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Trauma Case Reports Dec 2023Hepatic artery pseudoaneurysms are an uncommon complication of blunt hepatic trauma typically presenting in a delayed fashion. A 40-year-old male presented to a trauma...
Hepatic artery pseudoaneurysms are an uncommon complication of blunt hepatic trauma typically presenting in a delayed fashion. A 40-year-old male presented to a trauma centre after a 6-metre fall from a construction site with multiple injuries including a grade IV liver laceration centred around the porta hepatis. This liver injury was managed non-operatively. On day sixteen of admission, he had a sudden cardiac arrest from haemorrhagic shock with a subsequent CT demonstrating a ruptured extrahepatic proper hepatic artery pseudoaneurysm. Despite laparotomy and vessel repair, he died from pulmonary complications of aspiration pneumonia and acute lung injury associated with massive transfusion. The literature demonstrates conflicting views regarding the utility of repeat CT to detect a pseudoaneurysm in asymptomatic, non-operatively managed patients with blunt hepatic trauma. In particular, the literature does not distinguish the utility of repeat routine CT for intrahepatic and extrahepatic hepatic artery pseudoaneurysm, the latter if which is rarer. Current guidelines recommend against it, but there are observational studies suggesting utility, particularly in high grade (≥IV) liver injury. In patients with a high-grade injury extending to the porta hepatis, repeat imaging should be considered to detect possible pseudoaneurysm.
PubMed: 38035049
DOI: 10.1016/j.tcr.2023.100970 -
Clinical Case Reports Mar 2024Some cases of left ventricular pseudoaneurysms (LVPAs) are asymptomatic. While cardiac magnetic resonance imaging is important, a chest x-ray can easily be performed and...
Some cases of left ventricular pseudoaneurysms (LVPAs) are asymptomatic. While cardiac magnetic resonance imaging is important, a chest x-ray can easily be performed and is also crucial for the detection of LVPA during the first outpatient visit.
PubMed: 38487647
DOI: 10.1002/ccr3.8599 -
VideoGIE : An Official Video Journal of... Apr 2024EUS-guided vascular intervention has expanded the horizons of diagnostic as well as therapeutic interventions for vascular pathology. EUS-guided embolization is a... (Review)
Review
BACKGROUNDS AND AIMS
EUS-guided vascular intervention has expanded the horizons of diagnostic as well as therapeutic interventions for vascular pathology. EUS-guided embolization is a commonly performed technique for the treatment of gastric varices. However, there is a lack of data on the standardization of the technique. Here, we review the techniques and difficulties encountered during EUS-guided embolization of varices and pseudoaneurysms.
METHODS
This article and accompanying video describe the EUS-guided embolization techniques for various vascular lesions. EUS-guided embolization was achieved by combination therapy using coils and cyanoacrylate. Complete obliteration of the lesions was documented on follow-up. The existing literature of EUS-guided embolization therapy is also reviewed.
RESULTS
Patients with various vascular lesions, including gastric varices, ectopic duodenal varices, and splenic artery pseudoaneurysms, were successfully treated with EUS-guided coil plus cyanoacrylate injection. Patients with gastric varices underwent treatment with 2 EUS-guided techniques: (1) direct puncture of the varix and embolization and (2) feeder vessel embolization. Following embolization, the absence of Doppler flow within the varix and pseudoaneurysm was documented.
CONCLUSIONS
Techniques of EUS-guided embolization of varices and pseudoaneurysms are demonstrated. Understanding the techniques and the challenges encountered during therapy is crucial to optimize outcomes and reduce adverse events.
PubMed: 38618622
DOI: 10.1016/j.vgie.2023.12.006 -
Methodist DeBakey Cardiovascular Journal 2024Left ventricular assist devices (LVAD) are surgically implanted mechanical support devices utilized with increasing frequency as a bridge to myocardial recovery,...
