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Emergency Radiology Dec 2018Management of splenic pseudoaneurysms in hemodynamically stable patients has shifted toward nonoperative management, including watchful waiting and endovascular...
Management of splenic pseudoaneurysms in hemodynamically stable patients has shifted toward nonoperative management, including watchful waiting and endovascular embolization. Standard of treatment does not include percutaneous embolization for splenic pseudoaneurysm repair. In this case report, we document a successful percutaneous embolization of a post traumatic splenic pseudoaneurysm with thrombin. Percutaneous embolization of splenic pseudoaneurysms can be considered a viable technique in patients who fail endovascular embolization or have lesions inaccessible to endovascular repair.
Topics: Accidents, Traffic; Aneurysm, False; Angiography; Embolization, Therapeutic; Humans; Male; Middle Aged; Motorcycles; Spleen; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 30155849
DOI: 10.1007/s10140-018-1636-5 -
Journal of Cardiothoracic Surgery Apr 2013Left ventricular pseudoaneurysms and true aneurysms are two possible complications of myocardial infarction. However, while pseudoaneuryms require urgent surgical...
Left ventricular pseudoaneurysms and true aneurysms are two possible complications of myocardial infarction. However, while pseudoaneuryms require urgent surgical resection, true aneuryms can often be managed medically, making imperative an accurate diagnosis.The authors describe a case of a delayed rupture of a true aneurysm that was contained and gave rise to a pseudoaneurysm inside of a true aneurysm. The echocardiography allowed the differential diagnosis for a timely surgical intervention which resulted in the patient's full recovery.
Topics: Aneurysm, False; Diagnosis, Differential; Echocardiography; Heart Aneurysm; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Rupture
PubMed: 23594391
DOI: 10.1186/1749-8090-8-97 -
Acta Bio-medica : Atenei Parmensis Apr 2021The laparoscopic approach has become the gold standard for cholecystectomy. However, it could have some major complications. Among them, it can be considered...
INTRODUCTION
The laparoscopic approach has become the gold standard for cholecystectomy. However, it could have some major complications. Among them, it can be considered postoperative pseudoaneurysms of the cystic or hepatic arteries. Haemobilia secondary to a cystic artery pseudoaneurysm is extremely rare.
CASE REPORT
Here we present a case from our centre of haemobilia in association with a cystic artery pseudoaneurysm, as a late complication of VLC. An 18-year-old girl underwent laparoscopic cholecystectomy; during surgery, due to viscero-perietal tight adhesions and due to the close proximity of the cystic duct to the biliary ducts, we suspected a bile duct injury. So, decision was taken to convert to open surgery: a suture was performed to repair the coledocic duct injury and an endoscopic papillotomy was performed with subsequent positioning of an endoscopic plastic biliary endoprothesis at the hepatocholedochus. One month after surgery, the patient showed clinical signs of hypovolemic shock. She underwent Computed Tomography Angiography, showing a possible arterial lesion, just adjacent to surgical clip. Therefore, patient underwent angiographic examination, which confirmed an 8 mm pseudoaneurysm arising from cystic artery, just adjacent to surgical clips. Superselective catheterization of vessel was performed, and two coils were released, until obtaining complete exclusion of the vascular lesion. The patient was discharged five days after procedure, with good general condition.
CONCLUSION
Pseudoaneurysms of the cystic artery are uncommon entities, rarely reported in the literature, and often caused by cholecystitis or iatrogenic biliary injury. All conditions that are responsible for vessels' injuries could also cause haemobilia. Even if pseudoaneurysm of cystic artery with haemobilia is a rare event, it has to be considered as a complication of VLC. Angiographic approach should be the treatment of choice.
Topics: Adolescent; Aneurysm, False; Cholecystectomy; Cholecystectomy, Laparoscopic; Female; Hemobilia; Hepatic Artery; Humans
PubMed: 33944818
DOI: 10.23750/abm.v92iS1.10821 -
Journal of Cardiac Surgery Jun 2022We report a case of successful minimally invasive transthoracic coiling of a left ventricle pseudoaneurysm after iatrogenic cardiac perforation with a good long-term...
BACKGROUND
We report a case of successful minimally invasive transthoracic coiling of a left ventricle pseudoaneurysm after iatrogenic cardiac perforation with a good long-term result. The pseudoaneurysm could be repaired neither by an open surgery because of poor general state of the patient nor interventionally because of a partial sealing with an Amplatzer Septal Occluder blocking the tight neck of the aneurysm.
METHODS AND RESULTS
We performed a transthoracic coiling of the left ventricle pseudoaneurysm using a direct ultrasound-guided puncture via intercostal access below the lingula. The access puncture was performed during a single lung apnea at the end of an expiration phase with a contralateral single lung ventilation. The patient successfully recovered and has been followed-up during the 5 years.
CONCLUSIONS
Transthoracic coil embolization is a minimally invasive treatment option for otherwise inoperable patients with cardiac pseudoaneurysms with good long-term results.
