizawa, Kousuke; Fujiwara, Keiichi

    2015-01-01

    We report the case of a 62-year-old man who experienced a left axillary artery pseudoaneurysm that was secondary to nonunion of a 30-year-old left midshaft clavicle fracture. He initially underwent endovascular repair using a self-expanding nitinol stent graft, which was perforated at postoperative day 5. Therefore, we performed open repair with concomitant clavicle resection, and no complications were observed during an approximately 6-year follow-up. We recommend performing clavicle resection with vascular repair to prevent recurrence in similar cases. PMID:26421082

  2. Experiência inicial com o uso de adesivo tissular contendo trombina para tratamento do pseudo-aneurisma femoral Treatment of femoral pseudoaneurysm with thrombin tissue adhesive: initial experience

    Directory of Open Access Journals (Sweden)

    Daniel Mendes Pinto

    2006-03-01

    Full Text Available O pseudo-aneurisma (PSA após cateterização femoral tem sido diagnosticado com regularidade em serviços com grande movimento de intervenções percutâneas, com incidência variando de 0,05 a 6%. PSA femorais pequenos podem ser acompanhados até a resolução espontânea. As opções de tratamento são: compressão guiada por ultra-som, injeção de trombina para trombose do PSA e tratamento cirúrgico. A injeção percutânea de trombina tem a vantagem de ser um procedimento indolor e rápido. Podem ser utilizados trombina isolada ou preparados contendo trombina associada a fibrinogênio e fatores de coagulação. A experiência inicial dos autores de cinco casos tratados com injeção de adesivo tissular contendo trombina mostrou resultado satisfatório em quatro; um caso necessitou tratamento cirúrgico. Não houve sucesso com uso isolado de trombina humana, porém, ocorreu trombose imediata após injeção de preparado de trombina associada a fibrinogênio/fator XIII. Neste artigo, são discutidas as opções de tratamento dos PSA femorais e a técnica do uso de trombina percutânea.Pseudoaneurysms caused by femoral artery catheterization have been regularly diagnosed in medical units with a great number of percutaneous interventions, with a documented incidence between 0.05 and 6%. Small femoral pseudoaneurysms undergo spontaneous resolution. Treatment options are: ultrasound-guided compression, thrombin injection to induce pseudoaneurysm thrombosis and surgical treatment. Percutaneous thrombin injection has the advantage of being a fast and painless procedure. Both isolated thrombin and thrombin preparations with fibrinogen and coagulation factors can be used. The authors' initial experience with five cases treated with thrombin tissue adhesive showed successful results in four; one case required surgery. There was no success with isolated human thrombin, but immediate thrombosis was achieved after injection of thrombin associated to

  3. Coil embolization of internal mammary artery injured during central vein catheter and cardiac pacemaker lead insertion

    Energy Technology Data Exchange (ETDEWEB)

    Chemelli, A.P. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)], E-mail: Andreas.Chemelli@i-med.ac.at; Chemelli-Steingruber, I.E. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria); Bonaros, N. [Department of Cardiovascular Surgery, Innsbruck Medical University (Austria); Luckner, G. [Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University (Austria); Millonig, G. [Department of Gastroenterology and Hepatology, Innsbruck Medical University (Austria); Seppi, K. [Department of Neurology, Innsbruck Medical University (Austria); Lottersberger, C.; Jaschke, W. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)

    2009-08-15

    Purpose: This study describes several cases of endovascular coil embolization of the proximal internal mammary artery injured by blind approach to the subclavian vein for central venous catheter or pacemaker lead insertion. Materials and methods: We conducted a retrospective analysis of five patients with iatrogenic arterial lesions of the internal mammary artery (IMA). The lesions occurred in three patients from a puncture of the subclavian vein during insertion of a central venous catheter and in two patients from a puncture of the subclavian vein for insertion of a pacemaker lead. Four patients had acute symptoms of bleeding with mediastinal hematoma and hematothorax and one patient was investigated in a chronic stage. A pseudoaneurysm was detected in all five patients. All four acute and hemodynamic unstable patients required hemodynamic support. Results: In all patients, embolization was performed using a coaxial catheter technique, and a long segment of the IMA adjacent distally and proximally to the source of bleeding was occluded with pushable microcoils. In one patient, additional mechanically detachable microcoils were used at the very proximal part of the IMA. Microcoil embolization of the IMA was successful in all patients, and the source of bleeding was eliminated in all patients. Conclusion: Transarterial coil embolization is a feasible and efficient method in treating acute bleeding and pseudoaneurysm of the IMA and should be considered if mediastinal hematoma or hemathorax occurs after blind puncture of the subclavian vein.

  4. A life-threatening infective pseudoaneurysm of the left ventricle in a toddler

    Directory of Open Access Journals (Sweden)

    Mani Ram Krishna

    2015-01-01

    Full Text Available Pseudoaneurysms of the ventricle are an uncommon occurrence in children. They may be secondary to previous cardiac surgery or infection of the pericardial space. Infective pseudoaneurysms require urgent surgery because rupture of the pseudoaneurysm may have catastrophic consequences. The outcome with surgery is excellent. We report a toddler with ruptured pseudoaneurysm secondary to purulent pericarditis who recovered with an emergency surgical closure of the opening of the pseudo-aneurysm.

  5. Treatment of carotid artery aneurysms with covered stents; Aneurysmabehandlung der Arteria carotis interna mit gecoverten Stents

    Energy Technology Data Exchange (ETDEWEB)

    Rohr, A.; Alfke, K.; Doerner, L.; Jansen, O. [UKSH Kiel (Germany). Neurochirurgie Neuroradiologie; Bartsch, T.; Stingele, R. [UKSH Kiel (Germany). Neurologie

    2007-10-15

    Purpose: Evaluation of the use of covered stents in treating pseudoaneurysms of the cervical and intracranial/extradural carotid artery and determination of the periprocedural and short- to mid-term complication rate. Materials and Methods: 8 patients with 9 spontaneous dissecting aneurysms of the cervical carotid artery - 5 of which were symptomatic - plus one patient with ofthalmoplegia due to an aneurysm of the cavernous carotid artery were studied. While the latter was treated with a PTFE-covered balloon-mounted stainless steel stent (Jostent/Graftmaster), a self-expanding PTFE-covered Nitonol Stent (Symbiot) was used in all other cases. Intervention was performed with local anesthesia. Aspirin and Clopidogrel were both used as antiplatelet drugs. Clinical signs and symptoms and vascular imaging with DS, MR, CT angiography and ultrasound were recorded during patient follow-up, with a mean follow-up period of 14.6 months (4 - 30). Results: We were able to treat 8 out of 10 aneurysms (80 %) using covered stents. The aneurysms were immediately occluded and the associated stenoses of the parent vessel were eliminated. No clinically relevant complications occurred during the procedure or in the follow-up interval. In two cases, elongation of the carotid artery prevented the stent from being positioned over the aneurysm neck. These cases were shown to be stable with the use of antiplatelet drugs. Conclusion: Covered stents can be used in the treatment of pseudoaneurysms of the carotid artery as an alternative to long-term antithrombotic medication or surgery. In our study treatment was effective (80 %) and free of complications in the short- and mid-term follow-up. Possible indications, technique and the use of imaging modalities for patient follow-up are discussed. (orig.)

  6. [Tunnelled central venous line-associated infections in patients with pulmonary arterial hypertension treated with intravenous prostacyclin].

    Science.gov (United States)

    Boucly, Athénaïs; O'Connell, Caroline; Savale, Laurent; O'Callaghan, Dermot S; Jaïs, Xavier; Montani, David; Humbert, Marc; Simonneau, Gérald; Sitbon, Olivier

    2016-01-01

    Intravenous prostacyclins are a valuable treatment for patients with severe pulmonary arterial hypertension, leading to improved exercise capacity, haemodynamics, quality of life and survival. Unfortunately, due to the short half-life of these drugs, they need to be administered continuously through central venous catheters. Despite aseptic technique, regular dressing changes, tunneled central venous catheters and patient education, patients are exposed to central venous catheter associated infections. These infections cause significant morbidity and mortality. The clinical presentation, microbiology, consequences and management of these central venous catheter associated infections in pulmonary arterial hypertension patients treated with intravenous prostacyclins are discussed.

  7. Peptide-micelle hybrids containing fasudil for targeted delivery to the pulmonary arteries and arterioles to treat pulmonary arterial hypertension.

    Science.gov (United States)

    Gupta, Nilesh; Ibrahim, Hany M; Ahsan, Fakhrul

    2014-11-01

    This study investigates the respirability and efficacy of peptide-micelle hybrid nanoparticles as carriers for inhalational therapy of pulmonary arterial hypertension (PAH). CARSKNKDC (CAR), a cell-penetrating and lung-homing peptide, conjugated polyethylene glycol-distearoyl-phosphoethanolamine micelles containing fasudil, an investigational anti-PAH drug, were prepared by solvent evaporation method and characterized for various physicochemical properties. The pharmacokinetics and pharmacological efficacy of hybrid particles containing fasudil were evaluated in healthy rats and monocrotaline-induced PAH rats. CAR micelles containing fasudil had an entrapment efficiency of approximately 58%, showed controlled release of the drug, and were monodispersed with an average size of approximately 14 nm. Nuclear magnetic resonance scan confirmed the drug's presence in the core of peptide-micelle hybrid particles. Compared with plain micelles, CAR peptide increased the cellular uptake by approximately 1.7-fold and extended the drug half-life by approximately fivefold. The formulations were more prone to accumulate in the pulmonary vasculature than in the peripheral blood, which is evident from the ratio of the extent of reduction of pulmonary and systemic arterial pressures. On the whole, this study demonstrates that peptide-polymer hybrid micelles can serve as inhalational carriers for PAH therapy.

  8. A rare and lethal case of right common carotid pseudoaneurysm following whiplash trauma.

    Science.gov (United States)

    Pomara, Cristoforo; Bello, Stefania; Serinelli, Serenella; Fineschi, Vittorio

    2015-03-01

    Whiplash trauma from a car crash is one of the most common causes of neck injury, resulting in pain and dysfunction. We report on an unusual case of post-whiplash pseudoaneurysm of the right common carotid artery, which led to acute massive hemorrhage and death days after the initial trauma. A post-mortem computed tomography angiography showed rupture of the pseudoaneurysm of the right common carotid artery with the contrast agent leaking out into the mouth. The subsequent autopsy confirmed a large hemorrhagic clot extending to the right side of the neck and mediastinum. A rupture of the right wall of the oropharynx was identified with massive bronchial hemoaspiration. The case demonstrates a rare but lethal clinical entity, and is important in providing a better understanding of the potentially fatal consequences of minor trauma, such as whiplash injury, and its physiopathological mechanisms. Thus, changing symptoms after a whiplash injury should be carefully evaluated since they can be related to the underlying severe consequences of a rapid hyperextension-hyperflexion of the neck, as in the reported case.

  9. Single coronary artery; extremely rare coronary anomaly successfully treated surgically in young adult male.

    LENUS (Irish Health Repository)

    Shah, A R

    2010-05-01

    Single coronary artery arising from aortic root, is a rare congenital anomaly. A 30-year-old male presented with acute myocardial infarction (MI) complaining of chest pain and raised troponin levels. Emergency angiography showed no coronary lesions but both left and right coronary arteries arising from single ostium. Patient was operated electively and perioperative findings confirmed the diagnosis of single coronary artery, as left coronary artery after taking origin from right sinus of valsalva runs through the septum, before dividing into left anterior descending and circumflex branches. The single coronary ostium opened with a slit like incision over the course of left main coronary, making the size of ostium three to four times bigger than the native one. In addition left internal mammary artery was harvested and grafted to the left anterior descending branch distally. Patient made successful recovery. Four months follow up dobutamine stress echo showed no inducible ischemia.

  10. [Acquired coronary-cameral fistula complicated by a ventricular pseudoaneurysm].

    Science.gov (United States)

    Hammami, R; Bosmans, J; Voormolen, M; Vermeulen, T; Salgado, R; Vrints, C

    2013-12-01

    Coronary-cameral fistulas are usually congenital, rarely acquired; the complication of this anomaly with ventricular pseudoaneurysm is exceptional. We report a new case of acquired coronary-cameral fistula, occurred in a patient who had received a bypass graft and who had suffered from angina 1 year after the surgery. On computed tomography coronary angiography, the fistula seems to communicate the first diagonal to a left ventricle pseudoaneurysm. Embolization of the fistula and filling of the pseudoaneurysm by neurocoil were successfully performed. The clinical and angiographic control after 3 months showed symptoms improvement and absence of recanalization of the fistula.

  11. Development of coronary artery stenosis in a patient with metastatic renal cell carcinoma treated with sorafenib

    Directory of Open Access Journals (Sweden)

    Pantaleo Maria

    2012-06-01

    Full Text Available Abstract Background Tyrosine kinase inhibitors (TKIs are currently approved for the treatment of metastatic renal cell carcinoma (mRCC. The cardiotoxic effects of sorafenib and sunitinib may cause hypertension, left ventricular ejection fraction (LVEF dysfunction and/or congestive heart failure (CHF, and arterial thrombo-embolic events (ATE. Only three cases of coronary artery disease related to sorafenib therapy have been described in the literature, and all were due to arterial vasospasm without evidence of coronary artery stenosis on angiography. Cardiotoxicity is commonly associated with the presence of cardiovascular risk factors, such as a history of hypertension or coronary artery disease. Case presentation We describe a patient who experienced an unusual cardiac event after 2 years of sorafenib treatment. A 58-year-old man with mRCC developed acute coronary syndrome (ischemia/infarction associated with critical sub-occlusion of the common trunk of the left coronary artery and some of its branches, which was documented on coronary angiography. The patient underwent triple coronary artery bypass surgery, and sorafenib treatment was discontinued. He did not have any cardiovascular risk factors, and his cardiac function and morphology were normal prior to sorafenib treatment. Conclusions Further investigation of a larger patient population is needed to better understand cardiac damage due to TKI treatment. Understanding the usefulness of careful cardiovascular monitoring might be important for the prevention of fatal cardiovascular events, and to avoid discontinuation of therapy for the underlying cancer.

  12. Endovascular repair of traumatic external iliac vessel pseudoaneurysm and arteriovenous fistulae

    Directory of Open Access Journals (Sweden)

    Juan Marin

    2013-09-01

    Full Text Available A 17-year-old male patient presenting with an abdominal gunshot wound and severe hypovolemic shock was initially operated and presented several injuries to the small bowel and cecum associated with severe hemorrhage. The patient had to be operated twice due to hypothermia, acidosis, and coagulopathy. In the late postoperative period, murmur and fremitus were observed. Angiography revealed a pseudoaneurysm associated with arteriovenous fistulae at the left external iliac vessels. Lesions were repaired with a stent graft placed in the external iliac artery, with a satisfactory outcome. Control computed tomography performed 6 months later evidenced artery integrity with closure of the fistulae. Endovascular therapy should be the preferred method in this type of vascular trauma complications.

  13. Radial artery pseudo aneurysm after percutaneous cannulation using Seldinger technique

    Directory of Open Access Journals (Sweden)

    Anil Ranganath

    2011-01-01

    Full Text Available Cannulation of a peripheral artery in a patient allows for continuous blood pressure (BP monitoring and facilitates frequent arterial blood gas (ABG analysis. Complications include thrombosis, embolism risk, haemorrhage, sepsis, and formation of pseudo aneurysms. A 75-year-old male admitted via casualty with a collapse secondary to seizures. Patient was intubated and mechanically ventilated for 7 days. A right radial artery catheter was inserted on admission to casualty. The arterial catheter remained in situ for 7 days. Five days following its removal, the skin site appeared inflamed and a wound swab grew methicillin resistant Staphylococcus aureus (MRSA. Eight days later a distinct bulging of the radial artery was noticed. An ultrasound was done and it showed radial artery pseudoaneurysm, the diagnosis was confirmed by angiogram. Delayed radial artery pseudoaneurysm formation has only been reported in association with infection, and less than twenty of these cases have been reported in the literature.

  14. Radial artery pseudo aneurysm after percutaneous cannulation using Seldinger technique.

    Science.gov (United States)

    Ranganath, Anil; Hanumanthaiah, Deepak

    2011-05-01

    Cannulation of a peripheral artery in a patient allows for continuous blood pressure (BP) monitoring and facilitates frequent arterial blood gas (ABG) analysis. Complications include thrombosis, embolism risk, haemorrhage, sepsis, and formation of pseudo aneurysms. A 75-year-old male admitted via casualty with a collapse secondary to seizures. Patient was intubated and mechanically ventilated for 7 days. A right radial artery catheter was inserted on admission to casualty. The arterial catheter remained in situ for 7 days. Five days following its removal, the skin site appeared inflamed and a wound swab grew methicillin resistant Staphylococcus aureus (MRSA). Eight days later a distinct bulging of the radial artery was noticed. An ultrasound was done and it showed radial artery pseudoaneurysm, the diagnosis was confirmed by angiogram. Delayed radial artery pseudoaneurysm formation has only been reported in association with infection, and less than twenty of these cases have been reported in the literature.

  15. Cost and patency rate targets for the development of endovascular devices to treat femoropopliteal arterial disease

    NARCIS (Netherlands)

    G.S. Muradin (Galied); M.G.M. Hunink (Myriam)

    2001-01-01

    textabstractPURPOSE: To determine the criteria that would make use of an endovascular device cost-effective compared with bypass surgery and percutaneous transluminal angioplasty in the treatment of femoropopliteal arterial disease. MATERIALS AND METHODS: A decision mod

  16. 内脏动脉瘤的外科治疗%Surgical management of splanchnic artery aneurysms

    Institute of Scientific and Technical Information of China (English)

    舒畅; 罗明尧; 李全明; 姜晓华; 黎明; 周建平

    2011-01-01

    Objective To analyse the management of splanchnic artery aneurysms by open surgery and endoluminal therapy. Methods The clinical data of 10 splanchnic artery aneurysm patients (four male, six female) hospitalised from January 2002 were analysed retrospectively. The average age was (56 ± 13) years (28 - 74). Surgical or endoluminal treatment for six cases of splenic artery aneurysms or pseudoaneurysms were applied, among which multiple splenic artery aneurysms was found in one, and aberrant aneurysms at the proximal section of the splenic artery originating from a spleno-mesenteric trunk was found in three, splenic artery pseudoaneurysm in one and single aneurysm with normal splenic artery in anatomy in one. Besides, there were two superior mesenteric artery aneurysm, one of tuberculous celiac artery pseudoaneurysm and one renal artery aneurysm. Results The tuberculous celiac artery pseudoaneurysm was successfully managed by deploying a stent-graft endoluminally. One case was converted to open surgery after the splenic artery aneurysm was only paitially covered by a stent-graft. The other 8 cases were successfully treated by open surgery. All of the operations are successful. All patients were followed up from three months to six years, during which no death or other severe complications occurs. Conclusions The splanchnic artery varies from one to another anatomically. Preoperative CT scan or digital substraction angiology are helpful for the diagnosis of the splanchnic arterial aneurysms and choosing an appropriate management. Conventional open surgery is effective and reliable, while endoluminal therapy is a minimally invasive alternative.%目的 总结腔内技术和外科手段治疗内脏动脉瘤的疗效.方法 回顾性分析10例内脏动脉瘤患者的临床资料.男4例,女6例,年龄28~74岁,平均(56 ±13)岁.其中脾动脉真性动脉瘤5例,脾动脉假性动脉瘤1例,肠系膜上动脉瘤2例,腹腔干结核性假性动脉瘤1例,肾动脉瘤1

  17. A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery

    Directory of Open Access Journals (Sweden)

    Nobuhiro Takeuchi

    2012-01-01

    Full Text Available A 58-year-old female with a history of Wolff-Parkinson-White syndrome presented at our institution with palpitations and chest pain. Electrocardiography revealed paroxysmal supraventricular tachycardia with a heart rate of 188 beats/min. Antiarrhythmic drugs were ineffective, and tachycardia was resolved by electrical cardioversion. Transthoracic echocardiography revealed abnormal vessels around the right coronary artery (RCA and pulmonary artery (PA; in addition, we suspected coronary arteriovenous fistula (CAVF. Coronary angiography and coronary computed tomography revealed dilated fistula vessels, with a 1 cm saccular aneurysm around the RCA, originating from the proximal RCA and left anterior descending artery into the main trunk of PA. Therefore, we confirmed the diagnosis of CAVF with an unruptured aneurysm. We surgically ligated and clipped the fistula vessels and resected the aneurysm. The resected aneurysm measured  cm in size. Pathological examination of the resected aneurysm revealed hypertrophic walls comprising proliferating fibroblasts cells thin elastic fibers. Very few atherosclerotic changes manifested in the aneurysm walls. We report the case of a patient with CAVF and an unruptured coronary artery aneurysm who was successfully treated by surgery.

  18. Cardiac catheterization: What causes a pseudoaneurysm? Should a pseudoaneurysm always be treated?

    Science.gov (United States)

    ... FC, et al., eds. Thoracic aneurysms and aortic dissection. In: Schwartz's Principles of Surgery. 9th ed. New ... logo are trademarks of Mayo Foundation for Medical Education and Research. © 1998-2017 Mayo Foundation for Medical ...

  19. Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization.

    Science.gov (United States)

    Sankararaman, Senthilkumar; Velayuthan, Sujithra; Vea, Romulo; Herbst, John

    2013-06-01

    Bleeding from gastric varices due to splenic vein obstruction is extremely rare in children, but it can be catastrophic. Reported herein is the case of a teenager with splenic vein thrombosis and chronic decompensated liver disease from autoimmune hepatitis who presented with massive gastric variceal bleeding. Standard medical management did not control the bleeding. Due to decompensated liver disease and continuous active bleeding, emergency partial splenic artery embolization was preferred over splenectomy or a shunt procedure. Bleeding was successfully controlled by partial splenic artery embolization by decreasing the inflow of blood into the portal system. It is concluded that emergency partial splenic artery embolization is a safer alternative life-saving procedure to manage severe gastric variceal bleeding due to splenic vein obstruction in a patient with high surgical risk. To our knowledge, only one other patient with similar management has been reported in the pediatric age group.

  20. latrogenic aortic pseudoaneurysm following anterior thoracic spine surgery masquerading as chronic infection

    Institute of Scientific and Technical Information of China (English)

    Vijay Goni; Ajay Bahl; Nirmal Raj Gopinathan; Vibhu Krishnan; Rajesh Kumar

    2013-01-01

    Late vascular complications involving aorta are rare but devastating adversities following anterior thoracic spine operations are present.The current article describes our experience with one such patient who had an iatrogenic pseudoaneurysm of the thoracic aorta,mimicking infection.The patient was treated successfully following concomitant efforts by multidisciplinary experts with shunting.We wish to highlight upon the significance of recognizing the possible sinister consequences of a dangerously prominent spinal implant and the role of a suspicious surgeon in identifying these menacing complications at the right time.

  1. Iatrogenic aortic pseudoaneurysm following anterior thoracic spine surgery masquerading as chronic infection

    Directory of Open Access Journals (Sweden)

    Goni Vijay

    2013-12-01

    Full Text Available 【Abstract】Late vascular complications involving aorta are rare but devastating adversities following anterior thoracic spine operations are present. The current article describes our experience with one such patient who had an iatrogenic pseudoaneurysm of the thoracic aorta, mimick- ing infection. The patient was treated successfully follow- ing concomitant efforts by multidisciplinary experts with shunting. We wish to highlight upon the significance of recognizing the possible sinister consequences of a dan- gerously prominent spinal implant and the role of a suspi- cious surgeon in identifying these menacing complications at the right time. Key words: Fractures, bone; Aorta, thoracic; Aneurysm, false; Iatrogenic disease

  2. Falso Aneurisma Femoral Iatrogénico: Ainda uma indicação para a Cirurgia Convencional? Iatrogenic femoral pseudoaneurysm: still an indication for conventional surgery?

    Directory of Open Access Journals (Sweden)

    Nelson Oliveira

    2011-12-01

    report. Case Report: Sixty-one year old Caucasian male, with personal history of Hypertension, previous myocardial infarct, dilated myocardiopathy, paroxistic auricular fibrillation, with an implanted cardiodefibrillator, was submitted to His Bundle ablation by right femoral catheterization. He was referred because of the presence of a painful pulsating mass at the catheterization site. A color-Doppler confirmed the diagnosis of Pseudoaneurysm of the right Deep Femoral Artery with 3cm of diameter and the presence of an Arteriovenous Fistula between the superficial femoral vessels. The patient was treated in a Classic fashion, with exclusion of the pseudoaneurysm and repair of the superficial artery and vein. Conclusion: First-line treatment for PAN remains non-invasive but Open Surgical repair is still an important alternative in the management of a restrict group of patients.

  3. Imaging diagnosis and interventional treatment of pseudoaneurysm%假性动脉瘤的影像学诊断及介入治疗

    Institute of Scientific and Technical Information of China (English)

    尹桂亭

    2016-01-01

    Objective TO investiGate tHe imaGinG diaGnOsis and effect Of pseudOaneurysm. Methods THirty patients WitH pseudOaneurysm frOm May 2012 tO May 2014 Were seLected,tHe imaGe di-aGnOsis and treatment infOrmatiOn Were retrOspectiveLy anaLyzed. Results THe LOcatiOns Of tHe tumOr:3 caese Of subcLavian artery,1 case Of tHe cOmmOn carOtid artery,1 case Of anteriOr tibiaL artery,1 case Of tHOracic aOrta,6 cases Of femOraL artery,7 cases Of renaL artery,1 case Of inferiOr GLuteaL artery,1 case Of Hepatic artery,1 case Of superiOr GLuteaL artery,1 case Of GastrOduOdenaL,1 case Of eXternaL pudendaL artery,1 case Of GastrOduOdenaL artery,3 cases Of internaL pudendaL artery,1 case Of bracHiaL artery,1 case Of pancreatic duOdenaL intestinaL artery. SiXteen patients treated by embOLizatiOn,nO cOntrast eXtrav-asatiOn,tumOr becames smaLLer and sOft,Gain a stabLe cOnditiOn,immediateLy stOp bLeedinG,permanent cure ends. FOurteen patients Were cured by surGicaL treatment. Conclusions FOr cLinicaL diaGnOsis Of traumatic aneurysm,DSA LOcate is tHe mOst accurate,interventiOnaL tHerapy in tHe treatment Of pseudOa-neurysm can acHieve tHe desired OutcOmes,especiaLLy in criticaL cOnditiOn,Has siGnificance tO prOtect tHe patients’quaLity Of Life.%目的:探讨假性动脉瘤采用影像学方法的诊治效果。方法选取南阳市第一人民医院2012年5月至2014年5月收治的假性动脉瘤患者30例,回顾性分析其影像学诊治资料。结果30例假性动脉瘤患者发生部位:锁骨下动脉3例,颈总动脉1例,胫前动脉1例,胸主动脉1例,股动脉6例,肾动脉7例,臀下动脉1例,肝动脉1例,臀上动脉1例,胃十二指肠1例,阴部外动脉1例,胃十二指肠动脉1例,阴部内动脉3例,肱动脉1例,胰十二指肠下动脉1例。栓塞治疗16例,无造影剂外溢,肿块变小、变软,病情稳定、立即止血、永久性治愈的目的。14例外科手术者均治愈。结论临床针对外伤性动脉瘤诊

  4. Peroneal artery pseudoaneurysm – a case report and literature review

    OpenAIRE

    Hayes Paul; Cousins Claire; See Teikchoon; Sadat Umar; Gaunt Michael

    2007-01-01

    RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are. Abstract Backgrou...

  5. Fusiform superior cerebellar artery aneurysm treated with STA-SCA bypass and trapping

    Directory of Open Access Journals (Sweden)

    Fabricio C Lamis

    2014-01-01

    Full Text Available Background: Fusiform aneurysms of cerebellar arteries are rare. Different surgical techniques to address these challenging lesions have been described, and their application depends on whether the goal is to maintain the flow in the parent vessel or to occlude it. Case Description: The authors reported a case of a fusiform aneurysm located in the lateral pontomesencephalic segment of the superior cerebellar artery (SCA in a 32-year-old man who presented with subarachnoid hemorrhage. The patient was subjected to aneurysm trapping followed by a bypass between the superficial temporal artery (STA and SCA and had an uneventful recovery. Conclusions: Although only a few cases of fusiform aneurysms in the supracerebellar artery have been reported in the literature, the treatment strategies adopted were diverse. In selected cases of patients in good neurological condition with ruptured fusiform aneurysms at the proximal segments of SCA and who have poor evidence of collateral supply, the possibility of a STA-SCA bypass with aneurysm trapping must be considered. A review of the current treatment modalities of this pathology is also presented.

  6. Angio-embolization of a renal pseudoaneurysm complicating a percutaneous renal biopsy: a case report.

    Science.gov (United States)

    Rafik, Hicham; Azizi, Mounia; El Kabbaj, Driss; Benyahia, Mohammed

    2015-01-01

    We report the treatment of a bleeding renal pseudoaneurysm by angio-embolization. A 21 years old woman developed macroscopic haematuria following renal biopsy. Renal angio-scan showed a 1.4 cm renal pseudoaneurysm in the left kidney. The presence of pseudoaneurysm was confirmed by selective renal angiography. Successful embolization was performed using gelatine sponge particles.

  7. [Injuries of the intracranial part of the carotid artery].

    Science.gov (United States)

    Sulla, I; Kafka, J; Mach, P; Výrostko, J; Kat'uch, V

    2000-07-01

    The objective of the submitted work was to draw attention to different types of injuries of the intracranial portion of the carotid artery and some problems associated with its solution. The investigated group comprised 7 subjects (2 women, 5 men) aged 19 to 76 years who attended between Jan. 1, 1995 and Feb. 29 2000 the Neurosurgical Clinic in Kosice with sequelae of injuries of the intracranial carotid artery. Two patients developed a pseudoaneurysm. In one case it was manifested by subarachnoid haemorrhage on the 24th day after a crash, in one instance by diplopia six weeks after a retrobulbar injection. Injury of the intracavernous portion of the artery was manifested in one instance by profuse epistaxis on the 17th day after a fall from a bicycle, four times by the development of a carotid-cavernous fistula several days to 3 years after the head injury. In the diagnosis classical as well as MR and digital subtraction angiography were used. In the patient with epistaxis classical carotid angiography was 3 times negative. The results are comparable with data in the literature. In three patients the problem was resolved by ligature of the common carotid artery on the neck. In another three it was necessary to use extra-intracranial trapping. One patient will be subjected to endovascular surgery. Two patients died (a 76-year-old woman from bronchopneumonia, a 19-year-old man from meningitis, despite a liquor fistula treated correctly by a patch).

  8. Cervical Spondylopathy Involving the Vertebral Arteries Treated by Body-Acupuncture Combined with Scalp-Acupuncture in 72 Cases

    Institute of Scientific and Technical Information of China (English)

    李保民; 柴富明; 高洪明

    2002-01-01

    @@ Among various types of cervical spondylopathy, the one involving the vertebral arteries is frequently encountered in the middle-aged and the old people. It is often accompanied with arteriosclerosis and high blood viscosity, and clinically it is difficult to be treated. From March 1996 to December 2000, the authors hadtreated 72 cases of cervical spondylopathy of this type and achieved satisfactory therapeutic effects shown by clinical symptoms and indicated by the trans-cranial Doppler ultrasonic examination (TCD). This is reported as follows.

  9. Symmetrical peripheral gangrene complicating ventricular pseudoaneurysm: a report of an unusual case and a brief review of the literature*

    Science.gov (United States)

    Ghosh, Sudip Kumar; Majumder, Biswajit; Ghosh, Sandip; Chatterjee, Sharmistha; Agarwal, Megha

    2016-01-01

    Symmetrical peripheral gangrene is an ischemic necrosis simultaneously involving the distal portions of two or more extremities without any proximal arterial obstruction or vasculitis. It may occur as a result of a large number of infectious and non-infectious causes. A few cases of symmetrical peripheral gangrene associated with cardiac disease have been described in the literature. We describe a case of symmetrical peripheral gangrene complicating ventricular pseudoaneurysm, probably a hitherto unreported occurrence. In this report, we sought to emphasize the importance of cardiac evaluation while dealing with a case of symmetrical peripheral gangrene. PMID:28300932

  10. Ruptured Left Gastric Artery Aneurysm Successfully Treated by Thrombin Injection: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    S. Chandran

    2005-01-01

    Full Text Available This short report describes the successful use of a new minimally invasive technique for the treatment of acute gastric artery aneurysm rupture. It emphasises the importance of persistence and multiple imaging modalities in the presence of gastrointestinal bleeding. The photographs and case history clearly illustrate the nonoperative management and highlight learning points for experienced surgeons and trainees alike in the management of this potentially fatal condition.

  11. Exercise training enhances insulin-stimulated nerve arterial vasodilation in rats with insulin-treated experimental diabetes.

    Science.gov (United States)

    Olver, T Dylan; McDonald, Matthew W; Grisé, Kenneth N; Dey, Adwitia; Allen, Matti D; Medeiros, Philip J; Lacefield, James C; Jackson, Dwayne N; Rice, Charles L; Melling, C W James; Noble, Earl G; Shoemaker, J Kevin

    2014-06-15

    Insulin stimulates nerve arterial vasodilation through a nitric oxide (NO) synthase (NOS) mechanism. Experimental diabetes reduces vasa nervorum NO reactivity. Studies investigating hyperglycemia and nerve arterial vasodilation typically omit insulin treatment and use sedentary rats resulting in severe hyperglycemia. We tested the hypotheses that 1) insulin-treated experimental diabetes and inactivity (DS rats) will attenuate insulin-mediated nerve arterial vasodilation, and 2) deficits in vasodilation in DS rats will be overcome by concurrent exercise training (DX rats; 75-85% VO2 max, 1 h/day, 5 days/wk, for 10 wk). The baseline index of vascular conductance values (VCi = nerve blood flow velocity/mean arterial blood pressure) were similar (P ≥ 0.68), but peak VCi and the area under the curve (AUCi) for the VCi during a euglycemic hyperinsulinemic clamp (EHC; 10 mU·kg(-1)·min(-1)) were lower in DS rats versus control sedentary (CS) rats and DX rats (P ≤ 0.01). Motor nerve conduction velocity (MNCV) was lower in DS rats versus CS rats and DX rats (P ≤ 0.01). When compared with DS rats, DX rats expressed greater nerve endothelial NOS (eNOS) protein content (P = 0.04). In a separate analysis, we examined the impact of diabetes in exercise-trained rats alone. When compared with exercise-trained control rats (CX), DX rats had a lower AUCi during the EHC, lower MNCV values, and lower sciatic nerve eNOS protein content (P ≤ 0.03). Therefore, vasa nervorum and motor nerve function are impaired in DS rats. Such deficits in rats with diabetes can be overcome by concurrent exercise training. However, in exercise-trained rats (CX and DX groups), moderate hyperglycemia lowers vasa nervorum and nerve function.

  12. Clinical arterial infusion of calcium gluconate: The preferred method for treating hydrofluoric acid burns of distal human limbs

    Directory of Open Access Journals (Sweden)

    Yuanhai Zhang

    2014-02-01

    Full Text Available Objective: This study was designed to evaluate the efficiency and safety of arterial infusions of calcium gluconate to treat hydrofluoric (HF acid burns of the distal human limbs. Materials and Methods: Eligible patients with HF burn limbs, collected from January 2008 to October 2011, were given the arterial infusion of calcium gluconate into the injured limbs. The measures of pain were conducted before the infusion, immediately after the infusion, 4 h after the infusion, and 2 days after the infusion by the visual analogy score (VAS. If the VAS score was higher than 4.0 at the time point 4 h after the first infusion, the infusion was repeated. The time of wound healing, and the number and ratio of the cases receiving the surgical operation were also evaluated. Results: A total of 118 patients, male (107 cases and female (11 cases, were collected, including 64 cases of outpatients and 54 cases of inpatients. The age of the subjects ranged from 16 to 60 years, with the mean age of 37.6. The burn sites were located in the lateral limbs (28 cases and in the unilateral limbs (90 cases. For 107 cases, the pain scores decreased quickly after the first infusion. The other 11 cases, with the VAS score higher than 4.0 at the time point 4 h after the first infusion, received the second infusion. The average time of wound healing and the ratio of the cases receiving the surgical operation were closely related to the interval from the injury to the reception of infusion. Conclusions: Arterial infusion of calcium gluconate, effectively relieving the pain, blocking wound progressive deepening, and causing no adverse effects, could be the preferential method to treat hydrofluoric acid burns of the distal human limbs.

  13. Transcatheter Arterial Chemoembolization With Gelatin Sponge Microparticles Treated for BCLC Stage B Hepatocellular Carcinoma: A Single Center Retrospective Study.

    Science.gov (United States)

    Kamran, Asad Ullah; Liu, Ying; Li, Feng E; Liu, Song; Wu, Jian Lin; Zhang, Yue Wei

    2015-12-01

    Gelatin sponge particles are commonly used in the conventional transarterial chemoembolization (c-TACE) as an adjuvant embolizing agent for hepatocellular carcinoma (HCC). However, there are few reports regarding the clinical applications of gelatin sponge microparticles (GSMs) as a main embolizing agent in the treatment of HCC. This retrospective study aim to evaluate the efficacy and safety of patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC treated with intra-arterial injection of 350 to 560 μm GSMs mixed with anticancer agents.Twenty-four patients with unresectable BCLC stage B HCC without any prior treatment underwent transarterial chemoembolization with gelatin sponge microparticles (GSMs-TACE) of diameter 350 to 560 μm mixed with lobaplatin. The mixture was injected into tumor-feeding arteries until the sluggish flow in selective artery. Safety was measured by assessing complication rate, and efficacy was reflected by assessing response to mRECIST therapy and overall survival. The survival rate was calculated using the Kaplan-Meier method.All 24 BCLC stage B HCC patients showed good tolerance to the procedure. The mean follow-up period was 27 months and mean number of TACE treatments per patient was 3.7 sessions (range 1-10) during the follow-up period. Postprocedure complications were mild and treated by symptomatic treatment. Six months and 1 year overall survival rates were 100% and 87.5%, respectively. Overall median survival time was 25 months (95%CI: 21.06-28.95 months).GSMs-TACE is a safe and effective method for BCLC stage B HCC patients.