Left ventricular assist devices (LVAD) are surgically implanted mechanical support devices utilized with increasing frequency as a bridge to myocardial recovery, destination therapy, and heart transplantation. While the use of such devices in patients with advanced heart failure has shown significant survival benefits and improved quality of life, they bear their own risks and complications. Bleeding, infection, pump thrombosis, and stroke are just some of the serious complications associated with LVADs. LVAD-associated pseudoaneurysms are rare, with prior reports of occurrence at the left ventricular apex and at the anastomosis site of the outflow graft to the ascending aorta. Typically, this device-related complication requires surgical repair and, if at all feasible, heart transplantation. However, in cases of difficult anatomy, unfavorable position, and significant comorbidities, surgery may be contraindicated due to high surgical risk. This case portrays a patient suffering from a left ventricular pseudoaneurysm after HeartMate-III implantation that was not amenable to surgical repair due to heightened surgical risk. We document the first pseudoaneurysm associated with the HeartMate-III in available literature and describe a novel management strategy of documented nonoperative course of LVAD-associated pseudoaneurysm, with the patient surviving 56+ months with medical optimization and management.
Topics: Humans; Conservative Treatment; Aneurysm, False; Heart-Assist Devices; Quality of Life; Aorta
PubMed: 38250571
DOI: 10.14797/mdcvj.1301 -
Indian Journal of Thoracic and... Jan 2024Pseudoaneurysms of the aortic root are rare. A case of prosthetic aortic valve infection progressing from a confined intramural abscess to a ruptured abscess... (Review)
Review
UNLABELLED
Pseudoaneurysms of the aortic root are rare. A case of prosthetic aortic valve infection progressing from a confined intramural abscess to a ruptured abscess communicating with the aorta and forming a large pseudoaneurysm is described. Additionally, data from all cases and case series, published between 2000 and 2021, was analyzed. A PUBMED search for the keywords "aortic root mycotic aneurysm," "aortic root abscess AND infective endocarditis," and "aortic root mycotic aneurysm AND infective endocarditis" yielded 152 publications (with 157 cases described): Aortic pseudoaneurysm is more common in males (80.9%, = 127). Mean age is 51 years (4 months-84 years). The most common symptom is fever (68.5%, = 102). Mean time until diagnosis is 27.2 days. Embolic complications are present in 17.8% ( = 28) at diagnosis. Most cases are due to valvular infections ( = 72 cases, 45.9%). Prior cardiac surgery is documented in 49.0% ( = 77). The mean time interval for developing aortic root abscess following heart surgery is 32.2 months. 22.3% ( = 35) are immunocompromised. Aetiological agents were sp. (34.1%, = 47) and sp. (23.2%, = 32). Mean antimicrobial therapy lasts 58.5 days. Outcome with surgery is superior to medical treatment: overall inpatient mortality 18.5% ( = 27); with surgery 12.2% ( = 15 out of 123 patients), with only medical management 47.8% ( = 11 out of 23 patients). In conclusion, aortic root pseudoaneurysm occurs most commonly in middle-aged male patients. History of prior aortic procedures is commonly present. Correct diagnosis hinges on detailed history, transoesophageal echocardiography, and computed tomography (CT) aorta. Surgery is the preferred therapeutic option.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12055-023-01580-x.
PubMed: 38125320
DOI: 10.1007/s12055-023-01580-x -
Clinical Practice and Cases in... Nov 2023Traumatic pseudoaneurysms of the limbs are rare, with few cases described in vascular literature. Treatment is variable and dependent upon presentation and impact on...
INTRODUCTION
Traumatic pseudoaneurysms of the limbs are rare, with few cases described in vascular literature. Treatment is variable and dependent upon presentation and impact on local anatomy affected. Rapid assessment can be performed with ultrasound and assist in treatment decisions. We describe a case of traumatic anterior tibial artery pseudoaneurysm, which was rapidly identified with point-of-care ultrasound leading to definitive surgical management.
CASE REPORT
A 37-year-old female presented to the emergency department for evaluation of right lower extremity pain and swelling following an exercise session with weighted squats and thigh abductor machines. She was found to have an anterior tibial artery pseudoaneurysm on point-of-care ultrasound, later confirmed with formal ultrasound as well as angiography, and was admitted for surgical management.
CONCLUSION
Traumatic pseudoaneurysms can rapidly be differentiated from other mass lesions and contributors to compartment syndrome using point-of-care ultrasound.
PubMed: 38353196
DOI: 10.5811/cpcem.1458 -
Journal of Vascular and Interventional... Apr 2024
Topics: Humans; Aneurysm, False; Femoral Artery
PubMed: 38521563
DOI: 10.1016/j.jvir.2023.12.570 -
Vascular Nov 2023Axillary artery aneurysms in children are rare and multifactorial. The presenting clinical picture can range from an incidental discovery to threatening symptoms,... (Review)
Review
OBJECTIVES
Axillary artery aneurysms in children are rare and multifactorial. The presenting clinical picture can range from an incidental discovery to threatening symptoms, including loss of extremity function. With the present study we aim to give a comprehensive review of the existing literature focusing on the etiology and management of this rare but threatening pathology.