Topics: Aneurysm, False; Heart Injuries; Heart Ventricles; Humans; Septal Occluder Device; Treatment Outcome
PubMed: 35289967
DOI: 10.1111/jocs.16420 -
Circulation. Cardiovascular... Aug 2011Left ventricular pseudoaneurysm is a rare but serious complication from myocardial infarction and cardiac surgery. Although standard treatment is surgical intervention,...
BACKGROUND
Left ventricular pseudoaneurysm is a rare but serious complication from myocardial infarction and cardiac surgery. Although standard treatment is surgical intervention, percutaneous closure of left ventricular pseudoaneurysm has become an option for high-risk surgical candidates. Experience with percutaneous treatment is limited to a few single case reports. This is the first series of percutaneous treatment of the left ventricular pseudoaneurysms.
METHODS AND RESULTS
This is a retrospective analysis of 9 procedures of percutaneous repair of left ventricular pseudoaneurysm in 7 consecutive patients (ages 51 to 83 years, 6 men) completed in our Structural Heart Disease center from June 2008 to December 2010. All patients were considered as a high risk for surgery because of multiple comorbidities. Multiple imaging modalities were used before, during, and after the procedures to improve success and efficacy. The left ventricular pseudoaneurysms of all 7 patients were successfully repaired. Fluoroscopy time on average was 36.5±24.0 minutes (range, 12.4 to 75.7 minutes). All patients were followed up for a period ranging from 3 to 32 months after the procedure. Each patient improved by at least 1 New York Heart Association functional class, and 4 patients improved by 2 classes.
CONCLUSIONS
Transcatheter closure of the left ventricular pseudoaneurysm is a feasible alternative for high-risk surgical candidates. The use of multiple imaging modalities is required for a detail planning and execution of the procedure.
Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Aneurysm, False; Cardiac Catheterization; Diagnostic Imaging; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Retrospective Studies; Ventricular Dysfunction, Left; Wound Closure Techniques
PubMed: 21791672
DOI: 10.1161/CIRCINTERVENTIONS.111.962464 -
Annals of Vascular Surgery Oct 2014Endovascular treatment of posttraumatic pseudoaneurysms has become a viable less-invasive option when compared with open repair. In this study, we present a case of a... (Review)
Review
Endovascular treatment of posttraumatic pseudoaneurysms has become a viable less-invasive option when compared with open repair. In this study, we present a case of a posttraumatic pseudoaneurysm of the posterior tibial artery in a 34-year-old man treated with endovascular stent grafting. An extensive review of the literature has been performed.
Topics: Adult; Aneurysm, False; Anticoagulants; Diagnostic Imaging; Endovascular Procedures; Humans; Male; Stents; Tibial Arteries; Wounds, Penetrating
PubMed: 24530718
DOI: 10.1016/j.avsg.2014.02.013 -
The American Journal of Case Reports Aug 2020BACKGROUND Pseudoaneurysms are a known pathology commonly recognized after disruption of the vascular wall leads to the development of a hematoma. Although...
BACKGROUND Pseudoaneurysms are a known pathology commonly recognized after disruption of the vascular wall leads to the development of a hematoma. Although pseudoaneurysms are common, occurrence in the location of the superior rectal artery is exceedingly rare, has been documented in the literature only 7 times, and can be extremely dangerous. Patients can present with vague abdominal complaints, pain, gastrointestinal bleeding, and development of hematomas, and can progress to hemodynamic instability related to hypovolemia. This phenomenon requires swift recognition and patient management, as well as stabilization, to achieve desired results and minimize morbidity and mortality. CASE REPORT We report the case of a 79-year-old man who presented after minor trauma with gastrointestinal bleeding and was diagnosed with a retroperitoneal hematoma. Although he was stabilized and discharged, conventional angiography diagnosing and treating his causative superior rectal artery pseudoaneurysm was not completed until a second traumatic event resulted in recurrent presentation with worsened symptoms and retroperitoneal hematoma enlargement. CONCLUSIONS Superior rectal artery pseudoaneurysm is a rarely-reported phenomenon, usually occurring after a traumatic event. It can lead to significant anemia, hypovolemic shock, blood transfusion, and other serious consequences. It can be difficult to diagnose given its location and obscurity. However, upon diagnosis, swift treatment is recommended, for which a variety of both surgical and endovascular approaches have been employed to prevent exsanguination.
Topics: Aged; Aneurysm, False; Angiography; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Mesenteric Artery, Inferior
PubMed: 32845874
DOI: 10.12659/AJCR.924529 -
Blood Coagulation & Fibrinolysis : An... Jul 2013The incidence of bleeding as a result of a pseudoaneurysm in haemophilia is very low. The diagnosis should be suspected if the patient has a history of arterial trauma.... (Review)
Review
The incidence of bleeding as a result of a pseudoaneurysm in haemophilia is very low. The diagnosis should be suspected if the patient has a history of arterial trauma. Pseudoaneurysms can appear anywhere where trauma occurs. This can include arterial access for catheterization, blunt trauma or penetrating trauma. The diagnosis should be confirmed using Duplex ultrasonography, computed tomography (CT) angiogram or conventional angiogram. Many options exist for the treatment of pseudoaneurysms. Although surgery was the gold standard treatment in the past (surgical ligation with or without distal bypass), several less invasive treatment options are popular today. They include covered stent, ultrasound probe compression and ultrasound-guided thrombin injection. So far, only 14 pseudoaneurysms have been reported in patients with haemophilia: nine were located in the musculoskeletal system (four in the hand, four in the knee, one in the ankle), whereas five were non-musculoskeletal. Early diagnosis and treatment of this complication is vital. Endovascular treatment offers a minimally invasive treatment option. If arterial embolization fails to solve the pseudoaneurysm, open vascular surgery with surgical ligation with or without distal bypass should be performed. Whatever the procedure, a correct surgical haemostasis must be achieved by the infusion of factor concentrate (recombinant or plasma-derived) at the right dose and tranexamic acid. The advent of activated prothrombin complex concentrates and recombinant factor VIII (rFVIIa) has made invasive procedures possible in haemophilia patients with high-titre inhibitors.