  14. Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Zi-Liang [Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (China); Gao, Bu-Lang [Department of Medical Research Shijiazhuang First Hospital, Hebei Medical University (China); Li, Tian-Xiao, E-mail: litianxiaod@163.com [Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (China); Cai, Dong-Yang; Zhu, Liang-Fu; Bai, Wei-Xing; Xue, Jiang-Yu; Li, Zhao-Shuo [Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (China)

    2015-09-15

    Highlights: • Symptomatic vertebral artery stenosis can be treated with intracranial stenting. • Stenting for intracranial vertebral artery stenosis is safe and effective. • Stenting for intracranial vertebral artery stenosis can prevent long-term stroke. - Abstract: Purpose: To investigate the safety, effect and instent restenosis rate of Wingspan stenting in treating patients with intracranial vertebral artery atherosclerotic stenosis (70–99%) concurrent with contralateral vertebral artery atherosclerotic diseases. Materials and methods: Eighty-eight patients with severe symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) combined with contralateral vertebral artery atherosclerotic diseases were treated with the Wingpsan stent. All the baseline, cerebral angiography, success rate, perioperative complications, clinical and imaging follow-up data were prospectively analyzed. Results: The success rate of stenting was 100%, and the mean stenotic rate was reduced from prestenting (84.9 ± 6.8)% to poststenting (17.2 ± 5.9)%. The perioperative stroke rate was 1.1%. Among eighty patients (90.9%) with clinical follow-up 8-62 months (mean 29.3 ± 17.2) poststenting, five (6.3%) had posterior circulation TIA only, three (3.8%) had mild stroke in the posterior circulation but recovered completely, and another five patients greater than 70 years old died of non-ischemic stroke. Imaging follow-up in 46 patients (52.3%) 5–54 months (mean 9.9 ± 9.9) following stenting revealed instent restenosis in 12 patients (26.1%) including 7 (58.3%) symptomatic restenosis. Age and residual stenosis were the two factors to significantly (P < 0.05) affect instent restenosis. Conclusion: Wingspan stenting in the intracranial vertebral artery atherosclerotic stenosis combined with contralateral vertebral artery atherosclerotic diseases has a low perioperative stroke rate and a good preventive effect on long-term ischemic stroke, but the instent restenosis

  15. Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery

    Energy Technology Data Exchange (ETDEWEB)

    Gutzeit, Andreas, E-mail: andreas.gutzeit@ksw.ch; Schie, Bram van, E-mail: Bram.vanschie@hotmail.com; Schoch, Eric, E-mail: eric.schoch@ksw.ch [Cantonal Hospital Winterthur, Department of Radiology (Switzerland); Hergan, Klaus, E-mail: k.hergan@salk.at [Paracelsus Medical University Salzburg, Department of Radiology (Austria); Graf, Nicole, E-mail: graf@biostatistics.ch; Binkert, Christoph A., E-mail: christoph.binkert@ksw.ch [Cantonal Hospital Winterthur, Department of Radiology (Switzerland)

    2012-10-15

    Introduction: The purpose of the present study was to analyze complications following antegrade puncture of the common femoral artery (CFA) and the superficial femoral artery (SFA) using vascular closure systems (VCS). Methods: A single-center, retrospective study was performed after obtaining approval from the institutional review board and informed consent from all patients. At our center, the CFA or SFA are used for arterial access. All patients were evaluated clinically on the same day. If there was any suspicion of an access site problem, Duplex ultrasound was performed. Results: Access location was the CFA in 50 patients and the SFA in 130 patients. The sheath size ranged from 4F to 10F. Two patients had to be excluded because of lack of follow-up. Successful hemostasis was achieved in 162 of 178 cases (91 %). The following complications were observed in 16 patients (8.9 %): 4 pseudoaneurysms (2.2 %), 11 hematomas (6.2 %), and 1 vascular occlusion (0.5 %). The two pseudoaneurysms healed spontaneously, in one case an ultrasound-guided thrombin injection was performed, and one aneurysm was compressed manually. No further medical therapy was needed for the hematomas. The one vascular occlusion was treated immediately with angioplasty using a contralateral approach. No significant difference was noted between the CFA and the SFA group with respect to complications (p = 1.000). Conclusions: The use of closure devices for an antegrade approach up to 10F is feasible and safe. No differences in low complication rates were observed between CFA and SFA.

  16. Superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis in treating moyamoya disease: surgical techniques, indications and midterm follow-up results

    Institute of Scientific and Technical Information of China (English)

    XU Bin; SONG Dong-lei; MAO Ying; GU Yu-xiang; XU Hong; LIAO Yu-jun; LIU Chuang-hong; ZHOU Liang-fu

    2012-01-01

    Background Surgical interventions for moyamoya disease include direct and indirect revascularizations.This study aimed to evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass combined with an indirect revascularization procedure,encephalo-duro-myo-synangiosis,in the treatment of moyamoya disease.Methods From October 2005 to November 2009,we performed this combined revascularization procedure in 111 patients with different types and stages of moyamoya disease.The superficial temporal artery,middle meningeal artery and the deep temporal artery were evaluated for individualized surgical planning in these cases.The integrity of the deep temporal artery and the middle meningeal artery network,and the pre-existing spontaneous anastomoses of the distal branches of the external carotid artery with the cortical arteries were well preserved.The mean follow-up time was 72.5 months,all clinical and radiological data were retrospectively reviewed.Results A total of 198 stomas were performed in 122 hemispheres,all remaining patent until the last follow-up.The encephalo-duro-myo-synangiosis resulted in extensive anastomoses of the deep temporal artery (100%),the middle meningeal artery (90.9%),and the sphenopalatine artery (39.8%) with the cortical arteries,respectitvely.The superficial temporal artery,deep temporal artery,and the middle meningeal artery were significantly thickened in 88 patients as determined by digital subtraction angiography at follow-up.The relative cerebral blood flow increased significantly within one week after the operation.At 6 months post the operation,the relative cerebral blood flow was further increased by 15.5% from the gradual formation of anastomoses as a result of indirect revascularization.Transient ischemic attacks were effectively reduced or totally arrested.The neurological deficits significantly improved in 37 patients,with the National Institutes of Health Stroke Scale scores lowered by 2

  17. Aortic Pseudoaneurysm Secondary to Mediastinitis due to Esophageal Perforation

    Directory of Open Access Journals (Sweden)

    Claudia Patricia Zuluaga

    2016-01-01

    Full Text Available Esophageal perforation is a condition associated with high morbidity and mortality rates; it requires early diagnosis and treatment. The most common complication of esophageal rupture is mediastinitis. There are several case reports in the literature of mediastinitis secondary to esophageal perforation and development of aortic pseudoaneurysm as a complication. We report the case of a patient with an 8-day history of esophageal perforation due to foreign body (fishbone with mediastinitis and aortic pseudoaneurysm. The diagnosis was made using Computed Tomography (CT with intravenous and oral water-soluble contrast material. An esophagogastroduodenoscopy did not detect the perforation.

  18. Massive variceal bleeding secondary to splenic vein thrombosis successfully treated with splenic artery embolization: a case report

    Directory of Open Access Journals (Sweden)

    Michalopoulos Antonis

    2010-05-01

    Full Text Available Abstract Introduction Splenic vein thrombosis results in localized portal hypertension called sinistral portal hypertension, which may also lead to massive upper gastrointestinal bleeding. Symptomatic sinistral portal hypertension is usually best treated by splenectomy, but interventional radiological techniques are safe and effective alternatives in the management of a massive hemorrhage, particularly in cases that have a high surgical risk. Case presentation We describe a 23-year-old Greek man with acute massive gastric variceal bleeding caused by splenic vein thrombosis due to a missing von Leiden factor, which was successfully managed with splenic arterial embolization. Conclusions Interventional radiological techniques are attractive alternatives for patients with a high surgical risk or in cases when the immediate surgical excision of the spleen is technically difficult. Additionally, surgery is not always successful because of the presence of numerous portal collaterals and adhesion. Splenic artery embolization is now emerging as a safe and effective alternative to surgery in the management of massive hemorrhage from gastric varices due to splenic vein thrombosis, which often occurs in patients with hypercoagulability.

  19. Binding of human coronary artery endothelial cells to plasma-treated titanium dioxide nanotubes of different diameters.

    Science.gov (United States)

    Flašker, Ajda; Kulkarni, Mukta; Mrak-Poljšak, Katjuša; Junkar, Ita; Čučnik, Saša; Žigon, Polona; Mazare, Anca; Schmuki, Patrik; Iglič, Aleš; Sodin-Semrl, Snezna

    2016-05-01

    Nanoscale topography in improving vascular response in vitro was established previously on various titanium surfaces. In the present study different surface nanotopographies that is different diameters of titanium dioxide (TiO2 ) nanotubes (NTs) were fabricated by electrochemical anodization and conditioned with highly reactive gaseous oxygen plasma. The morphology of different diameter NTs was studied by scanning electron microscopy and atomic force microscopy, while changes in chemical composition on the surface before and after plasma treatment were determined by X-ray photoelectron spectroscopy. Performance of human coronary artery endothelial cells (HCAEC) on those conditioned surfaces was studied in regard to cell proliferation, released IL-6 protein and immunofluorescence microscopy (IFM). We show that HCAEC function is dependent on the diameter of the TiO2 NTs, functioning far less optimally when bound to 100 nm TiO2 NTs as compared to Ti foil, 15 nm NTs or 50 nm NTs. There were improved, morphological cell shape changes, observed with IFM, between HCAEC growing on oxygen-rich plasma-treated versus nontreated 100 nm NTs. These endothelialized conditioned Ti nanosurfaces could elucidate optimization conditions necessary for vascular implants in coronary arteries.

  20. Embolization of Life-Threatening Arterial Rupture in Patients with Vascular Ehlers–Danlos Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Takuya, E-mail: okabone@gmail.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Frank, Michael, E-mail: michael.frank@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Pellerin, Olivier, E-mail: olivier@pellerin.as; Primio, Massimiliano Di, E-mail: massimiliano.di.primio@gmail.com; Angelopoulos, Georgios, E-mail: giorginos78@msn.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Boughenou, Marie-Fazia, E-mail: marie-fazia.boughenou@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Anesthesia and Surgical Intensive Care Unit (France); Pagny, Jean-Yves, E-mail: jean-yves.pagny@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Messas, Emmanuel, E-mail: emmanuel.messas@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Sapoval, Marc, E-mail: marc.sapoval2@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France)

    2013-05-09

    PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture.

  1. Interventional Management of Delayed and Massive Hemobilia due to Arterial Erosion by Metallic Biliary Stent

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hee Seok [Dept. of Radiology, Gyeongsang National University Hospital, Jinju (Korea, Republic of); Shin, Tae Beom [Dept. of Diagnostic Radiology, Kimhae Jung Ang Hospital, Kimhae (Korea, Republic of); Hwang, Jae Cheol [Dept. of Radiology, Ulsan Hospital, Ulsan (Korea, Republic of); Bae, Jae Ik [Dept. of Radiology, Ajou University Hospital, Suwon (Korea, Republic of); Kim, Chang Won [Dept. of Radiology, Busan National University Hospital, Busan (Korea, Republic of)

    2012-01-15

    To evaluate the effectiveness of interventional management for delayed and massive hemobilia secondary to arterial erosion self expandable metallic stent (SES) in with biliary duct malignancy. Over 8-year period, eight patients who suffered from delayed massive hemobilia after SES placement for malignant biliary obstruction as palliative procedure, were included. The mean period between SES placement and presence of massive gastrointestinal hemorrhage was 66.5 days (15-152 days), pancreatic cancer (n = 2), Klatskin tumor (n = 2), common bile duct cancer (n = 2), intrahepatic cholangiocarcinoma (n = 1), and gastric cancer with ductal invasion (n = 1). Angiographic findings were pseudoaneurysm (n = 6), contrast extravasation (n = 1) and arterial spasm at segment (n = 1). Six patients underwent embolization of injured vessels using microcoils and N-butyl cyanoacrylate. Two patients underwent stent graft placement at right hepatic artery to prevent ischemic hepatic damage because of the presence of portal vein occlusion. Massive hemobilia was successfully controlled by the embolization of arteries (n = 6) and stent graft placement (n = 2) without related complications. The delayed massive hemobilia to arterial erosion metallic biliary stent is rare this complication be successfully treated by interventional management.

  2. Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest.

    Science.gov (United States)

    Xing, Jingjun; Li, Shangxun; Zhang, Lin; Yang, Yi; Duan, Yijie; Li, Wenhe; Zhou, Yiwu

    2015-01-01

    Traumatic coronary pseudoaneurysm has been described to be mainly associated to iatrogenic lesion of the coronary arteries. However, chest-stab-wound-related coronary pseudoaneurysm caused by isolated partial incision of a coronary artery giving rise to fatal delayed cardiac tamponade is very rare. We describe an autopsy case in which this potentially fatal complication developed 8 days later after a thoracic stab wound. Unfortunately, the imaging examination failed to detect this defect during hospitalization. Postmortem examination revealed that the posterior wall of the left anterior descending coronary artery was intact but that the anterior wall was incised, forming a micropseudoaneurysm which had ruptured. This case highlights that isolated coronary artery injuries must be considered in any patient with a penetrating wound to the thorax, and coronary pseudoaneurysms should not be missed in these patients.

  3. Should incidental asymptomatic angiographic stenoses and occlusions be treated in patients with peripheral arterial disease?

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2009-09-01

    The clinical importance of angiographically detected asymptomatic lower-limb stenoses and occlusions is unknown. This study aims to (i) assess the clinical outcome of asymptomatic lesions in the lower limb, (ii) identify predictors of clinical deterioration, and (iii) determine which asymptomatic lower-limb lesions should be treated at presentation.

  4. Carotid-cavernous fistula caused by laceration of persistent fetal trigeminal artery treated with single catheter coil embolization

    Directory of Open Access Journals (Sweden)

    Benjamin L Brown

    2012-01-01

    Full Text Available We present the endovascular treatment of traumatic carotid-cavernous fistula from persistent fetal trigeminal artery (PFTA laceration. To date, there are six such cases of traumatic PFTA-cavernous fistulas reported in the literature. These injuries can pose a unique challenge in that rupture of a PFTA in its course through the cavernous sinus may produce a fistula feeding from both anterior and posterior circulations. Previously, these have been treated with dual catheter coil embolization from the carotid and basilar systems. We utilize a single catheter technique accessing the cavernous sinus through the origin of the PFTA on the internal carotid. Both anterior and posterior fistula components may be embolized through this single access. This represents a simple yet safe treatment option.

  5. [Arterial injury associated with tension-free vaginal tape procedure successfully treated by radiological embolization: a case report].

    Science.gov (United States)

    Takatera, Hiroshi; Mukai, Masatoshi; Fujii, Takahiro; Nishi, Masayo; Okada, Hiroshi; Nishimine, Kiyoshi; Tsushima, Juichi

    2006-09-01

    A 75-year-old woman underwent a tension-free vaginal tape (TVT) procedure for urinary stress incontinence. The patient complained of lower abdominal pain, a feeling of lower abdominal distension and nausea three hours after the operation. In addition, systolic blood pressure decreased gradually to 80 mmHg. Enhanced computed tomography revealed a retropubic hematoma sized up to 16 cm X 12 cm X 11 cm and bleeding from a vessel running through the posterosuperior aspect of the pubic bone. Successively, arteriography was performed. The arteriogram also confirmed arterial injury, which was successfully treated by selective embolization using a gelatin sponge and pushable coils. Postoperative course was uneventful requiring neither blood transfusion nor surgical removal of the hematoma.

  6. Treat-to-target strategies in pulmonary arterial hypertension: the importance of using multiple goals

    Directory of Open Access Journals (Sweden)

    N. Galiè

    2010-12-01

    Full Text Available Major advances have occurred in the treatment of pulmonary arterial hypertension (PAH over the past decade. The advent of PAH-specific pharmacological treatments has offered hope to patients with a debilitating, progressive disease and a poor prognosis. Combined drug treatment offers improved benefits over monotherapy, and current treatment guidelines for PAH recommend a sequential add-on approach to combination therapy for patients in New York Heart Association (NYHA/World Health Organization functional class (WHO FC II–IV. Goal-oriented therapy determines the timing of treatment escalation by inadequate response to known prognostic indicators. Close monitoring of patients aids the early identification of inadequate response, so that treatment can be escalated promptly and before the patient's condition deteriorates further. Existing treatment goals are based on baseline values of prognostic indicators, but it is vital to identify risk factors that are both relevant during treatment and that can be assessed during follow-up appointments. Data from different PAH aetiologies indicate that NYHA/WHO FC is the most appropriate prognostic marker, with 6-min walk distance and several haemodynamic parameters representing alternatives. Future refinement of goal-oriented therapy could include the use of multiple prognostic markers, while additional, large clinical trials will answer questions concerning choice and combination of treatment goals.

  7. Arterial spin-labeled MRI study of migraine attacks treated with rizatriptan.

    Science.gov (United States)

    Kato, Yuji; Araki, Nobuo; Matsuda, Hiroshi; Ito, Yasuo; Suzuki, Chihiro

    2010-06-01

    Spin-tag perfusion imaging is an MRI method that quantitatively measures cerebral blood flow. Compared with conventional perfusion techniques, advantages of this arterial spin-labeling (ASL) include repeatability and the avoidance of intravenous contrast administration. In the present study, we performed an analysis of 3T high-field MRI examinations utilizing ASL perfusion during migraine attacks. A 32-year-old male patient was studied in three situations: during migraine attack within 1 h post-onset, 30 min after oral administration of rizatriptan 10 mg, and attack-free period. Normalized ASL images acquired during migraine attack showed significant relative hypoperfusion in the bilateral median thalamic areas including hypothalamus and significant relative hyperperfusion in the frontal cortex compared to images acquired during the migraine-free state. When normalized ASL images acquired 30 min after treatment were compared with those acquired during the attack, relative improvement of perfusion in the bilateral median thalamic areas including hypothalamus was observed. Hypothalamus and its surrounding areas may participate in the pathogenesis in migraine attack.

  8. Use of a Javid™ shunt in the management of axillary artery injury as a complication of fracture of the surgical neck of the humerus: a case report

    Directory of Open Access Journals (Sweden)

    Suttie Stuart A

    2008-08-01

    Full Text Available Abstract Introduction Axillary artery injury is a rare but severe complication of fractures of the surgical neck of the humerus. Case presentation We present a case of axillary artery pseudoaneurysm secondary to such a fracture, in a 82-year-old white woman, presenting 10 weeks after the initial injury, successfully treated with subclavian to brachial reversed vein bypass together with simultaneous open reduction and internal fixation of the fracture. We discuss the use of a Javid™ shunt during combined upper limb revascularisation and open reduction and internal fixation of the fractured humerus. Conclusion This case highlights the usefulness of a Javid™ shunt, over other forms of vascular shunts, in prompt restoration of blood flow to effect limb salvage. It can be considered as a temporary measure whilst awaiting definitive revascularisation which can be performed following fracture fixation.

  9. Pseudoaneurysm of the left atrium following infective endocarditis

    Science.gov (United States)

    Manuel, Devi A; Sahayo, Bino John; Thomson, Viji Samuel; Jose, Jacob

    2017-01-01

    Transthoracic echocardiogram of a 3-year-old child showed a hypoechoic cavity in the posterior wall of the left atrium communicating with the left ventricle through an orifice in the mitral annulus, suggestive of pseudoaneurysm (Ps), probably the result of infective endocarditis. Three-dimensional echocardiography was helpful to confirm the diagnosis and assess the anatomical relationship of the Ps. PMID:28163437

  10. Delayed presentation of pseudoaneurysm complicating closed humeral fracture: MR diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Harris, O. [Dept. of Radiology, Whiston Hospital, Liverpool (United Kingdom); Roche, C.J.; Torreggiani, W.C.; Munk, P.L. [Dept. of Radiology, Vancouver General Hospital (Canada); Ritchie, D.A.; McWilliams, R. [Dept. of Radiology, Royal Liverpool University Hospital (United Kingdom); Jane, M. [Dept. of Orthopaedic Surgery, Royal Liverpool University Hospital (United Kingdom)

    2001-11-01

    Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patients who developed unsuspected pseudoaneurysms following closed humeral fracture. Both patients presented with a mass, suspicious for malignancy. In each case, diagnosis was made by magnetic resonance imaging. (orig.)

  11. Intrarenal pseudoaneurysm after percutaneous nephrolithotomy: angiotomographic assessment and endovascular management

    Directory of Open Access Journals (Sweden)

    M. F. Massulo-Aguiar

    2006-08-01

    Full Text Available We report a case of intrarenal pseudoaneurysm of the right kidney after percutaneous nephrolithotomy (PCNL in supine position. Diagnosis was established by angiotomography with a 3-D reconstruction. Treatment was successfully achieved by endovascular occlusion using N-butyl-2-cyanoacrylate.

  12. 暂时性体外胫后动脉旁路治疗髂股动脉损伤%Temporary Ex Vivo posterior tibial artery bypass for treating iliofemoral artery injury

    Institute of Scientific and Technical Information of China (English)

    王彤; 郭维忠; 张旭; 黄秀革; 杨丽艳; 孙建新; 赵宝宁

    2014-01-01

    目的:报道暂时性体外胫后动脉旁路治疗髂股动脉损伤的手术方法及临床疗效。方法1993年2月—2013年2月,设计并采用暂时性体外胫后动脉旁路术,治疗钝性髂股动脉闭合伤,伴Ⅲ~Ⅳ级失血性休克患者104例。双下肢胫后动脉行端端吻合,术后(30±10) d再行髂股动脉重建,7 d后分离血管旁路。结果本组患者伤肢均成活,体外旁路术均获得成功。术后平均随访(48±2.7)个月,所有患者双下肢肌力均为5级,静态两点辨别觉测试得分双足基本等同。结论采用胫后动脉暂时性体外旁路术治疗髂股动脉损伤合并严重失血性休克,能快速恢复下肢远端血供,手术风险较低,手术时间短,失血量少,为后期修复髂股动脉创造有利条件。%Objective To report the method and effect of temporary ex vivo posterior tibial artery bypass for treating iliofemoral artery injury. Methods From February 1993 to December 2013, we designed and applied temporary ex vivo posterior tibial artery bypass to treat blunt iliofemoral artery close injury in 104 patients, with 3 or 4 hemorrhagic shock. An end to end anastomosis between the two posterior tibial arteries was performed. The iliofemoral artery was reconstructed in 30+10 days postoperation, and separated blood vessel bypass in 7 days. Results The injury limbs all Survived, all cases were followed up for average 48 months, the muscle strength of both legs was of grade 5 based on Medical Research Council scale. Static two-point discrimination test scores were similar on both feet. Conclusion It is a feasible choice that applying temporary ex vivo posterior tibial artery bypass to treating iliofemoral artery injury with hemorrhagic shock. And it provides advantageous andition for treating iliofemoral artery in later stage.

  13. Delayed hemorrhage from hepatic artery after ultrasound-guided percutaneous liver biopsy: A case report

    Institute of Scientific and Technical Information of China (English)

    Fen-Yu Ren; Xi-Xu Piao; Ailian Jin

    2006-01-01

    Percutaneous liver biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. Pseudoaneurysm of hepatic artery is an unusual complication after ultrasound-guided percutaneous liver biopsy. Delayed hemorrhage occurs much less frequently. We report a case of pseudoaneurysm of the hepatic artery of a 46-year-old man who was admitted for abdominal pain after 4 d of liver biopsy. The bleeding was controlled initially by angiographic embolization.However, recurrent bleeding could not be controlled by repeat angiography, and the patient died 4 d after admission from multiorgan failure. The admittedly rare possibility of delayed hemorrhage should be considered whenever a liver biopsy is performed.

  14. Distance to thrombus on MR angiography predicts outcome of middle cerebral artery occlusion treated with IV thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Gawlitza, Matthias; Quaeschling, Ulf; Schob, Stefan; Hoffmann, Karl-Titus; Lobsien, Donald [University Hospital Leipzig, Department of Neuroradiology, Leipzig (Germany); Friedrich, Benjamin; Schaudinn, Alexander [University Hospital Leipzig, Department of Diagnostic and Interventional Radiology, Leipzig (Germany); Hobohm, Carsten [University Hospital Leipzig, Department of Neurology, Leipzig (Germany)

    2015-10-15

    The distance to thrombus (DT) on CT angiography was recently proposed as a predictor of outcome in patients treated by intravenous thrombolysis (IVT) for stroke due to occlusion of the middle cerebral artery (MCA). The purpose of the present study was to validate its inter-rater reliability and its prognostic value on contrast-enhanced magnetic resonance angiography (CE-MRA). Furthermore, we investigated the relation between DT and FLAIR-vascular hyperintensities (FVH) as a surrogate of collateral circulation and hypoperfusion. Patients with acute MCA occlusions treated by IVT and diagnosed with magnetic resonance imaging (MRI) were included. Two readers measured DT. FVH and acute DWI lesion volumes were quantified. Clinical status was determined using the initial NIH stroke scale (NIHSS) and 90-day modified Rankin Scale (90d mRS). Sixty-one patients showed a lesion on diffusion-weighted magnetic resonance images and an occlusion of the MCA on CE-MRA. We found significant inverse correlations between DT and NIHSS scores at admission (ρ = -0.29; P = 0.02), DT and mRS at 90 days (ρ = -0.29; P = 0.04), and between DT and FVH (ρ = -0.32; P = 0.01). For a DT <22 mm, the likelihood of an unfavorable outcome (90d mRS 3-6 or NIHSS score improvement of ≤10 points at discharge) was >50 %. Initial DWI lesion volumes showed no correlation with the outcome. Excellent inter-rater agreement for DT was observed (Cronbach's α = 0.98; P < 0.001). DT on CE-MRA is reliably measurable, correlates inversely with FLAIR-vascular hyperintensities, and predicts outcome in patients with acute MCA occlusion treated with IVT. (orig.)

  15. Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared to clopidogrel: Data from the PLATO trials

    DEFF Research Database (Denmark)

    Patel, Manesh R.; Becker, Richard C.; Wojdyla, Daniel M.;

    Abstract 14299: Cardiovascular Events in Acute Coronary Syndrome Patients With Peripheral Arterial Disease Treated With Ticagrelor Compared to Clopidogrel: Data From the PLATO Trial Manesh R Patel1; Richard C Becker1; Daniel M Wojdyla2; Håkan Emanuelsson3; William Hiatt4; Jay Horrow5; Steen Husted6...

  16. Vertebral artery orifice stenosis: a report of 43 cases from northwest iran treated with angioplasty and stenting.

    Science.gov (United States)

    Mohammadian, R; Najaran, A; Sohrabi, B; Mansourizadeh, R; Mohammadian, F; Nasiri, B; Farhoudi, M

    2011-10-31

    More than one quarter of all transient ischemic attacks (TIA's) and ischemic strokes involve tissue supplied by the vertebrobasilar (VB) circulation. Vertebral artery stenotic lesion, particularly at the origin of the vertebral artery, is not uncommon but it is a less studied area. Here we present our endovascular treatment experience in a group of patients with vertebral artery orifice stenosis. We enrolled a group of patients with vertebral artery orifice stenosis who presented with confirmed posterior circulation stroke. Vertebrobasilar insufficiency syndrome was confirmed by imaging studies and clinical findings. Vertebral artery stenosis diagnosed by CT or MR Angiography and confirmed by Conventional and digital subtraction angiography (DSA). Angiography was performed by using of femoral or radial artery approach. From October 2008 to January 2010, forty-three consecutive patients (69.8% men) underwent stent placement for symptomatic vertebral artery orifice stenosis. Mean degree of stenosis was 70.45 +/- 7.455 percent and mean age was 71.65 +/- 7.743 years . In the 22 patients (22/43, 51.16%) stenosis were in left side. In the thirty patients (30/43, 69.6%) there was evidence of atherosclerotic disease in the internal carotid artery and in the 23% contra lateral vertebral artery was involved. There were five different cases with left renal artery stenosis especially in the men with left vertebral artery stenosis. Initial technical success rate was 100%. No cerebrovascular complications or embolic events occurred. Six months control angiography follow-up revealed one patient with stent occlusion and moderate (40%) restenosis in the another patient. According to our finding angioplasty and stenting for vertebral artery orifice stenosis is safe and effective. Patients with vertebral artery orifice disease frequently have coexistent atherosclerotic stenosis in the other major extracranial arteries including carotid and renal arteries.

  17. Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass.

    Science.gov (United States)

    Lansen, T A; Kasoff, S S; Arguelles, J H

    1989-07-01

    Saccular intracranial aneurysms occur infrequently in children, and the incidence of pediatric giant aneurysms is statistically in the same proportion as in adults. The management of these giant aneurysms can be treacherous. This paper presents a case of a 9-year-old boy with a giant aneurysm of the right middle cerebral artery that was successfully managed by ligation of the middle cerebral artery using a Drake tourniquet with the patient awake and by augmentation of the middle cerebral artery circulation with superficial temporal artery-middle cerebral artery anastomosis without excision of the lesion.

  18. [Risk factors for long-term result of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm].

    Science.gov (United States)

    Ye, W; Di, X; Liu, Q; Li, Y J; Zheng, Y H; Zeng, R; Song, X J; Liu, Z L; Liu, C W

    2016-12-06

    Objective: To summarize results of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm(AIPA), and to analysis clinical predictors of long term major adverse clinical events(MACE). Methods: Retrospectively collected endovascular treatment for AIPA cases in Peking Union Medical College Hospital within 2000 to 2015. Twenty-nine cases with AIPA treated by endovascular therapy were enrolled in this study. Twenty five cases were male, range from 23 to 67 years old, mean age was (39.3±11.4) years old.Demographic characters, locations of aneurysms, type to auto-immune disease, immuno medical therapy, operation strategy and long term follow-up data were reported. Statistical analysis was made to verify clinical predictors of long-term MACE. Results: Among the 29 cases, 22 cases with bechet's disease, 4 cases with Takayasu's arteritis, 2 cases with systemic lupus erythematosus, 1 cases with polyarteritis nodosa. Eight cases had ruptured or pending ruptured pesudo-aneurysms, the rest 21 cases had dull pain or no overt symptome. Twenty-four cases had infra-renal artery aneurysms, two were para-and supra-renal artery, two were supra-celiac artery, and the rest one had multiple aneurysms involved thoracic and abdominal aorta.All the cases received regular immune medical therapy except the three emergency cases. All the operations were under general anaesthesia. Nineteen cases underwent classical Endovascular aortic aneurysm repair (EVAR), 5 cases underwent fenestration EVAR, the rest 5 cases underwent hybrid procedure. All the 29 operations were successful, without conversion to open surgery. Major peri-operation complication included 3 incision infection, 3 pulmonary infection. No death occurred. All the cases received regular follow-up from 1 to 120 months. There were five recurrence of pseudo-aneurysm, 1 case suffered from iliac limb occlusion. 5 cases received re-intervention procedure. No occlusion of revascularizal visceral artery was

  19. Iatrogenic Femoral Pseudoaneurysm and Secondary Ipsilateral Deep Vein Thrombosis: An Indication for Early Surgical Exploration.

    Science.gov (United States)

    Papadakis, Marios; Zirngibl, Hubert; Floros, Nikolaos

    2016-07-01

    Pseudoaneurysm formation often complicates transfemoral interventional procedures. Nonsurgical treatment consists of femoral compression and thrombin injection under ultrasound guidance. We report a 74-year-old man who was diagnosed with a pseudoaneurysm, following coronary angiography. Duplex ultrasound revealed deep vein thrombosis of the ipsilateral common femoral vein. Ultrasound-guided thrombin injection was unsuccessfully performed, and the patient subsequently underwent surgical exploration for repair of the pseudoaneurysm and release of the venous compression. The increased local inflammation, because of the thrombosis, added in surgical difficulties. We conclude that early surgical intervention should be considered as a primary strategy in patients with femoral pseudoaneurysms and deep vein thrombosis secondary to femoral compression.

  20. Pathophysiological Mechanisms on Treating Pulmonary Arterial Hypertension with Artemisinine%青蒿素治疗肺动脉高压的病理生理机制

    Institute of Scientific and Technical Information of China (English)

    文宏

    2011-01-01

    肺动脉高压(PAH)是以肺动脉压力升高和肺动脉重构为特征的病理生理综合征.由于其发病机制较为复杂,目前尚无有效的治愈措施,预后差.如何有效降低PAH的肺动脉压力,减轻或逆转肺动脉重构,改善患者的预后已成为PAH治疗领域的研究热点.现就青蒿素在PAH治疗中可能的保护性病理生理机制予以综述,旨在探讨青蒿素防治PAH的理论基础.%Pulmonary arterial hypertension is a pathophysiological syndrome characterized by high pulmonary arterial pressure and pulmonary arterial remodeling. Due to its complex pathogenesis, at present , there is no effective healing treatment and the prognosis is poor. How to effectively decrease the pulmonary arterial pressure, alleviating or reversing the pulmonary arterial remodeling and improving the prognosis is becoming the hot topics in the field of PAH treatment. The protective pathophysiological mechanisms on treating pulmonary arterial hypertension with artemisinine is reviewed,in aiming to study its pharmacological foundation of the prevention with PAH.

  1. Acetylcholine and bradykinin enhance hypotension and affect the function of remodeled conduit arteries in SHR and SHR treated with nitric oxide donors

    Directory of Open Access Journals (Sweden)

    Gerová M.

    2005-01-01

    Full Text Available Discrepancy was found between enhanced hypotension and attenuated relaxation of conduit arteries in response to acetylcholine (ACh and bradykinin (BK in nitric oxide (NO-deficient hypertension. The question is whether a similar phenomenon occurs in spontaneously hypertensive rats (SHR with a different pathogenesis. Wistar rats, SHR, and SHR treated with NO donors [molsidomine (50 mg/kg or pentaerythritol tetranitrate (100 mg/kg, twice a day, by gavage] were studied. After 6 weeks of treatment systolic blood pressure (BP was increased significantly in experimental groups. Under anesthesia, the carotid artery was cannulated for BP recording and the jugular vein for drug administration. The iliac artery was used for in vitro studies and determination of geometry. Compared to control, SHR showed a significantly enhanced (P < 0.01 hypotensive response to ACh (1 and 10 µg, 87.9 ± 6.9 and 108.1 ± 5.1 vs 35.9 ± 4.7 and 64.0 ± 3.3 mmHg, and BK (100 µg, 106.7 ± 8.3 vs 53.3 ± 5.2 mmHg. SHR receiving NO donors yielded similar results. In contrast, maximum relaxation of the iliac artery in response to ACh was attenuated in SHR (12.1 ± 3.6 vs 74.2 ± 8.6% in controls, P < 0.01. Iliac artery inner diameter also increased (680 ± 46 vs 828 ± 28 µm in controls, P < 0.01. Wall thickness, wall cross-section area, wall thickness/inner diameter ratio increased significantly (P < 0.01. No differences were found in this respect among SHR and SHR treated with NO donors. These findings demonstrated enhanced hypotension and attenuated relaxation of the conduit artery in response to NO activators in SHR and in SHR treated with NO donors, a response similar to that found in NO-deficient hypertension.

  2. Arterial Ligation for Infected Femoral Psuedo-Aneurysm in Drug Injecting Abusers

    Directory of Open Access Journals (Sweden)

    Mohammadzade Mohammad Ali

    2009-10-01

    Full Text Available Pseudo-aneurysm of the femoral artery is the most common arterial complication in drug injecting abusers. Scholars in vascular surgery have published debating statements regarding techniques of successful surgical management during last two decades. We present the results of simple arterial ligation in a series of 32 patients presenting with infected femoral pseudo-aneurysm. Most of the patients were males (89%. Young persons in the age group of 15-44 years were mostly affected. Site of lesion included common femoral artery in 65% , superficial femoral artery 28% and at bifurcation 6.2%. celulitis in 14 (53%, abscess & "ncelulitis in 6 (19%, necrosing fasciitis in 2 (6.2% and vascular abscess in 7 (22% cases were the forms of associated local infection. There was no hemorrhage, vascular thrombosis, amputation, or mortality. Claudicating were the only complications identified in 2 patients with Tripe ligation. Ligation is the optimal management for infected pseudo-aneurysms because it is easy, cost-effective, and safe. Early reconstruction is not recommended, since there is an extended infection in the location of the pseudo-aneurysm.

  3. The Use of Low-Dose Recombinant Tissue Plasminogen Activator to Treat a Preterm Infant with an Intrauterine Spontaneous Arterial Thromboembolis

    Directory of Open Access Journals (Sweden)

    Yaşar Demirelli

    2015-12-01

    Full Text Available Neonatal thromboembolic events are rare, and only a few cases of intrauterine spontaneous arterial thromboembolisms have been reported in the literature. Thrombolytic therapy with recombinant tissue plasminogen activator is usually the preferred treatment because it has a short half-life, fewer systemic side effects, and a strong, specific affinity for fibrin. Protocols vary from center to center, but there is still no consensus regarding the proper dosage or treatment duration. Herein, we present the case of an intrauterine spontaneous arterial thromboembolism in a preterm infant that completely resolved after being treated with low-dose recombinant tissue plasminogen activator (0.02 mg/kg/h.