METHOD
A comprehensive review was made in a multi-staged manner. All identified studies have been categorized based on the type of lesions (true or false aneurysm) and their etiologies.
RESULTS
The treatments differ from the extension of the lesions and from the etiology.
CONCLUSIONS
Open surgery repair with great saphenous vein is still the best long-term approach, but even endovascular, embolization, or conservative management can be considered.
PubMed: 37953599
DOI: 10.1177/17085381231215595 -
Journal of Surgical Case Reports Aug 2023Iatrogenic pseudoaneurysms (IPA) are a rare complication of transradial coronary intervention. This brief report aims to present a case report of a radial artery...
Iatrogenic pseudoaneurysms (IPA) are a rare complication of transradial coronary intervention. This brief report aims to present a case report of a radial artery pseudoaneurysm and to review the current management of this entity. Because of the increased performance of transradial coronary intervention, IPA have become more common. Doppler ultrasonography is a fundamental tool to aid the differential diagnosis with other pathologies. There is no consensus on the treatment, which may range from conservative management to surgical repair. Close surveillance after the procedure and early diagnosis are essential to avoid serious complications, such as ischemia of the hand. The management of IPA depends upon morphological characteristics and associated symptoms.
PubMed: 37560606
DOI: 10.1093/jscr/rjad446 -
Vascular Aug 2023Profunda femoris artery aneurysms (PFAAs), which comprise true profunda femoris artery aneurysms (TPFAAs) and profunda femoris artery pseudoaneuryms (PFA PSAs), are rare...
OBJECTIVE
Profunda femoris artery aneurysms (PFAAs), which comprise true profunda femoris artery aneurysms (TPFAAs) and profunda femoris artery pseudoaneuryms (PFA PSAs), are rare but clinically significant diseases of the peripheral arterial vasculature. Our aim is to describe our institution's 15-year experience with PFAAs (TPFAAs and PFA PSAs) to provide insight into patient characteristics, diagnostic imaging modalities, and surgical interventions that contribute to clinically important outcomes in patients with PFAAs.
METHODS
We conducted a retrospective study at our institution using our radiology database.
RESULTS
We identified six patients with PFA PSAs and four patients with TPFAAs. The clinical presentation of PFA PSAs included a triad of thigh pain, bleeding, and unexplained anemia. There was variety in the aetiologies of PFA PSAs, arising from catheterizations, upper thigh fractures, anastomotic complications, or unknown causes. Most patients with PFA PSAs had hypertension and coronary artery disease, and half of our cohort had peripheral vascular disease. All patients were imaged with duplex ultrasonography (DUS) or computed tomography (CT), the latter being more accurate. All patients with PFA PSAs underwent endovascular treatment, including glue, thrombin, or coil embolization as well as stent-graft insertions. All TPFAAs presented to our center were small and incidentally discovered, explaining the conservative management of our TPFAAs. Two of the four TPFAAs were idiopathic in nature, while one was attributed to post-stenotic dilatation, and another was found in a patient with Ehlers Danlos Syndrome. There was an association between TPFAAs and multiple synchronous or asynchronous aneurysms.
CONCLUSION
Pseudoaneurysms of the PFA are mostly iatrogenic in nature and can present with the triad of thigh swelling, bleeding, and unexplained anemia. If the clinical picture is suggestive of a PFA PSA but DUS does not detect a pseudoaneurysm, CT may be added as a more accurate imaging modality. Endovascular embolization is used in smaller pseudoaneurysms and in poor surgical candidates. Multiple glue, coil, or thrombin injections may be required to fully thrombose the pseudoaneurysm sac. True aneurysms of the PFA are associated with synchronous/asynchronous aneurysms and small TPFAAs should be carefully monitored, as there is a risk of enlargement and rupture.
Topics: Humans; Aneurysm, False; Retrospective Studies; Thrombin; Treatment Outcome; Aneurysm; Femoral Artery; Anemia
PubMed: 35324355
DOI: 10.1177/17085381221084811