Topics: Aneurysm, False; Angiography; Ankle; Embolization, Therapeutic; Factor VIII; Hand; Hemophilia A; Hemorrhage; Humans; Knee; Musculoskeletal System; Tomography, X-Ray Computed; Ultrasonography, Doppler, Duplex; Vascular Surgical Procedures
PubMed: 23337709
DOI: 10.1097/MBC.0b013e32835e42aa -
Interactive Cardiovascular and Thoracic... Jun 2009To assess the etiology, management and outcome of iliac pseudoaneurysms following renal transplantation.
OBJECTIVES
To assess the etiology, management and outcome of iliac pseudoaneurysms following renal transplantation.
METHODS
Eleven patients who underwent repair between 1982 and 2007 were identified. Five (Group 1) presented pseudoaneurysm at the anastomosis of the donor renal and native iliac arteries, and six (Group 2) presented iliac pseudoaneurysm following transplant nephrectomy. Intraoperative cultures and immunohistochemical examinations were obtained from all surgical cases to determine the existence of a relationship between infection or transplant rejection and pseudoaneurysm formation.
RESULTS
Endovascular repair (EVR) was used to treat three patients, while eight patients underwent open repair (OR). Transplant nephrectomy was needed in all cases but one after anastomotic pseudoaneurysm repair. After pseudoaneurysm excision, arterial reconstruction was performed in all cases, with a limb salvage rate of 100%. At 30 days, no patients died in the EVR subgroup. In the OR subgroup, one patient died of sepsis (12.5%). Cultures taken from the pseudoaneurysm wall and content grew Candida albicans and E. coli in two febrile patients. Pathologic evaluation of donor renal arteries revealed evidence of chronic rejection in three patients (60%) in Group 1, and in two (33.3%) in Group 2. No patients in either Group presented late infection, failure of vascular reconstruction nor pseudoaneurysm recurrence. The follow-up ranges from 20 to 89 months.
CONCLUSIONS
The etiology of pseudoaneurysms in this location is multifactorial, however, an association with chronic rejection must be considered. Though rare, the development of pseudoaneurysms at the donor renal-external iliac artery anastomosis results in high rates of transplant nephrectomy. Less invasive endovascular techniques offer a new therapeutic option in this challenging scenario notwithstanding the fact that they require further validation.
Topics: Adult; Aged; Anastomosis, Surgical; Aneurysm, False; Candida albicans; Escherichia coli; Female; Humans; Iliac Artery; Kidney Transplantation; Magnetic Resonance Angiography; Male; Middle Aged; Nephrectomy; Renal Artery; Reoperation; Retrospective Studies; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures
PubMed: 19289398
DOI: 10.1510/icvts.2008.200386 -
Experimental and Clinical... Feb 2023Mycotic pseudoaneurysms are a rare, life-threatening complication after pancreas transplant. There have been limited reports of endovascular treatment of mycotic...
Mycotic pseudoaneurysms are a rare, life-threatening complication after pancreas transplant. There have been limited reports of endovascular treatment of mycotic pseudoaneurysms in pancreas transplant recipients. Herein, we report on a case of a mycotic pseudoaneurysm from Pseudomonas aeruginosa after pancreas transplant. A 53-year-old male recipient underwent an uneventful simultaneous pancreas and kidney transplant. He was readmitted 48 days posttransplant with fevers and rigors. Pan-cultures were performed and broad-spectrum antibiotics were initiated. Imaging studies demonstrated a large mycotic pseudoaneurysm arising from the right common iliac artery adjacent to the arterial Y-graft anastomosis of the transplant pancreas. Endovascular stent placement was used to exclude the pseudoaneurysm prior to transplant pancreatectomy. During pancreatectomy, the lateral wall of the common iliac artery was found to be necrotic with significant exposure of the endovascular stent. After ligation and excision of the common iliac artery, a femorofemoral bypass was performed to revascularize the lower extremity. This case report highlights the advantage of a staged endovascular and surgical management strategy for complex mycotic pseudoaneurysms after pancreas transplant.
Topics: Male; Humans; Middle Aged; Aneurysm, False; Stents; Iliac Artery; Pancreas Transplantation; Endovascular Procedures; Pancreas
PubMed: 36919726
DOI: 10.6002/ect.2022.0326