  4. Prognosis of patients with coronary artery disease treated in different therapy units at department of cardiology: a retrospective cohort study

    Science.gov (United States)

    Fu, Cong; Yao, Yuyu; Wang, Xin; Yu, Chaojun; Ma, Genshan

    2015-01-01

    Background: Coronary artery disease (CAD) is a major health problem in global. Benefit from different care unit for various type of CAD is remaining unknown. We investigate if coronary care unit (CCU) reduces the incidence of major adverse cardiovascular events (MACEs). Method: 806 CAD patients including stable angina (SA) and acute coronary syndrome (ACS) who treated in department of cardiology were involved in the study as two groups. Each group involved two subgroups according to the therapy unit including CCU and normal unit. 12-48 months follow-up was carried out. The primary end point was all cause mortality. Results: For SA, death from any cause occurred in 1.0% of the patients in the normal group (1 of 108), as compared with 5.1% in the CCU group (3 of 59) (hazard ratio [HR], 0.164; 95% confidence interval [CI], 0.017 to 1.580; P=0.118). Kaplan-Meier survival analysis showed that there were no significant differences between the two subgroups with respect to the risk of death (P=0.074), revascularization (P=0.660), stroke (P=0.497), heart failure (P=0.658) and hemorrhage (P=0.096). For ACS, death occurred in 1.9% of the patients in the normal subgroup (5 of 267), as compared with 1.3% in the CCU subgroup (5 of 372) (HR, 1.403; 95% CI, 0.406-4.846; P=0.593). Kaplan-Meier survival analysis showed that there were no significant differences between the two subgroups with respect to the risk of death (P=0.591), revascularization (P=0.996), stroke (P=0.425), heart failure (P=0.625). Conclusion: CAD patients treated in CCU obtain little benefits compared with normal. PMID:26629060

  5. Predictive Factors of Downstaging of Hepatocellular Carcinoma Beyond the Milan Criteria Treated with Intra-arterial Therapies

    Energy Technology Data Exchange (ETDEWEB)

    Bova, Valentina; Miraglia, Roberto, E-mail: rmiraglia@ismett.edu; Maruzzelli, Luigi [Mediterranean Institute for Transplantation and Advanced Specialized Therapies, (ISMETT), Department of Diagnostic and Interventional Radiology (Italy); Vizzini, Giovanni Battista [Mediterranean Institute for Transplantation and Advanced Specialized Therapies, (ISMETT), Department of Hepatology (Italy); Luca, Angelo [Mediterranean Institute for Transplantation and Advanced Specialized Therapies, (ISMETT), Department of Diagnostic and Interventional Radiology (Italy)

    2013-04-15

    This study was designed to analyze the clinical results in patients suitable for liver transplantation with hepatocellular carcinoma (HCC) who exceeded Milan criteria, which underwent intra-arterial therapies (IAT), to determine predictive factors of successful downstaging. A total of 277 consecutive patients with cirrhosis and HCC were treated by IAT (transarterial oily chemoembolization, transarterial chemoembolization, transarterial embolization) in a single center. Eighty patients exceed the Milan criteria. Patients with infiltrative HCC, hypovascular HCC, and portal vein thrombosis were excluded, with a final study population of 48 patients. Tumor response to IAT was evaluated with CT and/or MRI according to modified RECIST criteria. Successful downstaging was defined as a reduction in the number and size of viable tumors to within the Milan criteria, and serum alpha-fetoprotein (AFP) <100 ng/mL, for at least 6 months. Nineteen patients (39 %) had their tumors successfully downstaged; 29 patients (61 %) did not. Multivariate analysis showed that AFP level <100 ng/mL and 3-year calculated survival probability using the Metroticket calculator were the only independent predictors of successful downstaging (p < 0.023 and p < 0.049 respectively). Biological characteristics of HCC as AFP levels <100 ng/mL and high 3-year calculated survival probability may predict a good response to downstage after IAT.

  6. Emergency Transcatheter Arterial Embolization for Acute Renal Hemorrhage.

    Science.gov (United States)

    Wang, Hong Liang; Xu, Chun Yang; Wang, Hong Hui; Xu, Wei

    2015-10-01

    The aims of this study were to identify arteriographic manifestations of acute renal hemorrhage and to evaluate the efficacy of emergency embolization. Emergency renal artery angiography was performed on 83 patients with acute renal hemorrhage. As soon as bleeding arteries were identified, emergency embolization was performed using gelatin sponge, polyvinyl alcohol particles, and coils. The arteriographic presentation and the effect of the treatment for acute renal hemorrhage were analyzed retrospectively. Contrast extravasation was observed in 41 patients. Renal arteriovenous fistulas were found in 12 of the 41 patients. In all, 8 other patients had a renal pseudoaneurysm, 5 had pseudoaneurysm rupture complicated by a renal arteriovenous fistula, and 1 had pseudoaneurysm rupture complicated by a renal artery-calyceal fistula. Another 16 patients had tumor vasculature seen on arteriography. Before the procedure, 35 patients underwent renal artery computed tomography angiography (CTA). Following emergency embolization, complete hemostasis was achieved in 80 patients, although persistent hematuria was present in 3 renal trauma patients and 1 patient who had undergone percutaneous nephrolithotomy (justifying surgical removal of the ipsilateral kidney in this patient). Two-year follow-up revealed an overall effective rate of 95.18 % (79/83) for emergency embolization. There were no serious complications. Emergency embolization is a safe, effective, minimally invasive treatment for renal hemorrhage. Because of the diversified arteriographic presentation of acute renal hemorrhage, proper selection of the embolic agent is a key to successful hemostasis. Preoperative renal CTA plays an important role in diagnosing and localizing the bleeding artery.

  7. Long-term outcome in patients treated with sirolimus-eluting stents in complex coronary artery lesions

    DEFF Research Database (Denmark)

    Kelbaek, Henning; Kløvgaard, Lene; Helqvist, Steffen;

    2008-01-01

    data of the long-term outcome of patients with complex coronary artery lesions. METHODS: We randomly assigned 322 patients with total coronary occlusions or lesions located in bifurcations, ostial, or angulated segments of the coronary arteries to have SES or BMS implanted. RESULTS: At 3 years, major...... benefit was observed up to 3 years after implantation of SES in patients with complex coronary artery lesions. The rate of late adverse events was similar in the 2 groups, and stent thromboses occurred rarely after 1 year. (Sirolimus Eluting Stents in Complex Coronary Lesions [SCANDSTENT]; NCT00151658)...

  8. A Controlled Clinical Study between Hepatic Arterial Infusion with Embolized Curcuma Aromatic Oil and Chemical Drugs in Treating Primary Liver Cancer

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To evaluate the effectiveness, toxicity and prospective application of hepatic arterial infusion (HAI) with embolized Curcuma Aromatic oil (CAO) in treating primary liver cancer (PLC). Methods: In the treated group, 32 patients with PLC were treated by HAI with 1-3 ml embolized CAO and oral administration of Chinese herbal medicine. In the control group, 32 patients with PLC were treated with transcatheter artery chemoembolization (TACE). Results: In the treated group, one patient attained complete remission (CR) and 13 partial remission (PR), the total effective rate being 43.75%. The level of alpha fetal protein (AFP) turned to normal range in 7 cases and decreased in other 7. In the control group, 10 obtained PR and the total effective rate being 31.25%, AFP level turned to normal in 5 and decreased in 2. There was no statistical significance between the two groups. The incidences of post-embolism Sydrome, such as fever, abdominal pain and vomiting were similar between the two groups but no myelosuppression occurred in the treated group with significant difference as comparing with that in the control group (P<0.01). The mean survival time, median survival time, 1-, 2- and 3-year survival rate in the treated group were 11.5 months, 10 months, 37.5%, 13.3% and 6.9% respectively, while in the control group they were 7.25 months, 6 months, 15.6%, 3.2% and 0% respectively. Better result in mean survival time, median survival time and 1-year survival rate was found in the treated group than that of the control group (P<0.05). Conclusion:HAI with embolized CAO showed a similar good effect in treating PLC as that of TACE, but superior to TACE with longer survival time and milder myelosuppression.

  9. Pseudo-aneurisma post-traumático de tronco de arteria coronaria izquierda Post-traumatic false (pseudo aneurysm of the left main coronary artery

    Directory of Open Access Journals (Sweden)

    Melina M. Gallo

    2011-08-01

    Full Text Available El pseudo-aneurisma de arteria coronaria es extremadamente raro. Su historia natural es poco conocida y su tratamiento discutido. Se presenta el caso de un paciente con pseudo-aneurisma de tronco de la coronaria izquierda e infarto antero-apical del ventrículo izquierdo cinco años después de un paro cardíaco secundario a un traumatismo no penetrante de tórax. Se consideró entonces que la lesión no era pasible de corrección percutánea o quirúrgica por lo que se optó por tratamiento médico conservador. Una angiografía coronaria por tomografía computarizada multicorte realizada 10 años después del evento inicial mostró ausencia de progresión de la lesión.Coronary pseudo-aneurysm is an extremely rare entity. Its natural history is scarcely known and its treatment is controversial. We report a case of pseudo-aneurysm of the left main coronary artery associated with an antero-apical infarct of the left ventricle diagnosed five years after a cardiac arrest following a non-penetrating thoracic trauma. The patient was treated conservatively because percutaneous or surgical correction were not considered suitable for this lesion. A multidetector computed tomography coronary angiogram performed 10 years after the initial event showed no evidence of progression.

  10. Coronary artery problems and disease in adults with congenital heart disease: how to evaluate, how to prevent, how to treat.

    Science.gov (United States)

    Cataldo, S; Stuart, A G

    2014-10-01

    There are a wide variety of coronary artery anomalies and disease in adults with congenital heart disease (CHD). In fact, the increasing burden of acquired coronary artery disease (CAD) has to be considered in addition to congenital abnormalities of the coronary arteries, isolated or associated to other congenital diseases. This is largely a consequence of the increasing number of patients reaching older age. Due to complex underlying cardiac anatomy, previous surgery and comorbidities, treatment can be challenging. Individualized and multidisciplinary management involving congenital heart cardiologists, cardiac surgeons, coronary interventionists and imaging specialists is essential. This review gives an overview of coronary artery involvement in adults with CHD, summarizes the current literature and focuses on prevention, diagnosis and treatment. The potential role of cardiovascular risk factors for CAD is also discussed.

  11. Hyperbaric programs in the United States: Locations and capabilities of treating decompression sickness, arterial gas embolisms, and acute carbon monoxide poisoning: survey results.

    Science.gov (United States)

    Chin, Walter; Jacoby, Laura; Simon, Olivia; Talati, Nisha; Wegrzyn, Gracelene; Jacoby, Rachelle; Proano, Jacob; Sprau, Susan E; Markovitz, Gerald; Hsu, Rita; Joo, Ellie

    2016-01-01

    Hyperbaric oxygen therapy is the primary treatment for arterial gas embolism, decompression sickness and acute carbon monoxide poisoning. Though there has been a proliferation of hyperbaric centers throughout the United States, a scarcity of centers equipped to treat emergency indications makes transport of patients necessary. To locate and characterize hyperbaric chambers capable of treating emergency cases, a survey of centers throughout the entire United States was conducted. Using Google, Yahoo, HyperbaricLink and the UHMS directory, a database for United States chambers was created. Four researchers called clinicians from the database to administer the survey. All centers were contacted for response until four calls went unreturned or a center declined to be included. The survey assessed chamber readiness to respond to high-acuity patients, including staff availability, use of medical equipment such as ventilators and intravenous infusion devices, and responding yes to treating hyperbaric emergencies within a 12-month period. Only 43 (11.9%, N = 361) centers had equipment, intravenous infusion pumps and ventilators, and staff necessary to treat high-acuity patients. Considering that a primary purpose of hyperbaric oxygen therapy is the treatment of arterial gas embolism and decompression sickness, more hyperbaric centers nationwide should be able to accommodate these emergency cases quickly and safely.

  12. Case of “Slow” Stroke from Carotid Artery Occlusion Treated by Delayed but Cautious Endovascular Intervention

    Directory of Open Access Journals (Sweden)

    Kachi Illoh

    2011-01-01

    Full Text Available In a challenging case of carotid occlusion with slowly evolving stroke, we used brain imaging to facilitate endovascular revascularization resulting in the relief of the patient's symptoms. Patients with carotid occlusion and continued neurological worsening or fluctuations present enormous treatment challenges. These patients may present “slow” strokes with subacute infarcts that present significant challenges and risks during attempts at revascularization of the occluded artery. We present such a case in which we used multimodal imaging techniques, including MR-perfusion, to facilitate endovascular revascularization. Our approach of delayed but cautious intra-arterial thrombolytic therapy, guided by brain imaging, and followed by stent placement across the residual stenosis, enabled revascularization of the occluded artery without overt in-hospital complications.

  13. Upper limb artery segmental occlusions due to chronic use of ergotamine combined with itraconazole, treated by thrombolysis

    Directory of Open Access Journals (Sweden)

    Nodari Franco

    2011-08-01

    Full Text Available Abstract Background The ergotamine tartrate associated with certain categories of drugs can lead to critical ischemia of the extremities. Discontinuation of taking ergotamine is usually sufficient for the total regression of ischemia, but in some cases it could be necessary thrombolytic and anticoagulant therapy to avoid amputation. Case report A woman of 62 years presented with a severe pain left forearm appeared 10 days ago, with a worsening trend. The same symptoms appeared after 5 days also in the right forearm. Physical examination showed the right arm slightly hypothermic, with radial reduced pulse in presence of reduced sensitivity. The left arm was frankly hypothermic, pulse less on radial and with an ulnar humeral reduced pulse, associated to a decreased sensitivity and motility. Clinical history shows a chronic headache for which the patient took a daily basis for years Cafergot suppository (equivalent to 3.2 mg of ergotamine. From about ten days had begun therapy with itraconazole for vaginal candidiasis. The Color-Doppler ultrasound shown arterial thrombosis of the upper limbs (humeral and radial bilateral, with minimal residual flow to the right and no signal on the humeral and radial left artery. Results Angiography revealed progressive reduction in size of the axillary artery and right humeral artery stenosis with right segmental occlusions and multiple hypertrophic collateral circulations at the elbow joint. At the level of the right forearm was recognizable only the radial artery, decreased in size. Does not recognize the ulnar, interosseous artery was thin. To the left showed progressive reduction in size of the distal subclavian and humeral artery, determined by multiple segmental steno-occlusion with collateral vessels serving only a thin hypotrophic interosseous artery. Arteriographic findings were compatible with systemic drug-induced disease. The immediate implementation of thrombolysis, continued for 26 hours, with

  14. Mucormycosis resulting in a pseudoaneurysm in the spleen

    Energy Technology Data Exchange (ETDEWEB)

    Nevitt, P.C.; Das Narla, L. [Medical College of Virginia, Virginia Commonwealth Univ., Richmond (United States); Hingsbergen, E.A. [Children' s Radiologic Institute, Children' s Hospital, Columbus, OH (United States)

    2001-02-01

    Mucormycosis is an uncommon and frequently fatal fungal infection. It characteristically affects patients with diabetes mellitus or patients with severe immunosuppression. The hallmark of mucormycosis infection is tissue infarction and vascular invasion. We present clinical data and imaging studies of a 16 year-old child with acute lymphoblastic leukemia complicated by disseminated mucormycosis resulting in a pseudoaneurysm of the spleen. This was successfully managed by a combination of systemic antifungal therapy (Amphotericin B) and surgery (splenectomy). This entity has not been described in the literature. (orig.)

  15. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Zhi-yu LI; Bin LI; Yu-lian WU; Qiu-ping XIE

    2013-01-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic.In cases where gastrointestinal (GI) bleeding is present,however,the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment.A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article.The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography.After embolization,the bleeding stopped and stabilized for the entire follow-up period without any severe complications.In conclusion,embolization of the splenic artery is a simple,safe,and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  16. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review.

    Science.gov (United States)

    Li, Zhi-yu; Li, Bin; Wu, Yu-lian; Xie, Qiu-ping

    2013-06-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic. In cases where gastrointestinal (GI) bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article. The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography. After embolization, the bleeding stopped and stabilized for the entire follow-up period without any severe complications. In conclusion, embolization of the splenic artery is a simple, safe, and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  17. Left Ventricular Pseudoaneurysm Following Inferior Myocardial Infarction: A Case for Conservative Management

    Science.gov (United States)

    Ludmir, Jonathan; Kapoor, Karan; George, Praveen; Khural, Jasjeet; Barr, Brian

    2016-01-01

    Left ventricular pseudoaneurysm is a rare complication of myocardial infarction that carries a high mortality rate. Although conventional wisdom suggests prompt surgical repair in order to mitigate risk of expansion and rupture, there are some data to support non-operative management in asymptomatic individuals with likely chronic pseudoaneurysms, particularly when surgical candidacy is poor. We present a case of a medically managed left ventricular pseudoaneurysm subsequent to inferior ST-segment elevation myocardial infarction with 6-month follow-up data. PMID:28197266

  18. Brachial plexus palsy due to subclavian artery pseudo aneurysm from internal jugular cannulation

    Directory of Open Access Journals (Sweden)

    Modi Manisha

    2007-01-01

    Full Text Available Internal jugular vein is the preferred route for central venous cannulation because of easy accessibility and high success rate. Arterial puncture is the most common complication, the reported incidence being 9.3%. However, brachial plexus palsy following arterial puncture is a rare complication of this procedure. We report a case of brachial plexus palsy due to compression by right subclavian pseudoaneurysm as a result of internal jugular vein cannulation in chronic renal failure patient.

  19. A case of catatonia status-post left middle cerebral artery cerebrovascular accident, treated successfully with olanzapine.

    Science.gov (United States)

    Spiegel, David R; Klaiber, Nicholas

    2013-01-01

    Catatonia is a psychomotor phenomenon associated with psychiatric/medical conditions. We present a patient who developed catatonia status-post left middle cerebral artery infarct. With a Bush Francis Catatonia Rating Scale score of 43 on admission, treatment with olanzapine reduced this score to 2, by discharge.

  20. Giant hepatic artery aneurysm associated with immunoglobulin G4-related disease successfully treated using a liquid embolic agent

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Michele; Virgilio, Edoardo; Laurino, Florindo; Orgera, Gianluigi; Mene, Paolo; Pirozzi, Nicola; Ziparo, Vincenzo; Cavallini, Marco [St. Andrea Hospital, Rome (Italy)

    2015-08-15

    The occurrence of a giant hepatic artery aneurysm (GHAA) in a patient with systemic vasculitis is very rare. Herein, we describe our endovascular treatment experience of a GHAA associated with immunoglobulin G4-related disease (IgG4-RD) consisting primarily of a liquid embolic injection and deployment of a vascular plug.

  1. Arterial hypertension treated with angiotensin converting enzyme inhibitors and glucocorticoids are independent risk factors associated with decreased glomerular filtration rate in systemic sclerosis.

    Science.gov (United States)

    Ostojic, Predrag; Stojanovski, Natasa

    2017-03-01

    The aim of this study was to estimate prevalence and severity of renal insufficiency in systemic sclerosis (SSc) and to assess risk factors associated with reduced glomerular filtration rate (GFR) in SSc patients. Seventy-three consecutive patients with SSc (67 women and 6 men), mean age 56.2 years, mean disease duration 6.7 years, were included in this cross-sectional study. GFR was measured by creatinine clearance (CCr) in all patients, as well as 24-h proteinuria. We assessed frequency and severity of renal insufficiency in our patients with SSc and estimated the association of renal insufficiency with age, disease duration, subtype of the disease, earlier diagnosed arterial hypertension, and medications for which we assumed to affect renal function-cytostatics, nonsteroidal anti-inflammatory drugs, glucocorticoids, ACE inhibitors, diuretics, and calcium channel blockers (CCB). Fifty-six out of 73 patients with SSc (76.7%) had reduced GFR (CCr lower than 90 ml/min), compared to 17/73 (23.3%) of patients with normal renal function. Mild renal insufficiency was noticed in 28/73 (38.4%), moderate in 21/73 (28.8%) and severe renal insufficiency in 5/73 (6.8%). End-stage renal disease (CCr arterial hypertension and treatment with glucocorticoids are independent risk factors for reduced GFR. On the other hand, age, disease duration, disease form, as well as antibodies (anticentromere antibodies-ACA and anti-topoisomerase I antibodies-ATA) were excluded as independent risk factors. Patients with SSc and arterial hypertension treated with CCB had significantly higher mean CCr than patients treated with diuretics (90.4 vs 53.5 ml/min, p = 0.03), or patients treated with ACE inhibitors (90.4 vs 41.7 ml/min, p = 0.001). Decreased GFR is common in SSc. Most of patients have mild or moderate renal insufficiency. Previously diagnosed arterial hypertension, especially when treated with ACE inhibitors or diuretics, and glucocorticoids are independent risk factors

  2. Management of Head and Neck Pseudoaneurysms: A Review of 33 Consecutive Cases

    Directory of Open Access Journals (Sweden)

    Eliza Anderson

    2014-01-01

    Full Text Available Background. Endosaccular coiling, vessel occlusion, stenting, stent-assisted coiling, and flow diversion are all endovascular treatment options for pseudoaneurysms (PAs of the head and neck. We explore different clinical situations in which these were selected for PA management at a single institution. Methods. Over a period of ten years, 33 patients presented to our hospital with PAs of the head and neck. Their outcomes and procedural complications are discussed. Results. We observed a complication rate of 18.2% (6 of 33, consisting predominantly of infarcts following vessel occlusion. As measured by the modified Rankin Scale, 25 (75.8% patients had achieved favorable outcomes on discharge. A single patient who was treated with stent-assisted coiling expired following procedural complications. Conclusions. In our series, most patients with traumatic/iatrogenic PAs were successfully treated with parent vessel sacrifice. When parent vessel occlusion is not an option, stenting with or without coiling, or flow diversion, may also be safe and effective alternatives.

  3. Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2014-01-01

    Full Text Available Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic-valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra-operative transesophageal echocardiography (TEE helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post-procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function.

  4. [A double aorto-enteric fistula secondary to an aortic pseudoaneurysm. Its anatomical correction].

    Science.gov (United States)

    de Frutos Rincón, J L; Canales Reina, J; Gianpaolo, B; Iglesias Martínez, E; Viñas Salas, J; Casals Garrido, R; Reñé Espinet, J; Pérez Ruiz, L

    1991-01-01

    A very rare case of double fistula aorto-enteric jejunal and ileal, draining to an aortic pseudoaneurysm, is presented. There were not evidence of sepsis, and by this reason pseudoaneurysm and prosthesis were removed, a new prosthesis was inserted by reconstruction "in situ", and intestinal fistulas were closed. The short- and large-term postoperatory was satisfactory. A review about possible mechanisms implicated in a fistula, diagnosis and therapeutic alternatives was made.

  5. Successful endovascular treatment of a hemodialysis graft pseudoaneurysm by covered stent and direct percutaneous thrombin injection.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-07-25

    Vascular access for hemodialysis remains a challenge for nephrologists, vascular surgeons, and interventional radiologists alike. Arteriovenous fistula and synthetic grafts remain the access of choice for long-term hemodialysis; however, they are subject to complications from infection and repeated needle cannulation. Pseudoaneurysms are an increasingly recognized adverse event. At present, there are many minimally invasive methods to repair these wall defects. We present a graft pseudoaneurysm, which required a combination of endovascular stent graft placement and percutaneous thrombin injection for successful occlusion.

  6. A Case of Ruptured Blood Blister-like Aneurysm Treated with Pipeline Embolization Device: Clinical Significance of Fetal-type Posterior Communicating Artery

    Science.gov (United States)

    Park, Ki-Su; Son, Won-Soo; Park, Jaechan; Kim, Young-Sun; Kim, Byung Moon

    2017-01-01

    Blood-blister like aneurysms (BBAs) are challenging lesions because of their wide fragile neck. Flow-diverting stents (FDSs), such as the Pipeline Embolization Device (PED), have been applied to treat BBAs less amenable to more established techniques of treatment. However, the use of FDSs, including the PED, in acute subarachnoid hemorrhage (SAH) still remains controversial. We report a case of aneurysm regrowth following PED application for a ruptured BBA that overlapped the origin of the dominant posterior communicating artery (PCoA), which was successfully treated after coil trapping of the origin of the fetal-type PCoA. And, we discuss the clinical significance of the fetal-type PCoA communicating with a BBA in terms of PED failure. PMID:28316868

  7. Endovascular covered stent treatment for descending aorta pseudoaneurysm following coarctation of the aorta repair in an infant.

    Science.gov (United States)

    Takawira, Farirai F; Sinyangwe, Greenwood; Mooloo, Rene

    2010-12-01

    The development of a pseudoaneurysm is a rare complication following repair of a coarctation of the aorta. Surgical management of pseudoaneurysms is associated with high morbidity and mortality. We describe the successful endovascular deployment of a covered stent in a sick infant with a descending aorta pseudoaneurysm, following the repair of an aortic coarctation. We highlight the challenges we encountered. Endovascular repair is a safe palliative alternative to re-do open surgery in unstable infants with large pseudoaneurysms following aortic coarctation repair. The role of endovascular stents as the final definitive therapy will remain limited by the deployable, small-size stents in small, growing children.

  8. Levels of vitamin C In the blood plasma patients treated with coronary artery bypass grafting increases significantly after surgery.

    Science.gov (United States)

    Kleszczewski, Tomasz; Modzelewska, Beata; Lisowska, Anna; Buzun, Leszek; Kleszczewska, Ewa

    2017-01-01

    One strong risk factor of coronary artery disease (CAD), which affects the levels of vitamin C in the blood is cigarette smoking. The supplementary effects of coronary artery bypass grafting (CABG) is smoking cessation by patients. Therefore, the aim of this study was to examine the level of vitamin C in the blood plasma one day before and one month after CABG. Human blood were collected from 20 patients (men); 1day before and 1 month after CABG. All patients were smoker and after CABG they declared their not smoking. The concentration of vitamin C in the blood plasma was assayed by FIA method with spectrophotometric detection. The mean value of the vitamin C concentration 1day before CABG was 12.36±2.84μmol/L (mean±SD), 1 month after CABG 40.07±10.95μmol/L (mean±SD). The average increase in the concentration of vitamin C was 3.27±0.73 times (mean±SD) and showed significant positive correlations (Pearson r=0.657, p=0.002). It should be consider incorporating the recommendations of preoperative smoking cessation for at least one month prior to CABG and/or additional supplementation. In addition it would be relevant to monitor the level of vitamin C in the patients' blood in the preoperative period.

  9. The Effect of Arterial pH on Oxygenation Persists Even in Infants Treated with Inhaled Nitric Oxide

    Directory of Open Access Journals (Sweden)

    Aimee M. Barton

    2011-01-01

    Full Text Available Objective. To validate the empiric observation that pH has an important effect on oxygenation in infants receiving iNO. Study Design. Demographics, ventilator settings, arterial blood gases (ABG, and interventions for up to 96 hours of life were extracted from the charts of 51 infants receiving iNO. Need for ECMO and survival to discharge were noted. Mean blood pressure (MBP and mean airway pressure (MAP were recorded. The arterial/alveolar (a/A ratio was used as the primary outcome. Analysis was by simple linear regression and multiple linear regression analyses and Fisher's exact test. pH responsiveness was arbitrarily defined as a correlation coefficient (CC of >0.40 with 7.55. Of 11 patients requiring ECMO, only 3 exhibited responsiveness at any time in their course. Three responders required ECMO. Conclusion. This small study suggests that failure or inability to optimize pH may account for observed unresponsiveness to iNO. Maintaining a pH > 7.5 using hyperventilation is not recommended.

  10. Peptide-micelle Hybrids Containing Fasudil for Targeted Delivery to the Pulmonary Arteries and Arterioles to Treat PAH

    Science.gov (United States)

    Gupta, Nilesh; Ibrahim, Hany M.; Ahsan, Fakhrul

    2017-01-01

    This study investigates the respirability and efficacy of peptide-micelle hybrid nanoparticles as carriers for inhalational therapy of pulmonary arterial hypertension (PAH). CARSKNKDC (CAR), a cell penetrating and lung homing peptide, conjugated DSPE-PEG micelles containing fasudil, an investigational anti-PAH drug, were prepared by solvent evaporation method and characterized for various physicochemical properties. The pharmacokinetics and pharmacological efficacy of hybrid particles containing fasudil were evaluated in healthy rats and monocrotaline induced PAH rats, respectively. CAR-micelles containing fasudil had an entrapment efficiency of ∼58%, showed controlled release of the drug, and were monodispersed with an average size of ∼14nm. NMR scan confirmed the drug's presence in the core of peptide-micelle hybrid particles. Compared with plain micelles, CAR peptide increased the cellular uptake by ∼1.7-fold and extended the drug half-life by ∼5-fold. The formulations were more prone to accumulate in the pulmonary vasculature than in the peripheral blood, which is evident from the ratio of the extent of reduction of pulmonary and systemic arterial pressures. On the whole, this study demonstrates that peptide-polymer hybrid micelles can serve as inhalational carriers for PAH therapy. PMID:25266507

  11. The Use of ExoSeal Vascular Closure Device for Direct Antegrade Superficial Femoral Artery Puncture Site Hemostasis

    Energy Technology Data Exchange (ETDEWEB)

    Rimon, Uri, E-mail: rimonu@sheba.health.gov.il; Khaitovich, Boris, E-mail: borislena@012.net.il [Tel-Aviv University, Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Yakubovich, Dmitry, E-mail: Dmitry.Yakubovitch@sheba.health.gov.il [Tel-Aviv University, Vascular Surgery Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Bensaid, Paul, E-mail: paulbensaid@hotmail.com; Golan, Gil, E-mail: gilgolan201@gmail.com [Tel-Aviv University, Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel); Silverberg, Daniel, E-mail: Daniel.Silverberg@sheba.health.gov.il [Tel-Aviv University, Vascular Surgery Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine (Israel)

    2015-06-15

    PurposeThis study was designed to assess the efficacy and safety of the ExoSeal vascular closure device (VCD) to achieve hemostasis in antegrade access of the superficial femoral artery (SFA).MethodsWe retrospectively reviewed the outcome of ExoSeal VCD used for hemostasis in 110 accesses to the SFA in 93 patients between July 2011 and July 2013. All patients had patent proximal SFA based on computer tomography angiography or ultrasound duplex. Arterial calcifications at puncture site were graded using fluoroscopy. The SFA was accessed in an antegrade fashion with ultrasound or fluoroscopic guidance. In all patients, 5–7F vascular sheaths were used. The ExoSeal VCD was applied to achieve hemostasis at the end of the procedure. All patients were clinically examined and had ultrasound duplex exam for any puncture site complications during the 24 h postprocedure.ResultsIn all procedures, the ExoSeal was applied successfully. We did not encounter any device-related technical failure. There were four major complications in four patients (3.6 %): three pseudoaneurysms, which were treated with direct thrombin injection, and one hematoma, which necessitated transfusion of two blood units. All patients with complications were treated with anticoagulation preprocedure or received thrombolytic therapy.ConclusionsThe ExoSeal VCD can be safely used for antegrade puncture of the SFA, with a high procedural success rate (100 %) and a low rate of access site complications (3.6 %)

  12. Endovascular Treatment of Visceral Aneurysms and Pseudoaneurysms: Long-term Outcomes from a Multicenter European Study

    Energy Technology Data Exchange (ETDEWEB)

    Spiliopoulos, Stavros, E-mail: stavspiliop@upatras.gr; Sabharwal, Tarun [Guy' s and St Thomas' Hospitals NHS Trust, Department of Interventional Radiology (United Kingdom); Karnabatidis, Dimitrios [Patras University Hospital, Department of Diagnostic and Interventional Radiology (Greece); Brountzos, Elias [Attikon University Hospital, 2nd Radiology Department (Greece); Katsanos, Konstantinos [Patras University Hospital, Department of Diagnostic and Interventional Radiology (Greece); Krokidis, Miltiadis; Gkoutzios, Panagiotis [Guy' s and St Thomas' Hospitals NHS Trust, Department of Interventional Radiology (United Kingdom); Siablis, Dimitrios [Patras University Hospital, Department of Diagnostic and Interventional Radiology (Greece); Adam, Andreas [Guy' s and St Thomas' Hospitals NHS Trust, Department of Interventional Radiology (United Kingdom)

    2012-12-15

    Purpose: To investigate the percutaneous endovascular management of visceral aneurysms (VA) and visceral pseudoaneurysms (VPA) treated in three European interventional radiology departments. Methods: Patient archives from the department's databases were examined and retrospectively analyzed. Patients diagnosed between 2000 and 2010 with VA and/or VPA, confirmed by computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography and treated exclusively with percutaneous endovascular methods, were included in the study. The study's primary end points were procedural technical success, target lesion reintervention rate, and periprocedural mortality rate. Secondary end points included major and minor complications rates. Results: The medical records of 54 patients (41 male, mean age 55 {+-} 18.1 years) with 58 VAs or VPAs and treated with various percutaneous endovascular therapeutic modalities were analyzed. In total, 21 VAs (mean diameter 49.4 {+-} 21 mm, range 20-100 mm) and 37 VPAs (mean diameter 25.1 {+-} 14.6 mm, range 8-60 mm) were treated. Procedural technical success was achieved in 100% of the cases, while target lesion reintervention rate was 6.1% (2 of 33) and 14.2% (3 of 21) in the VPA and VA groups, respectively. Mean clinical follow-up period was 19.1 {+-} 21.4 months. Overall periprocedural mortality rate was 3% (1 of 33) in the VPA group and 0% (0 of 21) in the VA group. Conclusion: Percutaneous endovascular treatment of VAs and VPAs is safe and effective with low morbidity and mortality. There is a small but significant reintervention rate, particularly for true aneurysms; dedicated follow-up imaging is recommended. Successful aneurysm exclusion was achieved in all cases with a second procedure.

  13. Severe loin pain following renal biopsy in a high-risk patient: A case report of a rare combination of pseudoaneurysm and arterio-venous fistula

    Directory of Open Access Journals (Sweden)

    Desai Madhav

    2011-01-01

    Full Text Available We report a 50-year-old male patient with diabetes mellitus and hypertension who presented with low-grade fever, anuria and renal failure. He had no prior history of nephropathy and retinopathy. Since anuria persisted, a renal biopsy was performed using automated gun, under ultrasound guidance. Two hours after the renal biopsy was performed, the patient developed severe left loin pain that required analgesics and sedatives. Ultrasound of the abdomen performed immediately, two hours and four hours after the biopsy, did not reveal any hematoma. The hemoglobin was stable when the patient developed loin pain, but after eight hours decreased to 9.1 g/dL, and computed tomography scan of the abdomen revealed a big peri-nephric hematoma around the left kidney. He was managed with blood transfusions and a selective angiogram was done. It revealed a pseudoaneurysm and arterio-venous fistula from the segmental artery of lower pole of the left kidney; both were closed by using microcoils and liquid embolic agent N-butyl-cyanoacrylate (NBCA. The only risk factor the patient had at the time of renal biopsy was severe renal failure. Our case suggests that severe loin pain immediately after renal biopsy in a patient with renal failure warrants careful follow-up of hemoglobin and imaging, even if initial imaging is normal. Further fall of hemoglobin necessitates early evaluation with angiogram, which helps in diagnosing the treatable, although rare, complications like pseudoaneurysm and arterio-venous fistula.

  14. Modeling of drug and drug-encapsulated nanoparticle transport in patient-specific coronary artery walls to treat vulnerable plaques

    KAUST Repository

    Hossain, Shaolie S.

    2010-01-01

    The main objective of this work is to develop computational tools to support the design of a catheter-based local drug delivery system that uses nanoparticles as drug carriers in order to treat vulnerable plaques and diffuse atherosclerotic disease.

  15. Improved outcomes of elderly patients treated with drug-eluting versus bare metal stents in large coronary arteries

    DEFF Research Database (Denmark)

    Kurz, David J; Bernheim, Alain M; Tüller, David

    2015-01-01

    BACKGROUND: Drug-eluting stents (DES) improve outcomes in elderly patients with small coronary artery disease compared with bare-metal stents (BMS), but randomized data in elderly patients in need of large coronary stents are not available. METHODS: Planned secondary analysis of patients ≥75 years...... recruited to the "BASKET-PROVE" trial, in which 2,314 patients undergoing percutaneous coronary intervention for large (≥3.0 mm) native vessel disease were randomized 2:1 to DES (everolimus- vs sirolimus-eluting stents 1:1) versus BMS. All patients received 12 months of dual antiplatelet therapy....... The primary end point was a composite of cardiac death or nonfatal myocardial infarction at 2 years. RESULTS: Comparison of DES versus BMS among 405 patients ≥75 years showed significantly lower rates of the primary end point for DES (5.0% vs 11.6%; hazard ration (HR) 0.64 [0.44-0.91]; P = .014). Rates...

