-
Cardiovascular and Interventional... Jan 2022To investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm.
PURPOSE
To investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm.
MATERIALS AND METHODS
A retrospective analysis of patients who had undergone endovascular treatment of hepatic artery pseudoaneurysms between 2011 and 2020 was performed. Medical records were examined to obtain patients' surgical histories and to screen for active bleeding. Angiographic data on vascular access, target vessel, material used and technical success, defined as the exclusion of the pseudoaneurysm by means of a stent graft with sufficient control of bleeding, were collected. Vessel patency at follow-up CT was analyzed and classified as short-term (< 6 weeks), mid-term (between 6 weeks and 1 year), and long-term patency (> 1 year). In case of stent occlusion, collateralization and signs of hepatic hypoperfusion were examined.
RESULTS
In total, 30 patients were included and of these, 25 and 5 had undergone stent graft implantation and coiling, respectively. In patients with implanted stent grafts, technical success was achieved in 23/25 patients (92%). Follow-up CT scans were available in 16 patients, showing stent graft patency in 9/16 patients (56%). Short-term, mid-term, and long-term short-term stent patency was found in 81% (13/16), 40% (4/10), and 50% (2/4). In patients with stent graft occlusion, 86% (6/7) exhibited maintenance of arterial liver perfusion via collaterals and 14% (1/7) exhibited liver abscess during follow-up.
CONCLUSION
Stent graft provides an effective treatment for hepatic artery pseudoaneurysms. Even though patency rates decreased as a function of time, stent occlusion was mainly asymptomatic due to sufficient collateralization.
Topics: Aneurysm, False; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Follow-Up Studies; Hepatic Artery; Humans; Retrospective Studies; Stents; Treatment Outcome; Vascular Patency
PubMed: 34734334
DOI: 10.1007/s00270-021-02993-0 -
JACC. Cardiovascular Interventions Feb 2021
Topics: Aneurysm, False; Humans; Mammary Arteries; Sternotomy; Treatment Outcome
PubMed: 33516689
DOI: 10.1016/j.jcin.2020.11.037 -
Biomedicine & Pharmacotherapy =... May 2021Aneurysms are generally the result of dilation of all 3 layers of the vessel wall, and pseudoaneurysms are the result of localized extravasation of blood that is...
OBJECTIVES
Aneurysms are generally the result of dilation of all 3 layers of the vessel wall, and pseudoaneurysms are the result of localized extravasation of blood that is contained by surrounding tissue. Since there is still no recommended protocol to decrease aneurysm formation and progression, we hypothesised that intramural delivery of TGF β1 hydrogel can decrease aneurysm and pseudoaneurysm formation and progression.
MATERIALS
Male C57BL/6 J mice (12-14 wk), SD rats (200 g) and pig abdominal aortas were used, and hydrogels were fabricated by the interaction of sodium alginate (SA), hyaluronic acid (HA) and CaCO.
METHODS
A CaCl adventitial incubation model in mice and a decellularized human great saphenous vein patch angioplasty model in rats were used. TGF β1 hydrogel was intramurally delivered after CaCl incubation in mice; at day 7, the abdomen in some mice was reopened, and TGF β1 hydrogel was injected intramurally into the aorta. In rats, TGF β1 hydrogel was delivered intramurally after patch angioplasty completion. Tissues were harvested at day 14 and analysed by histology and immunohistochemistry staining. The pig aorta was also intramurally injected with hydrogel.
RESULTS
In mice, rhodamine hydrogel was still found between the medium and adventitia at day 14. In the mouse aneurysm model, there was a thicker wall and smaller amount of elastin breaks in the TGF β1 hydrogel-delivered groups both at day 0 and day 7 after CaCl incubation, and there were larger numbers of p-smad2- and TAK1-positive cells in the TGF β1 hydrogel-injected groups. In the rat decellularized human saphenous vein patch pseudoaneurysm model, there was a higher incidence of pseudoaneurysm formation when the patch was decellularized using 3% SDS, and delivery of TGF β1 hydrogel could effectively decrease the formation of pseudoaneurysm formation and increase p-smad2 and TAK1 expression. In pig aortas, hydrogels can be delivered between the medium and adventitia easily and successfully.
CONCLUSIONS
Intramural delivery of TGF β1 hydrogel can effectively decease aneurysm and pseudoaneurysm formation and progression in both mice and rats, and pig aortas can also be successfully intramurally injected with hydrogel. This technique may be a promising drug delivery method and therapeutic choice to decrease aneurysm and pseudoaneurysm formation and progression in the clinic.
Topics: Aneurysm, False; Animals; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Delayed-Action Preparations; Dilatation, Pathologic; Disease Models, Animal; Disease Progression; Drug Carriers; Drug Compounding; Hydrogels; MAP Kinase Kinase Kinases; Male; Mice, Inbred C57BL; Phosphorylation; Rats, Sprague-Dawley; Smad2 Protein; Sus scrofa; Transforming Growth Factor beta1; Mice; Rats
PubMed: 33545663
DOI: 10.1016/j.biopha.2021.111296 -
Anales de Pediatria Sep 2022
Topics: Aneurysm, False; Child; Humans
PubMed: 35279392
DOI: 10.1016/j.anpede.2021.09.002 -
BMJ Case Reports Jun 2021
Topics: Aneurysm, False; Diagnostic Imaging; Heart Aneurysm; Heart Ventricles; Humans
PubMed: 34158338
DOI: 10.1136/bcr-2021-243913 -
Journal of Vascular Surgery May 2022The objective of this study was to determine the clinical features of tuberculous aneurysms and risk factors for mortality.