  16. Blunt splenic trauma: Can contrast enhanced sonography be used for the screening of delayed pseudoaneurysms?

    Energy Technology Data Exchange (ETDEWEB)

    Poletti, Pierre-Alexandre, E-mail: Pierre-Alexandre.Poletti@hcuge.ch [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Becker, Christoph D.; Arditi, Daniel; Terraz, Sylvain [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Buchs, Nicolas [Department of Surgery, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Shanmuganathan, Kathirkamanathan [Department of Diagnostic Radiology and Nuclear Medicine, 22 S. Greene Street, Baltimore, MD 21201 (United States); Platon, Alexandra [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland)

    2013-11-01

    Purpose: To assess the value of contrast-enhanced sonography (CES) for the detection of delayed post-traumatic splenic pseudo-aneurysms, usually considered an indication for angiographic embolization. Methods: Sixty-three consecutive hemodynamically stable trauma patients in whom admission CT displayed a splenic injury of grade II or higher (AAST classification), without evidence of vascular involvement, were included in the study. CES of the spleen using a second generation contrast agent was systematically performed within 48–72 h after admission, for the detection of a pooling of contrast media suggestive of pseudoaneurysm. Within 6 h after contrast-enhanced sonography, all patients underwent an abdominal CT for control purposes. CES results were compared to CT findings, which were considered the reference standard. This study received approval from the institutional ethical board. Results: CES showed a blush of contrast consistent with a pseudoaneurysm in 6 of the 63 patients. All were confirmed at subsequent control CT. Pooling of contrast was found at CT in 2 patients in whom contrast-enhanced sonography was negative. There was no false positive CES examination for the suspicion of pseudoaneurysms. When compared to CT, the sensitivity, specificity, positive and negative predictive values of CES to suggest a pseudoaneurysms, were 75% (6/8), 100% (55/55), 100% (6/6), and 96% (55/57), respectively. Conclusion: Our data suggest that CES may be useful for the screening of delayed traumatic splenic pseudoaneurysms: if a negative CES does not absolutely rule out a pseudoaneurysm, a positive CES warrants an angiography, without need of control CT.

  17. Clinical and multidetector CT follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D rotational angiography

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jung Min; Park, Kwang Bo; Kim, Keon Ha; Jeon, Pyoung; Shin, Sung Wook; Park, Hong Suk; Do, Young Soo (Dept. of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)), email: kbparksmc@skku.edu; Kim, Dong-Ik; Kim, Young-Wook (Div. of Vascular Surgery, Dept. of Surgery, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of))

    2011-10-15

    Background: There are very few reports regarding the use of 3D rotational angiography (3D RA) in embolization of renal artery aneurysms (RAAs). No valuable data have been reported on the follow-up result of coil embolization for RAAs on computed tomography (CT). Purpose: To evaluate the clinical and multidetector computed tomography (MDCT) follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D RA. Material and Methods: Six patients diagnosed with RAAs were included. Five patients underwent detachable coil embolization. Five patients underwent 3D RA and the parameters used for planning endovascular treatment obtained by 2D CT, reformatted 3D CT angiography (3D CTA), 2D digital subtraction angiography (2D DSA) and 3D RA were compared. The post embolization MDCT follow-up findings were analyzed retrospectively. Results: The technical success rate for detachable coil embolization was 40%. The 3D CTA showed the dome-to-neck ratio (DNR) and tangential view of the renal artery aneurysm in five patients (83.3%) and the 2D CT showed it in four (66.7%). An optimal working angle assessment could not be obtained on the 2D CT and 3D CTA. The 3D RA showed the DNR, tangential view, and optimal working angle in all patients. Renal infarction occurred in three patients and Postprocedural hypertension developed in two patients during the follow-up period. Conclusion: The 3D RA was useful in preoperative determination of adequate working angle for detachable coil embolization of RAAs. Late complications of detachable coil embolization for RAAs were renal infarction and hypertension

  18. Hif1α down-regulation is associated with transposition of great arteries in mice treated with a retinoic acid antagonist

    Directory of Open Access Journals (Sweden)

    Amati Francesca

    2010-09-01

    Full Text Available Abstract Background Congenital heart defect (CHD account for 25% of all human congenital abnormalities. However, very few CHD-causing genes have been identified so far. A promising approach for the identification of essential cardiac regulators whose mutations may be linked to human CHD, is the molecular and genetic analysis of heart development. With the use of a triple retinoic acid competitive antagonist (BMS189453 we previously developed a mouse model of congenital heart defects (81%, thymic abnormalities (98% and neural tube defects (20%. D-TGA (D-transposition of great arteries was the most prevalent cardiac defect observed (61%. Recently we were able to partially rescue this abnormal phenotype (CHD were reduced to 64.8%, p = 0.05, by oral administration of folic acid (FA. Now we have performed a microarray analysis in our mouse models to discover genes/transcripts potentially implicated in the pathogenesis of this CHD. Results We analysed mouse embryos (8.5 dpc treated with BMS189453 alone and with BMS189453 plus folic acid (FA by microarray and qRT-PCR. By selecting a fold change (FC ≥ ± 1.5, we detected 447 genes that were differentially expressed in BMS-treated embryos vs. untreated control embryos, while 239 genes were differentially expressed in BMS-treated embryos whose mothers had also received FA supplementation vs. BMS-treated embryos. On the basis of microarray and qRT-PCR results, we further analysed the Hif1α gene. In fact Hif1α is down-regulated in BMS-treated embryos vs. untreated controls (FCmicro = -1.79; FCqRT-PCR = -1.76; p = 0.005 and its expression level is increased in BMS+FA-treated embryos compared to BMS-treated embryos (FCmicro = +1.17; FCqRT-PCR = +1.28: p = 0.005. Immunofluorescence experiments confirmed the under-expression of Hif1α protein in BMS-treated embryos compared to untreated and BMS+FA-treated embryos and, moreover, we demonstrated that at 8.5 dpc, Hif1α is mainly expressed in the embryo heart

  19. Risk factors for 1-year mortality in patients with intermediate-stage hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization

    Directory of Open Access Journals (Sweden)

    Chih-Lin Lin

    2014-12-01

    Conclusion: One-year mortality in patients with intermediate-stage HCC treated solely with TACE is not uncommon. High serum AFP level (> 400 ng/mL, CTP class B cirrhosis, and tumor size are independent risk factors for 1-year mortality in those patients.

  20. Bloodstream infections among patients treated with intravenous epoprostenol or intravenous treprostinil for pulmonary arterial hypertension--seven sites, United States, 2003-2006.

    Science.gov (United States)

    2007-03-02

    Pulmonary arterial hypertension (PAH) is a life-threatening disorder characterized by elevated pulmonary artery pressure and pulmonary vascular resistance. Continuous infusion of a prostanoid, which acts as a vasodilator and anti-proliferative agent, is indicated in the treatment of patients with severe PAH. Two prostanoids are approved for intravenous (IV) use in the United States: epoprostenol (epoprostenol sodium [brand name Flolan], Gilead, Foster City, California) and treprostinil (treprostinil sodium [brand name Remodulin], United Therapeutics, Silver Spring, Maryland). These drugs are administered to PAH patients at hundreds of treatment centers in the United States. In September 2006, CDC received a report from a PAH specialist of a suspected increase in the number of gram-negative bloodstream infections (BSIs) among PAH patients treated with IV treprostinil. CDC conducted a retrospective investigation with the assistance of several state health departments and the cooperation of seven PAH treatment centers to determine the relative rates of BSI in a sample of patients treated with IV treprostinil and IV epoprostenol during 2003--2006. This report describes the results of that investigation, which indicated that, based on combined data from seven separate PAH treatment centers, pooled mean rates of BSI (primarily gram-negative BSI) were significantly higher for patients on treprostinil than for those on epoprostenol. The results do not suggest intrinsic contamination of IV treprostinil as a cause of the infections; the difference in rates might have been caused by differences in preparation and storage of the two agents, differences in catheter care practices, or differences in the anti-inflammatory activity of the agents. Health-care providers who care for PAH patients should be aware of these findings. Further investigation is needed to determine the causes of the different infection rates at centers where this was observed and to determine whether such a

  1. Popliteal artery entrapment syndrome.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2010-01-01

    Popliteal artery entrapment syndrome is a rare abnormality of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. The following is a case report of a 19 year old female, in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically. A review of literature is also presented and provides details on how PAES is classified, diagnosed both clinically and radiologically, and treated surgically.

  2. Frequency of Acute Kidney Injury in Patients Treated With Normal Saline after Off-Pump Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Shima Sheybani

    2017-03-01

    Full Text Available Introduction: Acute kidney injury (AKI is a common postoperative complication of cardiac surgery, which is associated with an increased risk of morbidity and mortality. This study investigated the frequency of postoperative AKI in low risk adult patients undergoing off-pump coronary artery bypass grafting (CABG.Materials & Methods: All consecutive adult patients of American Society of Anesthesiologists (ASA class II and III, who were transferred to the post-operative cardiac surgery ICU after off-pump CABG and were low risk for AKI from October 2013 to September 2014 at Emam Reza Hospital, Mashhad, Iran were enrolled in this prospective cohort study at a teaching hospital. The patients were explored for AKI development, based on risk-injury-failure-loss- end stage kidney disease (RIFLE and acute kidney injury network (AKIN criteria, frequency of metabolic acidosis, hypernatremia, hyperchloremia, and length of stay in ICU.Results: According to the results of the present study, 479 patients with the mean age of 60.8±10.75 yrs were included. AKI occurred in 22 (4.4% and23 (4.8% patients, based on both the RIFLE and AKIN criteria, respectively with the highest rate of AKI, reported on the third and fourth post-operative days. Additionally, hyperchloremia and hypernatremia were observed in 71 (14.8% and 76 (15.9% patients, respectively. Only one case of mortality occurred during the study. Metabolic acidosis was reported in 112 (23.4% patients with a high anion gap in 60 (12.5% cases.Conclusion: The current study demonstrated that hypernatremia and metabolic acidosis but not AKI are frequently seen in patients receiving normal saline following off pump CABG with low risk for AKI.

  3. Low occurrence of digital ulcers in scleroderma patients treated with bosentan for pulmonary arterial hypertension: a retrospective case-control study.

    Science.gov (United States)

    Cozzi, F; Pigatto, E; Rizzo, M; Favaro, M; Zanatta, E; Cardarelli, S; Riato, L; Punzi, L

    2013-05-01

    Digital ulcers (DU) are one of the most common and debilitating manifestations of vasculopathy in systemic sclerosis (SSc). Their prevention is important in order to improve patients' outcome and as a result of the economic impact they have on society. Randomised controlled studies have demonstrated that bosentan, an endothelin receptor antagonist, reduces the appearance of new DU. The aim of this retrospective study was to evaluate the occurrence of DU in a group of patients receiving long-term bosentan treatment for pulmonary arterial hypertension associated with SSc (PAH-SSc). Patients with PAH-SSc and treated with bosentan for at least 6 months (n = 30) were evaluated. Thirty patients with SSc not treated with bosentan, but matched for sex, age, disease duration and cutaneous form of SSc, were considered as a control group. The occurrence of DU, defined as loss of tissue of varying degrees in the epidermis, dermis and subcutaneous tissue, was determined in the bosentan-treated and untreated groups. Mean duration of bosentan treatment was 3.6 years. DU were detected in six patients in the bosentan-treated group (20.0 %) and 16 patients (53.3 %) in the untreated group (p = 0.0015). There were no significant differences in demographic or clinical characteristics between patients with or without DU at study end. The occurrence of DU in patients with PAH-SSc receiving long-term bosentan treatment was significantly lower than in untreated patients. The results from this long-term observational study provide valuable information on management of patients with PAH-SSc.

  4. Juvenile Stroke: Cervical Artery Dissection in a Patient after a Polytrauma

    Directory of Open Access Journals (Sweden)

    Nicole Marschner-Preuth

    2013-01-01

    Full Text Available Dissections of the cervical arteries cause about 20% of total juvenile strokes. Approximately 4% of the carotid artery dissections are due to a (polytrauma such as car accidents. Despite improved diagnostic facilities, traumatic dissections are often underdiagnosed or diagnosed too late due to a lack of awareness of potential initial signs and symptoms.We report here a case of a delayed embolic stroke after a car accident caused by a dissection of the carotid artery and subsequent pseudoaneurysm.To reduce the long-term morbidity or mortality of multiple trauma patients, an early detection of cervical carotid and vertebral dissections is strictly necessary.

  5. Assessment of myocardial perfusion by positron emission tomography in patients with end-stage coronary artery disease treated with percutaneous myocardial revascularization

    Institute of Scientific and Technical Information of China (English)

    Marcus Wiemer; Johannes Peter Wielepp; Oliver Lindner; Wolfgang Burchert; Christoph Langer; Dieter Horstkotte; Thomas Butz

    2009-01-01

    Background Reportedly, patients with persistent refractory angina due to end-stage coronary artery disease (CAD) not amenable to traditional revascularization techniques have experienced symptomatic relief following laser revascularization, either surgical transmyocardial revascularization (TMR) or percutaneous myocardial revascularization (PMR). In spite of several hypotheses (i.e., channel patency, placebo effect, denervation, neoangiogenesis), the mechanism of action and the benefit remains controversial.Methods A prospective trial utilizing positron emission tomography (PET) was conducted as an attempt to correlate quantified myocardial blood flow (MBF) to clinical improvement following PMR. Thirteen consecutive patients with angina class >Ⅱ in spite of maximal medical treatment underwent PMR with a holmium:yttrium-aluminum-garnet (Ho:YAG) laser.MBF at rest and under hyperemia was assessed by [~(13)N]ammonia PET at baseline, 3 and 6 months following PMR.Results Mean angina class and exercise tolerance time improved at 6 months compared with baseline (P<0.001). The clinical results were accompanied with an improvement in hyperemic MBF (P=0.05) and a reduction in minimal coronary resistance (MCR; P<0.05) in PMR-treated segments. Opposite effects, reduced hyperemic MBF and increased MCR,were observed in nontreated segments. The increase in MCR in nontreated segments revealed the favorable therapeutic impact achieved in PMR-treated segments.Conclusion The results of this trial utilizing a quantitative technique to quantify myocardial perfusion link clinical improvement post-PMR to neoangiogenesis and consistently improved microcirculation.

  6. Surgical repair of a pseudoaneurysm of the ascending aorta after aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Almeida Rui Manuel Sequeira de

    2001-01-01

    Full Text Available We report the case of a patient with a pseudoaneurysm of the ascending aortic clinically diagnosed 5 months after surgical replacement of the aortic valve. Diagnosis was confirmed with the aid of two-dimensional echocardiography and helicoidal angiotomography. The corrective surgery, which consisted of a reinforced suture of the communication with the ascending aorta after opening and aspiration of the cavity of the pseudoaneurysm, was successfully performed through a complete sternotomy using extracorporeal circulation, femorofemoral cannulation, and moderate hypothermia, with no aortic clamping.

  7. PET/CT imaging of abdominal aorta with intramural hematomas, penetrating ulcer, and saccular pseudoaneurysm.

    Science.gov (United States)

    Nguyen, Vien X; Nguyen, Ba D

    2014-05-01

    Acute aortic syndromes, encompassing intramural hematoma, penetrating ulcer, and pseudoaneurysm, are best demonstrated by angiographic CT and magnetic resonance imaging. These imaging modalities provide an accurate evaluation and allow timely therapies of these frequently symptomatic lesions, thus reducing their morbidity and mortality. The inflammatory pathogenesis of these acute aortic syndromes may exhibit positive PET findings predictive of prognosis and outcomes of these vascular events. The authors present a case of PET/CT imaging showing asymptomatic intramural hematomas with penetrating ulcer and saccular pseudoaneurysm of the proximal abdominal aorta.

  8. Arteriovenous fistula complicating iliac artery pseudo aneurysm: diagnosis by CT angiography.

    Science.gov (United States)

    Huawei, L; Bei, D; Huan, Z; Zilai, P; Aorong, T; Kemin, C

    2002-01-01

    Fistula formation to the inferior vena cava is a rare complication of aortic aneurysm which is often misdiagnosed clinically. In one hundred of reported arteriocaval fistulae, none was originating from the right common iliac artery. We report a case of ileo-caval fistula due to a iatrogenic pseudoaneurysm. High resolution 3D imaging using breath-hold CT angiography is highly specific in identifying the location, extent of the aortocaval fistula as well as the neighbouring anatomic structures.

  9. Gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery successfully treated with coil embolization: a case report and review of the literature.

    Science.gov (United States)

    Namikawa, Masashi; Kakizaki, Satoru; Takakusaki, Satoshi; Saito, Shuichi; Yata, Yutaka; Mori, Masatomo

    2011-12-01

    Endoscopic hemostasis is a useful treatment modality for gastric ulcer bleeding. However, it is sometimes difficult to achieve hemostasis in cases with arterial bleeding, especially those complicated with vascular abnormalities. We describe a case with gastric ulcer bleeding from a variant left gastric artery accompanied by congenital absence of the splenic artery. A 50-year-old female was admitted to our hospital with dizziness and tarry stools. Upper gastrointestinal endoscopy revealed bleeding from a gastric ulcer, and endoscopic hemostasis by endoscopic clipping was carried out. Computed tomography and abdominal angiography revealed the variant left gastric artery running below the gastric ulcer. In spite of endoscopic hemostasis and medication, re-bleeding from the gastric ulcer occurred. A transcatheter coil embolization for the variant left gastric artery was performed and successfully achieved hemostasis. This case was accompanied by congenital absence of the splenic artery, which is an extremely rare condition. We herein describe this rare case and review previously reported cases.

  10. [Percutaneous angioplasty of the left renal artery in a patient with acute infarction of the left kidney with persistent occlusion of the right renal artery treated with angiotensin converting enzyme inhibitor].

    Science.gov (United States)

    Latacz, Paweł; Rudnik, Andrzej; Gutowska, Aleksandra; Zając, Mariola; Kondys, Marek; Ludyga, Tomasz; Kazibudzki, Marek; Cierpka, Lech

    2011-01-01

    A case of a 67 year-old woman with acute renal syndrome during treatment of angiotensin converting enzyme is presented. In angiography was affirmed acute occlusion left renal artery (LRA) with chronic occlusion right renal artery. Percutaneous angioplasty with implantation stent of the LRA were performed with optimal effect. In this article, the clinical management of patients with angiographically documented acute occlusion renal artery is discussed.

  11. Transradial artery intervention: an alternative approach for renal artery stent implantation?

    Institute of Scientific and Technical Information of China (English)

    LUO Jian-fang; WANG Hui-yong; HUANG Wen-hui; LIU Yuan; LI Guang; ZHOU Ying-ling; CHEN Ji-yan

    2012-01-01

    Background Transfemoral artery access is the main approach for the interventional treatment of renal artery stenosis (RAS).This study aimed to investigate the technical feasibility of a transradial interventional (TRI) treatment of renal artery stenosis.Methods A series of 23 patients who underwent transradial renal artery stenting from October 2010 to October 2011 were studied.Radial sheath system (Terumo,Japan) was used to get access to the radial artery.Radial tourniquet (Terumo) was used to stop bleeding.A 5Fr MPA (COOK,USA) was used to perform selective renal arteriography.Percutaneous renal artery stent systems were used to perform renal artery stenting.Results Renal artery angiography showed that 15 patients had unilateral renal artery stenosis and eight patients had bilateral renal artery stenosis.The descending aorta could not be catheterized in one patient because of the type Ⅲ aortic arch.Twenty-two patients successfully underwent transradial renal artery angiography and the technical success rate was 95.7%.There was no puncture site hematoma or pseudoaneurysm.Mean procedure time was (38.4±7.2) minutes,the mean amount of contrast agent used was (93.2±6.3) ml,and the mean postprocedure bleeding time was (3.2±1.9) minutes.Conclusion Transradial renal artery intervention is technically reliable with less invasion,rapid recovery,fewer complications and may become an alternative intervention approach for the treatment of renal artery stenosis.

  12. 血透致假性动脉瘤切除并内瘘成型术的围手术期护理%The Perioperative Care of Pseudoaneurysm Resection and Fistula Angioplasty that Caused by Hemodialysis

    Institute of Scientific and Technical Information of China (English)

    谢燕冰; 陈秋梅; 刘莲清; 全晓国; 陈丽姗

    2014-01-01

    目的:总结血透患者直穿致假性动脉瘤切除同时一期行内瘘成型术的围手术期护理要点。方法本院收治血透直穿致假性动脉瘤259例患者,其中行假性动脉瘤切除同时一期行内瘘成型手术127例患者作为治疗组,将其余132例患者作为对照组。回顾性分析对患者围手术期护理的效果,并做相关统计学分析处理。结果经精心治疗和护理,桡动脉假性动脉瘤的切除并一期内瘘成型术通畅率达94%,血流能满足血透需要。结论术前强调规范的心理护理和术肢护理,术后加强对并发症的观察并进行护理干预和指导,同时加强手功能锻炼的指导,可有效提高手术成功率,从而提高患者的生活质量和生存率。%Objective To summarize the perioperative nursing points of hemodialysis patients during pseudoaneurysm resection and one-stage fistula angioplasty. Methods 259 hemodialysis patients with pseudoaneurysm that caused by direct arterial puncture in our hos-pital were collected, and 127 patients of them received one-stage fistula angioplasty when conducting pseudoaneurysm resection. A ret-rospective analysis and a statistically analysis were performed on the effects of perioperative care of these patients. Results The suc-cess rate of radial artery pseudoaneurysm resection and one-stage fistula angioplasty up to 94% after carefully treatment and care, the blood flow could meet the requirements of hemodialysis. Conclusion Preoperative standardized psychological care and limb care, post-operative complications observation and nursing intervention, and limb functional exercise guidance can effectively improve the success rate of surgery, the quality of life and the survival rate.

  13. Clinical Practice Variability in Temperature Correction of Arterial Blood Gas Measurements and Outcomes in Hypothermia-Treated Patients After Cardiac Arrest.

    Science.gov (United States)

    Terman, Samuel Waller; Nicholas, Katherine S; Hume, Benjamin; Silbergleit, Robert

    2015-09-01

    Mechanical ventilation in patients treated with mild therapeutic hypothermia (MTH) for the postcardiac arrest syndrome may be challenging given changes in solubility of arterial blood gases (ABGs) with cooling. Whether ABG measurements should be temperature corrected (TC) remain unknown. We sought to describe practice variability in TC at a single institution and explored the association between TC and neurological outcome. We conducted a retrospective cohort study reviewing electronic health records of all patients treated with MTH after cardiac arrest. We examined whether the percentage of TC ABGs relative to total number of ABGs drawn for each subject during hypothermia was associated with the neurological outcome at hospital discharge and 6-12-month follow-up. The cerebral performance category of 1-2 was defined as a favorable outcome in the logistic regression models. 1223 ABGs were obtained during MTH on 122 subjects over 6 years. TC was never used in 72 subjects (59%; no TC group), made available in 1-74% of ABGs in 17 subjects (14%; intermediate TC group), and made available in ≥75% of ABGs in 33 subjects (27%; mostly TC group). Groups differed in the proportion of subjects with shockable presenting rhythms (47% vs. 47% vs. 76%, p=0.02) and admitting ICU (p=0.005). Favorable 6-month outcomes were more common in the mostly TC than no TC group (48% vs. 25%; OR [95% CI]: 2.9 [1.2-7.1]), but not after adjustment (OR 1.5, 95% CI 0.33-6.9). There was substantial practice variability in the temperature correction strategy. Availability of temperature-corrected ABGs was not associated with improved neurological outcomes after adjusting for covariates.

  14. Sildenafil and bosentan plasma concentrations in a human immunodeficiency virus-infected patient with pulmonary arterial hypertension treated with ritonavir-boosted protease inhibitor

    Directory of Open Access Journals (Sweden)

    Pierangelo Chinello

    2015-03-01

    Full Text Available Sildenafil and bosentan are increasingly used for the treatment of pulmonary arterial hypertension (PAH in HIV-infected patients. However, concerns exist about pharmacokinetic interactions among sildenafil, bosentan and antiretroviral drugs, including protease inhibitors (PI. We describe here the case of an HIV-infected patient with PAH, who was co-administered bosentan 125 mg twice daily and sildenafil 40 mg three times per day, together with a ritonavir-boosted PI-based antiretroviral therapy; plasma levels of bosentan, sildenafil, N-desmethylsildenafil, and PI were measured. The patient had a sildenafil Cthrough and Cmax of 276.94 ng/mL and 1733.19 ng/mL, respectively. The Cthrough and the Cmax of bosentan were 1546.53 ng/mL and 3365.99 ng/mL, respectively. The patient was able to tolerate as high sildenafil blood concentrations as 10 times those usually requested and did not report any significant adverse reaction to sildenafil during the follow-up period. Therapeutic drug monitoring should be considered during sildenafil therapy in patients concomitantly treated with ritonavir-boosted PI.

  15. Thoracic Aortic Injury: Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation

    Directory of Open Access Journals (Sweden)

    Konstantinos Lagios

    2015-01-01

    Full Text Available Iatrogenic aortic injuries are rare and well-recognized complications of a variety of procedures, including spinal surgery. The placement of pedicle screws is sometimes associated with devastating consequences. Aortic perforation with rapid hematoma formation and delayed aortic trauma leading to pseudoaneurysm formation have been described in the literature. A case describing a significant time interval between iatrogenic aortic injury and diagnosis in the absence of pseudoaneurysm formation is described in this paper and, according to our knowledge, is unique in the literature. The aortic injury was successfully treated, selecting the appropriate graft and, as a consequence, normal spinal cord blood flow was achieved.

  16. Thoracic Aortic Injury: Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation.

    Science.gov (United States)

    Lagios, Konstantinos; Karaolanis, Georgios; Perdikides, Theodossios; Bazinas, Theodoros; Kouris, Nikolaos; Sfikas, Spiros; Paxinos, Odysseas

    2015-01-01

    Iatrogenic aortic injuries are rare and well-recognized complications of a variety of procedures, including spinal surgery. The placement of pedicle screws is sometimes associated with devastating consequences. Aortic perforation with rapid hematoma formation and delayed aortic trauma leading to pseudoaneurysm formation have been described in the literature. A case describing a significant time interval between iatrogenic aortic injury and diagnosis in the absence of pseudoaneurysm formation is described in this paper and, according to our knowledge, is unique in the literature. The aortic injury was successfully treated, selecting the appropriate graft and, as a consequence, normal spinal cord blood flow was achieved.

  17. Multimodality imaging in the diagnosis of deep vein thrombosis and popliteal pseudoaneurysm complicating a sessile osteochondroma

    Energy Technology Data Exchange (ETDEWEB)

    Christensen, Jared D.; Monu, Johnny U.V. [University of Rochester School of Medicine and Dentistry, Department of Imaging Sciences, 601 Elmwood Ave., Box 648, Rochester, NY (United States)

    2008-08-15

    Synergistic use of ultrasonography, radiography, multidetector CT (MDCT) and MRI enabled a prompt and accurate diagnosis of a nonocclusive popliteal vein thrombus (deep venous thrombosis, DVT) and a pseudoaneurysm complicating a sessile osteochondroma in an 11-year-old boy who presented in the emergency department with sudden-onset nontraumatic pain in the posterior aspect of the knee. (orig.)

  18. Non-mycotic anastomotic pseudoaneurysm of renal allograft artery. Case Report.

    Science.gov (United States)

    Ardita, Vincenzo; Veroux, Massimiliano; Zerbo, Domenico; D'Arrigo, Giuseppe; Caglià, Pietro; Veroux, Pierfrancesco

    2016-06-20

    Le complicanze vascolari dopo il trapianto renale non sono comuni, e nella maggior parte dei casi si presentano nel periodo post-trapianto precoce. Gli pseudoaneurismi arteriosi coinvolgono l’anastomosi arteriosa del rene trapiantato e nella maggior parte dei casi riconoscono una eziologia micotica. Una donna di 62 anni, che è stata sottoposta otto mesi prima ad un trapianto renale, presentava un vago dolore in fossa iliaca destra. L’ecografia del rene trapiantato dimostrava la presenza di un’area ipoecogena in corrispondenza dell’ilo renale, che all’ecocolordoppler appariva riccamente vascolarizzata. La tomografia computerizzata confermava la diagnosi di pseudo-aneurisma anastomotico di 33 mm di diametro, coinvolgente l’arteria del rene trapiantato. La paziente è stata dunque sottoposta a intervento chirurgico di aneurismectomia, con successivo bypass fra arteria renale del rene trapiantato e arteria iliaca interna. La continuità arteriosa iliaca è stata dunque ristabilita attraverso un by-pass iliaco-esterno-femorale comune in vena safena invertita. L’ecocolordoppler intraoperatorio dimostrava la corretta perfusione del graft renale e la corretta pervietà del by-pass iliacofemorale. Il decorso post-operatorio è stato privo di complicanze significative, eccettuata una linforrea inguinale risolta spontaneamente in 22a giornata post-operatoria. Sei mesi dopo la procedura, la paziente è in ottime condizioni generali, con una funzionalità renale conservata e una corretta pervietà del by-pass iliacofemorale. Lo pseudo-aneurisma dell’arteria renale rappresenta una rara complicanza del trapianto renale. Nella maggior parte dei casi riconosce una eziologia micotica, spesso a causa di contaminazione diretta del graft durante le procedure di prelievo o conservazione dell’organo. Il trattamento è molto complesso, e in molti casi richiede l’espianto del graft. Tuttavia, in alcuni casi selezionati, è possibile eseguire il trattamento dell’aneurisma, preservando il rene trapiantato, come nel caso da noi descritto. In conclusione, lo pseudoaneurisma dell’arteria renale è una complicanza rara ma potenzialmente letale del trapianto renale. L’intervento chirurgico di resezione dell’aneurisma, sebbene tecnicamente complesso, consente di preservare la funzionalità del rene trapiantato.

  19. [Rupture of splenic artery pseudoaneurysm: an unusual cause of upper gastrointetinal bleeding].

    Science.gov (United States)

    Herrera-Fernández, Francisco Antonio; Palomeque-Jiménez, Antonio; Serrano-Puche, Félix; Calzado-Baeza, Salvador Francisco; Reyes-Moreno, Montserrat

    2014-01-01

    Antecedentes: tras una pancreatitis, el sangrado de un pseudoquiste pancreático es una complicación grave que puede conducir a una hemorragia digestiva masiva. La ruptura de ese pseudoquiste en el estómago es rara. Caso clínico: se comunica el caso de una paciente femenina de 34 años de edad, con antecedentes de alcoholismo y un pseudoquiste pancreático. Después de abandonar el estudio y seguimiento del pseudoquiste pancreático un año más tarde reingresó de urgencia debido a un cuadro de hemorragia digestiva alta. En una endoscopia del tubo digestivo alto se encontró sangrado activo en la región del fundus gástrico, que no pudo controlarse. La angio-tomografía axial computada abdominal confirmó el diagnóstico de pseudoaneurisma de la arteria esplénica, en íntimo contacto con la pared posterior del estómago y quizá fistulizado al mismo. La paciente se intervino con carácter urgente realizándose esplenopancreatectomía distal y fistulorrafia. Conclusión: en raras ocasiones la ruptura de un pseudoaneurisma de la arteria esplénica puede iniciarse como una hemorragia digestiva alta, que puede ser letal si no es tratada con urgencia.

  20. Stent graft implantation in an aortic pseudoaneurysm associated with a fractured Cheatham-Platinum stent in aortic coarctation.

    Science.gov (United States)

    Kuhelj, Dimitrij; Berden, Pavel; Podnar, Tomaž

    2016-03-01

    We report a case of aortic pseudoaneurysm associated with a fractured bare Cheatham-Platinum stent following stenting for aortic coarctation. These complications were recognised 6 years after the implantation procedure and were successfully managed by percutaneous stent graft implantation. Staged approach for stent dilatation might prevent development of aortic pseudoaneurysms. In addition, careful follow-up is warranted after stenting for aortic coarctation, particularly in patients with recognised aortic wall injury.

  1. Arterial Emboli Complicating Cisplatin Therapy

    OpenAIRE

    Tait, Campbell D.; Rankin, Elaine M

    2012-01-01

    We report three cases of arterial emboli in patients with lung cancer treated with cisplatin chemotherapy. All three patients were managed without surgical intervention but subsequent oncological treatment was complicated by the sequelae of arterial emboli. We discuss the issues surrounding these patients and the importance of identifying patients at risk of arterial embolic phenomena with cisplatin treatment.

  2. [Injury of femoral artery complicated with infection from injection of heroine].

    Science.gov (United States)

    Zhao, X; Li, L; Zhao, H

    1998-11-01

    Drug addiction has been one of the serious social problems. The peripheral phlebitis caused by drug injection is common, but the occurrence of pseudoaneurysm with infection of femoral artery from injection injury was rarely reported in China. From January 1995 to March 1996, six cases of injury of femoral artery with infection from heroine injection were admitted. The characteristics of the injury were described. The therapeutic measures and details of attention to be needed were discussed. It was concluded that this type of injury was different from the injury caused in agricultural, industrial or traffic accidents. The treatment of choice depended upon the type of injury.

  3. Index finger radial digital proper artery transfer and sleeve anastomosis to treat thumb digital artery defect%食指桡侧指固有动脉转位套入法治疗拇指断指

    Institute of Scientific and Technical Information of China (English)

    姚阳; 李崇杰

    2014-01-01

    Objective To investigate the effect of index finger radial digital proper artery transfer and sleeve anastomosis on treatment of thumb digital artery defect. Methods 10 cases of complete or incomplete thumb amputation with digital artery defect, but without tendon or nerve defect, were replanted by index finger radial digital proper artery transfer and sleeve anastomosis to thumb ulnar digital proper artery. Results All of 10 cases survived after operation, finger pulp was plump, color and lustre was florid. The patients were followed up for 10 months to 2 years, the hand function has obtained satisfactory recovery, and extrinsic feature was natural. Conclusion Index finger radial digital proper artery transfer and sleeve anastomosis is especially adaptive to the treatment of thumb digital artery defect.%目的:探讨食指桡侧指固有动脉转位套入法治疗拇指断指的疗效。方法对10例指动脉缺损而无肌腱神经缺损的拇指完全或不完全离断病例,采用食指桡侧指固有动脉转位与拇指尺侧指固有动脉行套入吻合法修复动脉,再植拇指。结果本组10例再植拇指均成活,指腹饱满,色泽红润,经6~24个月随访,患者手部功能恢复满意,外观自然,2例出现虎口狭窄,经手术改善。结论食指桡侧指固有动脉转位套入法适用于单纯拇指指动脉缺损的再植治疗。

  4. Hemoptysis and hemoperitoneum due to metastatic gestational choriocarcinma: bronchial artery embolization and superselective splenic artery embolization: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Beom; Park, Byung Ho; Yoon, Seong Kuk; Kim, Chan Sung; Lee, Jin Hwa; Oh, Jong Young [Donga University School of Medicine, Pusan (Korea, Republic of); Seong, Chang Kyu; Kim, Yong Joo; Kim, Young Hwan [Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2003-01-01

    Gestational choriocarcinoma is easily disseminated hematogenously and its hypervascular nature places the patient at risk of significant hemorrhage both at the sites of metastatic lesion and in the uterus. In addition, its tends to give rise to pseudoaneurysm formation. Treatment of the condition by percutaneous embolization has been reported in several published articles, and hemoperitoneum secondary to rupture of splenic metastasis of gestational choriocarcinoma has also been reported, as has angiographic embolization. Hemoptysis resulting from pulmonary metastasis and treatment by means of embolization of the bronchial artery have not been reported, however. In this article, we describe a case of hemoptysis and hemoperitoneum due to pulmonary and splenic metastasis of gestational choriocarcinoma. Treatment of the condition involved embolization of the bronchial artery and superselective embolization of the splenic artery.

  5. The Impact of Transient Hepatic Attenuation Differences in the Diagnosis of Pseudoaneurysm and Arteriovenous Fistula on Follow-Up CT Scans after Blunt Liver Trauma

    Directory of Open Access Journals (Sweden)

    Andreas Hjelm Brandt

    2014-09-01

    Full Text Available A feared complication to liver trauma is delayed vascular complication, such as pseudoaneurysm and arteriovenous fistula (PS/AF seen as focal enhancement on contrast-enhanced computed tomography (CT in the arterial phase. A hyperdense area termed transient hepatic attenuation difference (THAD representing altered hepatic blood flow can be seen in the arterial phase near the liver lesion. The objective of this study was to describe THAD and PS/AF on follow-up CT after blunt liver trauma, and to evaluate if THAD influenced the evaluation of PS/AF. Three radiology residents retrospectively evaluated scans of 78 patients. The gold standard for PS/AF was an evaluation by an experienced senior radiologist, while THAD was a consensus between the residents. PS/AF was present in 14% and THAD in 54%. THAD was located in the periphery of the lesion with hazy borders and mean HU levels of 100, while PS/AF was located within the lesion with focal enhancement and mean HU levels of 170 (p < 0.05. In evaluation of PS/AF, the likelihood of agreement between the observers and the gold standard was 89% when THAD was present, and 98% when THAD was absent (p = 0.04. THAD is common and can hamper the evaluation of PS/AF.

  6. Long-term outcome in patients treated with sirolimus-eluting stents in complex coronary artery lesions: 3-year results of the SCANDSTENT (Stenting Coronary Arteries in Non-Stress/Benestent Disease) trial

    DEFF Research Database (Denmark)

    Kelbaek, H.; Klovgaard, L.; Helqvist, S.;

    2008-01-01

    data of the long-term outcome of patients with complex coronary artery lesions. METHODS: We randomly assigned 322 patients with total coronary occlusions or lesions located in bifurcations, ostial, or angulated segments of the coronary arteries to have SES or BMS implanted. RESULTS: At 3 years, major...... performed between 1 and 3 years after the index treatment (p = NS). According to revised definitions, stent thrombosis occurred in 5 patients (3.1%) in the SES group and in 7 patients (4.4%) in the BMS group (p = NS); very late stent thrombosis was observed in 4 versus 1 patient. CONCLUSIONS: A continued...

  7. Silver-coated dacron prosthesis in the treatment of infection in arterial surgery: Case reports

    Directory of Open Access Journals (Sweden)

    Nenezić Dragoslav

    2008-01-01

    Full Text Available INTRODUCTION Although the incidence is low, infection of prosthetic vascular graft bears a high incidence of serious complications including 25-75% mortality rate and 40-75% limb loss. The standard treatment of vascular graft infection consists of excision of the prosthesis, wound debridement and extraanatomic revascularization. Conservative treatment might be an option in a limited number of patients. We present three cases of surgical and conservative treatment of vascular graft infection. CASE OUTLINE Case 1: A patient developed silver-coated graft infection after femorodistal arterial reconstruction performed because of critical limb ischemia. In the early postoperative period, massive skin and subcutaneous tissue necrosis developed, with the graft being exposed. After two months of persistent debridement and wound toilette, the defect was covered with a Thiersch skin graft. Case 2: PTFE graft infection in the right groin followed reconstruction of the isolated common femoral artery aneurysm. This graft was replaced with a silver-coated graft in situ. Reinfection of the proximal end of the implanted silver-coated graft occurred and the graft was exposed. After repeated debridement and wound toilette, the exposed prosthesis was covered with granulomatous tissue, and the wound healed. Case 3: A year after anastomotic pseudoaneurysm resection in the left groin, prosthesis was exposed following wound infection. This graft was substituted with a silver-coated graft in situ. The wound healed primarily. CONCLUSION These three cases demonstrate that under some circumstances vascular prosthesis infection can be successfully treated conservatively without graft removal, and also by in situ replacement using silver-coated graft.

  8. Hepatic pseudoaneurysm after traumatic liver injury; is CT follow-up warranted?

    DEFF Research Database (Denmark)

    Østerballe, Lene; Helgstrand, Frederik; Axelsen, Thomas

    2014-01-01

    INTRODUCTION: Hepatic pseudoaneurysm (HPA) is a rare complication after liver trauma, yet it is potentially fatal, as it can lead to sudden severe haemorrhage. The risk of developing posttraumatic HPA is one of the arguments for performing follow-up CT of patients with liver injuries. The aim...... no treatment failures. There was no correlation between the severity of the liver injury and development of HPA. 5 out of 7 patients were asymptomatic and would have been discharged without treatment if the protocol did not include a default follow-up CT. CONCLUSIONS: In conclusion, this study shows that HPA...... is not correlated to the severity of liver injury and it develops in 4% of patients after traumatic liver injury. In order to avoid potentially life-threatening haemorrhage from a post trauma hepatic pseudoaneurysm, it seems appropriate to do follow-up CT as part of the conservative management of blunt...

  9. How Is Pulmonary Hypertension Treated?

    Science.gov (United States)

    ... from the NHLBI on Twitter. How Is Pulmonary Hypertension Treated? Pulmonary hypertension (PH) has no cure. However, ... Types of Pulmonary Hypertension." ) Group 1 Pulmonary Arterial Hypertension Group 1 pulmonary arterial hypertension (PAH) includes PH ...

  10. Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

    OpenAIRE

    Zhou, Jian-Cang; Xu, Qiu-ping; Shen, Lai-gen; Pan, Kong-han; Mou, Yi-Ping

    2009-01-01

    Gastrointestinal bleeding due to aortoenteric fistula is extremely rare. Aortoenteric fistula is difficult to be diagnosed timely and entails a significant morbidity and mortality. Herein, we present an uncommon case of gastrointestinal bleeding caused by aortoduodenal fistula, which was a complication of a successful aortic reconstruction 4 months ago for an aortic pseudoaneurysm resulted from a stab wound 12 years ago. An urgent laparotomy confirmed an aortoduodenal fistula and repaired the...

  11. Diagnosis and Treatment Analysis of Massive Gastrointestinal Hemorrhage from Pseudoaneurysm Caused by Pancreatitis%胰腺炎并假性动脉瘤继发消化道大出血诊治剖析

    Institute of Scientific and Technical Information of China (English)

    蒋海涛; 陈银; 周本刚; 王红

    2016-01-01

    Objective To investigate the key points of diagnosis and treatment of pancreatic pseudoneurysm compli-cated with massive gastrointestinal hemorrhage. Methods Clinical data of a pancreatitis patient complicated with pseudoan-eurgs clinically manifested by massive hemorrhage was retrospectively analyzed, and the relevant literatures were reviewed. Results The patient was admitted for abdominal pain, hematemesis and tarry stool for a week, and had a history of pancreati-tis for 5 years. The patient with the major clinical symptom of massive gastrointestinal hemorrhage was diagnosed by abdominal enhanced CT, and then checked by digital subtraction angiography ( DSA) . The patient was treated by transcatheter arterial embolism ( TAE ) . After remobilization, clinical symptom was significantly alleviated, and discharged from hospital. CT showed no bleeding foci after 11 months of follow up after discharge, no gastrointestinal hemorrhage recurred. Conclusion Pancreatic pseudoneurysm is one of the rare complications of chronic pancreatitis. CT, DSA are the main diagnosis methods, and TAE is a safe and effective method for treatment of pancreatitis with pseudoaneurysm.%目的:探讨胰腺炎并假性动脉瘤继发消化道大出血的诊治要点。方法回顾性分析以消化道大出血为主要临床表现的胰腺炎并假性动脉瘤1例的临床资料并复习相关文献。结果本例因腹痛伴呕血、排柏油便1周入院。有胰腺炎病史5年。行腹部增强CT示疑似胃十二指肠假性动脉瘤破裂,行数字减影血管造影( DSA)确诊后行经导管动脉栓塞( TAE)治疗,栓塞后未再出血,痊愈出院。随访11个月,无再发出血。结论胰腺炎并假性动脉瘤形成是胰腺炎较少见的并发症之一,诊断主要依据CT、DSA等影像学检查,TAE是治疗胰源性假性动脉瘤最安全、有效的方法。

  12. 下肢动脉血栓内置管微量泵溶栓的观察及护理%THROMBOLYSIS THROUGH BUILT-IN MICRO-TUBE PUMP TO TREAT LOWER EXTREMITY ARTERIAL THROMBOSIS

    Institute of Scientific and Technical Information of China (English)

    孙艳艳

    2009-01-01

    Objective To explore the clinical effects and nursing mmethods of thrombolysis through built-in micro-tube pump to treat lower extremity arterial thrombosis.Methods 30 cases of lower extremity arterial thrombosis received built-in thrombosis through percutaneous femoral artery and had the micro-pumps reserved.Results 25 cases(83.3%) had their thrombosis completely dissolved and 5 cases (16.7%) got partiallly dissolved.5 cases got puncture point bleeding,3 cases got gum bleeding,2 cases got nasal bleeding and other 2 cases got hematuria.Conclusion Built-in micro-tube thrombolysis can be used effectively to treat Lower extremity arterial thrombosis and good nursing care is also needed to reduce complications.%目的 探讨急性下肢动脉血栓内置管联合微量泵溶栓的临床效果及护理方法.方法 对30例下肢动脉血栓患者经皮穿刺股动脉行内置管溶栓并保留导管接微量泵继续溶栓,观察其临床效果.结果 30例患者中,血栓完全溶解开通者25例(83.3%),部分溶解开通5例(16.7%).并发症:穿刺点出血5例,牙龈出血3例,鼻出血2例,血尿2例.结论 内置管联合微量泵溶栓是治疗急性下肢动脉血栓的有效方法,精心的护理可以减少并发症的发生.

  13. Pre-treatment ferritin level and alveolar-arterial oxygen gradient can predict mortality rate due to acute/subacute interstitial pneumonia in dermatomyositis treated by cyclosporine a/glucocorticosteroid combination therapy: a case control study [corrected].

    Directory of Open Access Journals (Sweden)

    Kentaro Isoda

    Full Text Available BACKGROUND: Acute/subacute interstitial pneumonia in dermatomyositis (DM-A/SIP is a disease associated with a poor prognosis that resists treatment with glucocorticosteroids (GC and progresses rapidly in a period of weeks to months to death. We retrospectively studied outcomes, prognostic factors, and their relations with survival rate in patients with DM-A/SIP treated with early cyclosporine A (CSA/GC combination therapy and 2-hour postdose blood concentration monitoring. METHODS: This study comprised 32 DM-A/SIP patients who were simultaneously treated with CSA and prednisolone. Clinical and laboratory findings were compared between those who died due to DM-A/SIP and those surviving 24 weeks after beginning of therapy. Prognostic factors were extracted, and their relations with the survival rate were evaluated. RESULTS: Of the 32 DM-A/SIP patients, 25 survived, 5 died of DM-A/SIP, and 2 died of infections. In those who died due to DM-A/SIP, ferritin level and the alveolar-arterial oxygen gradient were significantly increased compared with the survivors (P<0.001 and P = 0.002, respectively. Multivariate analyses showed that ferritin and alveolar-arterial oxygen gradient were independent prognostic factors of poor outcome. The survival rate 24 weeks after beginning of treatment was significantly lower in those with a ferritin level of ≥ 600 ng/ml and alveolar-arterial oxygen gradient of ≥ 45 Torr (P<0.001 and P<0.001, respectively. All patients with both prognostic factors died, and the outcome was significantly poorer in these patients than in those with one or neither of the prognostic factors (P<0.001. CONCLUSIONS: We identified pre-treatment high serum ferritin level and high alveolar-arterial oxygen gradient as poor prognostic factors in DM-A/SIP patients undergoing early CSA/GC combination therapy and showed that the outcomes were poor in patients with both factors.

  14. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

  15. 颈总动脉交感神经网剥脱术治疗脑性瘫痪的探讨%Discussion of common carotid artery sympathetic nerve net exfoliation therapy treating cerebral palsy

    Institute of Scientific and Technical Information of China (English)

    尹彪中; 李如求; 成顺成

    2002-01-01

    Objective To discuss mechanism of common carotid artery sympathetic nerve net exfoliation therapy treating sequela of cerebral palsy. Methods Examing and assessing before and after operation, curative effect analysis, Wals value assay and 1 year follow up to 124 patients. Result Score of patients in this group reached excellent 1 week after operation, reached good 1 year after operation, Wals value measure P≤ 0.05. Conclusion This operation had an effect on the promotion of mixed type; athetosis type cerebral palsy, upper limb function disorder and malfunction.

  16. Haemosuccus pancreaticus due to true splenic artery aneurysm: a rare cause of massive upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    MK Roy

    2010-07-01

    Full Text Available “Haemosuccus pancreaticus” is an unusual cause of severe upper gastrointestinal bleeding and results from rupture of splenic artery aneurysm into the pancreatic duct. More commonly, it is a pseudoaneurysm of the splenic artery which develops as sequelae of pancreatitis. However, true aneurysm of the splenic artery without pancreatitis has rarely been incriminated as the etiologic factor of this condition. Owing to the paucity of cases and limited knowledge about the disease, diagnosis as well as treatment become challenging. Here we describe a 60-year-old male presenting with severe recurrent upper gastrointestinal bleeding and abdominal pain, which, after considerable delay, was diagnosed to be due to splenic artery aneurysm. Following an unsuccessful endovascular embolisation, the patient was cured by distal pancreatectomy and ligation of aneurysm.

  17. Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

    Institute of Scientific and Technical Information of China (English)

    Motoki Nakai; Morio Sato; Hirohiko Tanihata; Tetsuo Sonomura; Shinya Sahara; Nobuyuki Kawai; Masashi Kimura; Masaki Terada

    2006-01-01

    A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration (BRTO) was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.

  18. Hormone receptor status of primary tumor as a prognostic factor in patients with liver metastases from breast cancer treated with transcatheter arterial chemoembolization

    Institute of Scientific and Technical Information of China (English)

    Kadri Altundag; Ozden Altundag; Serdal Aktolga; Ozlem Yavas; Cem Boruban

    2005-01-01

    @@ TO THE EDITOR We read with great interest the article by XP et al.[1] They reported the results of their experience with transcatheter arterial chemoembolization (TACE) and systemic chemotherapy for forty-five patients with liver metastases from breast cancer and evaluate the prognostic factors.In their study, the response and survival rates were significantly better in TACE group than in chemotherapy group.

  19. Acute embolic occlusion of the right common iliac artery after revision total hip arthroplasty treated with catheter-directed thrombolysis and balloon angioplasty: A case report

    Directory of Open Access Journals (Sweden)

    Hongqi Yang

    2015-07-01

    Full Text Available Methods: A 63-year-old woman with atrial fibrillation presented clinical symptoms and signs of acute ischemia in the right lower extremity on the 17th postoperative day after revision total hip arthroplasty of the left hip for aseptic loosening of femoral component. Aspirin was discontinued 7 days before surgery. Both computed tomography angiography and digital subtraction angiography demonstrated complete occlusion of the right common iliac artery. An emergency catheter-directed thrombolysis with urokinase combined with balloon angioplasty was performed to obtain complete patency of the right common iliac artery. Results: The patient received anticoagulation and antiplatelet therapy postoperatively and was fine at the 2-year follow-up. Conclusions: This case demonstrated that catheter-directed thrombolysis combined with balloon angioplasty could be an efficacious, minimally invasive approach for the treatment of acute embolic occlusion of the common iliac artery. Preoperative anticoagulation for patients undergoing total hip arthroplasty with long-term use of aspirin for atrial fibrillation needs further investigation.

  20. Interventiona1 diagnosis and treatment of hepatic artery complications after liver transplantation%肝移植术后肝动脉并发症的介入诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    陈尘; 高健; 胡立宝

    2015-01-01

    目的 评价介入技术在肝移植术后肝动脉并发症的诊断与治疗中的价值.方法 回顾性分析2005年5月至2015年4月北京大学人民医院8例肝移植术后肝动脉并发症患者介入诊断和治疗及随访资料.结果 肝动脉血栓形成6例,其中4例动脉溶栓后,发现伴肝动脉狭窄,2例重度狭窄者行肝动脉支架成形术,1例轻中度狭窄者仅予溶栓治疗,1例狭窄血管伴严重扭曲者溶栓治疗效果不佳,行开腹肝动脉切开取栓及吻合术;1例可见侧支循环建立,未予治疗;1例溶栓后血管通畅,未见狭窄.移植后脾动脉盗血综合征4例,行脾动脉栓塞术.肝动脉假性动脉瘤1例,行支架辅助动脉瘤栓塞术.随访1例肝动脉狭窄行动脉支架成形术患者术后5d因肝细胞广泛坏死行2次肝移植;余7例随访23 ~108个月肝功能均未见异常.结论 介入技术能有效地诊断和治疗肝移植术后肝动脉并发症.%Objective To evaluate the value of intervention technique in diagnosing and treating hepatic artery complications after liver transplantation.Methods Data of 8 patients with hepatic artery complications after liver transplantation from May 2005 to April 2015 were retrospectively analyzed.Results Totally 6 patients had hepatic artery thrombosis;among them,hepatic artery stenosis was found after intra-arterial thrombolysis in 4 cases.Among them,2 cases had severe stenosis and underwent hepatic artery stent angioplasty;1 case had mild-moderate stenosis and underwent thrombolytic therapy;1 case had ineffective thrombolysis due to severe artery distortion and underwent hepatic artery embolectomy and anastomosis.The collateral circulation was established in 1 case and no treatment was given;no hepatic artery stenosis was found after intra-arterial thrombolysis in 1 case;1 patient had splenic artery steal syndrome and underwent splenic artery embolization;1 patient had hepatic artery pseudoaneurysm formation and underwent stent

  1. 都梁软胶囊治疗基底动脉型偏头痛39例%Clinical Therapy Observation of Duliang Soft Capsule for Treating Basilar Artery Migraine in 39 Cases

    Institute of Scientific and Technical Information of China (English)

    陈忠伦; 王欣; 段劲峰

    2012-01-01

    目的 观察都梁软胶囊时基底动脉型偏头痛的治疗效果.方法 将76例患者随机分成治疗组(39例)和对照组(37例),治疗组联合服用都梁软胶囊和尼莫地平,对照组单用尼莫地平,治疗2周,观察疼痛及伴随症状的变化.结果 治疗组比对照组疼痛强度降低更明显(P<0.05),总有效率亦高于对照组(P<0.05).结论联合服用都梁软胶囊治疗基底动脉型偏头痛安全、有效.%Objective To investigate the effect of Duliang Soft Capsule in treating basilar artery migraine. Methods 76 cases of basilar artery migraine were randomly divided into two groups, the treatment group( 39 cases) and the control group( 37 cases ). The treatment group was given Duliang Soft Capsule plus nimodipine, while the control group received nimodipine alone. The change of pain and accompanied symptoms were observed after 2 - week treatment. Results The pain intensity in the treatment group was significantly decreased than the control group( P < 0. 05 ), the total effective rate was also higher than that in the control group( P < 0.05). Conclusion The combination use of Duliang Soft Capsule is safe and effective to treat basilar artery migraine.

  2. 补阳还五汤治疗椎基底动脉供血不足所致眩晕34例%Treating 34 cases of vertigo caused by vertebro-basilar artery insufficiency with the Buyanghuanwu decoction

    Institute of Scientific and Technical Information of China (English)

    万继松; 田中旺

    2012-01-01

      Objective: To observe the clinical effect of the Buyang Huanwu decoction in treating vertigo caused by vertebro-basilar artery insufficiency. Methods: The Buyang Huanwu decoction was given once a day modified with different symptoms. There were 20 days in each course of treatment. The clinical effect was observed after 2 courses of treatment. Results: The total effective rate was 91%. Conclusion: The Buyang Huanwu decoction had significant effect in treating vertigo caused by vertebro-basilar artery insufficiency.%  目的:观察补阳还五汤治疗椎基底动脉供血不足所致眩晕的临床疗效。方法:给予补阳还五汤,并随证加味治疗,1剂/d,20d 为1个疗程,2个疗程后观察疗效。结果:总有效率91%。结论:补阳还五汤治疗基底动脉供血不足所致眩晕疗效显著。

  3. Treating Arrhythmias in Children

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Treating Arrhythmias in Children Updated:Dec 21,2016 Many options ... card This content was last reviewed September 2016. Arrhythmia • Home • About Arrhythmia • Why Arrhythmia Matters • Understand Your ...

  4. Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

    Institute of Scientific and Technical Information of China (English)

    Jian-cang ZHOU; Qiu-ping XU; Lai-gen SHEN; Kong-han PAN; Yi-ping MOU

    2009-01-01

    Gastrointestinal bleeding due to aortoenteric fistula is extremely rare. Aortoenteric fistula is difficult to be diagnosed timely and entails a significant morbidity and mortality. Herein, we present an uncommon case of gastrointestinal bleeding caused by aortoduodenal fistula, which was a complication of a successful aortic reconstruction 4 months ago for an aortic pseudoaneurysm resulted from a stab wound 12 years ago. An urgent laparotomy confirmed an aortoduodenal fistula and repaired the defects in aorta and duodenum, but a prolonged shock led to the patient's death. In summary, early diagnosis and surgical intervention for aortoenteric fistula are vital for survival.

  5. Diagnosis and surgical treatment of post-infarction left ventricular pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    GAN Hui-li; ZHANG Jian-qun

    2009-01-01

    @@ Left ventficular pseudoaneurysm (LVPA) is a rare clinical entity that could be life-threatening. It could be of congenital and acquired origin.1,2 Among the acquired LVPA, post-infarction LVPA constitutes most of the cases. LVPA always occurs after acute myocardial infarction (MI) and develops chronically. Reliable diagnosis and early surgical intervention are vital for the patients' recovery. Here we present 7 cases of LVPA in Anzhen Hospital between May 1993 to March 2007, focusing on the evaluation of diagnosis methods and treatment efficiency of LVPA.

  6. Endovascular Repair of a Ruptured Aortic Extra-anatomic Bypass Pseudoaneurysm After Previous Coarctation Surgery.

    Science.gov (United States)

    Hörer, Tal; Toivola, Asko

    2015-01-01

    We present a short case of a total endovascular repair of a ruptured thoracic pseudoaneurysm after previous coarctation aortic conduit bypass surgery. A 67-year-old man with two previous coarctation repairs many years ago was admitted with chest pain, dyspnea, and hemoptysis. Computed tomography showed a rupture in the distal anastomosis of the thoracic extra-anatomic graft. Successful treatment was achieved by placement of an endovascular stent graft between the old graft and the native aorta and with a vascular plug occlusion of the native aorta.

  7. Left ventricular outflow tract pseudoaneurysm formation following three aortic valve replacement surgeries

    Directory of Open Access Journals (Sweden)

    Nasrien E Ibrahim

    2015-01-01

    Full Text Available We present a case of a pseudoaneurysm arising from the left ventricular outflow tract/aortic root as a complication of aortic valve surgery. A 45-year-old Nigerian female presented to our institution′s emergency department with chest discomfort. She had three bioprosthetic aortic valve replacements in the preceding year at an outside institution for aortic regurgitation and wanted a second opinion on remaining surgical options. The learning points relevant to this case are as follows: (1 Recognizing potential complications postmultiple valve surgeries, (2 screening patients for chronic infections and rheumatologic conditions that can contribute to failed valve surgeries.

  8. Evaluation of 24-Hour Arterial Stiffness Indices and Central Hemodynamics in Healthy Normotensive Subjects versus Treated or Untreated Hypertensive Patients: A Feasibility Study

    Directory of Open Access Journals (Sweden)

    Stefano Omboni

    2015-01-01

    Full Text Available Objective. Central blood pressure (BP and vascular indices estimated noninvasively over the 24 hours were compared between normotensive volunteers and hypertensive patients by a pulse wave analysis of ambulatory blood pressure recordings. Methods. Digitalized waveforms obtained during each brachial oscillometric BP measurement were stored in the device memory and analyzed by the validated Vasotens technology. Averages for the 24 hours and for the awake and asleep subperiods were computed. Results. 142 normotensives and 661 hypertensives were evaluated. 24-hour central BP, pulse wave velocity (PWV, and augmentation index (AI were significantly higher in the hypertensive group than in the normotensive group (119.3 versus 105.6 mmHg for systolic BP, 75.6 versus 72.3 mmHg for diastolic BP, 10.3 versus 10.0 m/sec for aortic PWV, −9.7 versus −40.7% for peripheral AI, and 24.7 versus 11.0% for aortic AI, whereas reflected wave transit time (RWTT was significantly lower in hypertensive patients (126.6 versus 139.0 ms. After adjusting for confounding factors a statistically significant between-group difference was still observed for central BP, RWTT, and peripheral AI. All estimates displayed a typical circadian rhythm. Conclusions. Noninvasive assessment of 24-hour arterial stiffness and central hemodynamics in daily life dynamic conditions may help in assessing the arterial function impairment in hypertensive patients.

  9. Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and difficult to treat arterial hypertension.

    Science.gov (United States)

    Jordan, Jens; Yumuk, Volkan; Schlaich, Markus; Nilsson, Peter M; Zahorska-Markiewicz, Barbara; Grassi, Guido; Schmieder, Roland E; Engeli, Stefan; Finer, Nick

    2012-06-01

    Obese patients are prone to arterial hypertension, require more antihypertensive medications, and have an increased risk of treatment-resistant arterial hypertension. Obesity-induced neurohumoral activation appears to be involved. The association between obesity and hypertension shows large inter-individual variability, likely through genetic mechanisms. Obesity affects overall cardiovascular and metabolic risk; yet, the relationship between obesity and cardiovascular risk is complex and not sufficiently addressed in clinical guidelines. The epidemiological observation that obesity may be protective in patients with established cardiovascular disease is difficult to translate into clinical experience and practice. Weight loss is often recommended as a means to lower blood pressure. However, current hypertension guidelines do not provide evidence-based guidance on how to institute weight loss. In fact, weight loss influences on blood pressure may be overestimated. Nevertheless, weight loss through bariatric surgery appears to decrease cardiovascular risk in severely obese patients. Eventually, most obese hypertensive patients will require antihypertensive medications. Data from large-scale studies with hard clinical endpoints on antihypertensive medications specifically addressing obese patients are lacking and the morbidity from the growing population of severely obese patients is poorly recognized or addressed. Because of their broad spectrum of beneficial effects, renin-angiotensin system inhibitors are considered to be the most appropriate drugs for antihypertensive treatment of obese patients. Most obese hypertensive patients require two or more antihypertensive drugs. Finally, how to combine weight loss strategies and antihypertensive treatment to achieve an optimal clinical outcome is unresolved.

  10. Endovascular rescue from arterial rupture and thrombosis during middle cerebral artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, J.Y.; Chung, Y.S. [Department of Neurosurgery, College of Medicine, Pundang CHA Hospital, 351 Yatap-ding, Pundang-gu, 463-712, Sungnam (Korea); Lee, B.H. [Department of Interventional Neuroradiology, College of Medicine, Pundang CHA Hospital, 351 Yatap-dong, Pundang-gu, 463-712, Sungnam (Korea); Kim, O.J. [Department of Emergency Medicine, College of Medicine, Pundang CHA Hospital, 351 Yatap-dong, Pundang-gu, 463-712, Sungnam (Korea)

    2003-08-01

    Intravascular stents are being used with increasing frequency in interventional neuroradiology. Iatrogenic arterial rupture is an uncommon but serious complication. We present a case of arterial rupture and subarachnoid haemorrhage during middle cerebral artery stenting, treated by emergency additional, overlapping stenting and balloon tamponade of the dissected vessel. Thrombotic occlusion of the artery was managed by intra-arterial abciximab. Normal vessel patency was re-established within 20 min and the patient recovered with no neurological deficit. (orig.)

  11. Transcatheter arterial embolization in gastric cancer patients with acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Joo; Shin, Ji Hoon; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Song, Ho-Young; Sung, Kyu-Bo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea)

    2009-04-15

    The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure. (orig.)

  12. Acute arterial occlusion - kidney

    Science.gov (United States)

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidney can often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury or trauma to ...

  13. Seguimento de dois anos em pacientes com hipertensão arterial pulmonar sob tratamento com sildenafila Seguimiento de dos años en pacientes con hipertensión arterial pulmonar bajo tratamiento con sildenafil Two-year follow-up of pulmonary arterial hypertension patients treated with sildenafil

    Directory of Open Access Journals (Sweden)

    Sonia Meiken Franchi

    2010-05-01

    6 minutos (DC6M y por el grado de disnea al final de la caminata (escala de Borg, siendo también registrada la saturación periférica de oxígeno (SpO26M, oximetría de pulso. RESULTADOS: En los 18 pacientes que completaron dos años de seguimiento, hubo un incremento progresivo y sostenido en la DC6M, tanto en el grupo HAPI (de 239 ± 160 m a 471 ± 66 m, p = 0,0076 como en el grupo HAP-CCg (de 361 ± 144 m a 445 ± 96m, p = 0,0031, con mejora de la disnea al final de la caminata (p BACKGROUND: The long-term effects of drugs developed for the control of pulmonary arterial hypertension (PAH are little known, since multicenter studies usually last 12 to 16 weeks. OBJECTIVE: To evaluate the two-year outcome of PAH patients receiving monotherapy with sildenafil (a phosphodiesterase-5 inhibitor, with regard to their functional capacity. METHODS: Twenty four patients (ages between 8 and 54 years with idiopathic PAH (IPAH, n = 9 or congenital heart disease-associated PAH (CHD-PAH, n = 15 were treated with sildenafil for two years, with daily oral doses ranging from 60 to 225 mg (tid. Physical capacity was assessed by the distance walked in the 6-minute walk test (DW6M and by the degree of dyspnea at the end of the walk (Borg scale; peripheral oxygen saturation was also recorded (SpO(26M, pulse oximetry. RESULTS: In the 18 patients who completed the two-year follow-up, there was a progressive and sustained increase in DW6M, both in the IPAH group (from 239 ± 160 m to 471 ± 66 m, p = 0.0076 and in the CHD-PAH group (from 361 ± 144 m to 445 ± 96m, p = 0.0031, with improvement of dyspnea at the end of the walk (p<0.05 for both groups. No decrease in SpO(26M was observed in the groups; in patients with CHD-PAH, in particular, SpO(26M went from 77 ± 20% to 79 ± 16% (p = 0.5248. Five deaths occurred (three in the IPAH group and one patient was lost to follow-up during the study period. CONCLUSION: In a two-year follow-up, sildenafil proved useful in the control of the

  14. 定点旋转手法配合中频治疗椎动脉型颈椎病%Vertebral Artery Type Cervical Spondylosis Treated with Cervical Rotatory and Local Manipulation Combined with Modulated Medium Frequency Electrotherapy

    Institute of Scientific and Technical Information of China (English)

    范斌; 冯敬

    2013-01-01

    To explore the curative effect of the combined traditional Chinese medical therapy for vertebral artery type cervical spondylosis.Metheds:238 cases of vertebral artery type cervical spondylosis were randomly divided into treatment group (128 cases) and controlled group (110 cases),the treatment group were treated with cervical rotatory and local manipulation and modulated medium frequency electrotherapy; the controlled group of 110 cases were treated with Tui Na manipulation.Results:After two courses of treatment,the significant effective rate was 68.75% (88 cases) ; the effective rate was27.34% (35 cases) ;the non effective rate was 3.91% (5 eases),the total effectiverate was 96.09% (133 cases) of the treatment group.To compare with the controlled group,there was statistical difference (P<0.001).Conclusion:Local manipulation combined with modulated medium frequency electrotherapy for vertebral artery type cervical spondylosis can alleviate symptoms significantly better and sooner than Tui Na treatment simply.%目的:探讨中医综合治疗推动脉型颈椎病的临床效果.方法:随机将238例患者分为治疗组128例,对照组110例,治疗组采用定点旋转手法配合中频治疗;对照组采用单纯推拿治疗.观察两组的治疗效果.结果:通过两个疗程治疗,治疗组显效88例(68.75%),有效35例(27.34%)无效5例(3.91%)总有效率133例(96.09%),与对照组相比,差异有显著性意义(P< 0.001).结论:定点旋转手法配合中频治疗椎动脉型颈椎病椎动脉型颈椎病起效快且疗效确切,疗效优于单纯推拿治疗.

  15. Cervical mimic coronary artery disease treated by tuina and chiropractic therapy in 30 cases%推拿配合整脊手法治疗颈型类冠心病30例

    Institute of Scientific and Technical Information of China (English)

    叶勇

    2012-01-01

    Objective To observe the clinical efficacy of tuina and chiropractic therapy in treating cervical mimic coronary artery disease. Methods Treatment group were treated by tuina and chiropractic therapy and control group were treated by traditional tuina therapy. The clinical efficacy? Score of symptoms and signs 、cervical vertebra physiology degree of curve were observed and compared between two groups. Results The total effective rate was 90.0% in treatment group and 66. 67% in control group after 1 treatment course,two groups of the difference was statistically significant (P<0.05); There was a statistically significant difference in the score of symptoms and signs and cervical vertebra physiology degree of curve between two groups after 1 treatment course(P<0.05). Conclusion Tuina and chiropractic therapy is effective to treat cervical mimic coronary artery disease.%目的 观察推拿配合颈椎整脊手法治疗颈型类冠心病的临床疗效.方法 试验组采用推拿配合颈椎整脊手法调整,对照组采用传统推拿手法,1个疗程后比较临床疗效、症状、体征积分及颈椎生理曲度.结果 2组治疗后,试验组总有效率90.0%,对照组总有效率66.67%,两组比较有显著性差异(P<0.05);症状、体征积分比较、颈椎生理曲度比较均有显著性差异(P<0.05).结论 推拿手法配合颈椎整脊手法治疗颈型类冠心病优于单纯推拿手法.

  16. 子宫动脉栓塞治疗子宫瘢痕妊娠11例%Clinical application of uterine artery embolization in treating uterine scar pregnancy

    Institute of Scientific and Technical Information of China (English)

    李统怀; 郑红枫

    2011-01-01

    Objective To evaluate uterine artery embolization in treating uterine scar pregnancy. Methods During the period from November 2007 to February 2010, 11 patients with uterine scar pregnancy were encountered in authors' hospital. All the patients had a history of lower uterine segment cesarean section. Four patients had to receive an emergency uterine artery embolization due to acute massive vaginal bleeding. The other 7 patients received intravenous chemotherapy with MTX (0.4 mg/kg/day, every 5 days as a treatment course). Emergency uterine artery embolization had to be carried out in three patients as they developed acute massive vaginal bleeding (blood loss ≥ 100 ml/hour) during the course of chemotherapy, while subsequent uterine artery embolization was performed in the remaining 4 patients after they had completed two courses of treatment when their blood HCG showed no significant decrease. The clinical results were analyzed. Results Remarkable decrease in serum HCG was seen in all 11 patients after interventional management. The vaginal bleeding in 7 patients was significantly reduced within half an hour after uterine artery embolization. The uterus together with intact fertility was successfully preserved in all 11 patients. Conclusion For the treatment of uterine scar pregnancy complicated by massive vaginal bleeding (blood loss ≥ 500 ml/24 h) and/or abnormal elevation of serum HCG (blood β-HCG ≥ 20 000 IU/L), ectopic pregnancy with the mass diameter ≥ 5 cm, uterine artery embolization treatment is very safe and effective. This technique can well preserve female patient's uterus and fertility ability. It is of value to employ this treatment in clinical practice.%目的 探讨子宫动脉栓塞治疗在子宫瘢痕妊娠中的临床应用价值.方法 2007年11月- 2010年2月收治子宫下段剖宫产术后子宫瘢痕妊娠11例,其中4例因阴道大出血入院后急诊行子宫动脉栓塞治疗;另7例患者行MTX静脉化疗(每天剂量为0

  17. Long-term safety and performance of the orbital atherectomy system for treating calcified coronary artery lesions: 5-Year follow-up in the ORBIT I trial

    Energy Technology Data Exchange (ETDEWEB)

    Bhatt, Parloop; Parikh, Parth [Care Institute of Medical Sciences (CIMS), Ahmedabad 380060, Gujarat (India); Patel, Apurva [Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH (United States); Chag, Milan; Chandarana, Anish [Care Institute of Medical Sciences (CIMS), Ahmedabad 380060, Gujarat (India); Parikh, Roosha [Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH (United States); Parikh, Keyur, E-mail: keyur.parikh@cims.me [Care Institute of Medical Sciences (CIMS), Ahmedabad 380060, Gujarat (India)

    2015-06-15

    Background/Purpose: The ORBIT I trial, a first-in-man study, was conducted to evaluate the safety and performance of the orbital atherectomy system (OAS) in treating de novo calcified coronary lesions. Methods/Materials: Fifty patients were enrolled between May and July 2008 based on several criteria, and were treated with the OAS followed by stent placement. The safety and performance of the OAS were evaluated by procedural success, device success, and overall major adverse cardiovascular event (MACE) rates, including cardiac death, myocardial infarction (MI) and need for target lesion revascularization (TLR). Our institution enrolled and treated 33 of the 50 patients and continued follow-up for 5 years. Results: Average age was 54 years and 91% were males. Mean lesion length was 15.9 mm. Device success was 100%, and average number of orbital atherectomy devices (OAD) used per patient was 1.3. Stents were placed directly after OAS in 31/32 patients (96.9%). All stents (average stent per lesion 1.1) were successfully deployed with 0.3% residual stenosis. The overall cumulative MACE rate was 6.1% in-hospital, 9.1% at 30 days, 12.1% at 6 months, 15.2% at 2 years, 18.2% at 3 years and 21.2% at 5 years (4 total cardiac deaths). None of the patients had Q-wave MIs. Angiographic complications were observed in 5 patients. No flow/slow flow due to distal embolization was observed. Conclusions: The ORBIT I trial suggests that OAS treatment continues to offer a safe and effective method to change compliance of calcified coronary lesions to facilitate optimal stent placement in these difficult-to-treat patients.

  18. Efficacy and Safety of a Novel Vascular Closure Device (Glubran 2 Seal) After Diagnostic and Interventional Angiography in Patients with Peripheral Arterial Occlusive Disease

    Energy Technology Data Exchange (ETDEWEB)

    Del Corso, Andrea [University of Pisa, Department of Vascular Surgery (Italy); Bargellini, Irene, E-mail: irenebargellini@hotmail.com; Cicorelli, Antonio; Perrone, Orsola [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy); Leo, Michele [University of Pisa, Department of Vascular Surgery (Italy); Lunardi, Alessandro [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy); Alberti, Aldo; Tomei, Francesca [University of Pisa, Department of Vascular Surgery (Italy); Cioni, Roberto [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy); Ferrari, Mauro [University of Pisa, Department of Vascular Surgery (Italy); Bartolozzi, Carlo [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy)

    2013-04-15

    To prospectively evaluate safety and efficacy of a novel vascular closure device (Glubran 2 Seal) after peripheral angiography in patients with peripheral arterial occlusive disease (PAOD). From December 2010 to June 2011, all consecutive patients with PAOD undergoing peripheral angiography were prospectively enrolled onto the study after percutaneous antegrade or retrograde puncture of the common femoral artery. After angiography, the Glubran 2 Seal device was used to achieve hemostasis. The following data were registered: technical success and manual compression duration, patients' discomfort (scale 0-5), operators' technical difficulty (scale 0-5), and vascular complications. The site of hemostasis was evaluated by clinical inspection and color-coded Duplex ultrasound performed 1 day and 1 month after the procedure. One hundred seventy-eight patients were enrolled (112 male, mean age 70.8 years) with a total of 206 puncture sites, including 104 (50.5 %) antegrade accesses. The device was successful in 198(96.1 %) of 206 procedures, with 8 cases of manual compression lasting longer than 5 min (maximum 20 min). No major vascular complications were observed, resulting in 100 % procedural success. Minor complications occurred in seven procedures (3.4 %), including two cases of pseudoaneurysms, successfully treated by ultrasound-guided glue injection. The mean {+-} standard deviation score for patients' discomfort was 0.9 {+-} 0.7, whereas the mean score for operators' difficulty was 1.2 {+-} 0.9. In patients with PAOD, the Glubran 2 Seal represents a simple, painless, and efficient vascular closure device, able to achieve hemostasis both in antegrade and retrograde accesses.