OBJECTIVES
The objective of this study was to determine the clinical features of tuberculous aneurysms and risk factors for mortality.
METHODS
We reviewed all case reports of tuberculous aneurysms in the English literature from January 2000 to December 2020. The clinical features and possible risk factors for mortality were recorded and analyzed.
RESULTS
In total, 174 cases of tuberculous aneurysms were identified. The morbidity of men was more than twice that of women. Male patients (51.47 ± 20.67 years) were older than female patients (39.52 ± 20.23 years; P < .05). The rupture rate in women (69.2%) was higher than that in men (48.8%). Tuberculosis (TB)-induced aneurysms often spontaneously ruptured 1.41 to 3.01 months after the onset of TB symptoms without any treatment, and Bacillus Calmette-Guerin (BCG)-induced aneurysms often spontaneously ruptured 10.51 to 26.49 months after BCG administration. The morbidity of large artery aneurysms was nearly twice that of middle artery aneurysms. However, middle artery aneurysms were more likely to rupture (75.4%) than large artery aneurysms (43.5%; P < .05). The rupture rate of BCG-induced aneurysms (37.0%) was lower than that of TB-induced aneurysms, regardless of whether there was a TB history (56.7%) or not (57.7%). Symptoms of TB occurred in 63.2% of patients, but only 8.6% of patients had both symptoms of TB and aneurysmal mass effects. Pain was the most common atypical clinical manifestation (50.0%). The Cox proportional hazards regression analysis and Kaplan-Meier estimator showed that rupture and no combined therapy were risk factors for mortality.
CONCLUSIONS
Tuberculous aneurysms seemingly shared the same demographic characteristics as common aneurysms. The clinical features of TB-induced aneurysms were different from those of BCG-induced aneurysms in terms of the aneurysm location and rupture rate. Tuberculous aneurysms may occur at any site of the cardiovascular system with a preponderance for large arteries. The changeable clinical manifestations were important index for diagnosis, but focusing only on clinical manifestations may lead to a missed diagnosis. The combination of anti-TB medications and surgery before aneurysm rupture may provide the best prognosis.
Topics: Aneurysm, False; Aneurysm, Ruptured; BCG Vaccine; Female; Humans; Intracranial Aneurysm; Male; Risk Factors; Tuberculosis
PubMed: 34788648
DOI: 10.1016/j.jvs.2021.10.048 -
Kidney International Mar 2020
Topics: Aneurysm, False; Humans; Renal Artery; Renal Artery Obstruction
PubMed: 32087894
DOI: 10.1016/j.kint.2019.09.008 -
BMJ Case Reports Feb 2020We describe a case of 49-year-old man who presented with chest pain and was diagnosed with non-ST elevation myocardial infarction. Transthoracic echocardiogram (TTE)...
We describe a case of 49-year-old man who presented with chest pain and was diagnosed with non-ST elevation myocardial infarction. Transthoracic echocardiogram (TTE) showed severe global hypokinesis of left ventricle with ejection fraction of 25%-30%. Left heart catheterisation showed severe right coronary stenosis and focal 60%-70% distal left anterior descending artery stenosis. Cardiac MRI (CMR) was done for evaluation of viability which showed a large pseudoaneurysm which was missed on TTE and left ventriculogram. Our case demonstrates the increasing importance of cardiac MRI in the diagnosis of left ventricular pseudoaneurysm. In our case left ventricular pseudoaneurysm was missed on TTE and left ventriculogram. It was diagnosed on CMR which was ordered for evaluation of myocardium viability.
Topics: Aneurysm, False; Cardiac Imaging Techniques; Chest Pain; Coronary Stenosis; Diagnosis, Differential; Echocardiography; Electrocardiography; Heart Aneurysm; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Rupture, Spontaneous; Treatment Outcome
PubMed: 32014988
DOI: 10.1136/bcr-2019-231680 -
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 -
Cirugia Pediatrica : Organo Oficial de... Apr 2022Splenic and hepatic pseudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture,...
INTRODUCTION
Splenic and hepatic pseudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture, which can lead to hemodynamic instability. The objective of this study was to describe our experience in the management of visceral PA.
MATERIAL AND METHODS
A retrospective study of patients under 15 years of age with blunt abdominal trauma associated with splenic and/or hepatic injury treated from 2012 to 2020 was carried out. PA formation and management were analyzed. All patients underwent CT-scan, which allowed trauma grade to be established, and also control contrast-enhanced ultrasonography (CEUS) in the first week following trauma. If PA was confirmed, angiography ± percutaneous embolization were performed.
RESULTS
A total of 32 patients with blunt trauma were included. Mean age was 8.7 ± 3.2 years (2-15 years). 68.7% (n = 22) of patients were male. Median trauma grade was grade III (grades II-IV). 33.3% (n = 5/15) of patients developed splenic PA, and 5.8% (n = 1/17) of patients developed hepatic PA, with mean diagnostic time being 3.7 ± 3 (3-8) days. PA formation was associated with higher severity scores, with a mean difference of 15.6 ± 5.3 (95% CI: 4.37:26.14 p < 0.008). All PA cases - except for one, which required urgent splenectomy - were treated with embolization (85.7%) (n = 5/6).
CONCLUSION
Visceral PA is underdiagnosed, with an incidence higher than reported. Imaging studies (CEUS) are required prior to discharge in the presence of severe trauma. Treatment remains controversial, but we recommend percutaneous embolization, with splenectomy being reserved for unstable patients.
Topics: Abdominal Injuries; Aneurysm, False; Child; Child, Preschool; Female; Humans; Male; Retrospective Studies; Spleen; Wounds, Nonpenetrating
PubMed: 35485756
DOI: 10.54847/cp.2022.02.16