  19. Peri-procedural use of rivaroxaban in elective percutaneous coronary intervention to treat stable coronary artery disease. The X-PLORER trial.

    Science.gov (United States)

    Vranckx, P; Leebeek, F W G; Tijssen, J G P; Koolen, J; Stammen, F; Herman, J-P R; de Winter, R J; van T Hof, A W J; Backx, B; Lindeboom, W; Kim, S-Y; Kirsch, B; van Eickels, M; Misselwitz, F; Verheugt, F W A

    2015-08-01

    Patients on rivaroxaban requiring percutaneous coronary intervention (PCI) represent a clinical conundrum. We aimed to investigate whether rivaroxaban, with or without an additional bolus of unfractionated heparin (UFH), effectively inhibits coagulation activation during PCI. Stable patients (n=108) undergoing elective PCI and on stable dual antiplatelet therapy were randomised (2:2:2:1) to a short treatment course of rivaroxaban 10 mg (n=30), rivaroxaban 20 mg (n=32), rivaroxaban 10 mg plus UFH (n=30) or standard peri-procedural UFH (n=16). Blood samples for markers of thrombin generation and coagulation activation were drawn prior to and at 0, 0.5, 2, 6-8 and 48 hours (h) after start of PCI. In patients treated with rivaroxaban (10 or 20 mg) and patients treated with rivaroxaban plus heparin, the levels of prothrombin fragment 1 + 2 at 2 h post-PCI were 0.16 [0.1] nmol/l (median) [interquartile range, IQR] and 0.17 [0.2] nmol/l, respectively. Thrombin-antithrombin complex values at 2 h post-PCI were 3.90 [6.8]µg/l and 3.90 [10.1] µg/l, respectively, remaining below the upper reference limit (URL) after PCI and stenting. This was comparable to the control group of UFH treatment alone. However, median values for thrombin-antithrombin complex passed above the URL with increasing tendency, starting at 2 h post-PCI in the UFH-alone arm but not in rivaroxaban-treated patients. In this exploratory trial, rivaroxaban effectively suppressed coagulation activation after elective PCI and stenting.

  20. Congenital pseudoaneurysm of mitral-aortic intervalvular fibrosa masquerading as left atrial mass in fetal life

    Science.gov (United States)

    Chidambarathanu, Shanthi; Raja, Vijayalakshmi; Suresh, Indrani

    2017-01-01

    A 28-week-old fetus was detected to have a single left atrial mass in prenatal ultrasound. Postnatal echocardiography showed an aneurysm between the anterior mitral leaflet and aortic valve, to the left of atrioventricular junction and communicating with the left ventricle through a narrow mouth. It probably originated from the mitral-aortic intervalvular fibrous tissue and an inherent weakness at this site might be the cause. Reported cases of pseudoaneurysm of mitral-aortic intervalvular fibrosa and subvalvular ventricular aneurysms seen following infective endocarditis, surgery, or trauma seem to have a similar anatomical background. This case explains the possibility of congenital aneurysm in this location which needs to be considered a differential diagnosis in similar cases. PMID:28163433

  1. Subacute Staphylococcus epidermidis Bacterial Endocarditis Complicated by Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Diane Elegino-Steffens

    2012-01-01

    Full Text Available The patient is a 75-year-old man with a history significant for hypertension and congestive heart failure who underwent a bioprosthetic aortic valve replacement secondary to acute onset of aortic insufficiency. Cultures of the native valve were positive for Staphylococcus epidermidis sensitive to nafcillin and intravenous cefazolin was initiated. On postoperative day 24, he developed acute decompensated heart failure. A transesophageal echocardiogram demonstrated a structurally abnormal mitral valve with severe regurgitation, anterior and posterior leaflet vegetations, and scallop prolapse. There was also evidence of a mitral-aortic intervalvular fibrosa pseudoaneurysm (P-MAIF with systolic expansion and flow within the aneurysm. Antibiotic treatment was changed from cefazolin to vancomycin for presumed development of methicillin-resistant Staphylococcus. He subsequently underwent a bioprosthetic mitral valve replacement and has restoration of health without sequella. This case highlights the development of a P-MAIF as a rare complication of both aortic or mitral valve replacement and infective endocarditis.

  2. Clinical values of surgery plus superselective arterial infusion chemotherapy on treating cervical cancer%介入化疗联合手术在子宫颈癌治疗中的价值

    Institute of Scientific and Technical Information of China (English)

    李环; 吴瑞芳; 马喆; 杨瑞; 李瑞珍; 楼宝阳; 曾荔苹

    2012-01-01

    目的 探讨超选择动脉插管灌注化疗(介入化疗)联合手术在子宫颈癌治疗中的临床应用价值.方法 将北京大学深圳医院自2002年4月至2010年1月间收治的ⅠB2~ⅡB期患者共84例作为介入化疗组,采取先介入化疗后手术的方案(8例未行手术),同期ⅠB1~ⅡA期直接手术的对照组82例患者作比较.结果 介入化疗有效76例,占90.5%;药物血液系统毒副反应中,白细胞无减少者47例(61.8%),血红蛋白无下降者59例(77.6%);所有患者手术切除顺利,手术后按照相同的标准辅以化放疗.两组患者手术时间、出血量、并发症等比较,差异无统计学意义(P>0.05).介入化疗组术后患者5年存活率达83.9%%.结论 介入化疗联合手术在临床上应用于局部晚期子宫颈癌,安全、有效,为ⅡB期的患者创造手术条件,可提高宫颈癌患者的治疗效果,改善患者的生活质量,具有良好的应用前景.%Objective To study the clinical significance of surgery plus superselective arterial infusion chemotherapy in the treatment of cervical carcinoma. Methods 84 cervical cancer patients of stage ⅠB2, ⅡB and ⅡB. who underwent operation after arterial infusion chemotherapy form April 2002 to January of 2010 consisted integrated treatment group (8 cases without surgery) (AIC group), while 82 patients who only received surgery in the same time were served as control group. Results The effective rate of arterial infusion chemotherapy was 90.5%. The toxicity including 61.8% grade 0 leucopenia and 77. 6% grade 0 anemia. After arterial infusion chemotherapy, all the surgery were satisfied. There was no significant difference between the two groups in the operation time, bleeding volume and complications (P>0.05). The 5 years survival rate in AIC group was over 83.9%. Conclusion Surgery plus superselective arterial infusion chemotherapy is safe and effective for treating advanced stage cervical cancer. It can

  3. 黄豆苷元联合倍他司汀治疗椎-基底动脉供血不足96例%Treating 96 cases of vertebro-basilar artery insufficiency with Daidzein and Betahistine

    Institute of Scientific and Technical Information of China (English)

    赵亚恒; 阴伟利; 钱仁义

    2015-01-01

    目的:观察黄豆苷元联合倍他司汀治疗椎-基底动脉供血不足的临床疗效。方法:将96例椎-基底动脉供血不足患者随机分成治疗组和对照组,治疗组应用黄豆苷元联合倍他司汀片,对照组应用倍他司汀片。结果:治疗组总有效率为87.5%,对照组总有效率为79.17%,差异有统计学意义(P<0.0l)。结论:黄豆苷元联合倍他司汀片组的疗效高于倍他司汀片组,故黄豆苷元联合倍他司汀是治疗老年人椎-基底动脉供血不足型眩晕的有效方法。%Objective:To observe clinical efficacy of Daidzein and Betahistine on vertebro-basilar artery insufficiency. Methods:96 cases were randomly divided into the treatment group and the control group. The treatment group took Daidzein and Betahistine; the control group took Betahistine. Results: The total efficiency was 87.5%in the treatment group and 79.1%in the control group. P<0.01. Conclusion:Treating vertebro-basilar artery insufficiency with Daidzein and Betahistine could receive better efficacy.

  4. 经动脉骨髓干细胞移植治疗股骨头坏死61例%The artery transplantation of bone marrow stem cells to treat 61 cases of femoral head necrosis

    Institute of Scientific and Technical Information of China (English)

    高泽锋; 王娜; 许楠; 崔庆明; 曹晓芙

    2015-01-01

    目的:研究分析经动脉骨髓干细胞移植治疗股骨头坏死的临床效果。方法选取该院骨科2012年9月—2013年9月收治的61例股骨头坏死的患者,给予所有患者经动脉骨髓干细胞移植治疗,观察患者的临床治疗效果。结果所有患者通过治疗后,53例髋关节疼痛具有不同程度的缓解,占86.9%。其中行走间距延长的患者有33例,占54.1%;关节功能有所改善的患者有20例,占32.8%。患者的生活质量得到较好的提高,其总有效率为86.9%。结论针对股骨头坏死的患者,采取经动脉骨髓干细胞移植治疗,其操作方法简便、安全有效,在治疗的时候没有不良反应,其是治疗股骨头坏死的理想方式。%Objective Research and analysis the artery of the bone marrow stem cell transplantation for treatment of femoral head necrosis. Methods Select our hospital between September 2012 and September 2012 were 61 cases of patients with femoral head necrosis, giving all the artery in patients with bone marrow stem cell transplantation therapy, observe the clinical therapeutic effect of patients. Results With patients after treatment, 53 cases of the hip joint with different degree of pain relief, and accounted for 86.9%. 33 cases of patients with walking distance to extend, accounted for 54.1%; Joint function improvement in 20 cases of pa-tients, accounting for 32.8%. The patientˊs quality of life for the better, the total effective rate was 86.9%. Conclusion Via artery approaches for the patients with femoral head necrosis, bone marrow stem cell transplant treatment, its operation method is simple, safe and effective, and in the treatment of no adverse reaction, it is an ideal way to treat femoral head necrosis.

  5. The Relationships between Polymorphisms in Genes Encoding the Growth Factors TGF-β1, PDGFB, EGF, bFGF and VEGF-A and the Restenosis Process in Patients with Stable Coronary Artery Disease Treated with Bare Metal Stent.

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    Tadeusz Osadnik

    Full Text Available Neointima forming after stent implantation consists of vascular smooth muscle cells (VSMCs in 90%. Growth factors TGF-β1, PDGFB, EGF, bFGF and VEGF-A play an important role in VSMC proliferation and migration to the tunica intima after arterial wall injury. The aim of this paper was an analysis of functional polymorphisms in genes encoding TGF-β1, PDGFB, EGF, bFGF and VEGF-A in relation to in-stent restenosis (ISR.265 patients with a stable coronary artery disease (SCAD hospitalized in our center in the years 2007-2011 were included in the study. All patients underwent stent implantation at admission to the hospital and had another coronary angiography performed due to recurrence of the ailments or a positive result of the test assessing the coronary flow reserve. Angiographically significant ISR was defined as stenosis >50% in the stented coronary artery segment. The patients were divided into two groups-with angiographically significant ISR (n = 53 and without significant ISR (n = 212. Additionally, the assessment of late lumen loss (LLL in vessel was performed. EGF rs4444903 polymorphism was genotyped using the PCR-RFLP method whilst rs1800470 (TGFB1, rs2285094 (PDGFB rs308395 (bFGF and rs699947 (VEGF-A were determined using the TaqMan method.Angiographically significant ISR was significantly less frequently observed in the group of patients with the A/A genotype of rs1800470 polymorphism (TGFB1 versus patients with A/G and G/G genotypes. In the multivariable analysis, LLL was significantly lower in patients with the A/A genotype of rs1800470 (TGFB1 versus those with the A/G and G/G genotypes and higher in patients with the A/A genotype of the VEGF-A polymorphism versus the A/C and C/C genotypes. The C/C genotype of rs2285094 (PDGFB was associated with greater LLL compared to C/T heterozygotes and T/T homozygotes.The polymorphisms rs1800470, rs2285094 and rs6999447 of the TGFB1, PDGFB and VEGF-A genes, respectively, are associated with LLL

  6. Post-Operative hemorrhage after myomectomy: Safety and efficacy of transcatheter uterine artery embolization

    Energy Technology Data Exchange (ETDEWEB)

    Wan, Alvin Yu Hon [Dept. of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong (China); Shin, Ji Hoon; Yoon, Hyun Ki; Ko, Gi Young; Park, Sang Gik [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Seong, Nak Jong; Yoon, Chang Jin [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (Korea, Republic of)

    2014-06-15

    To evaluate the safety and clinical efficacy of transcatheter uterine artery embolization (UAE) for post-myomectomy hemorrhage. We identified eight female patients (age ranged from 29 to 51 years and with a median age of 37) in two regional hospitals who suffered from post-myomectomy hemorrhage requiring UAE during the time period from 2004 to 2012. A retrospective review of the patients' clinical data, uterine artery angiographic findings, embolization details, and clinical outcomes was conducted. The pelvic angiography findings were as follows: hypervascular staining without bleeding focus (n = 5); active contrast extravasation from the uterine artery (n = 2); and pseudoaneurysm in the uterus (n = 1). Gelatin sponge particle was used in bilateral uterine arteries of all eight patients, acting as an empirical or therapeutic embolization agent for the various angiographic findings. N-butyl-2-cyanoacrylate was administered to the target bleeding uterine arteries in the two patients with active contrast extravasation. Technical and clinical success were achieved in all patients (100%) with bleeding cessation and no further related surgical intervention or embolization procedure was required for hemorrhage control. Uterine artery dissection occurred in one patient as a minor complication. Normal menstrual cycles were restored in all patients. Uterine artery embolization is a safe, minimally invasive, and effective management option for controlling post-myomectomy hemorrhage without the need for hysterectomy.

  7. Effects of Acupressure on Fatigue and Depression in Hepatocellular Carcinoma Patients Treated with Transcatheter Arterial Chemoembolization: A Quasi-Experimental Study

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    Su-Chen Lan

    2015-01-01

    Full Text Available This study was to examine the effects of acupressure on fatigue and depression in HCC patients undergoing TACE. A quasiexperimental study design was used. Patients were evaluated at five time points: before treatment (T1 and 2, 3, 4, and 5 days after treating TACE (T2, T3, T4, and T5. Fatigue and depression were assessed by a VAS fatigue scale and a VAS depression scale at each time point. TFRS and BDI were administered at T1 and T5. Patients’ fatigue and depression were significantly higher at T5 than at T1 in two groups. Fatigue and depression increased in both the experimental and control groups’ patients over the five days of hospitalization during which TACE and chemotherapy were administered. The experimental group had significantly less fatigue than the control group, with lower subscale scores on physical, psychosocial, daily, and overall fatigue. There were no differences between the groups on depression. At posttest, the experimental group experienced lower physical, psychosocial, daily, and overall fatigue than the control group. Acupressure can improve fatigue in HCC patients during treatment with TACE but did not alleviate depression. Discharge planning should include home care for management of fatigue and depression.

  8. Endovascular repair of arterial iliac vessel wall lesions with a self-expandable nitinol stent graft system.

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    Birger Mensel

    Full Text Available OBJECTIVE: To assess the therapeutic outcome after endovascular repair of iliac arterial lesions (IALs using a self-expandable Nitinol stent graft system. METHODS: Between July 2006 and March 2013, 16 patients (13 males, mean age: 68 years with a self-expandable Nitinol stent graft. A total of 19 lesions were treated: nine true aneurysms, two anastomotic aneurysms, two dissections, one arteriovenous fistula, two type 1B endoleaks after endovascular aneurysm repair, one pseudoaneurysm, and two perforations after angioplasty. Pre-, intra-, and postinterventional imaging studies and the medical records were analyzed for technical and clinical success and postinterventional complications. RESULTS: The primary technical and clinical success rate was 81.3% (13/16 patients and 75.0% (12/16, respectively. Two patients had technical failure due to persistent type 1A endoleak and another patient due to acute stent graft thrombosis. One patient showed severe stent graft kinking on the first postinterventional day. In two patients, a second intervention was performed. The secondary technical and clinical success rate was 87.5% (14/16 and 93.8% (15/16. The minor complication rate was 6.3% (patient with painful hematoma at the access site. The major complication rate was 6.3% (patient with ipsilateral deep vein thrombosis. During median follow-up of 22.4 months, an infection of the aneurysm sac in one patient and a stent graft thrombosis in another patient were observed. CONCLUSION: Endovascular repair of various IALs with a self-expandable Nitinol stent graft is safe and effective.

  9. Safety and efficacy of the Perclose suture-mediated closure device following carotid artery stenting under clopidogrel platelet blockade

    Energy Technology Data Exchange (ETDEWEB)

    Zorger, Niels; Finkenzeller, Thomas; Lenhart, Markus; Hamer, Okka; Paetzel, Christian; Borisch, Inghita; Toepel, Ingolf; Feuerbach, Stefan; Link, Johann [University of Regensburg Klinikum, Franz-Josef-Strauss-Allee 11, 93042, Regensburg (Germany)

    2004-04-01

    The aim of this study was evaluation of a closure device (Perclose, Menlo Park, Calif.) for closure of the femoral artery access site in patients undergoing aggressive anticoagulation and platelet blockade after carotid stenting. Fifty-five patients who received clopidogrel in addition to aspirin and heparin as medication for carotid stenting were included for suture of the femoral access site after using 7- or 8-F guide catheters. The technical success, the time for suture, the clotting parameters, and complications were examined. Follow-up investigations, including ultrasound and clinical examinations, were performed. The groin was checked for possible hematoma, pseudoaneurysm, arteriovenous fistula, and local infection. Technical success was obtained in 51 of 54 patients (94%) after a mean procedure time of 6 min (range 5-10 min). The suture device was not used in one patient (2%) for anatomical reasons and failed to obtain hemostasis in 3 of 54 (6%) patients. In 4 of 54 patients (7%) bleeding was observed at the punctured site 4-6 h after intervention which was treated by a compression bandage. The mean dedicated activated clotting time was 137 s (range 29-287 s) before intervention and 349 s (150-958 s) just before deploying the Perclose device. During follow-up after 2 days (range 2-6 days) and 6 months no further complications of the puncture site were observed except for two large groin hematomas. No major complications occurred. Closure of the femoral access site after carotid stenting using a Perclose closure device is safe and effective even in patients receiving an aggressive anticoagulation and antiplatelet therapy. (orig.)

  10. Thoracic Sympathectomy for Severe Refractory Multivessel Coronary Artery Spasm.

    Science.gov (United States)

    Cardona-Guarache, Ricardo; Pozen, Jonah; Jahangiri, Arehzo; Koneru, Jayanthi; Shepard, Richard; Roberts, Charlotte; Abbate, Antonio; Cassano, Anthony

    2016-01-01

    Coronary artery spasm is a rare but potentially fatal disease. Herein, we report a case of recurrent ST-segment myocardial infarctions and ventricular fibrillation complicating severe multivessel coronary artery spasm successfully treated with bilateral thoracic surgical sympathectomy.

  11. Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

    Energy Technology Data Exchange (ETDEWEB)

    Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr; Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr; Dautry, Raphael, E-mail: raphael-dautry@yahoo.fr; Guerrache, Youcef, E-mail: docyoucef05@yahoo.fr [Hôpital Lariboisière-AP-HP, Department of Abdominal and Interventional Imaging (France); Ricbourg, Aude, E-mail: aude.ricbourg@lrb.aphp.fr [Hôpital Lariboisière-AP-HP, Department of Obstetrics and Gynecology (France); Gayat, Etienne, E-mail: etienne.gayat@lrb.aphp.fr [Diderot-Paris 7, Université-Sorbonne Paris-Cité (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr; Ledref, Olivier, E-mail: olivier.ledref@lrb.aphp.fr [Hôpital Lariboisière-AP-HP, Department of Abdominal and Interventional Imaging (France)

    2015-10-15

    Postpartum hemorrhage (PPH) is a potentially life-threatening condition, which needs multidisciplinary management. Uterine atony represents up to 80 % of all causes of PPH. Transcatheter arterial embolization (TAE) has now a well-established role in the management of severe PPH. TAE allows stopping the bleeding in 90 % of women with severe PHH, obviating surgery. Pledgets of gelatin sponge as torpedoes are commonly used for safe TAE, and coils, glue, and microspheres have been primarily used in specific situations such as arterial rupture, pseudoaneurysm, and arteriovenous fistula. TAE is a minimally invasive procedure with a low rate of complications, which preserves future fertility. Knowledge of causes of PPH, potential risks, and limitations of TAE is essential for a timely decision, optimizing TAE, preventing irreversible complications, avoiding hysterectomy, and ultimately preserving fertility.

  12. Hemosuccus Pancreaticus Due to Primary Splenic Artery Aneurysm: A Diagnostic and Therapeutic Challenge

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    Marco Massani

    2009-01-01

    Full Text Available Context Hemosuccus pancreaticus is a rare cause of upper chronic and intermittent gastrointestinal hemorrhage which cannot be easily detected by endoscopy. It is usually due to the rupture of a visceral aneurysm into the main pancreatic duct; splenic artery pseudoaneurysm associated with chronic pancreatitis represents the leading cause of this condition. The diagnosis is based on direct visualization of the hemorrhage through the main pancreatic duct at angiography. Given its rarity, difficulties in determining the source of bleeding can result in delayed treatment. Case report We present a rare case of true splenic artery aneurysm fistulized in the main pancreatic duct and misdiagnosed as a bleeding pancreatic pseudocyst on preoperative examination which included CT and MRCP. Conclusions Our experience confirms that the diagnosis of bleeding from the main pancreatic duct is very difficult. It requires careful and repeated evaluation by a team of specialists.

  13. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating pat

  14. Xuesetong Tablets Combined with Traction Physiotherapy for Treating 80 Cases of Cervical Spondylosis of Vertebral Artery Type%血塞通片联合牵引理疗治疗椎动脉型颈椎病80例

    Institute of Scientific and Technical Information of China (English)

    贺红霞

    2012-01-01

    Objective To investigate the efficacy of Xuesetong Tablets combined with the traction physiotherapy for treating 80 cases of cervical spondylosis of vertebral artery type. Methods 160 cases of cervical spondylosis of vertebral artery type were randomly divided into 2 groups, 80 cases in each group. The control group was given the traction physiotherapy combined with oral Betahistine Tablets 6 mg once,3 times daily,while the treatment group was treated with the traction physiotherapy combined with Xuesetong Tablets 50-100 mg once,3 times daily,for successive 4 weeks. The clinical symptoms,therapy efficacy and side effects were observed and recorded by transcranial Doppler (TCD ) detection before and after treatment. Results After 4 - week treatment,the clinical symptoms detected by TCD were significantly improved in the treatment group compared to the control group with statistical difference between the two groups ( P < 0. 05 ). The total effective rate was 90.00% in the treatment group,which was significantly higher than 73.75% in the control group, showing statistical difference between them(P < 0. 05 ). There are no obvious adverse reactions in the course of treatment. Conclusion Traction physiotherapy combined with Xuesetong Tablets has a significant clinical effect in the treatment of cervical spondylosis of vertebral artery type with less side effects,which can be popularized in clinical practice.%目的 观察应用血塞通片联合牵引理疗治疗椎动脉型颈椎病80例.方法 将诊断明确的160例患者随机均分为2组各80例.对照组采用牵引理疗联合口服倍他司汀片每次6mg、3次/d.治疗组采用牵引理疗联合血塞通片口服治疗,1次50~100mg、3次/d,连续治疗4周.观察并记录两组患者经颅多普勒检查(TCD)治疗前后变化情况、疗效以及药物副作用.结果 治疗4周后,治疗组患者症状TCD检查显示比对照组均显著改善,且差异有统计学意义(P<0.05).治疗组总有效率为90

  15. Multi-detector Computed Tomography Angiography of the Hepatic Artery in Liver Transplant Recipients

    Energy Technology Data Exchange (ETDEWEB)

    Boraschi, P.; Donati, F.; Cossu, M.C.; Gigoni, R.; Vignali, C.; Filipponi, F.; Bartolozzi, C.; Falaschi, F. [Pisa Univ. Hospital (Italy). 2nd Dept. of Radiology

    2005-08-01

    PURPOSE: To evaluate the ability of multi-detector row computed tomography angiography (CTA) in detecting hepatic artery complications in the follow-up of liver transplant patients, performing volume-rendering as reconstruction technique. MATERIAL AND METHODS: The anatomy of hepatic artery was studied in 27 liver transplant recipients with a four-row CT scanner using the following parameters: collimation, 1 mm; slice width, 1 mm; table feed, 6-8 mm/s; spiral reconstruction time, 0.5 s; reconstruction interval, 0.5 mm; mAs, 160; kVp, 120. Before the study, the patients received 1000 ml of water as oral contrast agent to produce negative contrast in the stomach and the small bowel. A non-ionic contrast medium was infused intravenously at a rate of 5 ml/s with a bolus tracking system. Volume-rendering of hepatic artery was performed with the 3D Virtuoso software. RESULTS: The celiac trunk, the hepatic artery, and the right and left hepatic arteries were successfully displayed in high detail in all patients. Side branches, including small collaterals, and hepatic artery anastomosis could also be readily visualized. Volume-rendered CTA detected six hepatic artery stenoses, two hepatic artery thromboses, and two intrahepatic pseudoaneurysms. In two cases, CT detected hepatic artery stenosis with a diameter reduction of less than 50%, while digital subtraction angiography showed a normal artery. CONCLUSION: Volume-rendered multi-detector CTA is a promising non-invasive technique, since it allows images of high quality to be generated with excellent anatomical visualization of the hepatic artery and its complications in liver transplant recipients.

  16. Nursing intervention of 20 lower limb artery patients involving the diagnosing and treating technique%20例下肢动脉栓塞患者介入诊疗术的护理干预

    Institute of Scientific and Technical Information of China (English)

    冯散香; 罗树兰; 邓梅珍; 伦爱美

    2009-01-01

    目的 总结对20例下肢动脉栓塞介入诊疗术患者采取护理干预后的护理效果.方法 对患者进行针对性术前心理支持及干预,术中术后精心护理,康复期的功能锻炼,生活习惯等进行护理干预.结果 患者在护理干预下积极配合治疗,临床治疗效果满意.结论 对下肢动脉栓塞介入术患者进行切实有效的护理干预能减轻患者的心理负担,术中术后的精心护理观察,术后患肢锻炼的正确指导,对促进患者早日康复,提高患者生活质量有重要意义.%Objective To summarize the effect of nursing intervention adopted to 20 lower limb artery embolism patients involving the diagnosing and treating technique. Methods Psychological support and intervention were carried out to patients before the pointed technique. During and after the technique, careful nursing was given to the patients. Nursing intervention was also carried on to the convalescene function exercise and habits and customs of patients. Results The patients coordinated to accept treatment positively under the nursing intervention and the clinical treatment result was satisfied. Conclusions The practical and effective nursing intervention carried to the patients involving diagnosing and treating technique is able to lighten patients' psychological burden. Careful nursing observation during and after the technique and correct instruction of extremity exercises after the technique are important to promote the patients to restore early and to improve the patients' quality of life.

  17. Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease

    Energy Technology Data Exchange (ETDEWEB)

    Hyare, Harpreet [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom)]. E-mail: hhyare@doctors.org.uk; Desigan, Sharmini [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Nicholl, Helen [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Guiney, Michael J. [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Brookes, Jocelyn A. [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom); Lees, William R. [Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU (United Kingdom)

    2006-08-15

    Purpose: Major arterial hemorrhage is an uncommon but serious complication of pancreatitis with high morbidity and mortality. Digital subtraction angiography (DSA) has long been the gold standard for the detection of a visceral artery pseudoaneurysm or for the site of active bleeding in patients with pancreatitis. Multi-section CT angiography is a minimally invasive technique which can provide high-resolution and high-contrast images of the arterial lumen and wall, with a much lower risk of complication and morbidity compared to DSA. The aim of this study was to determine the accuracy of multi-section CT angiography for the diagnosis of arterial complications of inflammatory pancreatitic disease. Materials and methods: A retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis between 1998 and 2004 was performed. Twenty-nine studies in 25 patients (20 males, 5 females) with a mean age of 50.9 years (range 11-67 years) were identified where multi-section CT angiography was performed in the 24 h preceding the digital subtraction angiogram. Results: Digital subtraction angiography detected a pseudoaneurysm or contrast extravasation in 19 studies and no bleeding was demonstrated in 9 studies. CT angiography correctly identified the site and type of bleeding in 18 of the 19 positive studies. CT angiography detected extravasation of contrast in one study that was not demonstrated on digital subtraction angiography. The sensitivity and specificity for multi-section CT angiography for the detection of major arterial bleeding on a background of pancreatitis were 0.947 and 0.900, respectively. Conclusion: Multi-section CT angiography is a sensitive and accurate technique for the detection of major arterial hemorrhage in inflammatory pancreatic disease and should be considered as the first investigation in the management of these patients.

  18. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  19. Atypical Vascular Involvement in a Case of Behçet's Disease

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    Alejandro Rodríguez Morata

    2012-01-01

    Full Text Available Introduction. Behçet's disease (BD is a form of vasculitis of unknown etiology which is rare in our environment. It is characterized by a variety of clinical manifestations and usually affects young adults. Recurrent oral and genital ulcers are a characteristic and extremely frequent symptom, but mortality is linked with more significant symptoms such as aortic pseudoaneurysm, pulmonary pseudoaneurysm, and cerebral venous thrombosis. Patient and Method. We present a case of a young male with atypical BD and severe polyvascular involvement (previous cerebral venous thrombosis and current peripheral venous thrombosis, acute ischemia, and peripheral arterial pseudoaneurysm who required urgent surgical intervention due to a symptomatic external iliac pseudoaneurysm. Result. The pseudoaneurysm was successfully treated, we performed an iliofemoral bypass, and we treated it with steroids and immunosuppressive therapy. Conclusions. These rare clinical manifestations highlight the importance of considering BD in young patients, even in usual cases of vascular intervention, whether arterial or venous in nature.

  20. Carotid artery stenting by non-femoral arterial approach in patients with difficult anatomy

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    R V Narayana

    2013-01-01

    Full Text Available Background: Carotid endarterectomy (CEA and carotid artery stenting (CAS are safe, effective, and standard methods to treat significant carotid artery stenosis. CAS is generally performed through femoral arterial access. We had six patients with significant carotid artery stenosis, who had difficult anatomy prohibiting a trans-femoral CAS. Those patients were given an option for CEA. However, they refused for surgical intervention. Aim: We investigated the feasibility of performing CAS from a non-femoral arterial approach in patients with difficult anatomies like severe aortic/aorto-iliac disease, tortuous aortic arch, and tortuous carotid artery origin. Materials and Methods: Six patients with difficult anatomy presented to us with either transient ischemic attack or stroke with high-grade carotid artery stenosis. Out of the six patients, three had aorto-iliac disease, one had high-grade coarctation of aorta, two had tortuous aortic arch and or tortuous carotid artery origin. All these patients were treated with CAS though non-femoral arterial route. Results: CAS could be done successfully in all these six patients; four of them were done through trans-brachial arterial route and two were done through a direct carotid artery puncture. There were no new neurological deficits seen in any of the patient post-procedure. Conclusion: CAS can be done safely through non-femoral arterial approach in patients with difficult anatomy.

  1. Fatal dissection of the pulmonary artery in pulmonary arterial hypertension

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    B. Degano

    2009-09-01

    Full Text Available A 41-yr-old patient with chronic stable idiopathic pulmonary arterial hypertension (PAH presented with sudden chest pain and unusual dyspnoea during physical exertion. The patient had been diagnosed with PAH at the age of 12 yrs and was in New York Heart Association functional class I/II. The patient was being treated with an anticoagulant regimen, low-dose diuretics and continuous intravenous epoprostenol therapy. A computed tomography scan showed ancient massive thrombi in dilated central pulmonary arteries, which were not haemodynamically significant (perfusion lung scans did not demonstrate segmental or larger defects, and extensive dissection of the right pulmonary artery starting from the intermediate branch. Due to the extensiveness of the dissection, the patient was immediately considered for heart–lung transplantation, but died 72 h after the onset of symptoms. Permission for post mortem examination was denied. Pulmonary artery dissection should be suspected in PAH patients presenting with chest pain and worsening dyspnoea. In the current case, the factors possibly associated with increased risk for dissection may include dilatation of the pulmonary artery, local inflammation favoured by in situ thrombosis, and acute increase of pulmonary pressure secondary to physical exertion. Extensive pulmonary artery dissection is a life-threatening complication of PAH, and urgent heart/lung transplantation might be the treatment of choice in eligible patients. In addition, better identification of the risk factors for pulmonary artery dissection may help in considering transplantation for selected patients at risk.

  2. 祛痛膏对椎动脉型颈椎病祛痛的临床疗效分析%A clinical analysis of treating vertebral artery type of cervical spondylosis with the Qutong ointment

    Institute of Scientific and Technical Information of China (English)

    韩福祥; 秘兴锋; 司俊梅; 李清云; 田秀华; 李忠伟; 赵雪艳; 赵广声

    2014-01-01

    Objective: To study clinical efficacy of the Qutong ointment on vertebral artery type of cervical spondylosis. Methods: 60 patients with vertebral artery type of cervical spondylosis, according to the odd and even number method, were randomly divided into control group and observation group, 30 cases respectively. The control group was given the Jingfukang granule, the observation group was treated by the Qutong ointment. Clinical effects and symptoms were compared in both. Results: The total efficacy in the control (66.67%) was obviously lower than that in the observation (93.33%). The difference was statistically significant (P<0.05). Symptomatic rates of vertigo, discomfort in neck, headache, blurred vision, fatigue, amnesia, instability of gait, purple tongue, white tongue fur and deep thready pulse were observed in both, the difference was statistically significant (P<0.05). Conclusion: The Qutong ointment was effective on vertical artery type of cervical spondylosis, showed lower symptomatic rate, and was worthy of clinical recommending.%目的:探讨祛痛膏对椎动脉型颈椎病祛痛的临床疗效。方法:将60例椎动脉型颈椎病患者按照奇偶数字法随机地均分为对照组与观察组,各30例。对照组口服颈复康颗粒治疗,观察组则采用自制祛痛膏治疗。比较两组临床治疗效果及治疗前后症状发生率。结果:对照组临床治疗总有效率为66.67%,显著低于观察组(93.33%)(P<0.05);两组治疗前后眩晕、颈部不适、头痛、视物模糊、倦怠乏力、健忘、步态不稳、舌暗、舌苔白及脉沉细等症状发生率差异均具有统计学意义(P<0.05~0.01),且观察组治疗后上述症状发生率均显著低于对照组治疗后(P<0.05)。结论:祛痛膏对椎动脉型颈椎病祛痛的临床疗效显著,且临床症状发生率也显著降低,值得在临床上加以推广及应用。

  3. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  4. [Percutaneous exclusion of traumatic abdominal aortic pseudoaneurysm from a brachial approach].

    Science.gov (United States)

    Gamboa, Ricardo; Ríos-Méndez, Raúl E; Solernó, Raúl; Giachello, Federico; Videla-Lynch, Ángeles; Sarmiento, Ricardo A

    2012-01-01

    Abdominal aortic pseudoaneurysm (AAP) is a rare lesion, although traumatic aortic injury is described as one of the main causes; both the rupture as the surgical treatment of the defect has high morbidity and mortality. Therefore, endovascular treatment either by chemical embolization or exclusion of defect with devices has emerged as an alternative treatment. However, there are risks such as occlusion of visceral vessels near the neck of the defect, embolization material or aortic rupture. Therefore, the choice of material and method of approach should be planned carefully in each case. We report a patient who ten years after abdominal wound firearm was diagnosed with AAP 17 x 13 cm, with short neck originated close to the ostium of the celiac trunk at an acute angle with the aortic axis. We perform the exclusion of the defect with a device designed for closing atrial septal defect from the left brachial access due to the angulation of the neck defect. There were no complications. At 72 hours was granted discharge. A month later, CT scan control showed the false aneurysm of equal size and no residual flow. The monitoring to date is five months and the patient remained asymptomatic.

  5. Caliber-Persistent Artery

    Directory of Open Access Journals (Sweden)

    Sabrina Araújo Pinho Costa

    2015-01-01

    Full Text Available Caliber-persistent artery (CPLA of the lip is a common vascular anomaly in which a main arterial branch extends to the surface of the mucous tissue with no reduction in its diameter. It usually manifests as pulsatile papule, is easily misdiagnosed, and is observed more frequently among older people, suggesting that its development may involve a degenerative process associated with aging; CPLA is also characterized by the loss of tone of the adjacent supporting connective tissue. Although the diagnosis is clinical, high-resolution Doppler ultrasound is a useful noninvasive tool for evaluating the lesion. This report describes the case of a 58-year-old male patient who complained of a lesion of the lower lip with bleeding and recurrent ulceration. The patient was successfully treated in our hospital after a diagnosis of CPLA and is currently undergoing a clinical outpatient follow-up with no complaints.

  6. Sirolimus-eluting cobalt alloyed stents in treating patients with coronary artery disease: six-month angiographic and one-year clinical follow-up result A prospective, historically controlled, multi-center clinical study

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qi; HONG Tao; CHEN Ji-lin; HUO Yong; SHEN Wei-feng; GAO Run-lin; XU Bo; YANG Yue-jin; ZHANG Rui-yan; LI Jian-ping; QIAO Shu-bin; ZHANG Jian-sheng; HU Jian; QIN Xue-wen

    2007-01-01

    Background The emergence of drug-eluting stents (DES) has dramatically reduced the incidence of in-stent restenosis.This study was conducted to evaluate the safetyand efficacy of sirolimus-eluting cobalt-chrome stents (Firebird 2) for treating patients with coronary artery disease.Methods Sixty-seven patients with de novo or non-stented restenostic coronary lesions were chosen to receive the Firebird 2 stent as the final treatment (Firebird 2 group). Another 49 consecutive patients were implanted with bare cobalt alloyed stents (Driver, Medtronic) withit the previous six months and served as historical controls (control group).Baseline clinical characteristics, angiographic features, procedural results, 30-day, 6-month and 12-month clinical follow-up regarding the occurrence of major adverse cardiac events (MACE), as well as the primary endpoint of late lumen loss at 6-month angiographic follow-up were compared between the two groups.Results The demographic characteristics were similar between the two groups despite more patients in the Firebird 2group who underwent previous percutaneous coronary intervention (22.4% vs 8.2%, P=0.0418) and who had diabetes mellitus (29.9% vs 12.2%, P=0.0253). In the Firebird 2 group, the mean diameter of the reference vessel was smaller((2.79±0.46) mm vs (2.98±0.49) mm, P=0.0175) and more stents were implanted for each lesion (1.28±0.52 vs 1.10±0.30, P=0.0060). Other angiographic, procedural results and the device success rate were similar between the two groups. The MACE rate at 30-day and 3-month was the same, but significantly fewer MACE occurred in the Firebird 2group at 6- and 12-month follow-up (1.5% vs 12.2% at 6 month, P=0.0168; 1.5% vs 26.5% at 12 month, P<0.0001). The primary endpoint of late lumen loss at 6-month angiographic follow-up was significantly reduced in the Firebird 2 group (in-stent: (0.05±0.09) mm vs (0.98±0.61) mm; in-segment: (0.05±0.18) mm vs (0.72±0.59) mm; P<0.0001) than the control group

  7. Arterial calcification: A new perspective?

    Science.gov (United States)

    Nicoll, R; Henein, M

    2017-02-01

    Arterial calcification is commonly seen in atherosclerosis, chronic kidney disease (CKD) and diabetes and has long been considered a natural progression of atherosclerosis. Yet it is a systemic condition, occurring in a wide and diverse range of disease states and no medical treatment for cardiovascular disease has yet found a way to regress it; on the contrary, lipid-lowering therapy may worsen its progression. Although numerous studies have found associations between calcification and biomarkers, none has yet found a unifying mechanism that explains the calcification found in atherosclerosis, CKD or diabetes and many of the biomarkers are equally associated with atheroma development and cardiovascular events. Furthermore, both presence and absence of coronary artery calcification appear predictive of plaque rupture and cardiovascular events, indicating that the association is not causal. This suggests that we are no further forward in understanding the true nature of arterial calcification or its pathogenesis, other than noting that it is 'multifactorial'. This is because most researchers view arterial calcification as a progressive pathological condition which must be treated. Instead, we hypothesise that calcification develops as an immune response to endothelial injury, such as shear stress or oxidative stress in diabetics, and is consequently part of the body's natural defences. This would explain why it has been found to be protective of plaque rupture and why it is unresponsive to lipid-lowering agents. We propose that instead of attempting to treat arterial calcification, we should instead be attempting to prevent or treat all causes of endothelial injury.

  8. Iatrogenic dissection of the celiac artery and its branches during TAE for HCC: results of follow-up in 30 cases

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Dae Young; Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Han, Man Chung [College of Medicine, Seoul National Univrsity, Seoul (Korea, Republic of); Suh, Chang Hae [College of Medicine, Inha University, Incheon (Korea, Republic of)

    1993-01-15

    The authors analyzed 30 patients whose celiac artery or its branches were dissected during the procedure of transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) and were followed up angiographically. The incidence of arterial dissection was 1.25%. The dissection occurred most frequently in the celiac artery (40% 12/30) and the proper hepatic artery (28% 7/30). The frequency of arterial dissection was affected by the status of the vessel and the experience of the operator. The follow-up angiography revealed complete recanalization in 40% (12/30), irregularity and narrowing of the lumen in 23% (7/30), pseudoaneurysm formation in 23% (7/30), and complete obstruction in 13% (4/30) of the cases. The rate of recanalization in the celiac artery was lower than that of any other arteries in our series. Recanalization to a certain degree without therapeutic intervention was observed in 72% of the dissected arteries enabling and contributing to subsequent successful TAE within 2 months in 78% of the patients with the dissection.

  9. A 3 year audit of infected pseudoaneurysms in intravenous drug users managed surgically in the Vascular Unit, Hospital Kuala Lumpur.

    Science.gov (United States)

    Zainal, A A; Yusha, A W

    1998-12-01

    This is a study of 54 intravenous drug user's (IVDUs) with infected pseudoaneurysms undergoing ligation and debridement at the Vascular Unit, Hospital Kuala Lumpur (HKL) from February 1993 to February 1996. The median age was 37 years with a male preponderance (53:1). Chinese form the largest ethnic group with 57.4% of the cases. Staphylococcus aureus was the most common organism cultured. Human immunodeficiency virus (HIV) positive cases numbered 21 (38.9%). Four of the patients had to have an above-knee amputation after surgery. Simple ligation and debridement of all necrotic tissue is an acceptable mode of therapy in these patients with low amputation rates.

  10. A rare case of splenic pseudoaneurysm in pediatric splenic blunt trauma patient: Review of diagnosis and management

    OpenAIRE

    Roger Chen Zhu; Vadim Kurbatov; Patricia Leung; Gainosuke Sugiyama; Valery Roudnitsky

    2015-01-01

    Introduction: Splenic pseudoaneurysms (SPA) are a rare but serious sequela of blunt traumatic injury to the spleen. Management of adult blunt splenic trauma is well-studied, however, in children, the management is much less well-defined. Presentation of case: A 15 year-old male presented with severe abdominal pain of acute onset after sustaining injury to his left side while playing football. FAST was positive for free fluid in the abdomen. Initial abdomen CT demonstrated a grade III/IV le...

  11. A rare case of splenic pseudoaneurysm in pediatric splenic blunt trauma patient: Review of diagnosis and management

    OpenAIRE

    Zhu, Roger Chen; Kurbatov, Vadim; Leung, Patricia; Sugiyama, Gainosuke; Roudnitsky, Valery

    2015-01-01

    Introduction Splenic pseudoaneurysms (SPA) are a rare but serious sequela of blunt traumatic injury to the spleen. Management of adult blunt splenic trauma is well-studied, however, in children, the management is much less well-defined. Presentation of case A 15 year-old male presented with severe abdominal pain of acute onset after sustaining injury to his left side while playing football. FAST was positive for free fluid in the abdomen. Initial abdomen CT demonstrated a grade III/IV left sp...

  12. Transarterial Embolization of Arterial Bleeding in Patients with Pelvic Bone Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ji Soo; Kwak, Hyo Sung; Han, Young Min [Chonbuk National University Hospital, Jeonju (Korea, Republic of)

    2009-11-15

    This study was designed to evaluate the usefulness of transcatheter arterial embolization (TAE) in hemodynamically unstable patients with a pelvic bone fracture. From November 2004 to July 2007, we retrospectively reviewed 211 patients with pelvic bone fractures. Of these patients, 24 patients with CT findings of active bleeding or hemodynamic instability underwent pelvic angiography. There were 13 female and 11 male patients, with an age range from 21 to 92 years (mean age, 58.3 years). To evaluate arterial injuries, angiography was performed, followed by TAE using coils, gelfoams and N-butyl-2-cyanoacrylate. The evaluation of risk factors between patients who were still alive and patients who had expired was performed statistically by use of the Student's t test and chisquared analysis. A total of 28 TAE procedures were performed in 24 patients and 50 injured arteries were occluded. Six patients (25%) died due to hypovolemic shock within 47 hours. Five of the patients were hemodynamically unstable (BP below 76/56 mmHg) prior to the angiographic procedure and one patient had a pseudoaneurysm located at the superior mesenteric artery. Dopamine usage and blood pressure before the procedure for patients showed a statistically significant difference between patients were still alive and patients who had expired (p = 0.01, p = 0.001). TAE is a safe and effective treatment for an arterial injury of a pelvic bone fracture. The outcome of patients with a hemodynamically unstable state before TAE is poor.

  13. TRAS principles blight arterial bypass and plasty.

    Directory of Open Access Journals (Sweden)

    Kothari M

    1997-04-01

    Full Text Available A new concept--Tissue Requisitions (Principle I/Relinquishes (Principle II Arterial Supply--of TRAS principles is introduced to help appreciate the failures/successes of modern medicine′s attempts at restoring arterial flow in luminally compromised coronary/carotid fields, an invasive branch rightly called vascular ReRheology, which comprises diagnosing/treating arterial blocks. The technical wizardry of arterial reconstruction (bypass or lumen--restoration (plasty has to reckon with the TRAS principles all the time.

  14. Efficacy analysis of alprostadil combined with betahistine in treating vertebral-basilar artery insufficiency%前列地尔联合倍他司汀治疗椎-基底动脉供血不足的疗效分析

    Institute of Scientific and Technical Information of China (English)

    肖有为; 许彩芹; 庞燕; 刘宇鹏

    2011-01-01

    目的 观察前列地尔联合倍他司汀治疗椎-基底动脉供血不足的临床疗效.方法 将136例椎-基底动脉供血不足患者随机分为前列地尔联合倍他司汀治疗组(68例)和倍他司汀对照组(68例),观察临床疗效及治疗前后椎-基底动脉平均血流速度的改善情况.结果 治疗组治愈率及总有效率高于对照组(P<0.05);治疗组各动脉平均血流速度均明显较对照组改善(P<0.05).结论 前列地尔联合倍他司汀治疗椎-基底动脉供血不足疗效显著.%Objective To observe the clinical efficacy of alprostadil combined with betahistine in treating vertebral-basilar artery insufficiency.Methods 136 patients with vertebral-basilar artery insufficiency were randomly divided into alprostadil combined with betahistine treatment group (68 cases) and betahistine control group (68 cases), clinical efficacy and the improvement of vertebral-basilar artery mean blood flow rate was observed before and after treatment.Results The cure rate and total effective rate of treatment group were higher ( P < 0.05 ); Artery mean blood flow velocity of treatment group were improved significantly than that in control group ( P < 0.05 ).Conclusion It is effective to treat the vertebral-basilar artery insufficiency with alprostadil combined with betahistine.

  15. Transcatheter Arterial Chemoembolization Combined with Thermotherapy for Treating Mid-Late Stage Liver Cancer in 31 Cases%动脉灌注栓塞术联合热疗治疗中晚期肝癌31例

    Institute of Scientific and Technical Information of China (English)

    彭杰; 胡章华; 杜驰

    2011-01-01

    目的 探讨动脉灌注栓塞术(TACE)联合深部热疗治疗中晚期原发性肝癌的疗效及毒副反应.方法 将63例患者随机分为治疗组31例和对照组32例,治疗组采用深部热疗加动脉灌注栓塞术,热疗每周2次,每次治疗间隔时间72 h以上,每5次热疗为1个疗程.对照组采用单纯动脉灌注栓塞术.热疗5次加介入治疗1次为1个疗程.评价患者疗效、生活质量和毒副反应.结果 治疗组与对照组有效率分别为70.97%和46.88%,两组近期疗效比较差异有显著意义(P=0.029);两组治疗后生活质量有显著性差异(P=0.011);主要不良反应均为消化道反应和血液学毒性,两组之间毒性反应无明显差异.结论 动脉灌注栓塞术联合热疗治疗原发性肝癌的疗效较好,可改善患者生活质量,且毒副反应低,值得临床推广.%Objective To observe the efficacy and toxicity of transcatheter arterial chemoembolization (TACE) combined with thermotherapy for treating mid-late stage primary liver cancer. Methods Sixty- three patients with primary liver cancer were randomly divided into the treatment group (31 cases) and the control group (32 cases).The treatment group was treated with deep thermotherapy combined with TACE. The thermotherapy was given twice a week after TACE with interval time of over 72 h, 5 times for a treatment cycle. The control group was given TACE alone. The effective rate, quality of life and toxicity were evaluated between the two groups. Results The rate of response (RR) in treatment group and control group were 70.97% and 46.88% respective, showing significant differences in the short- term efficacy between the two groups(P =0. 029). The quality of life after treatment in both groups had significant difference(P =0. 011). The major adverse reactions were gastrointestinal and hematologic toxicity with no significant differences between the two groups. Conclusion TACE combined with thermtherapy has better efficacy and

  16. Pseudoaneurysm of the mitral–aortic intervalvular fibrosa presenting after chest trauma and diagnosed by cardiac magnetic resonance: a case report

    Directory of Open Access Journals (Sweden)

    Barranhas Adriana

    2012-10-01

    Full Text Available Abstract Introduction Annular subvalvular pseudoaneurysm is a rare example of left ventricle aneurysm described predominantly in young African people. These aneurysms are divided into two different types, namely, submitral or subaortic, with subaortic being the less frequent kind. The subaortic type is most often localized in the mitral–aortic intervalvular fibrosa. To the best of our knowledge, this is the first report of a mitral–aortic intervalvular fibrosa pseudoaneurysm associated with coarctation of the aorta, anomalous pulmonary venous return, bicuspid aortic valve and patent ductus arteriosus diagnosed by cardiovascular magnetic resonance. Case presentation We report the case of a 15-year-old African-American boy with a history of mild chest trauma who underwent echocardiographic evaluation as part of an out-patient work up. The echocardiogram was suspicious for the presence of mitral-aortic intervalvular fibrosa pseudoaneurysm and cardiovascular magnetic resonance was then performed to better characterize this finding. In addition to confirming the presence of the aneurysm, cardiovascular magnetic resonance also revealed coarctation of the aorta, a bicuspid aortic valve, and anomalous pulmonary venous return. Conclusion In our case, cardiovascular magnetic resonance was helpful in: (a making a definite diagnosis of mitral–aortic intervalvular fibrosa pseudoaneurysm and its borders, which was not clear with an echocardiogram examination; and (b illustrating additional associated congenital anomalies including the anomalous pulmonary venous return.

  17. Segmented Coronary Artery Aneurysms and Kawasaki Disease

    Directory of Open Access Journals (Sweden)

    Hamid Reza Ghaemi

    2011-05-01

    Full Text Available Kawasaki disease (KD is an acute vasculitis syndrome of unknown etiology. It occurs in infants and young children,affecting mainly small and medium-sized arteries, particularly the coronary arteries. Generalized microvasculitis occurs in the first 10 days, and the inflammation persists in the walls of medium and small arteries, especially the coronary arteries, and changes to coronary artery aneurysms.We report the case of a 10-month-old girl referred to our center three months after the onset of disease due to the aneurysmsof the coronary arteries. During the acute phase of her illness, she received 2 gr/kg intravenous gamma globulin; and afterher referral to us, the patient was treated by antiaggregant doses of acetylsalicylic acid (ASA (5 mg/kg and Warfarin (1 mg/daily. At three months’ follow-up, the aneurysms still persisted in the echocardiogram.

  18. Subintimal arterial flossing with antegrade-retrograde intervention technique to treat long-segment occlusion of peripheral artery%同期双向内膜下血管成形技术治疗慢性下肢动脉全堵病变

    Institute of Scientific and Technical Information of China (English)

    叶猛; 施娅雪; 赵意平; 黄晓钟; 梁卫; 张皓; 周兆熊; 张纪蔚

    2011-01-01

    Objective To discuss the technique details of subintimal arterial flossing with antegrade-retrograde intervention(SAFARI)to improve technical success in the treatment of chronic total occlusions(CTO)diseases in lower extremity when there is failure to reenter the distal true lumen. Methods Between May 2009 and Aug 2010, 15 patients underwent endovascular recanalization with SAFARI technique. There were 8 male and 7 female patients with a mean age of 74.9 years. There were 3 patients with severe claudication(Rutherford category 3)and 12 patients with critical limb ischemia(Rutherford category 4 to 6). The clinical and follow-up data of these patients were analyzed retrospectively. Results Fourteen patients were treated with SAFARI techqiue successfully. The technique success rates were 93.3%. The mean ankle brachial index increased from 0. 39 to 0.83. Symptoms were relived in 86.6%patients, Ulcer were healed in 93.3% patients. Conclusions SAFARI technique is a safe and effective method in treating CTO diseases, when it is failure to renter the distal true lumen with subintimal angioplasty technique.%目的 探讨同期双向内膜下血管成形技术(subintimal arterial flossing with antegraderetrograde intervention,SAFARI)治疗下肢动脉慢性全堵病变(chronic total occlusions,CTO)的技术要点和注意事项.方法 2009年5月至2010年8月应用SAFARI技术对15例下肢动脉CTO病变患者进行了血管腔内治疗,其中男性8例,女性7例;年龄65~91岁,平均年龄74.9岁.按Rutherford下肢缺血分级标准:3级3例,4级6例,5级5例,6级1例.本组患者均为经传统内膜下血管成形术失败,进行了血管腔内动脉重建.结果 全组手术技术成功率为14/15.踝肱指数由术前0.39提高至术后1周的0.83.随访2~14个月,平均随访时间5.9个月.1例于术后1个月内发生支架内血栓形成.症状缓解率13/15,溃疡愈合率14/15.结论 SAFARI技术治疗下肢动脉CTO腔内治疗,成功率及保肢率高,

  19. Clinical value of selective renal arterial emobilization for the treatment of severe hemorrhage following percutaneous nephrolithotomy%选择性肾动脉栓塞治疗经皮肾镜取石术后大出血的临床价值

    Institute of Scientific and Technical Information of China (English)

    刘江泽; 刘四斌; 魏嵬; 熊远奎; 廖欣彬

    2011-01-01

    Objective: To assess the clinical value of selective renal arterial embolization with coil and PVA for the treatment of severe hemorrhage following minimally invasive percutaneous nephrolithotomy. Methods:27 cases of the image manifestation of renal arteriography, the effects and complications after embolotherapy were retrospectively reviewed. Results:The causes of bleeding after MPCNL included simple pseudoaneurysm (n=13,48. 1%) , pseudoaneurysms accompanied with arterial venous fistula (n=2, 7. 4%),arterial venous fistula treated by selective renal arterial embolization successfully at the first time. One patient recovered after the second treatment. In the meantime, the main renal function of all patients were reserved and no serious complication of embolization was observed. No hemorrhage recurrence and renal function failure appeared during the one month to 2 years follow up period. Conclusion: Selective renal arterial embolization is a minimally invasive, effective method and reserved the main renal function well. It is the first choice in the treatment of the patients who suffered severe hemorrhage caused by MPCNL%目的:探讨用弹簧圈、聚乙烯醇颗粒(PVA)选择性肾动脉栓塞治疗经皮肾镜取石术(MPCNL)术后大出血的临床价值。方法:回顾性分析27例MPCNL术后大出血患者的肾动脉造影表现、栓塞治疗效果及并发症等。结果:MPCNL术后出血的原因包括单纯假性动脉瘤13例(48.1%)、假性动脉瘤伴动静脉瘘2例(7.4%)、动-静脉瘘8例(29.6%)、对比剂外渗2例(7.4%),2例(7.4%)未发现异常。27例中26例1次、1例2次栓塞成功,27例全都保留了病肾的大部分组织和功能,无严重并发症,术后1个月~2年随访,肾功能良好,无再出血发生。结论:选择性肾动脉栓塞创伤小,见效快,能最大限

  20. [Acute arterial thrombosis of the extremity in pseudoxanthoma elasticum].

    Science.gov (United States)

    Rodríguez-Camarero, S J; Manchado, P; González, J A; Castro, M A; Rodero, J I; Mateo, A M

    1992-01-01

    We report a case of a patient with an elastic pseudoxanthoma (PXE) who presented an acute ischaemia at the left lower limb. The cause of such ischaemia was a thrombosis into the iliac and femoropopliteal arteries. Patient underwent a surgical procedure. The arteriopathy associated with a PXE rarely cause an arterial major occlusion. We did not found a case of acute arterial thrombotic ischaemia and PXE, treated with direct arterial revascularization in the reviewed literature.

  1. Parasternal approach for redo in ascending aorta pseudoaneurysm Abordagem paraesternal para refazer um pseudo-aneurisma aórtico

    Directory of Open Access Journals (Sweden)

    Guillermo Nuncio Vaccarino

    2008-06-01

    Full Text Available Aortic ascending pseudoaneurysm is a rare complication following aortic root surgery. The surgical solution of the complication is rather demanding and complex, especially when reaching the mediastinum. The latter translates into an elevated morbidity and mortality. We present a case performed through a minimal anterior right thoracotomy, which allowed us to dissect between the pseudoaneurysm and the internal site of the sternum as a first step prior to a second esternotomy. By using this approach, we minimized bleeding risks and the possibility of aortic rupture. This technique could have the potential to be generally applicable in this complication after further evaluation.Pseudo-aneurisma na parte ascendente da aorta é uma complicação rara após cirurgia da raiz da aorta. A solução cirúrgica é bastante exigente e complexa, especialmente quando chega ao mediastino. Esta parte última se traduz em elevada morbidade e mortalidade. Apresentamos um caso realizado por meio de uma toracotomia direita anterior mínima, que nos permitiu dissecar entre o pseudo-aneurisma e o sítio interno do esterno como um passo inicial, antes de uma segunda esternotomia. Ao usar essa abordagem, minimizamos os riscos de hemorragia e a possibilidade de um rompimento da aorta. Essa técnica tem o potencial para ser aplicável amplamente nessa complicação, após avaliação ulterior.

  2. Aneurisma de hiperfluxo próprio da artéria comunicante posterior decorrente de efeito hemodinâmico em paciente com oclusão da artéria subclávia tratado por angioplastia High flow"true" posterior communicating artery aneurysm due to hemodynamic effect in a patient with subclavian artery occlusion treated with angioplasty

    Directory of Open Access Journals (Sweden)

    José Maria Modenesi Freitas

    2005-09-01

    Full Text Available Aneurismas próprios da artéria comunicante posterior são extremamente raros possuindo uma incidência que varia de 0,1 a 2,8% de todos os aneurismas. O surgimento de aneurisma intracraniano em virtude de alterações de fluxo por oclusão arterial é descrito na literatura. Apresentamos o caso de homem de 69 anos, vítima de hemorragia subaracnóidea, com diagnóstico de aneurisma próprio da artéria comunicante posterior direita. Havia também, oclusão da artéria subclávia esquerda com roubo de fluxo da artéria vertebral direita pela vertebral esquerda. Realizou-se tratamento endovascular com angioplastia e colocação de stent na artéria subclávia esquerda com conseqüente oclusão do aneurisma. Discutimos o restabelecimento do fluxo arterial intracraniano como forma de tratamento deste aneurisma.True posterior communicating artery aneurysms are extremely rare with incidence ranges from 0.1% to 2.8% of all aneurysms. Cerebral aneurysm formation has been reported as a complication of artery occlusion by flow alteration. We present a 69 years old male patient presenting with subarachnoid hemorrhage with diagnosis of true right posterior communicating artery aneurysm. He had a left subclavian artery occlusion with flow theft from the right vertebral artery to the left vertebral artery. The patient underwent endovascular treatment with angioplasty and stent placement on the left subclavian artery and aneurysm occlusion result. We discuss the restablishment of cerebral blood flow as a treatment for this aneurysm.

  3. Continuous inhaled iloprost in a neonate with d-transposition of the great arteries and severe pulmonary arterial hypertension.

    Science.gov (United States)

    Dykes, John C; Torres, Marilyn; Alexander, Plato J

    2016-03-01

    This report describes the case of a neonate with d-transposition of the great arteries and severe pulmonary arterial hypertension stabilised in the post-operative period with continuous iloprost nebulisation. To our knowledge, this is the first documented method of treating post-operative severe pulmonary arterial hypertension with continuous inhaled iloprost in a patient with complex CHD. We found this method of delivering the drug very effective in stabilising haemodynamic swings in the setting of severe pulmonary arterial hypertension.

  4. Local intra-arterial thrombolysis in a 4-year-old male with vertebrobasilar artery thrombosis

    NARCIS (Netherlands)

    Janmaat, Mirjam; Gravendeel, Joost P; Uyttenboogaart, Maarten; Vroomen, Patrick C; Brouwer, Oebele F; Luijckx, Gert-Jan

    2009-01-01

    We report the case of a 4-year-old male with vertebrobasilar artery thrombosis for which he was treated with local intra-arterial urokinase 60 hours after onset of symptoms. Initially the patient had dysarthria and dysphagia. Brain magnetic resonance imaging (MRI) in a community hospital showed abno

  5. Peripheral arterial line (image)

    Science.gov (United States)

    A peripheral arterial line is a small, short plastic catheter placed through the skin into an artery of the arm or leg. The purpose of a peripheral arterial line is to allow continuous monitoring of ...

  6. Concentração de homocisteína em pacientes portadores de doença arterial periférica atendidos em um serviço público de saúde Level of homocysteine in patients with peripheral arterial disease treated at a public health care facility

    Directory of Open Access Journals (Sweden)

    Luciene de Souza Venâncio

    2009-12-01

    Full Text Available Contexto: Estudos recentes indicam que a concentração elevada de homocisteína é um fator de risco importante e prevalente para doença vascular aterosclerótica coronariana, cerebral e periférica. Objetivo: Tendo em vista a escassez de informações relacionadas à hiper-homocisteinemia em doença arterial periférica (DAP no Brasil e as peculiaridades de nossa população, o objetivo deste estudo foi avaliar a frequência de hiper-homocisteinemia em amostra dessa população em um ensaio clínico com indivíduos portadores e não portadores de DAP atendidos em um serviço público brasileiro. Métodos: Foi realizado um estudo ensaio clínico caso-controle com 40 indivíduos portadores de DAP confirmada por Doppler ultrassom (grupo DAP em comparação com 20 indivíduos voluntários sem DAP (grupo-controle. Resultados: A DAP predominante foi a isquemia crônica de membros (75%. As concentrações plasmáticas medianas de homocisteína de jejum foram significantemente maiores no grupo DAP do que no grupo-controle (16,7 versus 12,9 µmol/L, p = 0,001, tanto nos homens (18,9 versus 14,0 µmol/L, p = 0,005 quanto nas mulheres (13,9 versus 11,2 µmol/L, p = 0,025. Quanto à proporção de indivíduos com hiper-homocisteinemia, observou-se tendência a uma maior frequência no grupo DAP (60% em relação ao grupo-controle (30% (p = 0,054. Nos indivíduos com idade inferior a 60 anos foram encontrados valores medianos de homocisteína significantemente mais elevados no grupo DAP (p = 0,041. Conclusões: A hiper-homocisteinemia é um fator de risco importante e foi encontrada em 60% dos indivíduos portadores de DAP atendidos em um serviço público no Brasil.Background: Recent studies have suggested that high level of homocysteine is an important and prevalent risk factor for coronary, cerebral and peripheral arterial disease. Objective: In light of the lack of information on hyperhomocysteinemia in peripheral arterial disease (PAD in Brazil and

  7. Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries especially the internal carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Kachel, R.; Basche, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Radiologische Klinik); Heerklotz, I.; Grossmann, K. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Innere Medizin); Endler, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Neurologie und Psychiatrie)

    1991-06-01

    We present our experience with 105 patients in whom percutaneous transluminal angioplasty was performed in 112 stenosed or occluded supra-aortic arteries. Symtoms of cerebrovascular and/or vertebrobasilar insufficiency were present in 104 of the 105 patients. The angioplasty was successful in 35 stenoses of the internal carotid artery, 2 stenoses of the common carotid artery, 1 stenosis of the external carotid artery, 15 stenoses of the vertebral artery, 3 stenoses of the innominate artery and 44 stenoses of the subclavian artery. There were only 4 minor-complications (2 haematomas, 1 transient ischemic attack, 1 small thrombus of the internal carotid artery which was detected by 111-indium platelet scintigraphy and treated by thrombendarterectomy before the appearance of neurological symptoms). All patients were symptom free after angioplasty. During the observations period of 3 to 109 months (average 58 months) there were only two cases with re-stenosis after subclavian angioplasty. The results of more than 700 personal and international published percutaneous transluminal angioplasties of supra-aortic arteries are presented. The results suggest that angioplasty of supra-aortic arteries is an effective method. On strict definition of the indications, the complication rate for angioplasty of the supra-aortic arteries is not likely to be higher than that for operative treatment. (orig.).

  8. Treating Infertility

    Science.gov (United States)

    ... Education & Events Advocacy For Patients About ACOG Treating Infertility Home For Patients Search FAQs Treating Infertility Page ... Treating Infertility FAQ137, March 2015 PDF Format Treating Infertility Gynecologic Problems What is infertility? What treatment options ...

  9. Pregnancy after uterine arterial embolization

    Directory of Open Access Journals (Sweden)

    Cláudio E. Bonduki

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. METHODS: A retrospective study of 187 patients treated with uterine arterial embolization for symptomatic uterine fibroids between 2005-2008 was performed. Uterine arterial embolization was performed using polyvinyl alcohol particles (500-900 mm in diameter. Pregnancies were identified using screening questionnaires and the study database. RESULTS: There were 15 spontaneous pregnancies. Of these, 12.5% were miscarriages (n = 2, and 87.5% were successful live births (n = 14. The gestation time for the pregnancies with successful live births ranged from 36 to 39.2 weeks. The mean time between embolization and conception was 23.8 months (range, 5-54. One of the pregnancies resulted in twins. The newborn weights (n = 14 ranged from 2.260 to 3.605 kg (mean, 3.072 kg. One (7.1% was considered to have a low birth weight (2.260 kg. There were two cases of placenta accreta (12.5%, treated with hysterectomy in one case [6.3%], one case of premature rupture of the membranes (PRM (6.3%, and one case of preeclampsia (6.3%. All of the patients were delivered via Cesarean section. CONCLUSION: In this study, there was an increased risk of Cesarean delivery. There were no other major obstetric risks, suggesting that pregnancy after uterine arterial embolization is possible without significant morbidity or mortality.

  10. Adventitial cystic disease of the axillary artery.

    Science.gov (United States)

    Elster, Eric A; Hewlett, Stanley; DeRienzo, Damian P; Donovan, Sean; Georgia, Jeff; Yavorski, Chester C

    2002-01-01

    Adventitial cystic disease (ACD) is an extremely rare cause of arterial and venous insufficiency, with only 317 reported cases in the world literature. These lesions have been previously described in the popliteal fossa, external iliac artery, and distal brachial, radial, and ulnar arteries as well as in the proximal saphenous vein at the ankle. We describe here the first reported case of this disease in a proximal vessel, the axillary artery. A 33-year-old man was evaluated for upper extremity arterial insufficiency and was diagnosed with ACD on the basis of physical examination and radiographic findings, which was confirmed by pathological assessment. The patient was treated by excision of the lesion and interposition vein bypass. As this represents the first case of ACD in the proximal vasculature, it demonstrates that these lesions can occur in axial blood vessels.

  11. Spontaneous Coronary Artery Dissection with Cardiac Tamponade.

    Science.gov (United States)

    Goh, Anne C H; Lundstrom, Robert J

    2015-10-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome.

  12. The Use of an Upper-limb-artery Approach and Long Sheaths in Splanchnic Angiography and Interventional Procedures

    Energy Technology Data Exchange (ETDEWEB)

    Shimohira, Masashi; Ogino, Hiroyuki; Mori, Yuji; Shibamoto, Yuta (Dept. of Radiology, Nagoya City Univ. Graduate School of Medical Sciences, Nagoya (Japan)); Omiya, Hiroko; Suzuki, Hirochika (Dept. of Radiology, Tsushima City Hospital, Tsushima (Japan))

    2009-08-15

    Background: The prolonged bed-rest required achieving hemostasis after splanchnic angiography and interventional procedures can be avoided if the upper limb arteries are used. In such procedures, the use of long sheaths capable of reaching the descending aorta may be advantageous. Purpose: To analyze the results of procedures that utilizes an upper-limb-artery approach and long sheaths. Material and Methods: Two hundred forty-two patients with a mean age of 64 years underwent splanchnic angiography and interventional procedures via an upper limb artery using a long sheath (85 cm, 4-French). Repeat examinations were performed on 48 patients and the total number of examinations was 296. The records of these 296 examinations were reviewed and the success rate and complications were evaluated. Results: Overall, 295 of 296 (99.7%) examinations were successful, and one (0.3%) failed. Complications and side effects occurred in six cases (2.0%), a painful sheath manipulation occurred in two examinations (0.7%), and arterial occlusion (including temporary occlusion), hematoma of the puncture site, and pseudoaneurysm occurred in two (0.7%), one (0.3%), and one (0.3%) patient, respectively. Conclusion: The use of a long sheath capable of reaching the descending aorta enables the performance of splanchnic angiography and interventional procedures via the upper limb arteries

  13. Aneurysms of medium-sized arteries in Marfan syndrome.

    Science.gov (United States)

    Awais, Mazen; Williams, David M; Deeb, G Michael; Shea, Michael J

    2013-11-01

    Marfan syndrome is a relatively common connective tissue disorder that causes skin, ocular, skeletal, and cardiovascular abnormalities. High morbidity and mortality occur with aortic aneurysm and dissection. Other large-artery aneurysms, including carotid, subclavian, and iliac artery aneurysms, have also been associated with Marfan syndrome. It is not clear whether small- to medium-sized artery aneurysms are associated with Marfan syndrome. This report describes 4 patients with Marfan syndrome who have associated small- to medium-sized artery aneurysms with several complications. Additional investigations are needed to determine whether Marfan syndrome can cause small- to medium-sized artery aneurysms and how patients with these aneurysms should be treated.

  14. Research Progress of Extracorporeal Cardiac Shock Wave Therapy in Treating Coronary Artery Disease%体外心脏震波治疗冠心病的疗效研究进展

    Institute of Scientific and Technical Information of China (English)

    彭云珠; 杨萍

    2011-01-01

    Extracorporeal cardiac shock wave therapy (CSWT) is an effective and noninvasive therapeutic strategy for coronary artery disease. Additionally, it can enhance ischemic myocardium angiogenesis, improve ventricular remodeling after myocardial infarction, and it has been shown to relieve patient symptoms without side-effects. This article presents the history of CSWT in coronary artery disease, and reviews the development of the therapy and the assessment of the curative effects of CSWT.%体外心脏震波治疗是近年来治疗冠心病的一个安全无创的新方法.研究表明它能促进血管再生,改善心肌梗死后心室重构以及慢性心肌缺血患者症状,现对心脏震波治疗冠心病的疗效研究进展做一综述.

  15. Primary choriocarcinoma of uterine cervix treated by uterine artery drug pouring and embolism:one case report%子宫动脉药物灌注及栓塞治疗原发性宫颈绒癌一例

    Institute of Scientific and Technical Information of China (English)

    Yan Wang; Haiyang Jiang; Shaoguang Wang; Xuan Wang; Zhiyun Song

    2009-01-01

    Primary choriocarcinoma of the uterine cervix (PCC) is an extremely rare disease. The conventional treatment of PCC is a combination of hysterectomy and chemotherapy. We present one rare case proved by cervical biopsy. The patient was an 36-year-old Chinese woman with irregular vaginal bleeding for 60 days. A cervical tumoral mass was seen in the pel-vic examination and biopsy revealed active hyperplasia of trophoblastic cell, Because of massive vaginal haemorThage, the patient accepted uterine artery drug pouring and embolism emergently. This management had gained a satisfactory effect. Thus, Uterine artery drug pouring and embolism is one new and effective weapon for PCC, which can preserve the patient's productive abUity.

  16. Superior Mesenteric Artery Syndrome: An Infrequent Complication of Scoliosis Surgery

    Directory of Open Access Journals (Sweden)

    Metin Keskin

    2014-01-01

    Full Text Available Superior mesenteric artery syndrome is a rare condition that causes a proximal small intestinal obstruction due to contraction of the angle between the superior mesenteric artery and the aorta. Scoliosis surgery is one of the 15 reasons for superior mesenteric artery syndrome, which can present with acute or chronic manifestations. Although conservative treatment is usually possible, surgical treatment is required in certain cases that cannot be treated using conservative methods. In this paper, we describe a patient who developed superior mesenteric artery syndrome after scoliosis surgery and was treated with duodenojejunostomy due to failure and complications of conservative treatment.

  17. Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review.

    Science.gov (United States)

    Anichini, G; Passacantilli, E; Lenzi, J; Guidetti, G; Santoro, A

    2012-04-01

    Aneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery.

  18. Blood tracer kinetics in the arterial tree.

    Directory of Open Access Journals (Sweden)

    Elias Kellner

    Full Text Available Evaluation of blood supply of different organs relies on labeling blood with a suitable tracer. The tracer kinetics is linear: Tracer concentration at an observation site is a linear response to an input somewhere upstream the arterial flow. The corresponding impulse response functions are currently treated empirically without incorporating the relation to the vascular morphology of an organ. In this work we address this relation for the first time. We demonstrate that the form of the response function in the entire arterial tree is reduced to that of individual vessel segments under approximation of good blood mixing at vessel bifurcations. The resulting expression simplifies significantly when the geometric scaling of the vascular tree is taken into account. This suggests a new way to access the vascular morphology in vivo using experimentally determined response functions. However, it is an ill-posed inverse problem as demonstrated by an example using measured arterial spin labeling in large brain arteries. We further analyze transport in individual vessel segments and demonstrate that experimentally accessible tracer concentration in vessel segments depends on the measurement principle. Explicit expressions for the response functions are obtained for the major middle part of the arterial tree in which the blood flow in individual vessel segments can be treated as laminar. When applied to the analysis of regional cerebral blood flow measurements for which the necessary arterial input is evaluated in the carotid arteries, present theory predicts about 20% underestimation, which is in agreement with recent experimental data.

  19. Blood tracer kinetics in the arterial tree.

    Science.gov (United States)

    Kellner, Elias; Gall, Peter; Günther, Matthias; Reisert, Marco; Mader, Irina; Fleysher, Roman; Kiselev, Valerij G

    2014-01-01

    Evaluation of blood supply of different organs relies on labeling blood with a suitable tracer. The tracer kinetics is linear: Tracer concentration at an observation site is a linear response to an input somewhere upstream the arterial flow. The corresponding impulse response functions are currently treated empirically without incorporating the relation to the vascular morphology of an organ. In this work we address this relation for the first time. We demonstrate that the form of the response function in the entire arterial tree is reduced to that of individual vessel segments under approximation of good blood mixing at vessel bifurcations. The resulting expression simplifies significantly when the geometric scaling of the vascular tree is taken into account. This suggests a new way to access the vascular morphology in vivo using experimentally determined response functions. However, it is an ill-posed inverse problem as demonstrated by an example using measured arterial spin labeling in large brain arteries. We further analyze transport in individual vessel segments and demonstrate that experimentally accessible tracer concentration in vessel segments depends on the measurement principle. Explicit expressions for the response functions are obtained for the major middle part of the arterial tree in which the blood flow in individual vessel segments can be treated as laminar. When applied to the analysis of regional cerebral blood flow measurements for which the necessary arterial input is evaluated in the carotid arteries, present theory predicts about 20% underestimation, which is in agreement with recent experimental data.

  20. 腔内血管成形术治疗髂动脉长段慢性完全闭塞性病变%Endovascular angioplasty for the treatment of long iliac artery chronic total occlusions

    Institute of Scientific and Technical Information of China (English)

    叶开创; 施慧华; 刘光; 蒋米尔; 殷敏毅; 陆信武; 李维敏; 黄英; 黄新天; 陆民; 刘晓兵; 赵海光

    2011-01-01

    /118) during the follow-up.Significant restenosis or reocclusion was found in 7 iliac lesions and there were no major interventional complications,such as iliac artery rupture,stent displacement,pseudoaneurysms,and arteriovenous fistula.Conclusions Endovascular angioplasty is an effective,safe and feasible method in treating long iliac CTO with high patency rate.Combined left brachial and femoral access can increase the technical success rate significantly.

  1. Surgical repair of an aberrant splenic artery aneurysm: report of a case.

    Science.gov (United States)

    Illuminati, Giulio; LaMuraglia, Glenn; Nigri, Giuseppe; Vietri, Francesco

    2007-03-01

    Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.

  2. Symptomatic non-atherosclerotic bilateral extracranial vertebral artery occlusion treated with extracranial to intracranial bypass: case report Oclusão sintomática não-aterosclerótica da artéria vertebral extracraniana tratada com bypass: relato de caso

    Directory of Open Access Journals (Sweden)

    Leodante B. da Costa

    2006-09-01

    Full Text Available Posterior fossa ischemia is not a very frequent situation. It is responsible for about 25% of all ischemic strokes, and the vast majority of the cases are related to atherosclerotic stenosis of the vertebral and/or basilar arteries. Acute ischemia can also occur in the setting of vertebral artery dissection, traumatic or spontaneous. Recently, blunt trauma has been increasingly recognized as a cause for craniocervical artery injury. The management options for both traumatic and atherosclerotic lesions of the posterior fossa are still under debate. We present a case of a delayed onset of hemodynamic ischemic symptoms due to bilateral vertebral artery occlusion probably related to remote trauma to the head and neck in a 55-year-old-man treated successfully with extracranial to intracranial bypass.Acidentes vasculares cerebrais (AVC isquêmicos no sistema vertebro-basilar não são frequentes. Representam cerca de 25% dos AVCs isquêmicos, e a maioria é relacionada com aterosclerose das artérias vertebrais e/ou basilar. Isquemia aguda pode também ser resultado de dissecções da artéria vertebral, traumáticas ou espontâneas. Recentemente, traumatismos fechados têm sido cada vez mais reconhecidos como causa de lesão das artérias craniocervicais, podendo ou não resultar em sintomas isquêmicos. O tratamento para estas lesões, sejam traumáticas ou ateroscleróticas, ainda é motivo de debate. Relatamos o caso de um homem de 55 anos com sintomas isquêmicos, hemodinâmicos, tardios, devido a oclusão bilateral das artérias vertebrais, provavelmente relacionada a lesão traumática das artérias vertebrais, tratada com sucesso com bypass extra-intracraniano.

  3. Screening asymptomatic patients with diabetes for unknown coronary artery disease: Does it reduce risk? An open-label randomized trial comparing a strategy based on exercise testing aimed at revascularization with management based on pharmacological/behavioural treatment of traditional risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be Diagnosed and treated early in Diabetics?

    Directory of Open Access Journals (Sweden)

    Romano Stefania

    2009-12-01

    Full Text Available Abstract Background Coronary artery disease is the leading cause of morbidity and mortality in patients with type 2 diabetes. Screening for asymptomatic coronary artery disease with treatment by means of revascularization seems to be an appealing option for prevention. The utility of such a strategy has never been challenged in a randomized trial. Methods/Design In the present study a cohort of diabetic patients without any symptoms and without known coronary artery disease will be screened at two diabetes outpatients services. Those with intermediate or high risk (equal or greater than 10% according to the Italian risk chart will be asked to participate and enrolled. They will be seen and followed in order to provide the best adherence to medical therapy. Half of the patients will be randomized to undergo an exercise tolerance testing while the other group will continue to be regularly seen at diabetes outpatients services. Best medical/behavioral therapy will be offered to both groups. Those patients with a positive exercise tolerance testing will be studied by coronary angiography and treated according to the severity of coronary lesions by percutaneous stenting or surgery. The objective of the study is to evaluate the efficacy of the screening strategy aimed at revascularization. A cost-effectiveness analysis will be performed at the end of the follow up. Discussion The study will provide useful information about prevention and treatment of diabetic patients at high risk of coronary events. It will be made clearer if detection of silent coronary artery disease has to be recommended and followed by treatment. Given the simplicity of the study protocol, it will be easily transferable to the real world. Trial registration (ClinicalTrials.gov: NCT00547872

  4. Ultrasound-guided Femoral Artery Access for Minimally Invasive Neuro-intervention and Risk Factors for Access Site Hematoma

    Science.gov (United States)

    KURISU, Kota; OSANAI, Toshiya; KAZUMATA, Ken; NAKAYAMA, Naoki; ABUMIYA, Takeo; SHICHINOHE, Hideo; SHIMODA, Yusuke; HOUKIN, Kiyohiro

    2016-01-01

    Although ultrasound (US) guidance for venous access is becoming the “standard of care” for preventing access site complications, its feasibility for arterial access has not been fully investigated, especially in the neuro-interventional population. We conducted the first prospective cohort study on US-guided femoral artery access during neuro-interventional procedure. This study included 64 consecutive patients who underwent US-guided femoral artery access through 66 arterial access sites for diagnostic and/or neuro-interventional purposes. The number of attempts required for both the sheath insertion and the success of anterior wall puncture were recorded. In addition, the occurrence of major complications and hematoma formation on the arterial access site examined by US were statistically analyzed. The median number of attempts was 1 (1–2) and first-pass success rate was 63.6%. Anterior wall puncture was achieved in 98.5%. In one case (1.5%), a pseudoaneurysm was observed. In all cases, US clearly depicted a common femoral artery (CFA) and its bifurcation. Post-procedural hematoma was detected in 13 cases (19.7%), most of which were “tiny” or “moderate” in size. Low body mass index and antiplatelet therapy were the independent risk factors for access site hematoma. The US-guided CFA access was feasible even in neuro-interventional procedure. The method was particularly helpful in the patients with un-palpable pulsation of femoral arteries. To prevent arterial access site hematoma, special care should be taken in patients with low body mass index and who are on antiplatelet therapy. PMID:27194178

  5. Safety and efficacy of femoral artery closure with the FemoSeal(R) device after coronary angiography using a 7 French sheath.

    Science.gov (United States)

    Wanitschek, M M; Suessenbacher, A; Dörler, J; Pachinger, O; Moes, N; Alber, H F

    2011-09-01

    Post-cardiac catheterization femoral artery hemostasis can be accomplished with several mechanisms, including the FemoSeal® hemostasis device which has been designed and approved for closure of 6 French (F) arterial puncture sites. The aim of this study was to investigate whether the FemoSeal® vascular closure device can effectively and safely seal 7F arterial puncture sites after diagnostic and interventional cardiac catheterizations. Femoral artery puncture sites of 50 consecutive patients undergoing cardiac catheterization were closed with the FemoSeal® vascular closure device, according to the manufacturer's instructions. Efficacy endpoints were time to hemostasis and successful ambulation. Safety endpoints included bleeding complications, vessel occlusion and pseudoaneurysms. Mean time to hemostasis was 57.8±26.3 seconds (0-125 seconds). Hemostasis was achieved in 100 percent of the 50 patients. One patient suffered minor bleeding the next day, i.e. local hematoma. This clinical study demonstrates that the FemoSeal® vascular closure device, initially approved for closure of 6F arterial puncture sites, shows promising efficacy and safety to seal a larger (7F) femoral arterial puncture sites after diagnostic and interventional cardiac catheterizations.

  6. MR and CT diagnosis of carotid pseudoaneurysm in children following surgical resection of craniopharyngioma.

    Science.gov (United States)

    Lakhanpal, S K; Glasier, C M; James, C A; Angtuaco, E J

    1995-01-01

    We report the cases of two children who underwent CT, MR, MRA and angiography in the diagnosis of postoperative aneurysmal dilatation of the supraclinoid carotid arteries following surgical resection of craniopharyngioma. Craniopharyngiomas are relatively common lesions, accounting for 6-7% of brain tumors in children. They are histologically benign, causing symptoms by their growth within the sella and suprasellar cistern with compression of adjacent structures, especially the pituitary gland, hypothalamus and optic nerves, chiasm, and tracts. Complete surgical resection, particularly of large tumors, is complicated by the fact that the lesions are usually found within the circle of Willis, with displacement and adherence to the adventitia of these vessels [1, 2]. Recent reports in the neurosurgical literature have described aneurysmal dilatation of the supraclinoid internal carotid arteries following aggressive surgical resection of craniopharyngioma [3, 4].

  7. Capsaicin and arterial hypertensive crisis.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; La Rosa, Felice Carmelo; La Rocca, Roberto

    2010-10-08

    Chili peppers are rich in capsaicin. The potent vasodilator calcitonin gene-related peptide (CGRP) is stored in a population of C-fiber afferents that are sensitive to capsaicin. CGRP and peptides released from cardiac C fibers have a beneficial effect in myocardial ischemia and reperfusion. It has been reported that capsaicin pretreatment can deplete cardiac C-fiber peptide stores. Furthermore, it has also been reported that capsaicin-treated pigs have significantly increased mean arterial blood pressure compared with controls, and that the decrease in CGRP synthesis and release contributes to the elevated blood pressure. A case has also been reported of an arterial hypertensive crisis in a patient with a large ingestion of peppers and chili peppers the day before. We present a case of an arterial hypertensive crisis in a 19-year-old Italian man with an abundant ingestion of peppers and of chili peppers the preceding day. This case describes an unusual pattern of arterial hypertensive crisis due to capsaicin.

  8. Mesenteric artery ischemia

    Science.gov (United States)

    ... medlineplus.gov/ency/article/001156.htm Mesenteric artery ischemia To use the sharing features on this page, please enable JavaScript. Mesenteric artery ischemia occurs when there is a narrowing or blockage ...

  9. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnosis with CT Angiography

    Directory of Open Access Journals (Sweden)

    Guray Oncel

    2013-01-01

    Full Text Available Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA is a rare congenital anomaly. It is associated with early infant mortality and sudden death in adults. Traditionally, ALCAPA has been diagnosed by angiography or autopsy; however, the development of cardiac computed tomography (CT and magnetic resonance imaging (MRI has allowed noninvasive evaluation of the coronary anatomy by direct visualization of the origin of the left coronary artery (LCA from the pulmonary artery. We report a case of 10-year-old girl who has been on follow up for dilated cardiomyopathy for 4 years. The definitive diagnosis of ALCAPA is reached by multislice computed tomography (MSCT. The MSCT scan showed an anomalous origin of LCA from the pulmonary trunk, with a tortuous and dilated right coronary artery and right-to-left collateralization. Consequently, the patient was successfully treated with surgery.

  10. Upper limb arterial thromboembolism

    DEFF Research Database (Denmark)

    Andersen, L V; Lip, Gregory Y.H.; Lindholt, J S;

    2013-01-01

    The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF).......The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF)....

  11. 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.

  12. 椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素研究%Risk Factors of Restenosis in Postoperative Patients with Atherosclerotic Vertebral Artery Origin Stenosis Treated by Endovascular Stent Implantation

    Institute of Scientific and Technical Information of China (English)

    张广玉

    2016-01-01

    目的:探讨椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素。方法选择沧州市人民医院2013年1月—2015年6月收治的椎动脉起始部粥样硬化性狭窄患者64例,均行血管内支架置入术并随访6个月,记录其性别、年龄、合并症、吸烟史、病变部位、术前椎动脉直径、支架类型、支架直径、支架长度及术后狭窄长度,分析血管内支架置入术后再狭窄的危险因素。结果所有患者顺利完成血管内支架置入术,随访期间18例出现再狭窄(再狭窄组),46例未出现再狭窄(无再狭窄组),再狭窄发生率为28.1%。两组患者性别、年龄、高血压发生率、糖尿病发生率、高胆固醇血症发生率、病变部位、支架直径、支架长度及术后狭窄长度比较,差异无统计学意义(P ﹥0.05);再狭窄组患者吸烟史阳性率高于无再狭窄组,术前椎动脉直径短于无再狭窄组,采用药物支架者所占比例低于无再狭窄组(P ﹤0.05)。多因素 logistic 回归分析结果显示,有吸烟史〔β=0.098,OR =2.648,95%CI(1.159,4.674),P =0.001〕、术前椎动脉直径〔β=0.956,OR =2.614,95% CI(1.134,6.022),P =0.007〕为椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素,药物支架〔β=-0.612,OR =1.837,95% CI(1.086,4.597),P =0.029〕为保护因素。结论椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄发生率较高,有吸烟史、术前椎动脉直径为血管内支架置入术后再狭窄的危险因素,药物支架为保护因素。%Objective To investigate the risk factors of restenosis in postoperative patients with atherosclerotic vertebral artery origin stenosis treated by endovascular stent implantation. Methods A total of 64 patients with atherosclerotic vertebral artery origin stenosis were selected in

  13. 单吻合器行低位及超低位前切除术加髂内动脉置泵化疗治疗低位直肠癌的临床研究%The Clinical Research of Treating Low Rectal Cancer using Single Stapling Device in Low and Sublow Anterior Resection with Intra-internal Iliac Artery Implantation Pump Chemotherapy

    Institute of Scientific and Technical Information of China (English)

    杨波; 蒲永东; 刘斌; 何建苗; 董立国; 曹志宇; 赵华洲; 刘瑞军; 邢雨

    2011-01-01

    Objective:To explore the effect of treating low rectal cancer using single stapling device in low and sublow anterior resection with intra-internal iliac artery implantation pump chemotherapy. Methods:Sixty-eight cases of low rectal cancer were treated surgically with single tube stapling device with intra-internal iliac artery implantation pump chemotherapy. Results:Anastomosis was made in all patients successfully. Sixty-five cases of them were followed up and 4 cases of pelvic cavity recurrenced (5.88%),2 cases of anastomosis sterosis (2.94 %) were founded. No leakage and bleeding of anastomosis occurred.Conclusion:Treating low rectal cancer using single stapling device in low and sublow anterior resection with intra-internal iliac artery implantation pump chemotherapy is avialble. It is simple,safe and inexpensive with lower complication.It also have a perfect prognosis and can improve the quality of postoperative life.%目的:探讨使用单个国产吻合器行低位及超低位前切除术加髂内动脉置泵化疗治疗低位直肠癌的应用价值.方法:2002年5月~2009年12月,用单个国产弯管型消化道吻合器行直结肠吻合加髂内动脉置泵化疗治疗68例低位直肠癌患者,对临床资料和结粜进行分析总结.结果:本组全部吻合成功,术后盆腔复发3例(4.41%),吻合口狭窄2例(2.94%)无吻合口漏和吻合口出血发生.结论:用单吻合器行低位及超低位前切除术加髂内动脉置泵化疗治疗低位直肠癌是可行的,其操作简单安全,费用低,吻合成功率高,并发症少,即提商了患者术后生活质量,又改善了远期预后.

  14. Endovascular management of visceral artery aneurysms: When to watch, when to intervene?

    Institute of Scientific and Technical Information of China (English)

    Romaric; Loffroy; Sylvain; Favelier; Pierre; Pottecher; Pierre-Yves; Genson; Louis; Estivalet; Sophie; Gehin; Jean-Pierre; Cercueil; Denis; Krausé

    2015-01-01

    Visceral artery aneurysms(VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms(VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the firstline therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges.

  15. [Upper extremity arterial diseases].

    Science.gov (United States)

    Becker, F

    2007-02-01

    Compared to lower limb arterial diseases, upper limb arterial diseases look rare, heterogeneous with various etiologies and a rather vague clinical picture, but with a negligible risk of amputation. Almost all types of arterial diseases can be present in the upper limb, but the anatomical and hemodynamic conditions particular to the upper limb often confuse the issue. Thus, atherosclerosis affects mainly the subclavian artery in its proximal segment where the potential of collateral pathway is high making the symptomatic forms not very frequent whereas the prevalence of subclavian artery stenosis or occlusion is relatively high. The clinical examination and the etiologies are discussed according to the clinical, anatomical and hemodynamic context.

  16. Cerebral vascular findings in PAPA syndrome: cerebral arterial vasculopathy or vasculitis and a posterior cerebral artery dissecting aneurysm.

    Science.gov (United States)

    Khatibi, Kasra; Heit, Jeremy J; Telischak, Nicholas A; Elbers, Jorina M; Do, Huy M

    2016-08-01

    A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.

  17. Right Aortic Arch with a Retroesophageal Left Subclavian Artery and an Anomalous Origin of the Pulmonary Artery from the Aorta

    Science.gov (United States)

    Jeon, Chang-Seok; Shim, Man-shik; Yang, Ji-Hyuk; Jun, Tae-Gook

    2017-01-01

    We report the case of a newborn with a rare anatomic variation: a right aortic arch with a retroesophageal left subclavian artery and an anomalous origin of the pulmonary artery from the aorta. This variation was diagnosed using echocardiography and computed tomography, and we treated the condition surgically. PMID:28180103

  18. Transradial artery coronary angioplasty.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J; de Melker, E

    1995-01-01

    This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty equipment is feasible and that no major puncture site-related complications occur because hemostasis is obtained easily and because no major structures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplasty was attempted in 122 lesions (type A n = 67 [55%], Type B n = 37 [30%], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantitative coronary analysis was performed. Radial artery function and structure were assessed clinically and with Doppler and two-dimensional ultrasound on the day of discharge. Coronary catheterization via the radial artery was successful in 94 patients (94%). The 6 remaining patients had successful PTCA via the femoral artery (n = 5) or the brachial artery (n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the total study population.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

    Directory of Open Access Journals (Sweden)

    Wasmuth Hermann E

    2011-06-01

    Full Text Available Abstract Background Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage. Case presentation In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient. Conclusion Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

  20. Acute occlusion of the left subclavian artery with artery dissection

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Subclavian steal syndrome is cerebral or brain stem ischemia resulting from diversion of blood flow from the basilar artery to the subclavian artery, which is caused by occlusive disease of either the subclavian artery or the innominate artery before they branch off at the vertebral artery. In the patients with subclavian steal syndrome the subclavian artery is fed by retrograde flow from the vertebral artery via the carotids and the circle of Willis.

  1. Management of Extracranial Carotid Artery Aneurysm

    NARCIS (Netherlands)

    Welleweerd, J. C.; den Ruijter, H. M.; Nelissen, B. G. L.; Bots, M. L.; Kappelle, L. J.; Rinkel, G. J. E.; Moll, F. L.; de Borst, G. J.

    2015-01-01

    Introduction: Aneurysms of the extracranial carotid artery (ECAA) are rare. Several treatments have been developed over the last 20 years, yet the preferred method to treat ECAA remains unknown. This paper is a review of all available literature on the risk of complications and long-term outcome aft

  2. Dural AVM supplied by the ophthalmic artery.

    LENUS (Irish Health Repository)

    Flynn, T H

    2012-02-03

    Dural arteriovenous malformations in the anterior cranial fossa are rare and are especially prone to haemorrhage. These lesions are usually treated by surgical excision. We report the embolization of an anterior cranial fossa DAVM using an endovascular approach via the ophthalmic artery.

  3. Emergency endovascular repair of ruptured visceral artery aneurysms

    Directory of Open Access Journals (Sweden)

    Tang Tjun

    2007-07-01

    Full Text Available Abstract Background Visceral artery aneurysms although rare, have very high mortality if they rupture. Case presentation An interesting case of a bleeding inferior pancreaticduodenal artery aneurysm is reported in a young patient who presented with hypovolemic shock while being treated in the hospital after undergoing total knee replacement. Endovascular embolization was successfully employed to treat this patient, with early hospital discharge. Conclusion Prompt diagnosis and endovascular management of ruptured visceral aneuryms can decrease the associated mortality and morbidity.

  4. Two-vessel coronary artery dissection in the peripartum period. Case report and literature review.

    Science.gov (United States)

    Madu, E C; Kosinski, D J; Wilson, W R; Burket, M W; Fraker, T D; Ansel, G M

    1994-09-01

    The authors report a case of early peripartum myocardial infarction resulting from spontaneous dissection of the left anterior descending coronary artery and right coronary artery in a twenty-four-year-old woman. This is the first report of double-vessel coronary dissection involving both the left and right coronary arteries diagnosed antemortem and successfully treated.

  5. External iliac artery dissection secondary to endofibrosis in a cyclist.

    Science.gov (United States)

    Willson, Thomas D; Revesz, Elizabeth; Podbielski, Francis J; Blecha, Matthew J

    2010-07-01

    Endofibrosis of the external iliac artery is an uncommon disease affecting primarily young, otherwise healthy, endurance athletes. Thigh pain during maximal exercise with quick resolution postexercise is characteristic of the so-called cyclist's iliac syndrome. We report an unusual case in which the typical endofibrotic plaque was accompanied by dissection of the external iliac artery. The patient was treated surgically with excision of the affected artery segment and placement of an interposition graft. This case highlights an unusual finding in association with external iliac artery endofibrosis and provides an opportunity to briefly review the literature on the subject.

  6. Surgical procedure for coronary artery ectasia associated with saccular fistula.

    Science.gov (United States)

    Murakami, Masanori; Gohra, Hidenori; Yagi, Takeshi; Jinbou, Mitsutaka; Kobayashi, Toshiro; Saito, Satoshi; Takahashi, Tsuyoshi; Shiomi, Kotaro; Ono, Siro; Hamano, Kimikazu

    2014-09-01

    Echocardiography of a 60 year-old woman with a three-year history of heart murmur revealed a coronary artery fistula. Coronary angiography indicated right coronary artery ectasia and fistula. The pulmonary-to-systemic blood flow ratio was 1.4, and left-to-right shunt, 29%. On follow-up, infective endocarditis of the tricuspid valve had developed and was treated using antibiotics. The right coronary artery was dilated along its length and was saccular at the distal aspect. At this point, a fistula also connected by the left anterior descending and left circumflex arteries drained into the right ventricle. Fistula closure and reduction aneurysmectomy were performed.

  7. Bilateral accessory thoracodorsal artery.

    Science.gov (United States)

    Natsis, Konstantinos; Totlis, Trifon; Tsikaras, Prokopios; Skandalakis, Panagiotis

    2006-09-01

    The subscapular artery arises from the third part of the axillary artery and gives off the circumflex scapular and the thoracodorsal arteries. Although anatomical variations of the axillary artery are very common, the existence of a unilateral accessory thoracodorsal artery has been described in the literature only once. There are no reports of bilateral accessory thoracodorsal artery, in the literature. In the present study, a bilateral accessory thoracodorsal artery, originating on either side of the third part of the axillary artery, is described in a 68-year-old female cadaver. All the other branches of the axillary artery had a typical origin, course, distribution and termination. This extremely rare anatomical variation apart from the anatomical importance also has clinical significance for surgeons in this area. Especially, during the dissection or mobilization of the latissimus dorsi that is partly used for coverage problems in many regions of the body and also in dynamic cardiomyoplasty, any iatrogenic injury of this accessory artery may result in ischemia and functional loss of the graft.

  8. Improved survival for hepatocellular carcinoma with portal vein tumor thrombosis treated by intra-arterial chemotherapy combining etoposide, carboplatin, epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil: A p

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To investigate the poor prognosis of HCC with PVTT, we evaluated the efficacy by a new combination chemotherapy for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).METHODS: From 2002 to 2007, a total of 10 consecutive patients with Stage IVA HCC accompanied by PVTT were studied prospectively to examine the efficacy of treatment by intra-arterial infusion of a chemotherapeutic agents consisting of etoposide, carboplatin, epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil.RESULTS: The mean course of chemotherapy was 14.4 (range, 9-21) mo. One patient showed complete response (CR) with disappearance of HCC and PVTT after treatment, and the two patients showed partialresponse (PR), response rate (CR + PR/All cases 30%).The median survival time after the therapy was 457.2 d. The one-year survival rate was 70%. Adverse reactions were tolerable.CONCLUSION: Although the prognosis of most patients with Stage IVA HCC by PVTT is poor, our combination chemotherapy may induces long-term survival and is an effective treatment and produced anti-tumor activity with tolerable adverse effects in patients for advanced Stage IVA HCC accompanied by PVTT.

  9. Meta-analysis of the efficacy of transcatheter arterial chemoembolization combined with percutaneous ethanol injection in treating unresectable primary liver cancer%肝动脉化疗栓塞联合经皮无水乙醇注射治疗不能切除肝癌疗效的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    顾国文; 李相成

    2009-01-01

    目的 评价肝动脉化疗栓塞联合经皮无水乙醇注射治疗不能手术切除肝癌的疗效和安全性.方法 计算机检索MEDLINE、EMBASE、Cochrane图书馆和中国生物医学文献数据库、中国期刊全文数据库和万方数据库中的相关文献,语种不限,所有检索均截止至2008年06月10日.检索所有有关肝动脉化疗栓塞联合经皮无水乙醇注射治疗不能切除肝癌的随机对照试验,由2名评价员筛选和提取资料,并用Jadad量表进行质量评估,对符合纳入标准的研究采用RevMan4.2软件进行分析.结果 共纳入14个随机对照试验,12篇中文,2篇英文,总共857例肝癌患者.荟萃分析结果显示:与单用肝动脉化疗栓塞治疗不能手术切除肝癌组相比,肝动脉化疗栓塞联合经皮无水乙醇注射治疗可以明显提高总生存率、AFT转阴率和下降率,还可以明显提高瘤灶显效率:1、2、3年总生存率的相对危险度RR值(95%CI)分别为1.37(1.21~1.56)、1.74(1.49~2.04)、2.26(1.70~3.02);AFP转阴率、AFP下降率、瘤灶显效率的RR(95%CI)分别为1.69(1.38~2.07)、1.39(1.24~1.56)、1.56(1.38~1.77).有11篇研究报道了与治疗相关的不良反应,主要为轻中度发热、肝功能损害,消化道反应和暂时性肝区疼痛,没有与治疗相关严重并发症或死亡的报道.结论 现有证据显示相对于单用肝动脉化疗栓塞治疗不能切除肝癌,肝动脉化疗栓塞联合经皮无水乙醇注射治疗可以明显提高总生存率、AFP转阴率及下降率,还可以提高瘸灶坏死率和缩小率,且安全性较好.但由于纳入的研究多数方法学质量偏低,需更多高质最的临床随机对照试验进一步评估其疗效和安全性.%Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization combined with percutaneous ethanol injection in treating unresectable primary liver cancer. Methods MEDLINE (1966 - June 2008), EMBASE (1974 - June 2008

  10. Successful angioplasty during pregnancy for renal artery stenosis.

    Science.gov (United States)

    Margueritte, François; Velasco, Stephane; Pourrat, Olivier; Pierre, Fabrice

    2016-03-01

    Renal artery stenosis can be diagnosed during pregnancy and treated at the same time. A 30-year-old woman had a sudden, severe but asymptomatic hypertensive crisis at 21 weeks of gestation. The diagnosis of renal artery stenosis suspected on Doppler ultrasonography was confirmed and treated by renal angioplasty, which reduced her blood pressure. At 27 weeks of gestation, her blood pressure increased again, associated with significant proteinuria, suggesting pre-eclampsia. A cesarean section was performed giving birth to a healthy 940-g child. Renal artery stenosis should be considered when sudden and early-onset hypertension appears during pregnancy.

  11. Combined surgical and endovascular approach to treat a complex aortic coarctation without extracorporeal circulation.

    Science.gov (United States)

    Carrel, Thierry P; Berdat, Pascal A; Baumgartner, Iris; Dinkel, Hans-Peter; Schmidli, Jürg

    2004-10-01

    Various therapeutic approaches have been proposed to treat complex coarctation of the aorta (eg, recoarctation, which requires repetitive interventions, or coarctation with a hypoplastic aortic arch). Resection followed by end-to-end anastomosis or by graft interposition is technically demanding and exposes the patient to considerable perioperative risks. Cardiopulmonary bypass and deep hypothermic circulatory arrest may be necessary to control the distal aortic arch. The role of stent technology in treating this type of lesion has not yet been defined. We present a 21-year-old woman with a recurrent coarctation of the aorta associated with a hypoplastic aortic arch and a pseudoaneurysm of the proximal descending aorta. She had undergone 4 previous interventions. Treatment consisted of a combined surgical and endovascular approach without cardiopulmonary bypass and included extraanatomic aortic bypass, partial debranching of the supraaortic vessels, and stent-graft insertion to exclude the aneurysm.

  12. Celiac Artery Compression Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammed Muqeetadnan

    2013-01-01

    Full Text Available Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

  13. Arterial waveform analysis.

    Science.gov (United States)

    Esper, Stephen A; Pinsky, Michael R

    2014-12-01

    The bedside measurement of continuous arterial pressure values from waveform analysis has been routinely available via indwelling arterial catheterization for >50 years. Invasive blood pressure monitoring has been utilized in critically ill patients, in both the operating room and critical care units, to facilitate rapid diagnoses of cardiovascular insufficiency and monitor response to treatments aimed at correcting abnormalities before the consequences of either hypo- or hypertension are seen. Minimally invasive techniques to estimate cardiac output (CO) have gained increased appeal. This has led to the increased interest in arterial waveform analysis to provide this important information, as it is measured continuously in many operating rooms and intensive care units. Arterial waveform analysis also allows for the calculation of many so-called derived parameters intrinsically created by this pulse pressure profile. These include estimates of left ventricular stroke volume (SV), CO, vascular resistance, and during positive-pressure breathing, SV variation, and pulse pressure variation. This article focuses on the principles of arterial waveform analysis and their determinants, components of the arterial system, and arterial pulse contour. It will also address the advantage of measuring real-time CO by the arterial waveform and the benefits to measuring SV variation. Arterial waveform analysis has gained a large interest in the overall assessment and management of the critically ill and those at a risk of hemodynamic deterioration.

  14. The safety and efficacy of hemostasis with Clo-Sur P.A.D. after transcatheter arterial chemoembolization

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Chai; Jae, Hwan Jun; Kim, Sang Youn; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2007-04-15

    We wanted to evaluate the safety and efficacy of a new hemostatic device, Clo-Sur P.A.D., at an arterial access site after performing femoral arterial catheterization to achieve transcatheter arterial chemoembolization (TACE). From August 2002 to March 2005, 113 patients who underwent TACE and agreed on using the Clo-Sur P.A.D. were enrolled in this study. We evaluated the mean time interval from compression to the first movement and also to the first walk. We also evaluated such complications as rebleeding, pseudoaneurysm, vascular occlusion, hematoma, infection and pain. For 92 patients who had previous experiences with manual compression, we evaluated their preference of hemostatic method by asking them. Successful hemostasis was achieved with the Clo-Sur P.A.D. in 105 subjects (92%). The mean time interval from compression to the first movement was 201 minutes, and that to the first walk was 267 minutes. There was no statistical difference between the complicated and the uncomplicated groups for the mean time, prothrombin time, Child-Pugh class and platelet count ({rho} > 0.05). Rebleeding occurred in 3 patients (2.7%) and mild hematoma around puncture site was noted in 5 patients (5.4%). Eighty-seven patients (95%) preferred Clo-Sur P.A.D. to the manual compression method. The Clo-Sur P.A.D. is a safe and effective hemostatic device and it provides early ambulation after TACE.

  15. Aneurisma idiopático de artéria radial: relato de caso Idiopathic radial artery aneurysm: case report

    Directory of Open Access Journals (Sweden)

    Luiz Ernani Meira Jr.

    2011-12-01

    Full Text Available Os aneurismas da artéria radial são extremamente raros. Em sua maioria, consistem de pseudoaneurismas pós-traumáticos. Os aneurismas da artéria radial verdadeiros podem ser idiopáticos, congênitos, pós-estenóticos ou associados a patologias, tais como vasculites e doenças do tecido conjuntivo. Foi relatado um caso de aneurisma idiopático de artéria radial em uma criança de três anos, que, após completa investigação diagnóstica complementar, foi submetida à ressecção cirúrgica.Radial artery aneurysms are extremely rare. Post-traumatic pseudoaneurysms are the vast majority. True radial artery aneurysms can be idiopathic, congenital, poststenotic, or associated with some pathologies, such as vasculitis and conjunctive tissue diseases. We report a case of an idiopathic aneurysm of the radial artery in a three-year-old child who was submitted to surgical resection after a complete diagnostic approach.

  16. A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

    Directory of Open Access Journals (Sweden)

    Katleen Devue

    2014-01-01

    Full Text Available This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

  17. Anomalous origin of right coronary artery from pulmonary artery

    Directory of Open Access Journals (Sweden)

    Rajat Gupta

    2012-01-01

    Full Text Available Anomalous origin of coronary artery from the pulmonary artery is a rare anomaly that most frequently involves the left coronary artery and very rarely the right coronary artery. These lesions can be missed on echocardiography unless carefully looked for. We describe a case of isolated anomalous origin of right coronary artery from pulmonary artery diagnosed on echocardiography and confirmed by computed tomography (CT angiography.

  18. 赖诺普利、曲美他嗪对急性冠脉综合征并2型糖尿病的影响%Effects of lisinopril and trimetazidine treating acute coronary artery syndrome combined with 2-type diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    梁伦昌; 陈文智; 陈伟泉; 谭其平

    2011-01-01

    目的 探讨赖诺普利、曲美他嗪对急性冠脉综合征合并2型糖尿病患者血管内皮功能及糖化血红蛋白的影响,及心脏事件发生情况。方法 治疗组采用赖诺普利、曲美他嗪治疗,对照组采用传统方法治疗;在改善血管内皮功能、降低糖化血红蛋白、防治心血管事件等方面比较疗效。结果 治疗组在改善血管内皮功能、降低糖化血红蛋白(7.0%vs.8.0%)、防治心血管事件(13例vs.23例)等方面优于对照组。结论 赖诺普利、曲美他嗪对急性冠脉综合征合并2型糖尿病患者,可显著改善血管内皮功能、降低糖化血红蛋白、防治心血管事件,患者多方面受益。%Objective To explore effects of lisinopril and trimetazidine treating acute coronary artery syndrome combined with 2-type diabetes mellitus, such as blood vessel endothelium function and glycosylated hemoglobin effect and heart blood vessel event of acute coronary artery syndrome combined with 2-type diabetes mellitus. Methods Therapy group offered lisinopril and trimetazidine, control group received traditional method, compared with curative effect of improving blood vessel endothelium function, depressing glycosylated hemoglobin, preventing and curing heart blood vessel event. Results Therapy group is better than control group in improving blood vessel endothelium function, depressing glycosylated hemoglobin, preventing and curing heart blood vessel event. Conclusion Lisinopril and trimetazidine can improve blood vessel endothelium function, depress glycosylated hemoglobin, prevent and cure heart blood vessel event of acute coronary artery syndrome combined wih 2-type diabetes mellitus.Patients can benefit from it in many ways.

  19. Arterial hypoxaemia in cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Hillingsø, Jens; Christensen, E

    1998-01-01

    BACKGROUND: Although low arterial oxygen tension (Po2) has been claimed to occur in one to two thirds of patients with cirrhosis, hypoxaemia appears to be rare in clinical practice. AIMS: To assess the frequency of arterial hypoxaemia in cirrhosis in relation to clinical and haemodynamic......%, 96%, 96%, and 93% (NS). So2 was below the lower limit of 92% in 0%, 9%, 7%, and 24% (p arterial carbon dioxide tension, a low systemic vascular...... resistance, and a low indocyanine green clearance (p arterial hypoxaemia in cirrhosis is about 22% in patients without encephalopathy, but it varies from 10-40% depending on the degree of hepatic dysfunction. Arterial hypoxaemia in patients with cirrhosis of differing...

  20. Artery by Neuropeptides

    Directory of Open Access Journals (Sweden)

    Esmeralda Sofia Costa Delgado

    2012-01-01

    Methods. Isolated rabbit eyes (n=12 were perfused in situ with tyrode through the external ophthalmic artery. Effects of intra-arterial injections of NPY 200 μg/ml (Group A; n=6 and VIP 200 μg/ml (Group B; n=6 on the recorded pressure were obtained. For statistical analysis, Student's paired t-test and Fast Fourier Transform were used. Results. Spontaneous oscillations were observed before any drug administration in the 12 rabbit models. NPY produced an increase in total vascular resistance and a higher frequency and amplitude of oscillations, while VIP evoked the opposite effects. Conclusions. This study provides evidence of vasomotion in basal conditions in rabbit external ophthalmic artery. Concerning drug effects, NPY increased arterial resistance and enhanced vasomotion while VIP produced opposite effects which demonstrates their profound influence in arterial vasomotion.